BSN 266 Shadow Health Perioperative Hourly Rounds
for Sonia Best
2026 Update | With Complete Solutions
A 40-Question Clinical Simulation Review Exam Aligned with 2026/2027 Academic Standards,
AORN Guidelines, and Shadow Health Virtual Simulation Logic
Abstract. This Clinical Simulation Review Exam presents 40 high-fidelity, scenario-based
multiple-choice questions calibrated to the Shadow Health Perioperative Hourly Rounds: Sonia
Best virtual simulation and the 2026/2027 perioperative nursing academic standards. The exam is
partitioned into four thematic sections: (1) Preoperative Assessment, Preparation, and Patient
Education; (2) Intraoperative Safety, Time-Outs, and Positioning; (3) Postoperative Hourly
Rounds encompassing Neurovascular, Respiratory, and Hemodynamic Monitoring; and (4)
Complication Prevention, Pain Management, Wound Care, and contemporary 2026 Updates
including Enhanced Recovery After Surgery (ERAS) pathways, AI-driven early warning scores,
and multimodal analgesia. Cognitive-level distribution follows the 30/50/20 model
(recall/application/analysis). Each item includes four distractors of rigorously high plausibility, a
verified correct answer, and a step-by-step clinical rationale grounded in evidence-based
perioperative practice. A comprehensive grading rubric allocates 2.5 points per question (100
points total) with explicit partial-credit criteria and mastery thresholds.
Keywords: perioperative nursing; Shadow Health simulation; hourly rounds; ERAS; multimodal analgesia;
DVT prophylaxis; surgical time-out; AORN 2026; clinical judgment; Sonia Best.
Field Nursing — Perioperative Nursing (Shadow Health Clinical Simulation)
Skill Focus Preoperative Assessment; Intraoperative Safety; Hourly Rounds; Pain Management; Wound Care; DVT
Exam Type Clinical Simulation Review (Questions & Complete Solutions)
Year Alignment
Total Questions 40 (4 sections × 10)
Cognitive Mix 30% Recall · 50% Application · 20% Analysis
Question Style 75% Scenario-Based · 25% Direct
Grading 2.5 pts/question · 100 points total
Generation Date July 22, 2026
Format Note. Each question is presented as stem + four options (A–D) with the correct answer marked [CORRECT]. A
green Correct Answer line and a shaded Rationale block follow each item. A grading rubric and solution key appear after
Question 40.
,BSN 266 | Shadow Health Perioperative Hourly Rounds — Sonia Best | 2026 Update Clinical Simulation Review Exam
Section 1: Preoperative Assessment, Preparation, & Patient Education
This section evaluates the nurse's ability to verify informed consent, confirm NPO and allergy status, deliver
preoperative teaching (incentive spirometry, splinting, early ambulation), and establish baseline vital signs
within the Shadow Health Sonia Best simulation environment.
Q1: During the Shadow Health preoperative encounter, Sonia Best states she signed the consent form 30
minutes ago but asks the nurse to "explain again what they're doing to my abdomen." What is the
nurse's most appropriate action?
A. Reassure the patient that the signed form is legally sufficient and proceed with transport to the OR.
B. Call the circulating nurse to re-witness the signature after the patient is sedated.
C. Notify the surgeon that the patient may not fully understand the procedure and request the
surgeon return to clarify. [CORRECT]
D. Document the patient's question and continue preoperative teaching without escalating.
Correct Answer: C
Rationale. Informed consent requires comprehension, not merely a signature. When a patient demonstrates
uncertainty about the procedure, the nurse's legal and ethical obligation is to notify the surgeon, who is
responsible for explaining risks, benefits, and alternatives. Options A and D ignore the patient's unresolved
knowledge gap, violating the comprehension element of informed consent; option B is unsafe because consent
cannot be re-obtained after sedation.
Q2: Sonia Best is scheduled for an open abdominal procedure at 07:30. She tells the nurse she had "a few
sips of water with my morning pills" at 06:45. Applying 2026 ASA fasting guidelines, what is the correct
nursing action?
A. Continue preparation; clear liquids up to 2 hours before anesthesia are now permitted.
B. Notify anesthesia and the surgeon; the case may need delay because the intake was within 2 hours
and included medications. [CORRECT]
C. Administer a glass of water to dilute the medications before transport.
D. Document the intake but proceed because water is a clear liquid.
Correct Answer: B
Rationale. Although the ASA permits clear liquids up to 2 hours pre-op, intake of medications with water at
06:45 places the patient within the 2-hour window and introduces aspiration risk related to both timing and the
pills themselves. The nurse must escalate to anesthesia and the surgeon to determine delay. Option A ignores the
medication component; options C and D are unsafe and fail to escalate an aspiration risk in the simulated
perioperative workflow.
Page 2
, BSN 266 | Shadow Health Perioperative Hourly Rounds — Sonia Best | 2026 Update Clinical Simulation Review Exam
Q3: While verifying allergies in the Shadow Health chart, the nurse notes Sonia reports a "rash" to
amoxicillin and "swollen lips" after lisinopril. Which documentation reflects the correct nursing
interpretation?
A. Amoxicillin: true allergy; lisinopril: side effect — no action needed.
B. Both are side effects; document and continue without flagging.
C. Amoxicillin: likely hypersensitivity (rash); lisinopril: angioedema (swollen lips) — both require
prominent allergy flagging and provider notification. [CORRECT]
D. Lisinopril reaction is more severe; flag only lisinopril and proceed.
Correct Answer: C
Rationale. A rash following amoxicillin suggests drug hypersensitivity and contraindicates beta-lactam exposure
intraoperatively (e.g., prophylactic cefazolin may need substitution). Swollen lips with lisinopril signals
angioedema, a potentially life-threatening ACE-inhibitor reaction. Both must be flagged and communicated.
Options A, B, and D underestimate one or both reactions and would expose the patient to intraoperative allergen
risk.
Q4: Teaching Sonia Best to use the incentive spirometer preoperatively, the nurse identifies the MOST
critical instruction for preventing postoperative atelectasis:
A. Use the device once daily after surgery when short of breath.
B. Perform 10 slow, sustained breaths every hour while awake, holding inspiration for 3–5 seconds.
[CORRECT]
C. Cough forcefully after each use to clear secretions.
D. Use only when the nurse auscultates decreased breath sounds.
Correct Answer: B
Rationale. Incentive spirometry prevents atelectasis through sustained maximal inspiration performed frequently
(every hour while awake) with a 3–5 second hold to recruit alveoli. Option A is too infrequent; option C may
cause incisional stress and is not the primary purpose; option D is reactive rather than preventive. The hourly
cadence aligns with the postoperative hourly rounding structure central to the Shadow Health simulation.
Q5: Sonia Best is about to be taught splinting for a midline abdominal incision. Which demonstration
reflects correct technique?
A. Place a pillow firmly over the incision and exhale slowly while coughing.
B. Hold a folded pillow firmly against the incision with both hands, take a deep breath, and cough in
2–3 short bursts. [CORRECT]
C. Lie flat and avoid coughing to protect the incision.
D. Press only on the right side of the incision to avoid stressing the left.
Correct Answer: B
Rationale. Splinting reduces incisional tension during coughing by providing uniform counter-pressure with a
folded pillow held with both hands, followed by staged coughing bursts to mobilize secretions. Option A omits
the deep breath and burst-cough technique; option C promotes secretion retention and atelectasis; option D
provides uneven support and increases dehiscence risk.
Page 3
for Sonia Best
2026 Update | With Complete Solutions
A 40-Question Clinical Simulation Review Exam Aligned with 2026/2027 Academic Standards,
AORN Guidelines, and Shadow Health Virtual Simulation Logic
Abstract. This Clinical Simulation Review Exam presents 40 high-fidelity, scenario-based
multiple-choice questions calibrated to the Shadow Health Perioperative Hourly Rounds: Sonia
Best virtual simulation and the 2026/2027 perioperative nursing academic standards. The exam is
partitioned into four thematic sections: (1) Preoperative Assessment, Preparation, and Patient
Education; (2) Intraoperative Safety, Time-Outs, and Positioning; (3) Postoperative Hourly
Rounds encompassing Neurovascular, Respiratory, and Hemodynamic Monitoring; and (4)
Complication Prevention, Pain Management, Wound Care, and contemporary 2026 Updates
including Enhanced Recovery After Surgery (ERAS) pathways, AI-driven early warning scores,
and multimodal analgesia. Cognitive-level distribution follows the 30/50/20 model
(recall/application/analysis). Each item includes four distractors of rigorously high plausibility, a
verified correct answer, and a step-by-step clinical rationale grounded in evidence-based
perioperative practice. A comprehensive grading rubric allocates 2.5 points per question (100
points total) with explicit partial-credit criteria and mastery thresholds.
Keywords: perioperative nursing; Shadow Health simulation; hourly rounds; ERAS; multimodal analgesia;
DVT prophylaxis; surgical time-out; AORN 2026; clinical judgment; Sonia Best.
Field Nursing — Perioperative Nursing (Shadow Health Clinical Simulation)
Skill Focus Preoperative Assessment; Intraoperative Safety; Hourly Rounds; Pain Management; Wound Care; DVT
Exam Type Clinical Simulation Review (Questions & Complete Solutions)
Year Alignment
Total Questions 40 (4 sections × 10)
Cognitive Mix 30% Recall · 50% Application · 20% Analysis
Question Style 75% Scenario-Based · 25% Direct
Grading 2.5 pts/question · 100 points total
Generation Date July 22, 2026
Format Note. Each question is presented as stem + four options (A–D) with the correct answer marked [CORRECT]. A
green Correct Answer line and a shaded Rationale block follow each item. A grading rubric and solution key appear after
Question 40.
,BSN 266 | Shadow Health Perioperative Hourly Rounds — Sonia Best | 2026 Update Clinical Simulation Review Exam
Section 1: Preoperative Assessment, Preparation, & Patient Education
This section evaluates the nurse's ability to verify informed consent, confirm NPO and allergy status, deliver
preoperative teaching (incentive spirometry, splinting, early ambulation), and establish baseline vital signs
within the Shadow Health Sonia Best simulation environment.
Q1: During the Shadow Health preoperative encounter, Sonia Best states she signed the consent form 30
minutes ago but asks the nurse to "explain again what they're doing to my abdomen." What is the
nurse's most appropriate action?
A. Reassure the patient that the signed form is legally sufficient and proceed with transport to the OR.
B. Call the circulating nurse to re-witness the signature after the patient is sedated.
C. Notify the surgeon that the patient may not fully understand the procedure and request the
surgeon return to clarify. [CORRECT]
D. Document the patient's question and continue preoperative teaching without escalating.
Correct Answer: C
Rationale. Informed consent requires comprehension, not merely a signature. When a patient demonstrates
uncertainty about the procedure, the nurse's legal and ethical obligation is to notify the surgeon, who is
responsible for explaining risks, benefits, and alternatives. Options A and D ignore the patient's unresolved
knowledge gap, violating the comprehension element of informed consent; option B is unsafe because consent
cannot be re-obtained after sedation.
Q2: Sonia Best is scheduled for an open abdominal procedure at 07:30. She tells the nurse she had "a few
sips of water with my morning pills" at 06:45. Applying 2026 ASA fasting guidelines, what is the correct
nursing action?
A. Continue preparation; clear liquids up to 2 hours before anesthesia are now permitted.
B. Notify anesthesia and the surgeon; the case may need delay because the intake was within 2 hours
and included medications. [CORRECT]
C. Administer a glass of water to dilute the medications before transport.
D. Document the intake but proceed because water is a clear liquid.
Correct Answer: B
Rationale. Although the ASA permits clear liquids up to 2 hours pre-op, intake of medications with water at
06:45 places the patient within the 2-hour window and introduces aspiration risk related to both timing and the
pills themselves. The nurse must escalate to anesthesia and the surgeon to determine delay. Option A ignores the
medication component; options C and D are unsafe and fail to escalate an aspiration risk in the simulated
perioperative workflow.
Page 2
, BSN 266 | Shadow Health Perioperative Hourly Rounds — Sonia Best | 2026 Update Clinical Simulation Review Exam
Q3: While verifying allergies in the Shadow Health chart, the nurse notes Sonia reports a "rash" to
amoxicillin and "swollen lips" after lisinopril. Which documentation reflects the correct nursing
interpretation?
A. Amoxicillin: true allergy; lisinopril: side effect — no action needed.
B. Both are side effects; document and continue without flagging.
C. Amoxicillin: likely hypersensitivity (rash); lisinopril: angioedema (swollen lips) — both require
prominent allergy flagging and provider notification. [CORRECT]
D. Lisinopril reaction is more severe; flag only lisinopril and proceed.
Correct Answer: C
Rationale. A rash following amoxicillin suggests drug hypersensitivity and contraindicates beta-lactam exposure
intraoperatively (e.g., prophylactic cefazolin may need substitution). Swollen lips with lisinopril signals
angioedema, a potentially life-threatening ACE-inhibitor reaction. Both must be flagged and communicated.
Options A, B, and D underestimate one or both reactions and would expose the patient to intraoperative allergen
risk.
Q4: Teaching Sonia Best to use the incentive spirometer preoperatively, the nurse identifies the MOST
critical instruction for preventing postoperative atelectasis:
A. Use the device once daily after surgery when short of breath.
B. Perform 10 slow, sustained breaths every hour while awake, holding inspiration for 3–5 seconds.
[CORRECT]
C. Cough forcefully after each use to clear secretions.
D. Use only when the nurse auscultates decreased breath sounds.
Correct Answer: B
Rationale. Incentive spirometry prevents atelectasis through sustained maximal inspiration performed frequently
(every hour while awake) with a 3–5 second hold to recruit alveoli. Option A is too infrequent; option C may
cause incisional stress and is not the primary purpose; option D is reactive rather than preventive. The hourly
cadence aligns with the postoperative hourly rounding structure central to the Shadow Health simulation.
Q5: Sonia Best is about to be taught splinting for a midline abdominal incision. Which demonstration
reflects correct technique?
A. Place a pillow firmly over the incision and exhale slowly while coughing.
B. Hold a folded pillow firmly against the incision with both hands, take a deep breath, and cough in
2–3 short bursts. [CORRECT]
C. Lie flat and avoid coughing to protect the incision.
D. Press only on the right side of the incision to avoid stressing the left.
Correct Answer: B
Rationale. Splinting reduces incisional tension during coughing by providing uniform counter-pressure with a
folded pillow held with both hands, followed by staged coughing bursts to mobilize secretions. Option A omits
the deep breath and burst-cough technique; option C promotes secretion retention and atelectasis; option D
provides uneven support and increases dehiscence risk.
Page 3
