NSG3130 Exam 4 - Fundamental Concepts & Skills for Nursing
Practice II (2026/2027)
Actual Questions and Verified Answers | 100% Guarantee Pass
Galen College of Nursing | Baccalaureate Nursing Program
Section 1: Perioperative Nursing Care
Q1: A patient scheduled for an appendectomy asks the nurse, 'Why do I need to sign this consent form?' What is the
best response by the nurse?
A. A) 'The hospital requires it as a legal formality before any surgery.'
B. B) 'It confirms that your surgeon has explained the procedure, risks, benefits, and alternatives, and that you agree to the
surgery.' [CORRECT]
C. C) 'It protects the hospital from being sued if something goes wrong during surgery.'
D. D) 'It allows the surgeon to perform any additional procedures they find necessary.'
Correct Answer: B
Rationale: Informed consent is a legal and ethical process that ensures the patient understands the procedure, including its risks,
benefits, and alternatives, before voluntarily agreeing to treatment. Option A is incorrect because consent is far more than a legal
formality; it is rooted in the principle of patient autonomy. Option C is incorrect because the consent form does not shield the
hospital from liability, and framing it this way undermines the patient's right to informed decision-making. Option D is incorrect
because consent is specific to the planned procedure, and additional procedures would require separate consent.
Q2: The circulating nurse performs a surgical time-out before an abdominal procedure. Which action is the priority
during this process?
A. A) Confirming the sterilization date of the surgical instruments
B. B) Verifying the patient's identity, procedure, and surgical site with the entire team [CORRECT]
C. C) Ensuring the anesthesia machine is functioning properly
D. D) Documenting the patient's allergies in the operative record
Correct Answer: B
Rationale: The surgical time-out is a critical safety measure mandated by The Joint Commission's Universal Protocol, requiring
the entire surgical team to pause and jointly verify the correct patient, correct procedure, and correct surgical site. Option A is
incorrect because instrument sterilization is verified earlier during the preprocedure verification process, not during the time-out
itself. Option C is incorrect because anesthesia machine checks are the responsibility of the anesthesia provider and are
completed before the time-out. Option D is incorrect because allergy documentation occurs during preoperative assessment, not
as the focus of the time-out.
Q3: A patient is in the postanesthesia care unit (PACU) following a laparoscopic cholecystectomy. Which assessment
finding requires immediate intervention by the nurse?
A. A) Heart rate of 92 beats per minute
B. B) Respiratory rate of 8 breaths per minute [CORRECT]
C. C) Blood pressure of 140/88 mmHg
D. D) Temperature of 37.2°C (99.0°F)
Correct Answer: B
Rationale: A respiratory rate of 8 breaths per minute indicates respiratory depression, which is a life-threatening complication in
the PACU often caused by opioid medications or residual anesthetic effects. This finding requires immediate intervention,
including stimulation of the patient, administration of reversal agents such as naloxone, and possible airway support. Option A is
incorrect because a heart rate of 92 bpm is within normal limits for a postoperative patient and may reflect pain or anxiety. Option
C is incorrect because a blood pressure of 140/88 mmHg, while slightly elevated, is common postoperatively due to pain, stress,
or fluid shifts and does not require emergent intervention. Option D is incorrect because a temperature of 37.2°C is a normal
postoperative finding.
,Q4: The nurse is performing medication reconciliation for a patient scheduled for surgery tomorrow. Which action
is most important?
A. A) Withholding all home medications 24 hours before surgery
B. B) Documenting all current medications, including over-the-counter drugs and herbal supplements, and clarifying which
should be held or continued [CORRECT]
C. C) Asking the patient to bring all medication bottles to the preoperative visit
D. D) Contacting the pharmacy to refill prescriptions that are running low
Correct Answer: B
Rationale: Medication reconciliation is a critical safety process that involves creating a complete and accurate list of all
medications the patient is taking, including prescription drugs, over-the-counter medications, and herbal supplements, and then
determining which should be continued or held before surgery. Many medications, such as anticoagulants, antidiabetic agents,
and certain herbal supplements like garlic and ginkgo biloba, can increase surgical bleeding or interact with anesthetics. Option
A is incorrect because not all medications should be withheld; some, such as beta-blockers for cardiovascular conditions, should
be continued to prevent adverse events. Option C, while helpful, is a component of the reconciliation process but not the most
important action on its own. Option D is incorrect because refilling prescriptions is not within the nurse's scope for preoperative
preparation and is not the priority.
Q5: A patient who underwent a total hip replacement 2 days ago develops a swollen, warm, and tender left calf. What
is the nurse's priority action?
A. A) Apply a warm compress to the affected area
B. B) Measure the circumference of both calves and compare
C. C) Notify the health care provider immediately and avoid massaging the extremity [CORRECT]
D. D) Elevate the affected leg on pillows and encourage ambulation
Correct Answer: C
Rationale: The patient's findings of calf swelling, warmth, and tenderness are classic signs of deep vein thrombosis (DVT), a
serious postoperative complication that requires immediate medical evaluation and intervention. The nurse must notify the
provider promptly so that diagnostic studies such as a Doppler ultrasound can be ordered and anticoagulation therapy initiated if
confirmed. Massaging the affected extremity is contraindicated because it may dislodge a thrombus, potentially causing a fatal
pulmonary embolism. Option A is incorrect because applying warmth could mask symptoms or increase discomfort without
addressing the underlying risk. Option B is incorrect because although calf measurements can support the assessment, the
priority is to notify the provider of suspected DVT. Option D is incorrect because encouraging ambulation in a patient with
suspected DVT could dislodge the clot.
Q6: The nurse is providing preoperative teaching about fasting to a patient scheduled for morning surgery. Which
instruction is correct?
A. A) 'You may drink clear liquids up to 2 hours before your scheduled surgery time.' [CORRECT]
B. B) 'You should not eat or drink anything after midnight the night before surgery.'
C. C) 'You may have a light breakfast, such as toast and juice, 4 hours before surgery.'
D. D) 'You can drink water up to 30 minutes before arriving at the hospital.'
Correct Answer: A
Rationale: Current evidence-based guidelines from the American Society of Anesthesiologists (ASA) recommend that patients
may consume clear liquids up to 2 hours before elective surgery, which reduces patient discomfort while maintaining safety
regarding aspiration risk. Option B reflects outdated NPO-after-midnight guidelines that have been revised based on research
showing that prolonged fasting is unnecessary and can actually lead to dehydration, hypoglycemia, and patient discomfort.
Option C is incorrect because solid foods, including a light breakfast, generally should be stopped 6 to 8 hours before surgery.
Option D is incorrect because consuming water 30 minutes before surgery poses an aspiration risk during anesthesia induction.
, Q7: Which wound classification is assigned to a surgical procedure involving an incision into the stomach during a
colon resection with a bowel preparation?
A. A) Clean
B. B) Clean-contaminated [CORRECT]
C. C) Contaminated
D. D) Dirty
Correct Answer: B
Rationale: A clean-contaminated wound classification is assigned when a surgical procedure enters a controlled body cavity
(such as the gastrointestinal tract) without unusual contamination, and the surgical site was prepared with appropriate measures
such as bowel preparation. The risk of surgical site infection for clean-contaminated wounds is moderate, approximately 7% to
11%. Option A is incorrect because a clean classification applies to uninfected wounds in which no inflammation is encountered
and the respiratory, alimentary, or genitourinary tracts are not entered. Option C is incorrect because contaminated wounds
involve gross spillage from the gastrointestinal tract or a major break in sterile technique. Option D is incorrect because dirty or
infected wounds involve preexisting infection or perforated viscera with pus present.
Q8: A patient in the PACU reports a pain level of 8 out of 10 following an open appendectomy. The patient has a
prescription for morphine 2 mg IV every 10 minutes as needed for pain. What should the nurse do first?
A. A) Administer the prescribed morphine dose immediately
B. B) Assess the patient's vital signs and respiratory status before administering the opioid [CORRECT]
C. C) Offer non-pharmacological pain relief measures such as repositioning and deep breathing
D. D) Contact the surgeon to request a stronger analgesic
Correct Answer: B
Rationale: Before administering any opioid analgesic, the nurse must first assess the patient's vital signs, particularly respiratory
rate and depth, blood pressure, and level of consciousness, to establish a baseline and ensure it is safe to give the medication.
This is especially critical in the immediate postoperative period when residual anesthetic effects can potentiate opioid-induced
respiratory depression. Option A is incorrect because administering the medication without a prior assessment could be unsafe if
the patient has respiratory compromise. Option C is incorrect because while non-pharmacological measures are important
adjuncts, they are insufficient for severe postoperative pain rated at 8 out of 10. Option D is incorrect because the prescribed
medication is appropriate for the patient's pain level and does not yet need to be escalated.
Q9: The nurse is positioning a patient for a lithotomy procedure. Which nursing intervention is most important to
prevent complications?
A. A) Placing the safety strap 2 inches above the knees
B. B) Padding the patient's heels and avoiding excessive external rotation of the hips [CORRECT]
C. C) Ensuring the patient's arms are tucked at the sides with palms facing up
D. D) Applying a warming blanket to the upper body only
Correct Answer: B
Rationale: In the lithotomy position, the patient's legs are elevated in stirrups, which creates risk for nerve injury (particularly the
common peroneal and sciatic nerves), compartment syndrome, and pressure injury to the heels. The nurse must pad bony
prominences, especially the heels, and avoid excessive hip rotation or abduction to prevent injury. Option A is incorrect because
the safety strap should be placed 2 inches above the knees for supine positioning, not specifically for the lithotomy position.
Option C is incorrect because arm positioning, while important, is not the most critical concern for the lithotomy position
specifically. Option D is incorrect because while maintaining normothermia is important, it is not the priority intervention related to
the specific risks of lithotomy positioning.
Practice II (2026/2027)
Actual Questions and Verified Answers | 100% Guarantee Pass
Galen College of Nursing | Baccalaureate Nursing Program
Section 1: Perioperative Nursing Care
Q1: A patient scheduled for an appendectomy asks the nurse, 'Why do I need to sign this consent form?' What is the
best response by the nurse?
A. A) 'The hospital requires it as a legal formality before any surgery.'
B. B) 'It confirms that your surgeon has explained the procedure, risks, benefits, and alternatives, and that you agree to the
surgery.' [CORRECT]
C. C) 'It protects the hospital from being sued if something goes wrong during surgery.'
D. D) 'It allows the surgeon to perform any additional procedures they find necessary.'
Correct Answer: B
Rationale: Informed consent is a legal and ethical process that ensures the patient understands the procedure, including its risks,
benefits, and alternatives, before voluntarily agreeing to treatment. Option A is incorrect because consent is far more than a legal
formality; it is rooted in the principle of patient autonomy. Option C is incorrect because the consent form does not shield the
hospital from liability, and framing it this way undermines the patient's right to informed decision-making. Option D is incorrect
because consent is specific to the planned procedure, and additional procedures would require separate consent.
Q2: The circulating nurse performs a surgical time-out before an abdominal procedure. Which action is the priority
during this process?
A. A) Confirming the sterilization date of the surgical instruments
B. B) Verifying the patient's identity, procedure, and surgical site with the entire team [CORRECT]
C. C) Ensuring the anesthesia machine is functioning properly
D. D) Documenting the patient's allergies in the operative record
Correct Answer: B
Rationale: The surgical time-out is a critical safety measure mandated by The Joint Commission's Universal Protocol, requiring
the entire surgical team to pause and jointly verify the correct patient, correct procedure, and correct surgical site. Option A is
incorrect because instrument sterilization is verified earlier during the preprocedure verification process, not during the time-out
itself. Option C is incorrect because anesthesia machine checks are the responsibility of the anesthesia provider and are
completed before the time-out. Option D is incorrect because allergy documentation occurs during preoperative assessment, not
as the focus of the time-out.
Q3: A patient is in the postanesthesia care unit (PACU) following a laparoscopic cholecystectomy. Which assessment
finding requires immediate intervention by the nurse?
A. A) Heart rate of 92 beats per minute
B. B) Respiratory rate of 8 breaths per minute [CORRECT]
C. C) Blood pressure of 140/88 mmHg
D. D) Temperature of 37.2°C (99.0°F)
Correct Answer: B
Rationale: A respiratory rate of 8 breaths per minute indicates respiratory depression, which is a life-threatening complication in
the PACU often caused by opioid medications or residual anesthetic effects. This finding requires immediate intervention,
including stimulation of the patient, administration of reversal agents such as naloxone, and possible airway support. Option A is
incorrect because a heart rate of 92 bpm is within normal limits for a postoperative patient and may reflect pain or anxiety. Option
C is incorrect because a blood pressure of 140/88 mmHg, while slightly elevated, is common postoperatively due to pain, stress,
or fluid shifts and does not require emergent intervention. Option D is incorrect because a temperature of 37.2°C is a normal
postoperative finding.
,Q4: The nurse is performing medication reconciliation for a patient scheduled for surgery tomorrow. Which action
is most important?
A. A) Withholding all home medications 24 hours before surgery
B. B) Documenting all current medications, including over-the-counter drugs and herbal supplements, and clarifying which
should be held or continued [CORRECT]
C. C) Asking the patient to bring all medication bottles to the preoperative visit
D. D) Contacting the pharmacy to refill prescriptions that are running low
Correct Answer: B
Rationale: Medication reconciliation is a critical safety process that involves creating a complete and accurate list of all
medications the patient is taking, including prescription drugs, over-the-counter medications, and herbal supplements, and then
determining which should be continued or held before surgery. Many medications, such as anticoagulants, antidiabetic agents,
and certain herbal supplements like garlic and ginkgo biloba, can increase surgical bleeding or interact with anesthetics. Option
A is incorrect because not all medications should be withheld; some, such as beta-blockers for cardiovascular conditions, should
be continued to prevent adverse events. Option C, while helpful, is a component of the reconciliation process but not the most
important action on its own. Option D is incorrect because refilling prescriptions is not within the nurse's scope for preoperative
preparation and is not the priority.
Q5: A patient who underwent a total hip replacement 2 days ago develops a swollen, warm, and tender left calf. What
is the nurse's priority action?
A. A) Apply a warm compress to the affected area
B. B) Measure the circumference of both calves and compare
C. C) Notify the health care provider immediately and avoid massaging the extremity [CORRECT]
D. D) Elevate the affected leg on pillows and encourage ambulation
Correct Answer: C
Rationale: The patient's findings of calf swelling, warmth, and tenderness are classic signs of deep vein thrombosis (DVT), a
serious postoperative complication that requires immediate medical evaluation and intervention. The nurse must notify the
provider promptly so that diagnostic studies such as a Doppler ultrasound can be ordered and anticoagulation therapy initiated if
confirmed. Massaging the affected extremity is contraindicated because it may dislodge a thrombus, potentially causing a fatal
pulmonary embolism. Option A is incorrect because applying warmth could mask symptoms or increase discomfort without
addressing the underlying risk. Option B is incorrect because although calf measurements can support the assessment, the
priority is to notify the provider of suspected DVT. Option D is incorrect because encouraging ambulation in a patient with
suspected DVT could dislodge the clot.
Q6: The nurse is providing preoperative teaching about fasting to a patient scheduled for morning surgery. Which
instruction is correct?
A. A) 'You may drink clear liquids up to 2 hours before your scheduled surgery time.' [CORRECT]
B. B) 'You should not eat or drink anything after midnight the night before surgery.'
C. C) 'You may have a light breakfast, such as toast and juice, 4 hours before surgery.'
D. D) 'You can drink water up to 30 minutes before arriving at the hospital.'
Correct Answer: A
Rationale: Current evidence-based guidelines from the American Society of Anesthesiologists (ASA) recommend that patients
may consume clear liquids up to 2 hours before elective surgery, which reduces patient discomfort while maintaining safety
regarding aspiration risk. Option B reflects outdated NPO-after-midnight guidelines that have been revised based on research
showing that prolonged fasting is unnecessary and can actually lead to dehydration, hypoglycemia, and patient discomfort.
Option C is incorrect because solid foods, including a light breakfast, generally should be stopped 6 to 8 hours before surgery.
Option D is incorrect because consuming water 30 minutes before surgery poses an aspiration risk during anesthesia induction.
, Q7: Which wound classification is assigned to a surgical procedure involving an incision into the stomach during a
colon resection with a bowel preparation?
A. A) Clean
B. B) Clean-contaminated [CORRECT]
C. C) Contaminated
D. D) Dirty
Correct Answer: B
Rationale: A clean-contaminated wound classification is assigned when a surgical procedure enters a controlled body cavity
(such as the gastrointestinal tract) without unusual contamination, and the surgical site was prepared with appropriate measures
such as bowel preparation. The risk of surgical site infection for clean-contaminated wounds is moderate, approximately 7% to
11%. Option A is incorrect because a clean classification applies to uninfected wounds in which no inflammation is encountered
and the respiratory, alimentary, or genitourinary tracts are not entered. Option C is incorrect because contaminated wounds
involve gross spillage from the gastrointestinal tract or a major break in sterile technique. Option D is incorrect because dirty or
infected wounds involve preexisting infection or perforated viscera with pus present.
Q8: A patient in the PACU reports a pain level of 8 out of 10 following an open appendectomy. The patient has a
prescription for morphine 2 mg IV every 10 minutes as needed for pain. What should the nurse do first?
A. A) Administer the prescribed morphine dose immediately
B. B) Assess the patient's vital signs and respiratory status before administering the opioid [CORRECT]
C. C) Offer non-pharmacological pain relief measures such as repositioning and deep breathing
D. D) Contact the surgeon to request a stronger analgesic
Correct Answer: B
Rationale: Before administering any opioid analgesic, the nurse must first assess the patient's vital signs, particularly respiratory
rate and depth, blood pressure, and level of consciousness, to establish a baseline and ensure it is safe to give the medication.
This is especially critical in the immediate postoperative period when residual anesthetic effects can potentiate opioid-induced
respiratory depression. Option A is incorrect because administering the medication without a prior assessment could be unsafe if
the patient has respiratory compromise. Option C is incorrect because while non-pharmacological measures are important
adjuncts, they are insufficient for severe postoperative pain rated at 8 out of 10. Option D is incorrect because the prescribed
medication is appropriate for the patient's pain level and does not yet need to be escalated.
Q9: The nurse is positioning a patient for a lithotomy procedure. Which nursing intervention is most important to
prevent complications?
A. A) Placing the safety strap 2 inches above the knees
B. B) Padding the patient's heels and avoiding excessive external rotation of the hips [CORRECT]
C. C) Ensuring the patient's arms are tucked at the sides with palms facing up
D. D) Applying a warming blanket to the upper body only
Correct Answer: B
Rationale: In the lithotomy position, the patient's legs are elevated in stirrups, which creates risk for nerve injury (particularly the
common peroneal and sciatic nerves), compartment syndrome, and pressure injury to the heels. The nurse must pad bony
prominences, especially the heels, and avoid excessive hip rotation or abduction to prevent injury. Option A is incorrect because
the safety strap should be placed 2 inches above the knees for supine positioning, not specifically for the lithotomy position.
Option C is incorrect because arm positioning, while important, is not the most critical concern for the lithotomy position
specifically. Option D is incorrect because while maintaining normothermia is important, it is not the priority intervention related to
the specific risks of lithotomy positioning.
