NUR 6130 Exam 2 | Questions and Answers | Newest 2026 |
100% Correct - William Paterson University. - 150 Questions
Section 1: Perioperative Nursing (Questions 1-15)
1 A patient with a history of malignant hyperthermia (MH) is scheduled for laparoscopic cholecystectomy. The
anesthesia plan includes total intravenous anesthesia (TIVA) with propofol and remifentanil. Which statement
best reflects the perioperative nursing priority in this scenario?
A) Ensure the availability of dantrolene sodium and a MH cart in the operating room.
B) Preoxygenate with 100% oxygen for 5 minutes prior to induction.
C) Administer succinylcholine to facilitate endotracheal intubation.
D) Place the patient in Trendelenburg position to optimize surgical exposure.
Answer: A
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic crisis triggered by volatile anesthetics and
succinylcholine. TIVA with propofol and remifentanil is safe, but dantrolene must be immediately available.
Option B is standard for all patients but not specific to MH. Option C is contraindicated because succinylcholine
can trigger MH. Option D is irrelevant to MH prevention.
2 During a robotic-assisted prostatectomy, the patient is placed in steep Trendelenburg position with
pneumoperitoneum at 15 mmHg. The nurse notices a sudden decrease in end-tidal CO2 (ETCO2) from 38 to 28
mmHg, accompanied by a drop in oxygen saturation to 88%. What is the most likely cause?
A) Venous air embolism
B) Carbon dioxide embolism
C) Endobronchial intubation
D) Malignant hyperthermia
Answer: B
Rationale: During laparoscopic surgery with CO2 insufflation, a sudden decrease in ETCO2 and oxygen saturation
suggests CO2 embolism, where CO2 enters the bloodstream, causing gas exchange impairment. Venous air
embolism (A) typically occurs in sitting position craniotomies. Endobronchial intubation (C) would show increased
ETCO2 initially. Malignant hyperthermia (D) presents with hypercarbia and tachycardia.
3 A patient undergoing total hip arthroplasty under spinal anesthesia develops sudden hypotension and
bradycardia during cement insertion. The perioperative nurse anticipates which intervention as the priority?
A) Administer ephedrine 10 mg IV push
B) Administer atropine 0.5 mg IV push
C) Administer epinephrine 1 mcg IV push
D) Administer 500 mL lactated Ringer's bolus
Answer: C
Rationale: Cement implantation syndrome (CIS) causes hypotension, hypoxia, and bradycardia due to embolization
of marrow contents and vasodilation. Epinephrine is the preferred vasopressor for anaphylactoid reactions and
cardiac support. Ephedrine (A) is less potent. Atropine (B) treats bradycardia but not hypotension. Fluid bolus (D)
may be given but does not address vasodilation effectively.
4 Which finding in the preoperative assessment places a patient at highest risk for perioperative hypothermia?
A) Body mass index of 32 kg/m²
,B) History of hyperthyroidism treated with methimazole
C) Preoperative hemoglobin of 10.2 g/dL
D) Current use of a beta-adrenergic blocker
Answer: D
Rationale: Beta-blockers impair thermoregulatory vasoconstriction and shivering, increasing risk of hypothermia.
Obesity (A) provides insulation. Hyperthyroidism (B) increases metabolic heat. Anemia (C) is a minor risk factor.
Beta-blockade is a significant risk due to blunted sympathetic response.
5 During a Whipple procedure, the patient experiences an estimated blood loss of 1500 mL. The nurse prepares to
administer packed red blood cells (PRBCs). Which statement about intraoperative blood transfusion is correct?
A) PRBCs should be warmed to 40°C to prevent hypothermia.
B) Transfusion should be initiated when hemoglobin drops below 7 g/dL regardless of patient status.
C) Type O negative blood can be given emergently without crossmatch.
D) Leukoreduced PRBCs are indicated to prevent transfusion-related acute lung injury (TRALI).
Answer: C
Rationale: In life-threatening hemorrhage, type O negative (universal donor) PRBCs can be transfused without
crossmatch. Warming to 40°C (A) can damage cells; warming to 37°C is standard. Transfusion triggers (B) depend
on patient factors; 7 g/dL is a threshold in stable patients, not intraoperatively. Leukoreduction (D) reduces febrile
reactions and CMV transmission, not TRALI; TRALI prevention involves male-only plasma.
6 A patient undergoing emergency laparotomy for bowel obstruction has a nasogastric tube (NGT) placed
preoperatively. The nurse notes that the NGT is draining dark green fluid. Which action is most appropriate
regarding the NGT during the intraoperative period?
A) Clamp the NGT to prevent aspiration during induction.
B) Connect the NGT to low continuous suction.
C) Remove the NGT to reduce risk of esophageal injury.
D) Leave the NGT open to gravity drainage.
Answer: B
Rationale: Continuous suction decompresses the stomach and reduces risk of aspiration during induction and
surgery. Clamping (A) increases aspiration risk. Removal (C) is contraindicated because the bowel is obstructed.
Gravity drainage (D) is less effective than suction.
7 Which intraoperative nursing intervention is most effective in preventing surgical site infection (SSI) for a
colorectal surgery?
A) Administer prophylactic antibiotics within 60 minutes before incision.
B) Use a plastic adhesive drape over the surgical site.
C) Maintain normothermia with forced-air warming.
D) Irrigate the wound with saline containing gentamicin.
Answer: A
Rationale: Timely administration of prophylactic antibiotics is the most critical intervention to prevent SSI, with
evidence supporting administration within 60 minutes before incision. Plastic drapes (B) have mixed evidence.
Normothermia (C) reduces infection but is secondary to antibiotics. Wound irrigation (D) is not standard
prophylaxis.
8 A patient undergoing thyroidectomy under general anesthesia develops tachycardia (HR 140 bpm), hypertension
(BP 180/100), and hyperthermia (38.9°C) after induction. The nurse suspects thyroid storm. Which intervention
should the nurse prioritize?
,A) Administer propylthiouracil (PTU) 200 mg orally via nasogastric tube.
B) Administer propranolol 1 mg IV push.
C) Administer acetaminophen 650 mg rectally.
D) Apply cooling blankets and ice packs.
Answer: B
Rationale: Beta-blockade with propranolol rapidly controls tachycardia and hypertension in thyroid storm. PTU (A)
blocks thyroid hormone synthesis but does not address acute symptoms. Acetaminophen (C) treats fever but not
tachycardia. Cooling (D) is adjunctive but not the priority.
9 In the postoperative period, a patient who underwent a radical cystectomy with ileal conduit diversion is at high
risk for which electrolyte imbalance?
A) Hyperchloremic metabolic acidosis
B) Hypokalemic metabolic alkalosis
C) Hypernatremic dehydration
D) Hypocalcemic tetany
Answer: A
Rationale: Ileal conduit diversion uses a segment of ileum, which absorbs chloride and ammonium, leading to
hyperchloremic metabolic acidosis. Hypokalemia (B) may occur but is not the primary imbalance. Hypernatremia
(C) is not typical. Hypocalcemia (D) is associated with thyroid or parathyroid surgery.
10 A patient in the post-anesthesia care unit (PACU) after a laparoscopic nephrectomy has a respiratory rate of 8
breaths/min and is difficult to arouse. The nurse notes that the patient received fentanyl 100 mcg IV 30 minutes
ago. What is the most appropriate immediate action?
A) Administer naloxone 0.4 mg IV push.
B) Administer flumazenil 0.2 mg IV push.
C) Apply supplemental oxygen at 2 L/min via nasal cannula.
D) Stimulate the patient and encourage deep breathing.
Answer: A
Rationale: The patient shows signs of opioid-induced respiratory depression (bradypnea, sedation). Naloxone is the
reversal agent. Flumazenil (B) reverses benzodiazepines, not opioids. Oxygen (C) and stimulation (D) are
insufficient for significant respiratory depression.
11 A patient with a history of malignant hyperthermia (MH) is scheduled for elective laparoscopic
cholecystectomy. Which anesthetic agent is safest to use in this patient?
A) Sevoflurane
B) Succinylcholine
C) Propofol
D) Desflurane
Answer: C
Rationale: Propofol is a non-triggering agent for MH and is safe. Volatile anesthetics (sevoflurane, desflurane) and
succinylcholine are known triggers. Therefore, propofol-based total intravenous anesthesia (TIVA) is
recommended.
12 During a preoperative assessment, a patient reports taking St. John's wort daily. The nurse anesthetist is
concerned about potential interactions. Which statement accurately reflects the current best practice regarding
this herbal supplement?
, A) St. John's wort induces CYP3A4 and may reduce the efficacy of midazolam; it should be discontinued at least
5 half-lives before surgery.
B) St. John's wort has no significant interactions with anesthetic agents and can be continued safely.
C) St. John's wort potentiates the effects of opioids; the dose should be reduced by 50%.
D) St. John's wort increases the risk of bleeding; it should be stopped 7 days prior to surgery.
Answer: A
Rationale: St. John's wort is a potent inducer of CYP3A4, which can decrease the plasma concentration of drugs
metabolized by this enzyme, such as midazolam. Current guidelines recommend discontinuing St. John's wort 5
half-lives (about 5 days) before surgery to avoid subtherapeutic anesthesia. It does not significantly affect bleeding
or potentiate opioids.
13 A surgical patient with a known latex allergy is scheduled for a procedure. The perioperative team is preparing
the operating room. Which of the following actions is most critical to prevent a type I hypersensitivity reaction?
A) Use latex-free gloves for all team members and cover any latex-containing equipment with non-latex barriers.
B) Administer diphenhydramine 50 mg IV 30 minutes prior to induction.
C) Place the patient in a negative-pressure isolation room.
D) Premedicate with methylprednisolone 125 mg IV and ranitidine 50 mg IV.
Answer: A
Rationale: The primary prevention for latex allergy is strict avoidance of latex. Covering latex-containing items
(e.g., blood pressure cuff tubing) with non-latex barriers and using latex-free gloves are essential. Premedication
(antihistamines, steroids) is secondary and not a substitute for avoidance. Negative-pressure isolation is irrelevant.
14 A patient undergoing a prolonged abdominal surgery under general anesthesia develops a heart rate of 45 bpm
and a mean arterial pressure of 55 mmHg. The surgeon is applying traction to the mesentery. Which
intervention should the anesthesia provider implement first?
A) Administer atropine 0.5 mg IV.
B) Ask the surgeon to release traction.
C) Start a dopamine infusion at 5 mcg/kg/min.
D) Administer ephedrine 5 mg IV.
Answer: B
Rationale: Traction on the mesentery can trigger a vagal reflex causing bradycardia and hypotension. The first step
is to remove the stimulus by asking the surgeon to release traction. If that fails, pharmacologic intervention (e.g.,
atropine) may be needed. Ephedrine or dopamine may be used if hypotension persists, but addressing the cause is
primary.
15 A patient is positioned in the lithotomy position for a gynecologic procedure. Which of the following is the
most critical consideration for preventing positioning-related injury?
A) Ensure the patient's arms are tucked at the sides with the palms facing downward.
B) Limit the time in lithotomy to no more than 2 hours to prevent compartment syndrome.
C) Use stirrups that support the foot and ankle, avoiding pressure on the popliteal fossa.
D) Place a roll under the patient's lumbar spine to maintain lordosis.
Answer: C
Rationale: In lithotomy, improper leg positioning can compress the popliteal fossa, leading to nerve injury (common
peroneal) or vascular compromise. Stirrups should support the foot and ankle, and the knees should be slightly
flexed with hips abducted. Tucking arms with palms facing upward (not downward) avoids ulnar nerve injury.
Limiting time helps but is secondary to proper positioning. Lumbar support is not a priority in lithotomy.
100% Correct - William Paterson University. - 150 Questions
Section 1: Perioperative Nursing (Questions 1-15)
1 A patient with a history of malignant hyperthermia (MH) is scheduled for laparoscopic cholecystectomy. The
anesthesia plan includes total intravenous anesthesia (TIVA) with propofol and remifentanil. Which statement
best reflects the perioperative nursing priority in this scenario?
A) Ensure the availability of dantrolene sodium and a MH cart in the operating room.
B) Preoxygenate with 100% oxygen for 5 minutes prior to induction.
C) Administer succinylcholine to facilitate endotracheal intubation.
D) Place the patient in Trendelenburg position to optimize surgical exposure.
Answer: A
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic crisis triggered by volatile anesthetics and
succinylcholine. TIVA with propofol and remifentanil is safe, but dantrolene must be immediately available.
Option B is standard for all patients but not specific to MH. Option C is contraindicated because succinylcholine
can trigger MH. Option D is irrelevant to MH prevention.
2 During a robotic-assisted prostatectomy, the patient is placed in steep Trendelenburg position with
pneumoperitoneum at 15 mmHg. The nurse notices a sudden decrease in end-tidal CO2 (ETCO2) from 38 to 28
mmHg, accompanied by a drop in oxygen saturation to 88%. What is the most likely cause?
A) Venous air embolism
B) Carbon dioxide embolism
C) Endobronchial intubation
D) Malignant hyperthermia
Answer: B
Rationale: During laparoscopic surgery with CO2 insufflation, a sudden decrease in ETCO2 and oxygen saturation
suggests CO2 embolism, where CO2 enters the bloodstream, causing gas exchange impairment. Venous air
embolism (A) typically occurs in sitting position craniotomies. Endobronchial intubation (C) would show increased
ETCO2 initially. Malignant hyperthermia (D) presents with hypercarbia and tachycardia.
3 A patient undergoing total hip arthroplasty under spinal anesthesia develops sudden hypotension and
bradycardia during cement insertion. The perioperative nurse anticipates which intervention as the priority?
A) Administer ephedrine 10 mg IV push
B) Administer atropine 0.5 mg IV push
C) Administer epinephrine 1 mcg IV push
D) Administer 500 mL lactated Ringer's bolus
Answer: C
Rationale: Cement implantation syndrome (CIS) causes hypotension, hypoxia, and bradycardia due to embolization
of marrow contents and vasodilation. Epinephrine is the preferred vasopressor for anaphylactoid reactions and
cardiac support. Ephedrine (A) is less potent. Atropine (B) treats bradycardia but not hypotension. Fluid bolus (D)
may be given but does not address vasodilation effectively.
4 Which finding in the preoperative assessment places a patient at highest risk for perioperative hypothermia?
A) Body mass index of 32 kg/m²
,B) History of hyperthyroidism treated with methimazole
C) Preoperative hemoglobin of 10.2 g/dL
D) Current use of a beta-adrenergic blocker
Answer: D
Rationale: Beta-blockers impair thermoregulatory vasoconstriction and shivering, increasing risk of hypothermia.
Obesity (A) provides insulation. Hyperthyroidism (B) increases metabolic heat. Anemia (C) is a minor risk factor.
Beta-blockade is a significant risk due to blunted sympathetic response.
5 During a Whipple procedure, the patient experiences an estimated blood loss of 1500 mL. The nurse prepares to
administer packed red blood cells (PRBCs). Which statement about intraoperative blood transfusion is correct?
A) PRBCs should be warmed to 40°C to prevent hypothermia.
B) Transfusion should be initiated when hemoglobin drops below 7 g/dL regardless of patient status.
C) Type O negative blood can be given emergently without crossmatch.
D) Leukoreduced PRBCs are indicated to prevent transfusion-related acute lung injury (TRALI).
Answer: C
Rationale: In life-threatening hemorrhage, type O negative (universal donor) PRBCs can be transfused without
crossmatch. Warming to 40°C (A) can damage cells; warming to 37°C is standard. Transfusion triggers (B) depend
on patient factors; 7 g/dL is a threshold in stable patients, not intraoperatively. Leukoreduction (D) reduces febrile
reactions and CMV transmission, not TRALI; TRALI prevention involves male-only plasma.
6 A patient undergoing emergency laparotomy for bowel obstruction has a nasogastric tube (NGT) placed
preoperatively. The nurse notes that the NGT is draining dark green fluid. Which action is most appropriate
regarding the NGT during the intraoperative period?
A) Clamp the NGT to prevent aspiration during induction.
B) Connect the NGT to low continuous suction.
C) Remove the NGT to reduce risk of esophageal injury.
D) Leave the NGT open to gravity drainage.
Answer: B
Rationale: Continuous suction decompresses the stomach and reduces risk of aspiration during induction and
surgery. Clamping (A) increases aspiration risk. Removal (C) is contraindicated because the bowel is obstructed.
Gravity drainage (D) is less effective than suction.
7 Which intraoperative nursing intervention is most effective in preventing surgical site infection (SSI) for a
colorectal surgery?
A) Administer prophylactic antibiotics within 60 minutes before incision.
B) Use a plastic adhesive drape over the surgical site.
C) Maintain normothermia with forced-air warming.
D) Irrigate the wound with saline containing gentamicin.
Answer: A
Rationale: Timely administration of prophylactic antibiotics is the most critical intervention to prevent SSI, with
evidence supporting administration within 60 minutes before incision. Plastic drapes (B) have mixed evidence.
Normothermia (C) reduces infection but is secondary to antibiotics. Wound irrigation (D) is not standard
prophylaxis.
8 A patient undergoing thyroidectomy under general anesthesia develops tachycardia (HR 140 bpm), hypertension
(BP 180/100), and hyperthermia (38.9°C) after induction. The nurse suspects thyroid storm. Which intervention
should the nurse prioritize?
,A) Administer propylthiouracil (PTU) 200 mg orally via nasogastric tube.
B) Administer propranolol 1 mg IV push.
C) Administer acetaminophen 650 mg rectally.
D) Apply cooling blankets and ice packs.
Answer: B
Rationale: Beta-blockade with propranolol rapidly controls tachycardia and hypertension in thyroid storm. PTU (A)
blocks thyroid hormone synthesis but does not address acute symptoms. Acetaminophen (C) treats fever but not
tachycardia. Cooling (D) is adjunctive but not the priority.
9 In the postoperative period, a patient who underwent a radical cystectomy with ileal conduit diversion is at high
risk for which electrolyte imbalance?
A) Hyperchloremic metabolic acidosis
B) Hypokalemic metabolic alkalosis
C) Hypernatremic dehydration
D) Hypocalcemic tetany
Answer: A
Rationale: Ileal conduit diversion uses a segment of ileum, which absorbs chloride and ammonium, leading to
hyperchloremic metabolic acidosis. Hypokalemia (B) may occur but is not the primary imbalance. Hypernatremia
(C) is not typical. Hypocalcemia (D) is associated with thyroid or parathyroid surgery.
10 A patient in the post-anesthesia care unit (PACU) after a laparoscopic nephrectomy has a respiratory rate of 8
breaths/min and is difficult to arouse. The nurse notes that the patient received fentanyl 100 mcg IV 30 minutes
ago. What is the most appropriate immediate action?
A) Administer naloxone 0.4 mg IV push.
B) Administer flumazenil 0.2 mg IV push.
C) Apply supplemental oxygen at 2 L/min via nasal cannula.
D) Stimulate the patient and encourage deep breathing.
Answer: A
Rationale: The patient shows signs of opioid-induced respiratory depression (bradypnea, sedation). Naloxone is the
reversal agent. Flumazenil (B) reverses benzodiazepines, not opioids. Oxygen (C) and stimulation (D) are
insufficient for significant respiratory depression.
11 A patient with a history of malignant hyperthermia (MH) is scheduled for elective laparoscopic
cholecystectomy. Which anesthetic agent is safest to use in this patient?
A) Sevoflurane
B) Succinylcholine
C) Propofol
D) Desflurane
Answer: C
Rationale: Propofol is a non-triggering agent for MH and is safe. Volatile anesthetics (sevoflurane, desflurane) and
succinylcholine are known triggers. Therefore, propofol-based total intravenous anesthesia (TIVA) is
recommended.
12 During a preoperative assessment, a patient reports taking St. John's wort daily. The nurse anesthetist is
concerned about potential interactions. Which statement accurately reflects the current best practice regarding
this herbal supplement?
, A) St. John's wort induces CYP3A4 and may reduce the efficacy of midazolam; it should be discontinued at least
5 half-lives before surgery.
B) St. John's wort has no significant interactions with anesthetic agents and can be continued safely.
C) St. John's wort potentiates the effects of opioids; the dose should be reduced by 50%.
D) St. John's wort increases the risk of bleeding; it should be stopped 7 days prior to surgery.
Answer: A
Rationale: St. John's wort is a potent inducer of CYP3A4, which can decrease the plasma concentration of drugs
metabolized by this enzyme, such as midazolam. Current guidelines recommend discontinuing St. John's wort 5
half-lives (about 5 days) before surgery to avoid subtherapeutic anesthesia. It does not significantly affect bleeding
or potentiate opioids.
13 A surgical patient with a known latex allergy is scheduled for a procedure. The perioperative team is preparing
the operating room. Which of the following actions is most critical to prevent a type I hypersensitivity reaction?
A) Use latex-free gloves for all team members and cover any latex-containing equipment with non-latex barriers.
B) Administer diphenhydramine 50 mg IV 30 minutes prior to induction.
C) Place the patient in a negative-pressure isolation room.
D) Premedicate with methylprednisolone 125 mg IV and ranitidine 50 mg IV.
Answer: A
Rationale: The primary prevention for latex allergy is strict avoidance of latex. Covering latex-containing items
(e.g., blood pressure cuff tubing) with non-latex barriers and using latex-free gloves are essential. Premedication
(antihistamines, steroids) is secondary and not a substitute for avoidance. Negative-pressure isolation is irrelevant.
14 A patient undergoing a prolonged abdominal surgery under general anesthesia develops a heart rate of 45 bpm
and a mean arterial pressure of 55 mmHg. The surgeon is applying traction to the mesentery. Which
intervention should the anesthesia provider implement first?
A) Administer atropine 0.5 mg IV.
B) Ask the surgeon to release traction.
C) Start a dopamine infusion at 5 mcg/kg/min.
D) Administer ephedrine 5 mg IV.
Answer: B
Rationale: Traction on the mesentery can trigger a vagal reflex causing bradycardia and hypotension. The first step
is to remove the stimulus by asking the surgeon to release traction. If that fails, pharmacologic intervention (e.g.,
atropine) may be needed. Ephedrine or dopamine may be used if hypotension persists, but addressing the cause is
primary.
15 A patient is positioned in the lithotomy position for a gynecologic procedure. Which of the following is the
most critical consideration for preventing positioning-related injury?
A) Ensure the patient's arms are tucked at the sides with the palms facing downward.
B) Limit the time in lithotomy to no more than 2 hours to prevent compartment syndrome.
C) Use stirrups that support the foot and ankle, avoiding pressure on the popliteal fossa.
D) Place a roll under the patient's lumbar spine to maintain lordosis.
Answer: C
Rationale: In lithotomy, improper leg positioning can compress the popliteal fossa, leading to nerve injury (common
peroneal) or vascular compromise. Stirrups should support the foot and ankle, and the knees should be slightly
flexed with hips abducted. Tucking arms with palms facing upward (not downward) avoids ulnar nerve injury.
Limiting time helps but is secondary to proper positioning. Lumbar support is not a priority in lithotomy.
