,powerful tool for exam preparation, enabling students to assess their knowledge, identify areas for improvement,
and build confidence. By mastering these questions, students will be well-prepared to excel in their examinations
and provide safe, competent care in the operating room setting.
Keywords:
Operating Room Nursing, Perioperative Care, Surgical Asepsis, NCLEX-RN, Medical-Surgical Nursing, Patient
Safety, Anesthesia, Sterile Technique
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is clearly indicated,
followed by a detailed rationale explaining why it is correct and why the other options are incorrect. This format
enhances critical thinking and reinforces key concepts.
Compliance Checklist:
All questions align with the latest 2026-2027 AORN and ASPAN guidelines
Content mapped to the NCLEX-RN test plan for perioperative nursing
Answers and rationales verified by experienced perioperative nurse educators
Includes safety protocols and emergency procedures as per current standards
Suitable for self-assessment and group study in RLE settings
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-20 Roles, Legal aspects, Ethics, 13%
Foundations Communication
Surgical Asepsis and Infection 21-40 Sterile technique, Sterilization, Disinfection, 13%
Control Surgical hand scrub
Preoperative Nursing Care 41-60 Assessment, Informed consent, Patient 13%
education, Pre-op checklist
Intraoperative Nursing Care 61-90 Positioning, Anesthesia, Surgical counts, 20%
Hemostasis, Wound closure
Postoperative Nursing Care 91-120 PACU, Complications, Pain management, 20%
Discharge criteria
Special Considerations and 121-150 Malignant hyperthermia, Anaphylaxis, 20%
Emergencies Robotic surgery, Documentation
Page 2
,Q1. A patient with a history of malignant hyperthermia is scheduled for surgery
under general anesthesia. Which anesthetic agent is safest to use?
A. Sevoflurane
B. Propofol
C. Succinylcholine
D. Desflurane
Correct Answer: B. Propofol
Rationale: Propofol is a non-triggering intravenous anesthetic safe for MH-susceptible
patients. Volatile agents (sevoflurane, desflurane) and succinylcholine are known triggers
of MH. Therefore, the safest choice is propofol.
Why Wrong:
A - Sevoflurane is a volatile anesthetic that triggers malignant hyperthermia.
C - Succinylcholine is a depolarizing muscle relaxant known to trigger MH.
D - Desflurane is also a volatile anesthetic that can trigger MH.
Reference: Nagelhout, J.J., & Plaus, K. (2025). Nurse Anesthesia, 7th ed., Ch. 33.
Q2. During a laparoscopic cholecystectomy, the surgeon requests a 30-degree reverse
Trendelenburg position. What is the primary physiological rationale for this
positioning?
A. To improve visualization of the gallbladder by displacing the liver superiorly
B. To reduce the risk of venous air embolism by lowering the right atrium
C. To decrease the risk of regurgitation and aspiration by using gravity
D. To increase cardiac preload and maintain blood pressure during pneumoperitoneum
Correct Answer: A. To improve visualization of the gallbladder by displacing the liver
superiorly
Rationale: Reverse Trendelenburg (head up) uses gravity to displace the abdominal
contents downward, improving surgical exposure of the upper abdomen, particularly the
gallbladder. It also helps with ventilation but the primary surgical rationale is exposure.
Why Wrong:
B - Reverse Trendelenburg does not lower the right atrium; it raises the head, which
may increase air embolism risk in some procedures.
C - While reverse Trendelenburg can help with reflux, the primary purpose in this
surgery is exposure, not aspiration prevention.
D - Reverse Trendelenburg actually decreases preload and may cause hypotension, not
increase preload.
Reference: Phillips, N. (2025). Berry & Kohn's Operating Room Technique, 14th ed., Ch.
10.
Page 3
, Q3. Which of the following findings indicates a potential breach in sterile technique
during a surgical procedure?
A. The circulator opens a sterile package onto the sterile field using the wrapper as a
sterile barrier.
B. The scrub nurse turns to accept a sterile item from the circulator while keeping
hands within the sterile field.
C. The surgeon's sterile-gloved hands remain above the level of the waist at all times.
D. A sterile team member leans over the sterile field to adjust the overhead light.
Correct Answer: D. A sterile team member leans over the sterile field to adjust the
overhead light.
Rationale: Leaning over a sterile field contaminates it because the gown is not sterile at
the back or shoulders. Sterile personnel must maintain a 12-inch distance and avoid
reaching across unsterile areas. The other options represent correct sterile technique.
Why Wrong:
A - Opening a sterile package with the wrapper as a barrier is acceptable as long as the
inner surface remains sterile.
B - Turning to accept items is allowed if the circulator does not touch the sterile field
and the scrub nurse's hands remain sterile.
C - Keeping hands above the waist is a correct practice to maintain sterility.
Reference: AORN. (2025). Guidelines for Perioperative Practice. Sterile Technique.
Q4. A patient undergoing a craniotomy suddenly develops bradycardia and
hypotension after the surgeon injects a local anesthetic. Which complication is most
likely?
A. Local anesthetic systemic toxicity (LAST)
B. Autonomic dysreflexia
C. Cushing's triad
D. Venous air embolism
Correct Answer: A. Local anesthetic systemic toxicity (LAST)
Rationale: Injection of local anesthetic into a highly vascular area (scalp) can lead to
rapid systemic absorption and LAST, which initially presents with CNS excitation
(agitation, seizures) and then cardiovascular depression (bradycardia, hypotension). The
scenario is classic for LAST.
Why Wrong:
B - Autonomic dysreflexia occurs in patients with spinal cord injury above T6 and
presents with hypertension, not hypotension.
C - Cushing's triad is associated with increased intracranial pressure and includes
hypertension, bradycardia, and irregular respirations.
D - Venous air embolism presents with sudden hypotension, dysrhythmias, and a
Page 4
and build confidence. By mastering these questions, students will be well-prepared to excel in their examinations
and provide safe, competent care in the operating room setting.
Keywords:
Operating Room Nursing, Perioperative Care, Surgical Asepsis, NCLEX-RN, Medical-Surgical Nursing, Patient
Safety, Anesthesia, Sterile Technique
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is clearly indicated,
followed by a detailed rationale explaining why it is correct and why the other options are incorrect. This format
enhances critical thinking and reinforces key concepts.
Compliance Checklist:
All questions align with the latest 2026-2027 AORN and ASPAN guidelines
Content mapped to the NCLEX-RN test plan for perioperative nursing
Answers and rationales verified by experienced perioperative nurse educators
Includes safety protocols and emergency procedures as per current standards
Suitable for self-assessment and group study in RLE settings
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-20 Roles, Legal aspects, Ethics, 13%
Foundations Communication
Surgical Asepsis and Infection 21-40 Sterile technique, Sterilization, Disinfection, 13%
Control Surgical hand scrub
Preoperative Nursing Care 41-60 Assessment, Informed consent, Patient 13%
education, Pre-op checklist
Intraoperative Nursing Care 61-90 Positioning, Anesthesia, Surgical counts, 20%
Hemostasis, Wound closure
Postoperative Nursing Care 91-120 PACU, Complications, Pain management, 20%
Discharge criteria
Special Considerations and 121-150 Malignant hyperthermia, Anaphylaxis, 20%
Emergencies Robotic surgery, Documentation
Page 2
,Q1. A patient with a history of malignant hyperthermia is scheduled for surgery
under general anesthesia. Which anesthetic agent is safest to use?
A. Sevoflurane
B. Propofol
C. Succinylcholine
D. Desflurane
Correct Answer: B. Propofol
Rationale: Propofol is a non-triggering intravenous anesthetic safe for MH-susceptible
patients. Volatile agents (sevoflurane, desflurane) and succinylcholine are known triggers
of MH. Therefore, the safest choice is propofol.
Why Wrong:
A - Sevoflurane is a volatile anesthetic that triggers malignant hyperthermia.
C - Succinylcholine is a depolarizing muscle relaxant known to trigger MH.
D - Desflurane is also a volatile anesthetic that can trigger MH.
Reference: Nagelhout, J.J., & Plaus, K. (2025). Nurse Anesthesia, 7th ed., Ch. 33.
Q2. During a laparoscopic cholecystectomy, the surgeon requests a 30-degree reverse
Trendelenburg position. What is the primary physiological rationale for this
positioning?
A. To improve visualization of the gallbladder by displacing the liver superiorly
B. To reduce the risk of venous air embolism by lowering the right atrium
C. To decrease the risk of regurgitation and aspiration by using gravity
D. To increase cardiac preload and maintain blood pressure during pneumoperitoneum
Correct Answer: A. To improve visualization of the gallbladder by displacing the liver
superiorly
Rationale: Reverse Trendelenburg (head up) uses gravity to displace the abdominal
contents downward, improving surgical exposure of the upper abdomen, particularly the
gallbladder. It also helps with ventilation but the primary surgical rationale is exposure.
Why Wrong:
B - Reverse Trendelenburg does not lower the right atrium; it raises the head, which
may increase air embolism risk in some procedures.
C - While reverse Trendelenburg can help with reflux, the primary purpose in this
surgery is exposure, not aspiration prevention.
D - Reverse Trendelenburg actually decreases preload and may cause hypotension, not
increase preload.
Reference: Phillips, N. (2025). Berry & Kohn's Operating Room Technique, 14th ed., Ch.
10.
Page 3
, Q3. Which of the following findings indicates a potential breach in sterile technique
during a surgical procedure?
A. The circulator opens a sterile package onto the sterile field using the wrapper as a
sterile barrier.
B. The scrub nurse turns to accept a sterile item from the circulator while keeping
hands within the sterile field.
C. The surgeon's sterile-gloved hands remain above the level of the waist at all times.
D. A sterile team member leans over the sterile field to adjust the overhead light.
Correct Answer: D. A sterile team member leans over the sterile field to adjust the
overhead light.
Rationale: Leaning over a sterile field contaminates it because the gown is not sterile at
the back or shoulders. Sterile personnel must maintain a 12-inch distance and avoid
reaching across unsterile areas. The other options represent correct sterile technique.
Why Wrong:
A - Opening a sterile package with the wrapper as a barrier is acceptable as long as the
inner surface remains sterile.
B - Turning to accept items is allowed if the circulator does not touch the sterile field
and the scrub nurse's hands remain sterile.
C - Keeping hands above the waist is a correct practice to maintain sterility.
Reference: AORN. (2025). Guidelines for Perioperative Practice. Sterile Technique.
Q4. A patient undergoing a craniotomy suddenly develops bradycardia and
hypotension after the surgeon injects a local anesthetic. Which complication is most
likely?
A. Local anesthetic systemic toxicity (LAST)
B. Autonomic dysreflexia
C. Cushing's triad
D. Venous air embolism
Correct Answer: A. Local anesthetic systemic toxicity (LAST)
Rationale: Injection of local anesthetic into a highly vascular area (scalp) can lead to
rapid systemic absorption and LAST, which initially presents with CNS excitation
(agitation, seizures) and then cardiovascular depression (bradycardia, hypotension). The
scenario is classic for LAST.
Why Wrong:
B - Autonomic dysreflexia occurs in patients with spinal cord injury above T6 and
presents with hypertension, not hypotension.
C - Cushing's triad is associated with increased intracranial pressure and includes
hypertension, bradycardia, and irregular respirations.
D - Venous air embolism presents with sudden hypotension, dysrhythmias, and a
Page 4
