NSG 430 Exam 2 – GCU Adult Health Nursing II – (2026)
Actual Questions & Answers — 100 Questions
Section 1: Perioperative Nursing (Questions 1-10)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy under
general anesthesia. The patient uses a continuous positive airway pressure (CPAP) device at home. Which
preoperative intervention is most critical to reduce the risk of perioperative respiratory complications?
A) Request a preoperative arterial blood gas (ABG) to evaluate baseline oxygenation.
B) Instruct the patient to bring their CPAP device on the day of surgery for use in the post-anesthesia care unit
(PACU).
C) Administer a sedative premedication to reduce anxiety and promote sleep the night before surgery.
D) Obtain a sleep study report to confirm the diagnosis and severity of OSA.
Answer: B
Rationale: Bringing the CPAP device ensures early initiation of positive airway pressure postoperatively, preventing
airway obstruction and hypoxemia. Preoperative ABG is not routinely indicated unless severe hypoventilation is
suspected. Sedatives can worsen pharyngeal collapse in OSA patients. Sleep study confirmation is important but
not the most critical immediate intervention.
2 During a total knee arthroplasty, the surgical team observes that the sterile field has been contaminated by a
splash of irrigation fluid from a non-sterile source. The circulating nurse is the first to notice. What is the most
appropriate immediate action?
A) Continue the procedure but increase prophylactic antibiotic dosing to compensate for contamination.
B) Inform the surgeon and prepare to re-drape the entire surgical site and replace all contaminated instruments.
C) Apply a sterile barrier drape over the wet area and proceed with the surgery.
D) Wipe the contaminated area with an antiseptic solution and document the breach.
Answer: B
Rationale: Any break in sterility, especially from non-sterile fluid, requires immediate correction to prevent surgical
site infection. Re-draping and replacing contaminated instruments restores the sterile field. Increasing antibiotics
does not address contamination. Barrier drapes over wet areas may wick bacteria. Antiseptic wiping does not
restore sterility.
3 A patient undergoing an exploratory laparotomy under general anesthesia develops sudden hypotension,
tachycardia, and a decrease in end-tidal CO2 (ETCO2) from 38 mmHg to 25 mmHg. The surgeon notes no
significant bleeding. Which intraoperative complication should the nurse suspect first?
A) Malignant hyperthermia
B) Venous air embolism
C) Anaphylactic reaction to anesthetic agent
D) Myocardial infarction
Answer: B
Rationale: A sudden drop in ETCO2 with hypotension and tachycardia is classic for venous air embolism, especially
during laparotomy when surgical sites are above the heart. Malignant hyperthermia presents with hyperthermia,
rigidity, and acidosis. Anaphylaxis often includes bronchospasm and rash. Myocardial infarction would show ST
changes and cardiac enzyme elevation.
,4 A patient is positioned in the lithotomy position for a robotic-assisted prostatectomy. After the procedure, the
patient complains of numbness and weakness in the left lower extremity, with foot drop noted on assessment.
Which nerve injury is most likely?
A) Femoral nerve
B) Obturator nerve
C) Common peroneal nerve
D) Sciatic nerve
Answer: C
Rationale: The common peroneal nerve is vulnerable to compression at the fibular head during lithotomy
positioning, especially if the legs are not properly padded. Injury causes foot drop and numbness over the dorsum
of the foot. Femoral nerve injury affects hip flexion and knee extension. Obturator injury affects thigh adduction.
Sciatic injury affects hamstrings and all lower leg muscles.
5 In a patient undergoing a craniotomy for tumor resection, the anesthesia team administers mannitol 1 g/kg
intravenously. Which finding indicates the desired therapeutic effect has been achieved?
A) Urine output of 300 mL over the first hour after administration
B) Decrease in intracranial pressure (ICP) from 22 mmHg to 15 mmHg
C) Increase in mean arterial pressure (MAP) from 80 mmHg to 95 mmHg
D) Serum sodium level of 135 mEq/L
Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and lower ICP. A decrease in ICP is the
direct therapeutic goal. Increased urine output is a side effect but not the desired effect. MAP increase is not
expected; mannitol may initially cause volume expansion but not sustained hypertension. Hyponatremia can occur
but is not the goal.
6 A patient with a history of coronary artery disease is scheduled for an elective open abdominal aortic aneurysm
repair. The preoperative evaluation reveals an ejection fraction of 35% and a recent stress test showing
reversible ischemia. Which perioperative nursing intervention is most important to prevent myocardial injury?
A) Ensure beta-blocker therapy is continued through the morning of surgery
B) Administer supplemental oxygen at 4 L/min via nasal cannula during transport
C) Place a warming blanket to maintain normothermia
D) Insert a Foley catheter to monitor urine output hourly
Answer: A
Rationale: Continuing beta-blockers perioperatively reduces myocardial oxygen demand and prevents tachycardia,
which is critical in patients with known CAD and ischemia. Oxygen and warming are supportive but not the most
important. Foley catheter is standard but does not directly prevent myocardial injury.
7 A patient in the PACU after a hemicolectomy has a respiratory rate of 8 breaths per minute, oxygen saturation of
88% on room air, and is difficult to arouse. The patient received morphine 4 mg IV 30 minutes ago. Which
medication should the nurse prepare to administer?
A) Flumazenil
B) Naloxone
C) Dantrolene
D) Sugammadex
Answer: B
Rationale: The presentation suggests opioid-induced respiratory depression from morphine. Naloxone is the reversal
agent. Flumazenil reverses benzodiazepines. Dantrolene treats malignant hyperthermia. Sugammadex reverses
, neuromuscular blocking agents (e.g., rocuronium).
8 A patient with a history of type 2 diabetes mellitus is scheduled for a laparoscopic gastric bypass. The patient's
current medications include metformin and insulin glargine. Which preoperative glucose management plan is
most appropriate?
A) Hold both metformin and insulin glargine 24 hours before surgery
B) Hold metformin on the day of surgery; continue insulin glargine at a reduced dose
C) Continue both medications as prescribed; monitor glucose intraoperatively
D) Hold metformin 48 hours before surgery; administer full dose of insulin glargine on the morning of surgery
Answer: B
Rationale: Metformin is held on the day of surgery due to risk of lactic acidosis with fasting and contrast (if used).
Insulin glargine, a long-acting basal insulin, is typically continued at a reduced dose (e.g., 50-80%) to prevent
hyperglycemia while minimizing hypoglycemia risk. Holding insulin 24 hours could cause significant
hyperglycemia. Continuing metformin is unsafe. Full-dose glargine on surgery morning increases hypoglycemia
risk.
9 During a laparoscopic cholecystectomy, the surgeon requests that the circulating nurse lower the head of the bed
from 15 degrees reverse Trendelenburg to a 30-degree Trendelenburg position. Which physiological change
should the nurse anticipate and monitor for?
A) Decreased venous return and hypotension
B) Increased intracranial pressure and bradycardia
C) Increased venous return and potential for bradycardia
D) Decreased pulmonary compliance and hypoxemia
Answer: C
Rationale: Trendelenburg position (head down) increases venous return from the lower extremities, which can
increase preload and trigger a reflex bradycardia via baroreceptor response. Hypotension is not expected; instead,
blood pressure may rise. Increased ICP can occur but is less immediate than the hemodynamic effect. Pulmonary
compliance decreases due to abdominal pressure on the diaphragm, but hypoxemia is less direct.
10 A patient with a history of chronic kidney disease (CKD) stage 3 (eGFR 45 mL/min) is scheduled for a
coronary artery bypass graft (CABG) surgery. Which perioperative strategy is most important to prevent acute
kidney injury (AKI)?
A) Administer N-acetylcysteine 600 mg orally twice daily for 2 days before surgery
B) Maintain mean arterial pressure (MAP) above 65 mmHg during cardiopulmonary bypass
C) Use a urinary catheter to monitor output and administer furosemide if output <0.5 mL/kg/hr
D) Avoid all nephrotoxic medications including vancomycin and gentamicin
Answer: B
Rationale: Maintaining adequate renal perfusion pressure during cardiopulmonary bypass is critical to prevent
ischemic AKI. N-acetylcysteine is used for contrast-induced nephropathy, not surgical AKI. Furosemide may
worsen AKI if hypovolemia exists. Avoiding nephrotoxins is important but not the single most important strategy;
renal perfusion is paramount.
Section 2: Fluid and Electrolyte Imbalances (Questions 11-20)
Actual Questions & Answers — 100 Questions
Section 1: Perioperative Nursing (Questions 1-10)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy under
general anesthesia. The patient uses a continuous positive airway pressure (CPAP) device at home. Which
preoperative intervention is most critical to reduce the risk of perioperative respiratory complications?
A) Request a preoperative arterial blood gas (ABG) to evaluate baseline oxygenation.
B) Instruct the patient to bring their CPAP device on the day of surgery for use in the post-anesthesia care unit
(PACU).
C) Administer a sedative premedication to reduce anxiety and promote sleep the night before surgery.
D) Obtain a sleep study report to confirm the diagnosis and severity of OSA.
Answer: B
Rationale: Bringing the CPAP device ensures early initiation of positive airway pressure postoperatively, preventing
airway obstruction and hypoxemia. Preoperative ABG is not routinely indicated unless severe hypoventilation is
suspected. Sedatives can worsen pharyngeal collapse in OSA patients. Sleep study confirmation is important but
not the most critical immediate intervention.
2 During a total knee arthroplasty, the surgical team observes that the sterile field has been contaminated by a
splash of irrigation fluid from a non-sterile source. The circulating nurse is the first to notice. What is the most
appropriate immediate action?
A) Continue the procedure but increase prophylactic antibiotic dosing to compensate for contamination.
B) Inform the surgeon and prepare to re-drape the entire surgical site and replace all contaminated instruments.
C) Apply a sterile barrier drape over the wet area and proceed with the surgery.
D) Wipe the contaminated area with an antiseptic solution and document the breach.
Answer: B
Rationale: Any break in sterility, especially from non-sterile fluid, requires immediate correction to prevent surgical
site infection. Re-draping and replacing contaminated instruments restores the sterile field. Increasing antibiotics
does not address contamination. Barrier drapes over wet areas may wick bacteria. Antiseptic wiping does not
restore sterility.
3 A patient undergoing an exploratory laparotomy under general anesthesia develops sudden hypotension,
tachycardia, and a decrease in end-tidal CO2 (ETCO2) from 38 mmHg to 25 mmHg. The surgeon notes no
significant bleeding. Which intraoperative complication should the nurse suspect first?
A) Malignant hyperthermia
B) Venous air embolism
C) Anaphylactic reaction to anesthetic agent
D) Myocardial infarction
Answer: B
Rationale: A sudden drop in ETCO2 with hypotension and tachycardia is classic for venous air embolism, especially
during laparotomy when surgical sites are above the heart. Malignant hyperthermia presents with hyperthermia,
rigidity, and acidosis. Anaphylaxis often includes bronchospasm and rash. Myocardial infarction would show ST
changes and cardiac enzyme elevation.
,4 A patient is positioned in the lithotomy position for a robotic-assisted prostatectomy. After the procedure, the
patient complains of numbness and weakness in the left lower extremity, with foot drop noted on assessment.
Which nerve injury is most likely?
A) Femoral nerve
B) Obturator nerve
C) Common peroneal nerve
D) Sciatic nerve
Answer: C
Rationale: The common peroneal nerve is vulnerable to compression at the fibular head during lithotomy
positioning, especially if the legs are not properly padded. Injury causes foot drop and numbness over the dorsum
of the foot. Femoral nerve injury affects hip flexion and knee extension. Obturator injury affects thigh adduction.
Sciatic injury affects hamstrings and all lower leg muscles.
5 In a patient undergoing a craniotomy for tumor resection, the anesthesia team administers mannitol 1 g/kg
intravenously. Which finding indicates the desired therapeutic effect has been achieved?
A) Urine output of 300 mL over the first hour after administration
B) Decrease in intracranial pressure (ICP) from 22 mmHg to 15 mmHg
C) Increase in mean arterial pressure (MAP) from 80 mmHg to 95 mmHg
D) Serum sodium level of 135 mEq/L
Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and lower ICP. A decrease in ICP is the
direct therapeutic goal. Increased urine output is a side effect but not the desired effect. MAP increase is not
expected; mannitol may initially cause volume expansion but not sustained hypertension. Hyponatremia can occur
but is not the goal.
6 A patient with a history of coronary artery disease is scheduled for an elective open abdominal aortic aneurysm
repair. The preoperative evaluation reveals an ejection fraction of 35% and a recent stress test showing
reversible ischemia. Which perioperative nursing intervention is most important to prevent myocardial injury?
A) Ensure beta-blocker therapy is continued through the morning of surgery
B) Administer supplemental oxygen at 4 L/min via nasal cannula during transport
C) Place a warming blanket to maintain normothermia
D) Insert a Foley catheter to monitor urine output hourly
Answer: A
Rationale: Continuing beta-blockers perioperatively reduces myocardial oxygen demand and prevents tachycardia,
which is critical in patients with known CAD and ischemia. Oxygen and warming are supportive but not the most
important. Foley catheter is standard but does not directly prevent myocardial injury.
7 A patient in the PACU after a hemicolectomy has a respiratory rate of 8 breaths per minute, oxygen saturation of
88% on room air, and is difficult to arouse. The patient received morphine 4 mg IV 30 minutes ago. Which
medication should the nurse prepare to administer?
A) Flumazenil
B) Naloxone
C) Dantrolene
D) Sugammadex
Answer: B
Rationale: The presentation suggests opioid-induced respiratory depression from morphine. Naloxone is the reversal
agent. Flumazenil reverses benzodiazepines. Dantrolene treats malignant hyperthermia. Sugammadex reverses
, neuromuscular blocking agents (e.g., rocuronium).
8 A patient with a history of type 2 diabetes mellitus is scheduled for a laparoscopic gastric bypass. The patient's
current medications include metformin and insulin glargine. Which preoperative glucose management plan is
most appropriate?
A) Hold both metformin and insulin glargine 24 hours before surgery
B) Hold metformin on the day of surgery; continue insulin glargine at a reduced dose
C) Continue both medications as prescribed; monitor glucose intraoperatively
D) Hold metformin 48 hours before surgery; administer full dose of insulin glargine on the morning of surgery
Answer: B
Rationale: Metformin is held on the day of surgery due to risk of lactic acidosis with fasting and contrast (if used).
Insulin glargine, a long-acting basal insulin, is typically continued at a reduced dose (e.g., 50-80%) to prevent
hyperglycemia while minimizing hypoglycemia risk. Holding insulin 24 hours could cause significant
hyperglycemia. Continuing metformin is unsafe. Full-dose glargine on surgery morning increases hypoglycemia
risk.
9 During a laparoscopic cholecystectomy, the surgeon requests that the circulating nurse lower the head of the bed
from 15 degrees reverse Trendelenburg to a 30-degree Trendelenburg position. Which physiological change
should the nurse anticipate and monitor for?
A) Decreased venous return and hypotension
B) Increased intracranial pressure and bradycardia
C) Increased venous return and potential for bradycardia
D) Decreased pulmonary compliance and hypoxemia
Answer: C
Rationale: Trendelenburg position (head down) increases venous return from the lower extremities, which can
increase preload and trigger a reflex bradycardia via baroreceptor response. Hypotension is not expected; instead,
blood pressure may rise. Increased ICP can occur but is less immediate than the hemodynamic effect. Pulmonary
compliance decreases due to abdominal pressure on the diaphragm, but hypoxemia is less direct.
10 A patient with a history of chronic kidney disease (CKD) stage 3 (eGFR 45 mL/min) is scheduled for a
coronary artery bypass graft (CABG) surgery. Which perioperative strategy is most important to prevent acute
kidney injury (AKI)?
A) Administer N-acetylcysteine 600 mg orally twice daily for 2 days before surgery
B) Maintain mean arterial pressure (MAP) above 65 mmHg during cardiopulmonary bypass
C) Use a urinary catheter to monitor output and administer furosemide if output <0.5 mL/kg/hr
D) Avoid all nephrotoxic medications including vancomycin and gentamicin
Answer: B
Rationale: Maintaining adequate renal perfusion pressure during cardiopulmonary bypass is critical to prevent
ischemic AKI. N-acetylcysteine is used for contrast-induced nephropathy, not surgical AKI. Furosemide may
worsen AKI if hypovolemia exists. Avoiding nephrotoxins is important but not the single most important strategy;
renal perfusion is paramount.
Section 2: Fluid and Electrolyte Imbalances (Questions 11-20)
