NSG 4100 (Adult Health III) Exam 3 Practice Questions with
Multiple Choice Answers & Explanations in Italics - 149
Questions
Section 1: Perioperative Nursing Care (Questions 1-15)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy under
general anesthesia. The preoperative assessment reveals a STOP-Bang score of 7. Which of the following
perioperative interventions is most critical to reduce the risk of postoperative respiratory complications?
A) Administering a benzodiazepine preoperatively to reduce anxiety and promote sleep
B) Using a bispectral index (BIS) monitor to guide anesthetic depth
C) Implementing continuous positive airway pressure (CPAP) therapy both preoperatively and postoperatively
D) Extubating the patient while still deeply anesthetized to avoid coughing
Answer: C
Rationale: Patients with OSA are at high risk for airway obstruction and respiratory depression postoperatively.
CPAP therapy maintains airway patency and improves oxygenation. Benzodiazepines (A) can worsen respiratory
depression. BIS monitoring (B) is for anesthetic depth, not respiratory risk. Deep extubation (D) increases
aspiration and obstruction risk.
2 During an open abdominal aortic aneurysm repair, the surgical team requests that the nurse administer a fluid
bolus of 500 mL of lactated Ringer's solution. The patient has a history of heart failure with reduced ejection
fraction (30%). Which of the following is the most appropriate nursing action?
A) Administer the bolus as requested, as fluid resuscitation is critical for maintaining perfusion
B) Administer the bolus slowly over 2 hours to minimize cardiac overload
C) Question the order and suggest using a colloid solution instead
D) Hold the bolus and request a central venous pressure (CVP) measurement first
Answer: B
Rationale: In patients with heart failure, rapid fluid boluses can precipitate pulmonary edema. Administering the
bolus slowly (e.g., over 2 hours) allows for better tolerance. While questioning is appropriate (C), the order is for a
specific fluid; the nurse should adjust rate rather than substitute. Holding entirely (D) may delay necessary
resuscitation. CVP monitoring is not always immediately available.
3 A patient undergoing a colectomy under general anesthesia develops sudden hypotension, tachycardia, and a
drop in end-tidal CO2 (ETCO2) from 38 to 28 mmHg. The surgeon is currently closing the abdomen. What is
the priority nursing intervention?
A) Increase the IV fluid rate and administer a vasopressor
B) Notify the surgeon immediately and prepare for possible chest tube insertion
C) Check the patient's temperature and apply warming blankets
D) Reposition the patient into Trendelenburg to improve venous return
Answer: B
Rationale: The triad of hypotension, tachycardia, and decreased ETCO2 is classic for venous air embolism or
pneumothorax. In an open abdominal surgery, a pneumothorax can occur if the diaphragm is violated. Immediate
notification and chest tube preparation are critical. Fluids and vasopressors (A) may be supportive but do not
address the cause. Warming (C) is irrelevant. Trendelenburg (D) can worsen air embolism.
,4 Which of the following assessment findings in the post-anesthesia care unit (PACU) is most indicative of
malignant hyperthermia (MH) in a patient who received succinylcholine and sevoflurane?
A) Heart rate 110 bpm, blood pressure 100/60 mmHg, temperature 38.2°C
B) Generalized muscle rigidity, mixed respiratory and metabolic acidosis, and serum potassium 6.5 mEq/L
C) Shivering, oxygen saturation 94%, and urine output 30 mL/hour
D) Delayed emergence from anesthesia with pinpoint pupils
Answer: B
Rationale: MH presents with muscle rigidity, hyperkalemia, and acidosis due to uncontrolled calcium release.
Option B is classic. Mild tachycardia and low-grade fever (A) are nonspecific. Shivering (C) is common
postoperatively but not MH. Pinpoint pupils (D) suggest opioid overdose, not MH.
5 A patient is positioned in the lithotomy position for a robotic-assisted prostatectomy. After the procedure, the
patient reports numbness and tingling in the right foot, with inability to dorsiflex the ankle. Which nerve injury
is most likely, and what is the primary preventive measure?
A) Sciatic nerve injury; avoid hyperextension of the hip
B) Common peroneal nerve injury; ensure that the stirrups do not compress the lateral fibular head
C) Femoral nerve injury; limit abduction of the hip to 45 degrees
D) Tibial nerve injury; position the foot in neutral alignment
Answer: B
Rationale: The common peroneal nerve wraps around the fibular head and is vulnerable to compression in lithotomy
stirrups. Injury causes foot drop (loss of dorsiflexion) and sensory loss over the dorsum of the foot. Sciatic injury
(A) would affect plantar flexion and sensation. Femoral (C) affects hip flexion. Tibial (D) affects plantar flexion.
6 A patient in the preoperative holding area has a known allergy to sulfonamides. The surgeon orders cefazolin 2
grams IV for surgical site infection prophylaxis. Which of the following is the most appropriate nursing action?
A) Administer the cefazolin as ordered, as it is a cephalosporin and cross-reactivity risk is low
B) Hold the antibiotic and request an alternative such as clindamycin or vancomycin
C) Administer the cefazolin with a test dose and observe for 30 minutes
D) Administer diphenhydramine 25 mg IV before giving the cefazolin
Answer: A
Rationale: Current evidence indicates that the cross-reactivity between sulfonamides and cephalosporins is
extremely low (<1%). Therefore, cefazolin can be safely administered. Holding (B) is unnecessary and may delay
prophylaxis. Test doses (C) are not standard. Premedication (D) is not indicated.
7 A patient undergoing a Whipple procedure (pancreaticoduodenectomy) has an epidural catheter placed for
postoperative pain management. The nurse notes that the patient's blood pressure drops from 120/80 to 85/50
mmHg within 10 minutes of a bolus dose of 0.125% bupivacaine with fentanyl 2 mcg/mL. Which of the
following is the most likely cause?
A) Anaphylaxis to bupivacaine
B) Sympathetic blockade from the local anesthetic
C) Fentanyl-induced histamine release
D) Intravascular absorption of bupivacaine
Answer: B
Rationale: Epidural local anesthetics can cause sympathetic blockade, leading to vasodilation and hypotension. This
is a common, expected effect. Anaphylaxis (A) would include other symptoms. Fentanyl (C) rarely causes
histamine release at this dose. Intravascular absorption (D) would cause systemic toxicity, not isolated hypotension.
,8 A patient with a BMI of 42 kg/m² is scheduled for a vertical sleeve gastrectomy. During the preoperative
assessment, the nurse identifies a history of poorly controlled type 2 diabetes (HbA1c 9.5%) and hypertension
(BP 150/95 mmHg). Which of the following is the most important nursing intervention to optimize surgical
outcomes?
A) Advise the patient to stop all antihypertensive medications 24 hours before surgery
B) Request a preoperative echocardiogram to assess for pulmonary hypertension
C) Collaborate with the healthcare team to optimize glycemic control and blood pressure prior to surgery
D) Schedule the surgery early in the morning to minimize fasting duration
Answer: C
Rationale: Poorly controlled diabetes and hypertension increase risks of surgical site infection, cardiovascular
events, and delayed healing. Optimizing these preoperatively is essential. Stopping antihypertensives (A) can cause
rebound hypertension. Echocardiogram (B) may be indicated but is not the priority intervention. Early scheduling
(D) is not evidence-based for this scenario.
9 During a total knee arthroplasty, the surgical team uses a tourniquet on the thigh. The tourniquet time is 120
minutes. Which of the following is the most important nursing action to prevent a tourniquet-related
complication?
A) Document the tourniquet pressure and time every 15 minutes
B) Release the tourniquet for 10 minutes after 60 minutes of inflation
C) Apply the tourniquet over padding to avoid skin injury
D) Monitor for signs of compartment syndrome in the postoperative period
Answer: B
Rationale: Prolonged tourniquet inflation (>60 minutes) can cause ischemic injury and reperfusion syndrome.
Current guidelines recommend deflating the tourniquet after 60-90 minutes for at least 10 minutes to allow
reperfusion. Documentation (A) is important but does not prevent injury. Padding (C) is standard. Monitoring (D)
is postoperative, not preventive.
10 A patient in the PACU has a urine output of 20 mL over the past 2 hours after an open aortic aneurysm repair.
The patient's blood pressure is 90/60 mmHg, heart rate 110 bpm, and central venous pressure (CVP) is 4
mmHg. Which of the following is the priority intervention?
A) Administer furosemide 20 mg IV to promote diuresis
B) Administer a 500 mL bolus of isotonic crystalloid
C) Check the patient's serum creatinine and BUN levels
D) Insert a Foley catheter if not already in place
Answer: B
Rationale: The low urine output, hypotension, tachycardia, and low CVP indicate hypovolemia, likely from
hemorrhage or third spacing. The priority is fluid resuscitation. Diuretics (A) are contraindicated in hypovolemia.
Checking labs (C) is secondary. A Foley is likely already in place postoperatively; if not, insertion may be delayed.
11 A patient with a history of hypertension and coronary artery disease is undergoing elective laparoscopic
cholecystectomy under general anesthesia. During the procedure, the anesthesia provider notes a sudden
increase in end-tidal carbon dioxide (ETCO2) from 35 to 55 mm Hg over 5 minutes, accompanied by a
decrease in oxygen saturation from 98% to 90% on pulse oximetry. The patient's blood pressure drops from
120/80 to 85/50 mm Hg. The perioperative nurse suspects which complication and what is the priority
intervention?
A) Malignant hyperthermia; administer dantrolene and cool the patient
B) Venous air embolism; place the patient in Trendelenburg position and left lateral decubitus
, C) Carbon dioxide embolism; discontinue insufflation and notify the surgeon immediately
D) Pulmonary embolism; initiate cardiopulmonary resuscitation and prepare for thrombolysis
Answer: C
Rationale: The sudden rise in ETCO2 with hypotension and desaturation during laparoscopic surgery is classic for
carbon dioxide embolism from insufflation. Immediate discontinuation of insufflation and notification of the
surgeon are critical to prevent further gas entry. Malignant hyperthermia typically presents with hyperthermia,
rigidity, and acidosis, not isolated ETCO2 rise. Venous air embolism occurs more commonly in sitting
craniotomies, not laparoscopy. Pulmonary embolism is less acute and not directly related to insufflation.
12 A patient is scheduled for a total hip arthroplasty under spinal anesthesia. The perioperative nurse reviews the
preoperative checklist and notes that the patient has a history of deep vein thrombosis (DVT) and is currently
on rivaroxaban. The last dose was taken 48 hours ago. The surgical team plans to proceed with surgery. Which
action by the perioperative nurse is most appropriate?
A) Administer vitamin K as an antidote to reverse rivaroxaban effects before surgery
B) Notify the anesthesia provider and surgeon that the recommended washout period for rivaroxaban is 72 hours
for neuraxial anesthesia
C) Proceed with surgery as planned because rivaroxaban has a short half-life and 48 hours is sufficient
D) Request a stat prothrombin time (PT) and international normalized ratio (INR) to assess coagulation status
Answer: B
Rationale: For neuraxial anesthesia, rivaroxaban requires a washout period of at least 72 hours due to the risk of
spinal hematoma. The nurse must advocate for patient safety by notifying the team. Vitamin K does not reverse
rivaroxaban; it reverses warfarin. PT/INR is not reliable for assessing rivaroxaban effect. Proceeding without
adequate washout increases bleeding risk.
13 A patient undergoing a laparotomy under general anesthesia develops a heart rate of 45 bpm, blood pressure
70/40 mm Hg, and oxygen saturation 88% after the surgeon manipulates the abdominal contents. The
anesthesia provider administers atropine, but the bradycardia persists. What is the most likely cause of this
bradycardia and hypotension?
A) Oculocardiac reflex due to traction on extraocular muscles
B) Bezold-Jarisch reflex triggered by vagal stimulation from abdominal traction
C) Anaphylactic reaction to anesthetic agent causing vasodilation and bradycardia
D) Hypovolemia from occult hemorrhage leading to compensatory bradycardia
Answer: B
Rationale: The Bezold-Jarisch reflex is a vagally mediated reflex that causes bradycardia, hypotension, and
peripheral vasodilation in response to mechanical stimulation of cardiac or abdominal visceral afferents.
Abdominal traction during laparotomy can trigger this reflex. The oculocardiac reflex occurs with eye surgery, not
abdominal. Anaphylaxis typically presents with tachycardia, not bradycardia. Hypovolemia usually causes
tachycardia, not bradycardia.
14 A patient with a history of chronic obstructive pulmonary disease (COPD) is scheduled for an elective inguinal
hernia repair under general anesthesia. The perioperative nurse reviews the preoperative pulmonary function
tests, which show FEV1/FVC ratio of 0.55 and FEV1 of 40% predicted. Which of the following is the most
appropriate perioperative intervention to reduce the risk of postoperative pulmonary complications?
A) Administer high-flow oxygen via non-rebreather mask immediately after extubation
B) Encourage incentive spirometry every 2 hours while awake and consider noninvasive positive pressure
ventilation (NIPPV) if needed
C) Place the patient in a supine position for the first 24 hours postoperatively to promote lung expansion
Multiple Choice Answers & Explanations in Italics - 149
Questions
Section 1: Perioperative Nursing Care (Questions 1-15)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy under
general anesthesia. The preoperative assessment reveals a STOP-Bang score of 7. Which of the following
perioperative interventions is most critical to reduce the risk of postoperative respiratory complications?
A) Administering a benzodiazepine preoperatively to reduce anxiety and promote sleep
B) Using a bispectral index (BIS) monitor to guide anesthetic depth
C) Implementing continuous positive airway pressure (CPAP) therapy both preoperatively and postoperatively
D) Extubating the patient while still deeply anesthetized to avoid coughing
Answer: C
Rationale: Patients with OSA are at high risk for airway obstruction and respiratory depression postoperatively.
CPAP therapy maintains airway patency and improves oxygenation. Benzodiazepines (A) can worsen respiratory
depression. BIS monitoring (B) is for anesthetic depth, not respiratory risk. Deep extubation (D) increases
aspiration and obstruction risk.
2 During an open abdominal aortic aneurysm repair, the surgical team requests that the nurse administer a fluid
bolus of 500 mL of lactated Ringer's solution. The patient has a history of heart failure with reduced ejection
fraction (30%). Which of the following is the most appropriate nursing action?
A) Administer the bolus as requested, as fluid resuscitation is critical for maintaining perfusion
B) Administer the bolus slowly over 2 hours to minimize cardiac overload
C) Question the order and suggest using a colloid solution instead
D) Hold the bolus and request a central venous pressure (CVP) measurement first
Answer: B
Rationale: In patients with heart failure, rapid fluid boluses can precipitate pulmonary edema. Administering the
bolus slowly (e.g., over 2 hours) allows for better tolerance. While questioning is appropriate (C), the order is for a
specific fluid; the nurse should adjust rate rather than substitute. Holding entirely (D) may delay necessary
resuscitation. CVP monitoring is not always immediately available.
3 A patient undergoing a colectomy under general anesthesia develops sudden hypotension, tachycardia, and a
drop in end-tidal CO2 (ETCO2) from 38 to 28 mmHg. The surgeon is currently closing the abdomen. What is
the priority nursing intervention?
A) Increase the IV fluid rate and administer a vasopressor
B) Notify the surgeon immediately and prepare for possible chest tube insertion
C) Check the patient's temperature and apply warming blankets
D) Reposition the patient into Trendelenburg to improve venous return
Answer: B
Rationale: The triad of hypotension, tachycardia, and decreased ETCO2 is classic for venous air embolism or
pneumothorax. In an open abdominal surgery, a pneumothorax can occur if the diaphragm is violated. Immediate
notification and chest tube preparation are critical. Fluids and vasopressors (A) may be supportive but do not
address the cause. Warming (C) is irrelevant. Trendelenburg (D) can worsen air embolism.
,4 Which of the following assessment findings in the post-anesthesia care unit (PACU) is most indicative of
malignant hyperthermia (MH) in a patient who received succinylcholine and sevoflurane?
A) Heart rate 110 bpm, blood pressure 100/60 mmHg, temperature 38.2°C
B) Generalized muscle rigidity, mixed respiratory and metabolic acidosis, and serum potassium 6.5 mEq/L
C) Shivering, oxygen saturation 94%, and urine output 30 mL/hour
D) Delayed emergence from anesthesia with pinpoint pupils
Answer: B
Rationale: MH presents with muscle rigidity, hyperkalemia, and acidosis due to uncontrolled calcium release.
Option B is classic. Mild tachycardia and low-grade fever (A) are nonspecific. Shivering (C) is common
postoperatively but not MH. Pinpoint pupils (D) suggest opioid overdose, not MH.
5 A patient is positioned in the lithotomy position for a robotic-assisted prostatectomy. After the procedure, the
patient reports numbness and tingling in the right foot, with inability to dorsiflex the ankle. Which nerve injury
is most likely, and what is the primary preventive measure?
A) Sciatic nerve injury; avoid hyperextension of the hip
B) Common peroneal nerve injury; ensure that the stirrups do not compress the lateral fibular head
C) Femoral nerve injury; limit abduction of the hip to 45 degrees
D) Tibial nerve injury; position the foot in neutral alignment
Answer: B
Rationale: The common peroneal nerve wraps around the fibular head and is vulnerable to compression in lithotomy
stirrups. Injury causes foot drop (loss of dorsiflexion) and sensory loss over the dorsum of the foot. Sciatic injury
(A) would affect plantar flexion and sensation. Femoral (C) affects hip flexion. Tibial (D) affects plantar flexion.
6 A patient in the preoperative holding area has a known allergy to sulfonamides. The surgeon orders cefazolin 2
grams IV for surgical site infection prophylaxis. Which of the following is the most appropriate nursing action?
A) Administer the cefazolin as ordered, as it is a cephalosporin and cross-reactivity risk is low
B) Hold the antibiotic and request an alternative such as clindamycin or vancomycin
C) Administer the cefazolin with a test dose and observe for 30 minutes
D) Administer diphenhydramine 25 mg IV before giving the cefazolin
Answer: A
Rationale: Current evidence indicates that the cross-reactivity between sulfonamides and cephalosporins is
extremely low (<1%). Therefore, cefazolin can be safely administered. Holding (B) is unnecessary and may delay
prophylaxis. Test doses (C) are not standard. Premedication (D) is not indicated.
7 A patient undergoing a Whipple procedure (pancreaticoduodenectomy) has an epidural catheter placed for
postoperative pain management. The nurse notes that the patient's blood pressure drops from 120/80 to 85/50
mmHg within 10 minutes of a bolus dose of 0.125% bupivacaine with fentanyl 2 mcg/mL. Which of the
following is the most likely cause?
A) Anaphylaxis to bupivacaine
B) Sympathetic blockade from the local anesthetic
C) Fentanyl-induced histamine release
D) Intravascular absorption of bupivacaine
Answer: B
Rationale: Epidural local anesthetics can cause sympathetic blockade, leading to vasodilation and hypotension. This
is a common, expected effect. Anaphylaxis (A) would include other symptoms. Fentanyl (C) rarely causes
histamine release at this dose. Intravascular absorption (D) would cause systemic toxicity, not isolated hypotension.
,8 A patient with a BMI of 42 kg/m² is scheduled for a vertical sleeve gastrectomy. During the preoperative
assessment, the nurse identifies a history of poorly controlled type 2 diabetes (HbA1c 9.5%) and hypertension
(BP 150/95 mmHg). Which of the following is the most important nursing intervention to optimize surgical
outcomes?
A) Advise the patient to stop all antihypertensive medications 24 hours before surgery
B) Request a preoperative echocardiogram to assess for pulmonary hypertension
C) Collaborate with the healthcare team to optimize glycemic control and blood pressure prior to surgery
D) Schedule the surgery early in the morning to minimize fasting duration
Answer: C
Rationale: Poorly controlled diabetes and hypertension increase risks of surgical site infection, cardiovascular
events, and delayed healing. Optimizing these preoperatively is essential. Stopping antihypertensives (A) can cause
rebound hypertension. Echocardiogram (B) may be indicated but is not the priority intervention. Early scheduling
(D) is not evidence-based for this scenario.
9 During a total knee arthroplasty, the surgical team uses a tourniquet on the thigh. The tourniquet time is 120
minutes. Which of the following is the most important nursing action to prevent a tourniquet-related
complication?
A) Document the tourniquet pressure and time every 15 minutes
B) Release the tourniquet for 10 minutes after 60 minutes of inflation
C) Apply the tourniquet over padding to avoid skin injury
D) Monitor for signs of compartment syndrome in the postoperative period
Answer: B
Rationale: Prolonged tourniquet inflation (>60 minutes) can cause ischemic injury and reperfusion syndrome.
Current guidelines recommend deflating the tourniquet after 60-90 minutes for at least 10 minutes to allow
reperfusion. Documentation (A) is important but does not prevent injury. Padding (C) is standard. Monitoring (D)
is postoperative, not preventive.
10 A patient in the PACU has a urine output of 20 mL over the past 2 hours after an open aortic aneurysm repair.
The patient's blood pressure is 90/60 mmHg, heart rate 110 bpm, and central venous pressure (CVP) is 4
mmHg. Which of the following is the priority intervention?
A) Administer furosemide 20 mg IV to promote diuresis
B) Administer a 500 mL bolus of isotonic crystalloid
C) Check the patient's serum creatinine and BUN levels
D) Insert a Foley catheter if not already in place
Answer: B
Rationale: The low urine output, hypotension, tachycardia, and low CVP indicate hypovolemia, likely from
hemorrhage or third spacing. The priority is fluid resuscitation. Diuretics (A) are contraindicated in hypovolemia.
Checking labs (C) is secondary. A Foley is likely already in place postoperatively; if not, insertion may be delayed.
11 A patient with a history of hypertension and coronary artery disease is undergoing elective laparoscopic
cholecystectomy under general anesthesia. During the procedure, the anesthesia provider notes a sudden
increase in end-tidal carbon dioxide (ETCO2) from 35 to 55 mm Hg over 5 minutes, accompanied by a
decrease in oxygen saturation from 98% to 90% on pulse oximetry. The patient's blood pressure drops from
120/80 to 85/50 mm Hg. The perioperative nurse suspects which complication and what is the priority
intervention?
A) Malignant hyperthermia; administer dantrolene and cool the patient
B) Venous air embolism; place the patient in Trendelenburg position and left lateral decubitus
, C) Carbon dioxide embolism; discontinue insufflation and notify the surgeon immediately
D) Pulmonary embolism; initiate cardiopulmonary resuscitation and prepare for thrombolysis
Answer: C
Rationale: The sudden rise in ETCO2 with hypotension and desaturation during laparoscopic surgery is classic for
carbon dioxide embolism from insufflation. Immediate discontinuation of insufflation and notification of the
surgeon are critical to prevent further gas entry. Malignant hyperthermia typically presents with hyperthermia,
rigidity, and acidosis, not isolated ETCO2 rise. Venous air embolism occurs more commonly in sitting
craniotomies, not laparoscopy. Pulmonary embolism is less acute and not directly related to insufflation.
12 A patient is scheduled for a total hip arthroplasty under spinal anesthesia. The perioperative nurse reviews the
preoperative checklist and notes that the patient has a history of deep vein thrombosis (DVT) and is currently
on rivaroxaban. The last dose was taken 48 hours ago. The surgical team plans to proceed with surgery. Which
action by the perioperative nurse is most appropriate?
A) Administer vitamin K as an antidote to reverse rivaroxaban effects before surgery
B) Notify the anesthesia provider and surgeon that the recommended washout period for rivaroxaban is 72 hours
for neuraxial anesthesia
C) Proceed with surgery as planned because rivaroxaban has a short half-life and 48 hours is sufficient
D) Request a stat prothrombin time (PT) and international normalized ratio (INR) to assess coagulation status
Answer: B
Rationale: For neuraxial anesthesia, rivaroxaban requires a washout period of at least 72 hours due to the risk of
spinal hematoma. The nurse must advocate for patient safety by notifying the team. Vitamin K does not reverse
rivaroxaban; it reverses warfarin. PT/INR is not reliable for assessing rivaroxaban effect. Proceeding without
adequate washout increases bleeding risk.
13 A patient undergoing a laparotomy under general anesthesia develops a heart rate of 45 bpm, blood pressure
70/40 mm Hg, and oxygen saturation 88% after the surgeon manipulates the abdominal contents. The
anesthesia provider administers atropine, but the bradycardia persists. What is the most likely cause of this
bradycardia and hypotension?
A) Oculocardiac reflex due to traction on extraocular muscles
B) Bezold-Jarisch reflex triggered by vagal stimulation from abdominal traction
C) Anaphylactic reaction to anesthetic agent causing vasodilation and bradycardia
D) Hypovolemia from occult hemorrhage leading to compensatory bradycardia
Answer: B
Rationale: The Bezold-Jarisch reflex is a vagally mediated reflex that causes bradycardia, hypotension, and
peripheral vasodilation in response to mechanical stimulation of cardiac or abdominal visceral afferents.
Abdominal traction during laparotomy can trigger this reflex. The oculocardiac reflex occurs with eye surgery, not
abdominal. Anaphylaxis typically presents with tachycardia, not bradycardia. Hypovolemia usually causes
tachycardia, not bradycardia.
14 A patient with a history of chronic obstructive pulmonary disease (COPD) is scheduled for an elective inguinal
hernia repair under general anesthesia. The perioperative nurse reviews the preoperative pulmonary function
tests, which show FEV1/FVC ratio of 0.55 and FEV1 of 40% predicted. Which of the following is the most
appropriate perioperative intervention to reduce the risk of postoperative pulmonary complications?
A) Administer high-flow oxygen via non-rebreather mask immediately after extubation
B) Encourage incentive spirometry every 2 hours while awake and consider noninvasive positive pressure
ventilation (NIPPV) if needed
C) Place the patient in a supine position for the first 24 hours postoperatively to promote lung expansion
