CBN CBN Postoperative Care & Complications 2 — Questions and Answers
Question 1: Which postoperative complication is characterized by left shoulder (Kehr's sign) and upper abdominal pain in a bariatric patient?
- Anastomotic leak with diaphragmatic irritation (Correct answer)
- Pulmonary embolism
- Marginal ulcer
- Internal hernia
Correct answer: Anastomotic leak with diaphragmatic irritation
Kehr's sign (left shoulder pain) in a postoperative bariatric patient suggests anastomotic leak causing diaphragmatic irritation from leaked gastric contents.
Question 2: A bariatric patient develops severe episodic cramping and watery diarrhea 15–30 minutes after eating. The nurse recognizes this as:
- Late dumping syndrome
- Early dumping syndrome (Correct answer)
- Anastomotic leak
- Marginal ulcer
Correct answer: Early dumping syndrome
Early dumping syndrome occurs within 15–30 minutes of eating due to rapid gastric emptying causing osmotic fluid shifts into the small intestine, presenting with cramping and diarrhea.
Question 3: The MOST important nursing intervention to prevent deep vein thrombosis (DVT) after bariatric surgery is:
- Early ambulation beginning on postoperative day 1 (Correct answer)
- Bed rest for 48 hours post-surgery
- Restricting fluid intake to reduce venous pooling
- Elevating the head of bed to 45 degrees
Correct answer: Early ambulation beginning on postoperative day 1
Early ambulation is the most effective nursing intervention to prevent DVT after bariatric surgery by promoting venous return and reducing stasis.
Question 4: A patient six months post-Roux-en-Y gastric bypass reports severe epigastric pain that worsens with eating. The nurse suspects:
- Marginal ulcer (Correct answer)
- Dumping syndrome
- Stomal stenosis
- Internal hernia
Correct answer: Marginal ulcer
Marginal ulcers form at the gastrojejunal anastomosis and cause epigastric pain that typically worsens with food intake, occurring weeks to months postoperatively.
Question 5: Which postoperative lab finding requires IMMEDIATE intervention in a bariatric patient in the first 24 hours?
- Hemoglobin drop of 3 g/dL from baseline (Correct answer)
- Potassium of 3.3 mEq/L
- Blood glucose of 140 mg/dL
- White blood cell count of 11,000/μL
Correct answer: Hemoglobin drop of 3 g/dL from baseline
A hemoglobin drop of 3 g/dL in the first 24 hours suggests significant postoperative bleeding requiring immediate assessment and intervention.
Question 6: Which position is RECOMMENDED for a bariatric patient post-surgery to reduce respiratory complications?
- Reverse Trendelenburg (head elevated 30–45 degrees) (Correct answer)
- Flat supine
- Trendelenburg (head down)
- Left lateral decubitus only
Correct answer: Reverse Trendelenburg (head elevated 30–45 degrees)
Head-of-bed elevation at 30–45 degrees reduces diaphragmatic compression by abdominal contents, improving ventilation and reducing pulmonary complications in obese patients.
CBN CBN Postoperative Care & Complications 2
Which postoperative complication is characterized by left shoulder (Kehr's sign) and upper abdominal pain in a bariatric patient?