CBN Risk Management & Mitigation 2 — Questions and Answers
Question 1: A post-op gastric bypass patient develops tachycardia above 120 bpm with normal blood pressure and mild abdominal discomfort on day 1. What is the most important risk this may signal?
- Anastomotic leak (Correct answer)
- Normal post-anesthesia response
- Dehydration only
- Anxiety reaction
Correct answer: Anastomotic leak
Sustained tachycardia over 120 bpm is often the earliest and sometimes only sign of anastomotic leak after bariatric surgery.
Question 2: Which intervention best mitigates venous thromboembolism (VTE) risk in the immediate postoperative bariatric patient?
- Bed rest for 48 hours
- Early ambulation combined with chemoprophylaxis and sequential compression devices (Correct answer)
- Aspirin alone
- Fluid restriction
Correct answer: Early ambulation combined with chemoprophylaxis and sequential compression devices
Multimodal prophylaxis—early ambulation, pharmacologic anticoagulation, and mechanical compression—is the standard for VTE risk reduction in bariatric patients.
Question 3: What is the primary rationale for using weight-based dosing verification protocols for anticoagulants in bariatric patients?
- To reduce medication costs
- Standard fixed doses may be subtherapeutic in patients with severe obesity (Correct answer)
- Anticoagulants are contraindicated in obesity
- To shorten hospital stays
Correct answer: Standard fixed doses may be subtherapeutic in patients with severe obesity
Standard fixed anticoagulant doses may be inadequate in patients with severe obesity, so weight-based or adjusted dosing helps prevent VTE.
Question 4: Which equipment-related action most directly reduces the risk of patient injury during transfer of a patient weighing 180 kg?
- Using a standard hospital bed and two staff members
- Verifying weight capacity of lifts, beds, and transfer devices before use (Correct answer)
- Asking the patient to transfer independently
- Delaying transfers until discharge
Correct answer: Verifying weight capacity of lifts, beds, and transfer devices before use
Confirming that all equipment is rated for the patient's weight prevents equipment failure and injury to both patient and staff.
Question 5: A bariatric patient with obstructive sleep apnea refuses to use CPAP postoperatively. What is the nurse's best risk-mitigation response?
- Document refusal and take no further action
- Educate on respiratory risk, increase monitoring with continuous pulse oximetry, and notify the provider (Correct answer)
- Administer a sedative to help the patient sleep
- Discharge the patient early
Correct answer: Educate on respiratory risk, increase monitoring with continuous pulse oximetry, and notify the provider
Untreated OSA increases postoperative respiratory depression risk, so education, enhanced monitoring, and provider notification are essential.
Question 6: Which strategy best reduces medication administration errors related to altered drug absorption after gastric bypass?
- Continuing all preoperative extended-release medications unchanged
- Reviewing all medications and converting extended-release forms to immediate-release or liquid formulations when appropriate (Correct answer)
- Doubling all medication doses
- Discontinuing all oral medications permanently
Correct answer: Reviewing all medications and converting extended-release forms to immediate-release or liquid formulations when appropriate
Bypass anatomy impairs absorption of extended-release drugs, so formulation review and conversion reduces therapeutic failure and error risk.
Question 7: In a root cause analysis after a bariatric patient fall, which finding represents a system-level risk factor rather than an individual error?
- The nurse forgot to lock the bed wheels
- No bariatric-rated commodes were stocked on the unit (Correct answer)
- The patient stood up too quickly
- The aide misread the care plan
Correct answer: No bariatric-rated commodes were stocked on the unit
A lack of appropriately rated equipment on the unit is a system-level failure that requires organizational correction rather than individual remediation.
CBN Risk Management & Mitigation 2
A post-op gastric bypass patient develops tachycardia above 120 bpm with normal blood pressure and mild abdominal discomfort on day 1.
What is the most important risk this may signal?