CBN Risk Management & Mitigation 3 — Questions and Answers
Question 1: A sleeve gastrectomy patient reports left shoulder pain, hiccups, and fever on postoperative day 3. Which complication should the nurse suspect first?
- Musculoskeletal strain
- Staple-line leak with diaphragmatic irritation (Correct answer)
- Gastroesophageal reflux
- Incisional hernia
Correct answer: Staple-line leak with diaphragmatic irritation
Referred left shoulder pain with fever after sleeve gastrectomy suggests a staple-line leak irritating the diaphragm and requires urgent evaluation.
Question 2: Which staffing practice best mitigates safe-patient-handling injury risk on a bariatric surgical unit?
- Assigning the strongest nurse to bariatric patients
- Implementing a lift team and mandatory mechanical lift use policies (Correct answer)
- Limiting bariatric admissions
- Requiring patients to sign liability waivers
Correct answer: Implementing a lift team and mandatory mechanical lift use policies
Lift teams and mandatory mechanical lift policies reduce musculoskeletal injuries for staff and falls or skin injuries for patients.
Question 3: A patient 2 weeks after gastric bypass presents with confusion, ataxia, and nystagmus following persistent vomiting. Which preventable risk has likely materialized?
- Vitamin B12 deficiency
- Wernicke encephalopathy from thiamine deficiency (Correct answer)
- Iron deficiency anemia
- Hypercalcemia
Correct answer: Wernicke encephalopathy from thiamine deficiency
Persistent vomiting after bariatric surgery can rapidly deplete thiamine, and the triad of confusion, ataxia, and nystagmus signals Wernicke encephalopathy.
Question 4: Which documentation practice most strengthens legal risk protection when a bariatric patient declines recommended follow-up care?
- Noting 'patient noncompliant' in the chart
- Documenting the specific education provided, the patient's stated reason for refusal, and notification of the provider (Correct answer)
- Omitting the refusal to avoid liability
- Having another nurse co-sign a blank note
Correct answer: Documenting the specific education provided, the patient's stated reason for refusal, and notification of the provider
Objective documentation of education, the patient's informed refusal, and provider notification demonstrates the standard of care was met.
Question 5: What is the most appropriate mitigation when a preoperative bariatric patient screens positive for high-risk alcohol use?
- Proceed with surgery and reassess afterward
- Refer for evaluation and treatment before surgery, as alcohol use disorder risk increases after bypass (Correct answer)
- Cancel surgery permanently
- Advise switching to beer only
Correct answer: Refer for evaluation and treatment before surgery, as alcohol use disorder risk increases after bypass
Preoperative referral is critical because gastric bypass alters alcohol metabolism and increases the risk of postoperative alcohol use disorder.
Question 6: Which perioperative positioning measure reduces the risk of rhabdomyolysis in patients with a BMI over 50?
- Keeping the patient supine without padding
- Extra padding over pressure points and minimizing operative time (Correct answer)
- Trendelenburg positioning throughout
- Restricting IV fluids intraoperatively
Correct answer: Extra padding over pressure points and minimizing operative time
Prolonged pressure on muscle in patients with severe obesity can cause rhabdomyolysis, so padding and shorter operative times are key preventive measures.
Question 7: A nurse notices dark tea-colored urine and an elevated creatine kinase in a post-op patient with BMI 55. What is the priority risk-mitigation action?
- Restrict fluids to reduce urine output
- Notify the provider and anticipate aggressive IV hydration to protect the kidneys (Correct answer)
- Encourage oral protein supplements
- Apply a heating pad to the buttocks
Correct answer: Notify the provider and anticipate aggressive IV hydration to protect the kidneys
These findings suggest rhabdomyolysis, and aggressive hydration is needed to prevent myoglobin-induced acute kidney injury.
CBN Risk Management & Mitigation 3
A sleeve gastrectomy patient reports left shoulder pain, hiccups, and fever on postoperative day 3.
Which complication should the nurse suspect first?