CMSRN Perioperative 2 — Questions and Answers
Question 1: A patient is receiving epidural analgesia postoperatively. Which assessment finding requires immediate intervention?
- Pain score of 4/10
- Blood pressure 90/58 mmHg (Correct answer)
- Respiratory rate of 14 breaths/min
- Urine output of 35 mL/hr
Correct answer: Blood pressure 90/58 mmHg
Hypotension (BP 90/58) is a serious complication of epidural analgesia due to sympathetic blockade and requires immediate intervention.
Question 2: During the immediate postoperative period, a patient begins shivering uncontrollably. What is the priority nursing action?
- Administer antipyretic medication
- Apply warm blankets and active warming measures (Correct answer)
- Increase IV fluid rate
- Notify the surgeon immediately
Correct answer: Apply warm blankets and active warming measures
Postoperative shivering is commonly caused by hypothermia from operating room exposure; applying warm blankets is the priority intervention.
Question 3: A patient is 6 hours post-abdominal surgery and has not voided. Which assessment is most important before intervening?
- Last oral intake time
- Bladder scan for urinary retention (Correct answer)
- Type of anesthesia used
- Current pain level
Correct answer: Bladder scan for urinary retention
A bladder scan should be performed first to determine if urinary retention is present before any urinary intervention is initiated.
Question 4: Which laboratory value is most critical to assess before a patient is taken to the operating room for an elective procedure?
- Hemoglobin A1c of 7.2%
- Serum potassium of 2.9 mEq/L (Correct answer)
- Total cholesterol of 210 mg/dL
- Fasting glucose of 115 mg/dL
Correct answer: Serum potassium of 2.9 mEq/L
Hypokalemia (K+ 2.9 mEq/L) increases the risk of dangerous cardiac arrhythmias during anesthesia and must be corrected preoperatively.
Question 5: A patient scheduled for surgery reports taking aspirin daily for cardiac prophylaxis. The nurse's most appropriate action is to:
- Proceed with surgery as aspirin is safe perioperatively
- Document and notify the anesthesiologist and surgeon (Correct answer)
- Instruct the patient to take double the dose post-op
- Administer vitamin K to reverse aspirin's effects
Correct answer: Document and notify the anesthesiologist and surgeon
Aspirin's antiplatelet effects increase bleeding risk; the surgical and anesthesia teams must be notified to determine if surgery should be delayed.
Question 6: Which positioning complication is a patient undergoing a lengthy procedure in the lithotomy position most at risk for?
- Brachial plexus injury
- Compartment syndrome of the lower extremities (Correct answer)
- Radial nerve compression
- Cervical spine flexion injury
Correct answer: Compartment syndrome of the lower extremities
Extended lithotomy positioning compresses lower extremity compartments, increasing risk of compartment syndrome due to elevated pressure and reduced perfusion.
Question 7: A circulating nurse notices that the sterile field has been contaminated during surgery. The appropriate response is to:
- Continue the procedure if it was a minor contamination
- Immediately notify the scrub tech and surgeon and replace contaminated items (Correct answer)
- Document the contamination and monitor for signs of infection postoperatively
- Apply additional sterile drapes over the contaminated area
Correct answer: Immediately notify the scrub tech and surgeon and replace contaminated items
Any breach of the sterile field must be reported immediately and contaminated items replaced to prevent surgical site infection.
CMSRN Perioperative 2
A patient is receiving epidural analgesia postoperatively.
Which assessment finding requires immediate intervention?