CMSRN Perioperative 5 — Questions and Answers
Question 1: A patient is 2 days post-colostomy surgery and the stoma appears dark purple. What does this indicate?
- Normal healing of the mucosal tissue
- Ischemia of the stoma requiring immediate reporting (Correct answer)
- A normal color change related to bowel function
- Mild irritation from the ostomy pouch
Correct answer: Ischemia of the stoma requiring immediate reporting
A dark purple or black stoma indicates impaired blood flow and ischemia, which is an emergency requiring immediate surgical notification.
Question 2: Which intraoperative position places a patient at highest risk for air embolism?
- Supine with arms tucked
- Reverse Trendelenburg
- Sitting (beach chair) position (Correct answer)
- Prone with chest rolls
Correct answer: Sitting (beach chair) position
The sitting position creates a pressure gradient that allows air to enter open venous sinuses, making venous air embolism a significant risk.
Question 3: A patient undergoing a laparoscopic procedure develops sudden onset hypotension, bradycardia, and decreased SpO2 after insufflation. The nurse suspects:
- Pulmonary embolism from DVT
- CO2 embolism from pneumoperitoneum (Correct answer)
- Vasovagal reaction from pain
- Anaphylaxis to the surgical prep
Correct answer: CO2 embolism from pneumoperitoneum
CO2 embolism is a known complication of laparoscopic surgery when gas enters the vasculature, causing cardiovascular collapse and hypoxia.
Question 4: When teaching a patient about postoperative incentive spirometry, the nurse instructs the patient to:
- Exhale rapidly into the device to clear secretions
- Inhale slowly and deeply to maximally expand alveoli (Correct answer)
- Use the device only when experiencing dyspnea
- Complete two breaths per session every 4 hours
Correct answer: Inhale slowly and deeply to maximally expand alveoli
Incentive spirometry requires slow, maximal inhalation to fully expand alveoli and prevent atelectasis — the primary postoperative pulmonary complication.
Question 5: A nurse is preparing to transfer an unconscious patient from the OR table to the transport stretcher. The minimum number of people required for a safe transfer is:
- Two
- Three
- Four (Correct answer)
- One with a slide board
Correct answer: Four
A minimum of four people is required to safely transfer an unconscious patient — one at each extremity side, one at the head controlling the airway, and one directing.
Question 6: A patient with a history of obstructive sleep apnea (OSA) is admitted to the PACU. Which postoperative monitoring is most critical for this patient?
- Continuous cardiac telemetry monitoring
- Continuous pulse oximetry and capnography (Correct answer)
- Hourly urine output measurement
- Blood glucose checks every 2 hours
Correct answer: Continuous pulse oximetry and capnography
Patients with OSA are at high risk for postoperative respiratory depression; continuous SpO2 and capnography monitoring is essential to detect early desaturation and hypoventilation.
Question 7: The nurse preparing a patient for surgery uses the SBAR format to communicate a critical preoperative finding to the surgeon. In which component would the nurse state 'the patient's potassium is 2.8 mEq/L'?
- Situation (Correct answer)
- Background
- Assessment
- Recommendation
Correct answer: Situation
The Situation component of SBAR describes the current clinical problem or concern — reporting the specific abnormal lab value belongs here.
CMSRN Perioperative 5
A patient is 2 days post-colostomy surgery and the stoma appears dark purple.
What does this indicate?