CSFA Postoperative and Emergency Care 4 — Questions and Answers
Question 1: Which of the following interventions is the primary treatment for postoperative urinary retention (POUR) after spinal anesthesia?
- IV furosemide administration
- Urinary catheterization (Correct answer)
- Oral tamsulosin and observation
- Suprapubic percussion and increased oral fluid intake
Correct answer: Urinary catheterization
Urinary catheterization is the primary treatment for POUR when the bladder is significantly distended and the patient cannot void spontaneously.
Question 2: A surgical patient returning from the OR has a temperature of 38.9°C on day 2 postoperatively. What is the most common cause of fever at this time point?
- Wound infection
- Pulmonary atelectasis (Correct answer)
- Urinary tract infection
- Deep vein thrombosis
Correct answer: Pulmonary atelectasis
Fever within the first 48 hours postoperatively is most commonly caused by atelectasis due to shallow breathing and mucus plugging.
Question 3: During a postoperative assessment, the surgical first assistant notes that a patient's wound has separated with visible bowel loops protruding through the incision. This complication is called:
- Dehiscence
- Evisceration (Correct answer)
- Hematoma
- Seroma
Correct answer: Evisceration
Evisceration is the protrusion of abdominal viscera through an open wound, which is a surgical emergency requiring immediate sterile saline-moistened dressing and urgent return to the OR.
Question 4: What is the correct initial management of evisceration discovered postoperatively at the bedside?
- Attempt to manually reduce the bowel back into the abdomen
- Cover the exposed viscera with a sterile saline-moistened dressing and call the surgeon immediately (Correct answer)
- Apply an abdominal binder firmly over the wound
- Leave the wound open and keep the patient NPO until the surgeon arrives
Correct answer: Cover the exposed viscera with a sterile saline-moistened dressing and call the surgeon immediately
Covering the bowel with moist sterile dressings prevents desiccation and further contamination while the surgeon is urgently notified for operative repair.
Question 5: A patient on the surgical floor three days postoperatively develops a fever of 39.2°C, dysuria, and a urinalysis positive for nitrites and leukocyte esterase. What is the most likely source of infection?
- Surgical site infection
- Catheter-associated urinary tract infection (CAUTI) (Correct answer)
- Pneumonia
- Intravenous line bacteremia
Correct answer: Catheter-associated urinary tract infection (CAUTI)
Fever with urinary symptoms and a positive UA on postoperative day 3 in a patient who likely had an indwelling catheter is consistent with CAUTI.
Question 6: A patient recovering from a hip arthroplasty suddenly develops pleuritic chest pain, dyspnea, and tachycardia on postoperative day 3. The most likely diagnosis is:
- Myocardial infarction
- Pulmonary embolism (Correct answer)
- Pneumothorax
- Aspiration pneumonia
Correct answer: Pulmonary embolism
Pulmonary embolism classically presents with sudden pleuritic chest pain, dyspnea, and tachycardia following major orthopedic surgery, a high-risk period for DVT.
Question 7: Which parameter is monitored using a pulse oximeter?
- Partial pressure of arterial oxygen (PaO2)
- Peripheral arterial oxygen saturation (SpO2) (Correct answer)
- End-tidal carbon dioxide (EtCO2)
- Mixed venous oxygen saturation (SvO2)
Correct answer: Peripheral arterial oxygen saturation (SpO2)
Pulse oximetry measures peripheral arterial oxygen saturation (SpO2) using photoplethysmography based on light absorption differences between oxyhemoglobin and deoxyhemoglobin.
CSFA Postoperative and Emergency Care 4
Which of the following interventions is the primary treatment for postoperative urinary retention (POUR) after spinal anesthesia?