CSFA Postoperative Patient Management 4

Question 1

A patient's postoperative chest X-ray shows a wedge-shaped density in the right lower lobe. Combined with tachycardia, dyspnea, and elevated D-dimer, this presentation is MOST consistent with:

Accepted Answer

Pulmonary embolism with Hampton's hump sign

Answer

A Hampton's hump (wedge-shaped pleural-based density) in the setting of tachycardia and elevated D-dimer is a classic radiographic sign of pulmonary infarction from embolism.

Question 2

When educating a patient about incentive spirometry after open abdominal surgery, the surgical first assistant should instruct the patient to:

Accepted Answer

Use it 10 times every 1-2 hours while awake, holding the breath at peak inhalation

Answer

Incentive spirometry should be performed frequently while awake (every 1-2 hours) with sustained maximal inspiration to prevent atelectasis.

Question 3

A postoperative patient with a T6 spinal cord injury develops a sudden severe headache, hypertension (BP 210/110), bradycardia, and profuse diaphoresis above the injury level. The PRIORITY action is:

Accepted Answer

Identify and remove the noxious stimulus (check catheter, bowel distension)

Answer

Autonomic dysreflexia is a medical emergency triggered by noxious stimuli below the injury; removing the trigger (commonly bladder distension or pressure) is the first priority.

Question 4

Which postoperative electrolyte imbalance is MOST commonly associated with cardiac arrhythmias and is a known risk following prolonged nasogastric suctioning?

Accepted Answer

Hypokalemia

Answer

Prolonged NG suctioning removes gastric fluid rich in potassium and hydrogen ions, leading to hypokalemia and metabolic alkalosis that predispose to arrhythmias.

Question 5

A patient who had a Whipple procedure (pancreaticoduodenectomy) 3 days ago develops fever, leukocytosis, and a new onset of abdominal pain. Drain amylase levels are elevated 3x the upper limit of normal. This is MOST consistent with:

Accepted Answer

Pancreatic fistula/leak

Answer

Elevated drain amylase greater than 3x the upper limit of normal on postoperative day 3 or later is the diagnostic criterion for a postoperative pancreatic fistula.

CSFA - Certified Surgical First Assistant Practice Test

CSFA - Certified Surgical First Assistant Practice Test

CSFA Postoperative Patient Management 4