MSNCB Surgical Procedures & Postoperative Care 2 — Questions and Answers
Question 1: A patient returns from abdominal surgery with a Jackson-Pratt drain. The nurse notes 150 mL of bright red drainage in the first hour. What is the priority action?
- Document as expected output
- Notify the surgeon immediately (Correct answer)
- Reinforce the surgical dressing
- Increase IV fluid rate
Correct answer: Notify the surgeon immediately
Bright red drainage exceeding 100 mL/hr from a JP drain suggests active hemorrhage and requires immediate surgical notification.
Question 2: Which positioning is most appropriate for a patient after a right-sided pneumonectomy to facilitate lung expansion?
- Left lateral decubitus
- Right lateral decubitus or semi-Fowler's (Correct answer)
- Trendelenburg
- Prone
Correct answer: Right lateral decubitus or semi-Fowler's
Positioning on the operative side (right) or semi-Fowler's prevents mediastinal shift and supports the remaining lung.
Question 3: A postoperative patient's urine output drops to 20 mL/hr for 2 consecutive hours. The nurse should first:
- Administer a diuretic per PRN order
- Assess fluid status and check for kinked catheter tubing (Correct answer)
- Restrict IV fluids to prevent fluid overload
- Obtain a stat renal ultrasound
Correct answer: Assess fluid status and check for kinked catheter tubing
Oliguria (<30 mL/hr) first warrants assessment of volume status and mechanical causes before pharmacologic intervention.
Question 4: Following a laparoscopic cholecystectomy, a patient complains of right shoulder pain. The nurse correctly explains this is due to:
- Hepatic capsule inflammation
- Referred pain from diaphragmatic irritation by residual CO2 (Correct answer)
- Brachial plexus injury from positioning
- Biliary leak compressing the brachial nerve
Correct answer: Referred pain from diaphragmatic irritation by residual CO2
Residual CO2 gas used during laparoscopy irritates the diaphragm, causing referred pain to the shoulder via the phrenic nerve.
Question 5: A nurse is assessing a postoperative patient for malignant hyperthermia. The earliest sign is typically:
- Hyperthermia above 40°C
- Masseter muscle rigidity (Correct answer)
- Mottled skin and cyanosis
- Sudden cardiac dysrhythmia
Correct answer: Masseter muscle rigidity
Masseter spasm (jaw rigidity) after succinylcholine is often the earliest clinical sign of malignant hyperthermia.
Question 6: Which intervention best reduces the risk of postoperative deep vein thrombosis (DVT) in a patient who had a total knee replacement?
- Bed rest for 48 hours to prevent stress on the surgical site
- Early ambulation and sequential compression devices (Correct answer)
- Elevating both legs on pillows continuously
- Applying ice packs to bilateral lower extremities
Correct answer: Early ambulation and sequential compression devices
Early ambulation combined with SCDs promotes venous return and is the most effective combined approach to DVT prevention after orthopedic surgery.
Question 7: A patient post-thyroidectomy develops stridor, facial twitching, and a positive Chvostek's sign. The nurse should prepare to administer:
- Calcium gluconate IV (Correct answer)
- Potassium chloride IV
- Levothyroxine IV
- Magnesium sulfate IV
Correct answer: Calcium gluconate IV
Stridor and positive Chvostek's sign post-thyroidectomy indicate hypocalcemia from inadvertent parathyroid removal, treated with IV calcium gluconate.
MSNCB Surgical Procedures & Postoperative Care 2
A patient returns from abdominal surgery with a Jackson-Pratt drain.
The nurse notes 150 mL of bright red drainage in the first hour.
What is the priority action?