MSNCB Surgical Procedures & Postoperative Care 3 — Questions and Answers
Question 1: When assessing a postoperative patient's surgical wound on day 2, the nurse observes wound edges that are approximated with mild serous drainage. This finding is:
- Indicative of wound dehiscence
- A normal finding for primary intention healing (Correct answer)
- Suggestive of anaerobic infection
- Consistent with secondary intention healing only
Correct answer: A normal finding for primary intention healing
Approximated wound edges with mild serous drainage on postoperative day 2 are expected findings for primary intention healing.
Question 2: A patient receiving epidural analgesia postoperatively develops a blood pressure of 85/50 mmHg and heart rate of 55 bpm. The nurse's priority action is to:
- Increase the epidural infusion rate
- Discontinue the epidural and notify the anesthesiologist (Correct answer)
- Administer an antiemetic for vagal response
- Place the patient in Trendelenburg position only
Correct answer: Discontinue the epidural and notify the anesthesiologist
Hypotension and bradycardia with epidural analgesia suggest sympathetic blockade; the epidural must be stopped and the anesthesiologist notified immediately.
Question 3: Following a colostomy, a patient's stoma appears pale and dusky 12 hours postoperatively. The nurse should:
- Apply warm compresses and reassess in 1 hour
- Notify the surgeon immediately as this indicates ischemia (Correct answer)
- Gently massage the stoma to improve circulation
- Document as a normal finding for the first 24 hours
Correct answer: Notify the surgeon immediately as this indicates ischemia
A pale or dusky stoma indicates compromised vascular supply (ischemia), which requires immediate surgical notification.
Question 4: A postoperative patient uses a PCA pump and reports uncontrolled pain at level 8/10. The nurse assesses that the patient is not pressing the button correctly. The appropriate intervention is:
- Override the lockout and administer an extra bolus
- Educate the patient on proper PCA use and assess for barriers (Correct answer)
- Switch to IM opioids for better pain control
- Document and notify the physician that PCA is ineffective
Correct answer: Educate the patient on proper PCA use and assess for barriers
Patient education on correct PCA use addresses the root cause of underutilization before escalating to other analgesic routes.
Question 5: Which laboratory finding is most concerning in a patient 24 hours post-bowel resection?
- Hemoglobin 10.2 g/dL
- WBC 12,000/mm³
- Serum lactate 6 mmol/L (Correct answer)
- BUN 22 mg/dL
Correct answer: Serum lactate 6 mmol/L
An elevated serum lactate of 6 mmol/L signals anaerobic metabolism, suggesting tissue hypoperfusion or septic shock requiring urgent intervention.
Question 6: A patient who underwent repair of a perforated duodenal ulcer develops fever, board-like abdomen rigidity, and rebound tenderness on postoperative day 3. The nurse suspects:
- Paralytic ileus
- Peritonitis from anastomotic leak (Correct answer)
- Acute pancreatitis
- Wound hematoma
Correct answer: Peritonitis from anastomotic leak
Board-like rigidity and rebound tenderness with fever post-bowel surgery strongly suggest peritonitis, often from an anastomotic leak.
Question 7: To prevent aspiration pneumonia in a postoperative patient who is semiconscious, the nurse should:
- Position in supine with head flat to reduce aspiration risk
- Position in lateral recovery position until fully alert (Correct answer)
- Administer antiemetics prophylactically regardless of symptoms
- Encourage oral fluids to keep the airway moist
Correct answer: Position in lateral recovery position until fully alert
The lateral (recovery) position allows secretions to drain and prevents aspiration in a semiconscious patient.
MSNCB Surgical Procedures & Postoperative Care 3
When assessing a postoperative patient's surgical wound on day 2, the nurse observes wound edges that are approximated with mild serous drainage.
This finding is: