MSNCB Surgical Procedures & Postoperative Care 4 — Questions and Answers
Question 1: A patient's incentive spirometry goal is 1500 mL but they consistently achieve only 600 mL on postoperative day 1. The nurse's best intervention is to:
- Document and accept limited effort as normal postop
- Administer a bronchodilator and reassess
- Provide pain medication before sessions and coach proper technique (Correct answer)
- Discontinue incentive spirometry and use flutter valve instead
Correct answer: Provide pain medication before sessions and coach proper technique
Preemptive analgesia reduces splinting from incisional pain, the primary barrier to deep breathing, and coaching optimizes technique.
Question 2: Which sign indicates a patient's nasogastric tube may have migrated into the respiratory tract?
- Drainage of bile-colored fluid
- Coughing, cyanosis, and respiratory distress (Correct answer)
- Abdominal distension and absence of bowel sounds
- Return of clear gastric contents when aspirating
Correct answer: Coughing, cyanosis, and respiratory distress
Coughing, cyanosis, and respiratory distress indicate the NG tube is in the airway, requiring immediate removal and reassessment.
Question 3: A nurse notes that a patient's surgical wound edges are separating with visible subcutaneous tissue on postoperative day 5. No organs are protruding. This is classified as:
- Evisceration requiring immediate surgery
- Wound dehiscence requiring wound care and possible re-closure (Correct answer)
- Normal granulation tissue formation
- Wound fistula formation
Correct answer: Wound dehiscence requiring wound care and possible re-closure
Separation of wound edges without organ protrusion is dehiscence; evisceration refers to organ protrusion through the wound.
Question 4: When caring for a patient after spinal anesthesia, the nurse monitors for post-dural puncture headache. What characteristic feature differentiates this headache from other postoperative headaches?
- It is unilateral and throbbing
- It worsens when the patient sits or stands and improves when supine (Correct answer)
- It is accompanied by fever and nuchal rigidity
- It peaks at 72 hours and does not respond to analgesics
Correct answer: It worsens when the patient sits or stands and improves when supine
Post-dural puncture headache is positional, worsening with upright posture and relieved by lying flat due to CSF pressure changes.
Question 5: A patient post-carotid endarterectomy develops sudden-onset weakness of the contralateral arm and expressive aphasia. The nurse should first:
- Administer ordered antihypertensive medication
- Perform the NIH Stroke Scale and notify the surgeon stat (Correct answer)
- Position the patient supine and apply oxygen at 2 L/min
- Reassess in 15 minutes to see if symptoms resolve
Correct answer: Perform the NIH Stroke Scale and notify the surgeon stat
New focal neurologic deficits after carotid endarterectomy indicate possible stroke; immediate stroke assessment and surgical notification are required.
Question 6: Which finding in the immediate postoperative period requires the nurse to reposition the patient before anything else?
- Respiratory rate of 14 breaths/min
- SpO2 of 94% on room air
- SpO2 of 86% with audible snoring and a relaxed jaw (Correct answer)
- Blood pressure of 138/88 mmHg
Correct answer: SpO2 of 86% with audible snoring and a relaxed jaw
SpO2 of 86% with snoring indicates airway obstruction from a relaxed tongue; immediate jaw-thrust or head-tilt/chin-lift repositioning is the priority.
Question 7: A patient 2 days post-open appendectomy reports the urge to defecate but passes only flatus. The nurse's best response is:
- Administer a prescribed laxative immediately
- Reassure the patient that flatus indicates return of bowel function (Correct answer)
- Insert a rectal tube to facilitate gas expulsion
- Report to the surgeon as this suggests anastomotic failure
Correct answer: Reassure the patient that flatus indicates return of bowel function
Passage of flatus signals the return of peristalsis and is a normal, expected finding that should be encouraged and celebrated in postoperative patients.
MSNCB Surgical Procedures & Postoperative Care 4
A patient's incentive spirometry goal is 1500 mL but they consistently achieve only 600 mL on postoperative day 1.
The nurse's best intervention is to: