MSNCB Surgical Procedures & Postoperative Care 5 — Questions and Answers
Question 1: A patient recovering from abdominal aortic aneurysm repair suddenly develops mottling of both lower extremities, absent pedal pulses, and severe pain. The nurse recognizes this as:
- Expected vasospasm from hypothermia
- Acute limb ischemia from thromboembolism or graft occlusion (Correct answer)
- Compartment syndrome of the abdomen
- Venous thromboembolism bilaterally
Correct answer: Acute limb ischemia from thromboembolism or graft occlusion
Absent pulses, mottling, and acute pain after vascular surgery indicate acute limb ischemia from graft occlusion or thromboembolism, a surgical emergency.
Question 2: Which nursing action is most important when a patient returns from surgery with a temporary pacemaker?
- Ensure all electrical equipment is grounded and limit patient movement (Correct answer)
- Remove the pacemaker leads as soon as the patient is awake
- Encourage early ambulation to prevent thromboembolism
- Apply a warming blanket to prevent hypothermia-induced dysrhythmias
Correct answer: Ensure all electrical equipment is grounded and limit patient movement
Temporary pacemakers require electrical safety measures including grounding all equipment and limiting patient movement to prevent lead displacement.
Question 3: A nurse prepares a patient for discharge after a laparoscopic hernia repair. Which instruction is most important for the patient to receive?
- Resume full physical activity within 48 hours to speed recovery
- Avoid lifting more than 10 lbs and report fever, chills, or worsening pain (Correct answer)
- Change the dressing daily with sterile technique
- Return to the ER if stool is not passed within 24 hours
Correct answer: Avoid lifting more than 10 lbs and report fever, chills, or worsening pain
Activity restriction and recognizing signs of infection or recurrence are the highest priority discharge instructions after hernia repair.
Question 4: During wound irrigation of a dehisced surgical wound, which action by the nurse is incorrect?
- Using a 35 mL syringe with an 18-gauge angiocatheter for irrigation
- Directing irrigation solution from the cleanest to the most contaminated area
- Packing wet-to-dry gauze tightly to absorb all moisture (Correct answer)
- Documenting wound bed characteristics and drainage before packing
Correct answer: Packing wet-to-dry gauze tightly to absorb all moisture
Tight packing causes trauma to granulating tissue; moist wound healing requires loosely placed dressings that maintain a moist environment.
Question 5: A postoperative patient on hydromorphone PCA has a respiratory rate of 8 breaths/min and is difficult to arouse. The nurse should immediately:
- Decrease the PCA basal rate by 50%
- Administer naloxone per protocol and apply supplemental oxygen (Correct answer)
- Stimulate the patient verbally and recheck in 5 minutes
- Request an order for a lower opioid dose for the next PCA refill
Correct answer: Administer naloxone per protocol and apply supplemental oxygen
Respiratory rate <10 breaths/min with decreased level of consciousness indicates opioid-induced respiratory depression requiring naloxone reversal.
Question 6: Which serum marker is the most sensitive early indicator of anastomotic leak following colorectal surgery?
- Serum albumin
- C-reactive protein (CRP) on postoperative day 3-5 (Correct answer)
- Prothrombin time (PT/INR)
- Serum amylase
Correct answer: C-reactive protein (CRP) on postoperative day 3-5
Elevated CRP on postoperative days 3-5 is the most sensitive laboratory marker for detecting anastomotic leak before clinical signs appear.
Question 7: A nurse caring for a patient after total laryngectomy understands that the patient breathes exclusively through:
- A tracheostomy with an intact upper airway backup
- A permanent neck stoma with no connection to the upper airway (Correct answer)
- An oral airway adjunct placed by anesthesia
- Nasal cannula oxygen delivered via the nares
Correct answer: A permanent neck stoma with no connection to the upper airway
Total laryngectomy creates a permanent stoma as the only airway; the trachea is separated from the pharynx, so no upper airway connection exists.
MSNCB Surgical Procedures & Postoperative Care 5
A patient recovering from abdominal aortic aneurysm repair suddenly develops mottling of both lower extremities, absent pedal pulses, and severe pain.
The nurse recognizes this as: