Postoperative Care and Monitoring Practice Questions
20 free Postoperative Care and Monitoring practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A nurse in the PACU is caring for a client who just arrived after abdominal surgery. Which assessment finding should the nurse report to the healthcare provider immediately?
- A Serosanguineous drainage noted on the surgical dressing
- B Absent bowel sounds in all four quadrants
- C Snoring respirations and an oxygen saturation of 89%
- D A urine output of only 20 mL over the past hour
Correct answer: Snoring respirations and an oxygen saturation of 89%
Snoring respirations indicate potential airway obstruction, and an oxygen saturation below 90% is a critical sign of hypoxemia requiring immediate intervention. Airway and oxygenation are always the highest priority in postoperative care.
A client is 6 hours postoperative following a thyroidectomy. The nurse notes that the client has developed a hoarse voice and is complaining of 'tingling' in the fingers. What is the nurse's priority action?
- A Assess for Trousseau's sign and check serum calcium levels.
- B Reassure the client that hoarseness is normal after intubation.
- C Encourage the client to use an incentive spirometer.
- D Administer a dose of IV morphine for pain.
Correct answer: Assess for Trousseau's sign and check serum calcium levels.
Tingling in the fingers (paresthesia) after thyroid surgery can indicate hypocalcemia due to accidental parathyroid gland damage or removal. Assessing for Trousseau's or Chvostek's sign is critical to prevent tetany and seizures.
The nurse is preparing to discharge a client who had a laparoscopic cholecystectomy. Which statement by the client indicates a need for further teaching?
- A 'I will notify my doctor if I develop a fever over 101°F.'
- B 'I can take a tub bath tomorrow as long as I dry the incisions.'
- C 'I will avoid lifting any heavy objects for the next several weeks.'
- D 'I might have some right shoulder pain for a day or two.'
Correct answer: 'I can take a tub bath tomorrow as long as I dry the incisions.'
After laparoscopic surgery, clients should generally avoid soaking in a tub, pool, or hot tub until the incisions are fully healed to prevent infection. Showers are typically allowed, but immersion is contraindicated in the early recovery phase.
A postoperative client has a Jackson-Pratt (JP) drain. Which action should the nurse take to ensure the drain is functioning effectively?
- A Keep the bulb inflated to allow gravity drainage.
- B Pin the drain to the client's bedsheet to prevent pulling.
- C Irrigate the tubing with 30 mL of sterile normal saline every 4 hours.
- D Compress the bulb to establish negative pressure after emptying.
Correct answer: Compress the bulb to establish negative pressure after emptying.
A Jackson-Pratt drain relies on negative pressure to pull fluid from the surgical site. Compressing the bulb after emptying creates the suction necessary for the drain to function properly.
A nurse is assessing a client 24 hours after an open reduction internal fixation (ORIF) of the hip. The client is suddenly confused, tachypneic, and has petechiae on the chest. What should the nurse suspect?
- A Deep vein thrombosis (DVT)
- B Hypovolemic shock
- C Fat embolism syndrome
- D Hospital-acquired pneumonia
Correct answer: Fat embolism syndrome
Fat embolism syndrome is a risk after long bone fractures or orthopedic surgery. The triad of confusion (neurological changes), tachypnea (respiratory distress), and petechiae is classic for this condition.
Which nursing intervention is most effective in preventing postoperative atelectasis and pneumonia?
- A Administering prophylactic antibiotics as ordered
- B Restricting fluid intake to 1,000 mL per day
- C Encouraging frequent incentive spirometer use and splinted coughing
- D Maintaining the client in a supine position for 24 postoperative hours
Correct answer: Encouraging frequent incentive spirometer use and splinted coughing
Incentive spirometry and deep breathing promote alveolar expansion and the clearance of secretions. Splinting the incision with a pillow helps the client cough more effectively by reducing pain.
A client in the PACU has a suspected evisceration of an abdominal wound. What is the immediate nursing action?
- A Push the protruding organs back into the abdominal cavity.
- B Apply a dry, sterile gauze dressing over the wound.
- C Cover the wound with towels moistened in sterile saline.
- D Place the client in a high-Fowler's position.
Correct answer: Cover the wound with towels moistened in sterile saline.
Evisceration is a surgical emergency. The nurse must protect the exposed organs from drying and infection by covering them with sterile, saline-moistened dressings and notifying the surgeon immediately.
The nurse is monitoring a client who received spinal anesthesia. Which finding requires immediate intervention?
- A The client reports a headache when sitting up.
- B The client is unable to move their toes 1 hour after the procedure.
- C The client's blood pressure drops from 120/80 to 102/60 mmHg.
- D The client's respiratory rate is 8 breaths per minute.
Correct answer: The client's respiratory rate is 8 breaths per minute.
While hypotension and headaches are known side effects of spinal anesthesia, a respiratory rate of 8 indicates that the anesthesia may be ascending and affecting the diaphragm. This is a life-threatening complication requiring immediate respiratory support.
A client is 12 hours postoperative from a total knee arthroplasty. Which assessment is the priority for the nurse?
- A Assessing neurovascular status of the affected limb
- B Monitoring the client's temperature
- C Evaluating the client's appetite
- D Checking the surgical dressing for drainage or bleeding
Correct answer: Assessing neurovascular status of the affected limb
Neurovascular assessment (pulses, color, temperature, sensation, and movement) is the priority after orthopedic surgery to ensure that blood flow and nerve function are intact. Any compromise could lead to permanent tissue damage.
What is the primary purpose of administering an opioid antagonist like naloxone in the postoperative period?
- A To treat postoperative nausea and vomiting
- B To increase the sedative effects of anesthesia
- C To reverse significant opioid-induced respiratory depression
- D To enhance the analgesic effect of the primary pain medication
Correct answer: To reverse significant opioid-induced respiratory depression
Naloxone is used to reverse the effects of opioids, particularly when a client is experiencing severe respiratory depression or excessive sedation that compromises their safety.
A postoperative client has not voided for 8 hours since returning from surgery. What is the nurse's first action?
- A Perform a bladder scan immediately.
- B Insert a straight catheter immediately.
- C Increase the IV fluid rate.
- D Palpate the symphysis pubis for tenderness.
Correct answer: Perform a bladder scan immediately.
A bladder scan is a non-invasive way to determine the amount of urine in the bladder. This data helps the nurse decide if the issue is urinary retention or decreased urine production (dehydration/renal issues).
When assessing a postoperative wound, the nurse notes thick, yellow-green drainage. How should the nurse document this finding?
- A Serous drainage
- B Sanguineous drainage
- C Serosanguineous drainage
- D Purulent drainage
Correct answer: Purulent drainage
Purulent drainage is thick, opaque, and can be yellow, green, or brown. It is often a sign of infection and should be reported to the healthcare provider.
A nurse is caring for a client who is 48 hours postoperative. The client's calf is red, warm, and tender to the touch. Which action should the nurse avoid?
- A Notifying the healthcare provider
- B Elevating the affected leg
- C Massaging the affected area
- D Applying warm compresses as ordered
Correct answer: Massaging the affected area
Massaging the calf of a client with a suspected DVT is strictly contraindicated because it can dislodge the clot, leading to a pulmonary embolism. The nurse should keep the client on bed rest until further evaluation.
A client is 1 day postoperative and has been prescribed a clear liquid diet. Which item can the nurse safely provide?
- A Clear apple juice
- B Vanilla pudding
- C Orange juice with pulp
- D Cream of chicken soup
Correct answer: Clear apple juice
A clear liquid diet consists of liquids that are transparent at room temperature, such as apple juice, broth, and gelatin. Pudding and cream soups are part of a full liquid diet.
The nurse is monitoring a client's PCA (Patient-Controlled Analgesia) pump. What is the most important vital sign to monitor frequently?
- A Blood pressure level
- B Temperature
- C Heart rate
- D Respiratory rate
Correct answer: Respiratory rate
The most dangerous side effect of opioid use via PCA is respiratory depression. The nurse must monitor the respiratory rate and sedation level to ensure the client is not over-sedated.
What is the primary reason for keeping a client NPO until gag reflexes return after surgery?
- A To reduce the risk of aspiration pneumonia
- B To prevent postoperative weight gain
- C To minimize the occurrence of flatulence
- D To ensure the client is hungry enough to eat a balanced meal
Correct answer: To reduce the risk of aspiration pneumonia
If a client eats or drinks before their protective airway reflexes (gag and swallow) have returned, they are at high risk for aspirating contents into the lungs, leading to pneumonia.
A client is 2 days postoperative from abdominal surgery. The nurse notes that the client has a diminished appetite and a slightly distended abdomen. What is the nurse's priority assessment?
- A Auscultate bowel sounds and ask about flatus.
- B Assess for a positive Homan's sign.
- C Check the surgical site for signs of infection.
- D Monitor the client's electrolyte levels.
Correct answer: Auscultate bowel sounds and ask about flatus.
Distension and lack of appetite postoperatively can indicate a paralytic ileus. The nurse must assess for the return of bowel function by listening for bowel sounds and asking if the client is passing gas.
A nurse is caring for a postoperative client with a history of COPD. Which oxygen delivery method is generally preferred to maintain a precise Fio2?
- A Simple face mask
- B Nasal cannula
- C Non-rebreather mask
- D Venturi face mask
Correct answer: Venturi face mask
A Venturi mask is preferred for clients with COPD because it delivers a very precise and consistent concentration of oxygen, which is essential for clients who may rely on a hypoxic drive to breathe.
Which laboratory value would be most concerning in a client who is 2 days postoperative?
- A WBC count 18,000/mm³
- B Hemoglobin 11.5 g/dL
- C Potassium 3.8 mEq/L
- D Platelets 200,000/mm³
Correct answer: WBC count 18,000/mm³
A WBC count of 18,000 is significantly elevated (leukocytosis) and often indicates a postoperative infection. While some elevation is normal due to surgical stress, this level warrants further investigation.
A nurse is providing teaching for a client using an incentive spirometer. How should the nurse instruct the client to breathe?
- A Exhale forcefully into the device.
- B Take a quick, shallow breath in.
- C Breathe normally through the nose while holding the mouthpiece.
- D Take a slow, deep breath in and hold it for 3 seconds.
Correct answer: Take a slow, deep breath in and hold it for 3 seconds.
The goal of incentive spirometry is to achieve maximum lung expansion. This is done by taking a slow, deep inhalation and holding it at the peak to keep the alveoli open.