Surgical procedures are classified by urgency (elective, urgent, emergency) and by extent/risk (minor vs major). Knowing these categories helps nurses anticipate surgical urgency, preparation needs, and potential risks.

Rationale for correct answer:

3. Major, emergency: This surgery involves significant risk, requires entry into the abdominal cavity, and is performed immediately to control hemorrhage and prevent death. It fits both the major and emergency categories.

Rationale for incorrect answers:

1. Minor, diagnostic: Minor diagnostic procedures are usually planned, low-risk, and involve minimal tissue disruption (eg, biopsy, endoscopy).

2. Minor, elective: Elective surgeries are scheduled in advance and are not life-saving (eg, hernia repair, cosmetic procedures).

4. Major, palliative: Palliative procedures aim to relieve symptoms without curing (eg, debulking tumors).

Take home points:

• Major surgery involves significant tissue disruption and higher risks.
• Emergency surgery is unplanned, done immediately, and lifesaving.

General anesthesia causes a reversible loss of consciousness along with analgesia, amnesia, muscle relaxation, and suppression of reflexes. It is distinct from local/regional anesthesia, which only blocks sensation in a specific body part without affecting consciousness.

Rationale for correct answer:

4. Localized loss of sensation: This is the purpose of local or regional anesthesia, not general anesthesia. Students identifying this as a purpose of general anesthesia show a knowledge gap.

Rationale for incorrect answers:

1. Loss of consciousness: General anesthesia induces complete unconsciousness, rendering the patient unaware of pain and surroundings.

2. Relaxation of skeletal muscles: General anesthesia provides muscle relaxation, which facilitates intubation and surgical manipulation.

3. Reduction of reflex action: It suppresses reflexes (like gag or cough reflex) to allow safe surgical and anesthetic procedures.

Take home points:

• General anesthesia- unconsciousness, amnesia, analgesia, reflex suppression, and muscle relaxation.
• Local anesthesia- localized numbness without loss of consciousness; confusing the two indicates a gap in understanding.

Valid informed consent requires capacity (ability to understand and decide), comprehension (understands risks/benefits/alternatives), and voluntariness (not coerced). A witness’s role is to verify the signature is the patient’s and that the patient appears to sign voluntarily and knowingly.

Rationale for correct answer:

2. A 45-year-old patient who is oriented and alert: Adult, alert, and oriented patients who demonstrate understanding and voluntariness have capacity to consent; the witness may attest the signature.

Rationale for incorrect answers:

1. A 92-year-old patient who is severely confused: Severe confusion indicates lack of decision-making capacity; such a patient cannot give valid informed consent. A legal surrogate or court order is required.

3. A 10-year-old patient who is oriented and alert: Minors generally cannot provide legal consent, except in specific legal exceptions (e.g., emancipated minor, some treatment categories).

4. A 36-year-old patient who has had a narcotic premedication: Recent narcotic premedication can impair consciousness, judgement, and comprehension. If the patient is sedated or cognitively impaired by meds, consent is not valid.

Take home points:

• Only witness consent when the patient is an adult who is alert, oriented, and not impaired by drugs, confusion, or intoxication.
• Minors and cognitively impaired patients generally cannot consent

The liver metabolizes many anesthetics and produces clotting factors; impairment increases risks of bleeding, drug toxicity, infection, and poor wound healing. Preoperative evaluation should screen for hepatocellular injury (ALT/AST), cholestasis/excretory problems (bilirubin), and synthetic function/coagulation (albumin, PT/INR).

Rationale for correct answer:

3. ALT, AST, bilirubin: ALT/AST reflect hepatocellular injury; bilirubin reflects excretory function/cholestasis. Together they are the best single-resource panel here to judge preop liver status and prompt further testing

Rationale for incorrect answers:

1. Serum electrolytes: Assess fluid/electrolyte and acid–base balance (e.g., Na⁺, K⁺, Cl⁻, HCO₃⁻). While severe cirrhosis can cause hyponatremia, electrolytes are not specific measures of hepatic function.

2. BUN, Creatinine: Primarily evaluate renal function and drug clearance by the kidneys. Important preoperatively, especially if combined liver-kidney disease is suspected, but these do not measure liver injury.

4. Serum albumin: A marker of hepatic synthetic function and nutritional status. Useful for chronic liver disease severity, but with a long half-life (~20 days) it’s less sensitive to acute changes and, alone, gives an incomplete picture of preop liver risk.

Take home points:

• For preop liver assessment, prioritize a liver panel (ALT, AST, bilirubin ± ALP/GGT) and add PT/INR and albumin to gauge synthetic function.
• Abnormal liver tests change surgical/anesthetic risk and management; investigate and optimize before proceeding when possible.

Grieving is a process that includes sadness, yearning, and adjustment as the person works through what the loss means for identity and role. Disturbed body image is a different concept: it implies a disturbed self-image often accompanied by shame or revulsion.

Rationale for correct answer:

2. Grieving: A normal reaction to an expected significant loss (loss of a breast, body image, role, or sense of femininity). Sadness expressed about losing the breast is characteristic of grieving.

Rationale for incorrect answers:

1. Disturbed Body Image: Defined as confusion in the mental picture of oneself; commonly shows shame, embarrassment, guilt, or revulsion about appearance.

3. Fear: Characterized by dread, alarm, or apprehension about threats; the client’s sadness does not primarily indicate fear.

4. Ineffective Coping: Shown by inability to ask for help, inappropriate defenses, or failure to meet role expectations.

Take home points:

• Grieving is a normal response to anticipated loss.
• Distinguish grief (sadness, adjustment) from disturbed body image (shame/repulsion) and from ineffective coping (maladaptive behaviors).

Preoperative teaching focuses on safety priorities that reduce immediate perioperative risks. NPO status is fundamental because a full stomach increases the risk of aspiration during induction of anesthesia. Other instructions that prevent complications: deep-breathing and coughing to prevent pulmonary complications, calf exercises to reduce DVT risk, and correct understanding of anticoagulant management.

Rationale for correct answer:

4. “The nurse showed me how to contract and relax my calf muscles.” This demonstrates effective teaching about preventing venous stasis and DVT, which are key postoperative complications, especially after abdominal surgery.

Rationale for incorrect answers:

1. “I cannot eat or drink anything after midnight.” Current ASA (American Society of Anesthesiologists) guidelines allow clear fluids up to 2 hours before elective surgery and a light meal up to 6 hours before.

2. “I’m not going to cough after surgery because it might open my incision.” Clients are taught to cough and deep-breathe postoperatively to prevent atelectasis and pneumonia. Nurses also teach splinting the incision with a pillow or hands to support the wound during coughing.

3. “I might have a stroke if I stop taking my anticoagulant.” Anticoagulants are usually stopped several days before surgery to minimize bleeding risk. The client’s statement reflects misunderstanding of perioperative medication management.

Take home points:

• Best indicator of effective preoperative teaching: patient verbalizes accurate prevention strategies.
• NPO guidelines have evolved - clear fluids may be allowed closer to surgery, so “NPO after midnight” is not always correct.

Ambulatory surgery requires focused, practical preoperative teaching because patients are admitted and discharged quickly. The most effective single method is clear, concise written instructions that the patient can take home and consult after discharge.

Rationale for correct answer:

4. Written instructions: For same-day/ambulatory surgery, clear written instructions (NPO, meds, arrival time, postop care, warning signs, contact info) are most effective because patients can refer to them at home when implementing postoperative care and when questions arise.

Rationale for incorrect answers:

1. Lectures are passive and may provide too much information at once; they are less practical for brief, preop teaching when the patient needs concise, usable instructions.

2. Discussion is interactive and good for clarifying questions, but in the ambulatory setting time is limited and patients may not remember verbal details once they leave.

3. Audiovisuals: Videos can efficiently demonstrate techniques and reinforce key points, but the patient still usually needs a written summary to take home for later reference.

Take home points:

• Provide concise written instructions for same-day surgery.
• Include: NPO rules, meds, activity limits, warning signs, follow-up.

The nurse’s role is to gather data that may influence anesthesia, surgical safety, and recovery. Priority questions target pain, medications, allergies, and lifestyle factors that alter healing and anesthesia response.

Rationale for correct answers:

1. “Are you experiencing any pain?”: Pain assessment is essential because uncontrolled preoperative pain can complicate stress responses, recovery, and overall comfort.

4. “Do you have any medication allergies?”: Allergies must always be assessed to prevent life-threatening anaphylaxis during surgery. This includes medications, latex, and anesthesia-related agents.

5. “Do you use drugs and/or tobacco products?”: Smoking and drug use impair wound healing, increase anesthesia risks, and compromise cardiovascular and respiratory stability.

Rationale for incorrect answers:

2. “Do you exercise on a daily basis?” While exercise habits reflect general health, they are not a priority in the immediate preoperative assessment. The nurse must focus on factors that directly impact anesthesia and surgical risks.

3. “When do you regularly take your medications?”: Although medication timing is useful, the standard preoperative question focuses more on what medications the patient is taking, not when.

Take home points:

• Preoperative assessment should focus on factors that affect anesthesia safety and healing (medications, allergies, drug/tobacco use, current pain).
• Effective pre-op questioning prevents complications and ensures safe surgical planning.

Preoperative assessment must include a careful medication history because some drugs markedly alter surgical risk. Anticoagulants are especially important because they increase bleeding and may need to be stopped days before surgery or managed with bridging. Other drug classes (sedatives, opioids, laxatives, herbal supplements) also affect anesthesia and recovery - they may cause respiratory depression, hemodynamic instability, electrolyte imbalance, or drug interactions.

Rationale for correct answer:

1. Anticoagulants (warfarin, DOACs, heparin) increase perioperative bleeding risk and often require careful stopping/timing and possible bridging- they are a major concern in preoperative medication review.

Rationale for incorrect answers:

2. Antacids generally do not increase surgical risk; they are sometimes used preop to reduce gastric acidity/aspiration risk. They are not a primary source of perioperative complications.

3. Laxatives can cause dehydration or electrolyte disturbances if overused, which may affect anesthesia tolerance, but they are usually less likely than anticoagulants to directly increase surgical risk.

4. Sedatives: Chronic sedative use poses risks- respiratory depression, interactions, tolerance/withdrawal.

Take home points:

• Anticoagulants are the highest concern preoperatively due to bleeding risk; always clarify timing of last dose and plan perioperative management.
• Do a full med reconciliation; manage sedatives, electrolytes, and interactions before surgery to reduce complications.

The hemodynamic signs of hypovolemic shock in a postoperative patient - tachycardia with a weak (thready) pulse, decreasing blood pressure, reduced urine output (oliguria), and cool, clammy skin from peripheral vasoconstriction.

Rationale for correct answer:

2. Hypovolemic shock: Classic features are compensatory tachycardia with a rapid, weak pulse, hypotension as volume loss progresses, oliguria, cool/clammy pale skin from peripheral vasoconstriction, and altered mental status.

Rationale for incorrect answers:

1. Thrombophlebitis: Usually produces localized signs in the affected limb- pain, redness, warmth, swelling, a tender, cord-like vein.

3. Pneumonia: Presents with respiratory symptoms (cough, sputum, dyspnea), fever, tachypnea and focal lung signs on auscultation; it may cause systemic signs if severe -sepsis.

4. Wound dehiscence: Manifests with separation of incision layers, increased drainage, visible sutures/staples disruption, possible evisceration and local pain.

Take home points:

• Differentiate localized complications from systemic shock by focusing on systemic perfusion signs.
• The combination of rapid, weak pulse + hypotension + low urine output + cool, clammy skin is a red flag for hypovolemic shock.

Acute surgical pain is typically most intense in the early postoperative period - commonly within the first 24 to 48 hours - because residual anesthesia and short-acting intraoperative analgesics wear off and inflammatory nociception increases. Nurses should anticipate and proactively manage pain using multimodal analgesia.

Rationale for correct answer:

3. 12 to 36 hours after surgery: For many procedures the analgesic requirement is highest once residual anesthesia and immediate intraoperative analgesia have worn off and inflammatory pain processes are peaking - which frequently falls in the 12-36 hour window.

Rationale for incorrect answers:

1. Immediately after surgery: Some pain exists immediately, but many patients have residual anesthesia and receive intraoperative/early postoperative IV analgesia (PCA or bolus) in PACU.

2. 4 hours after surgery: This may be a high-pain period for some procedures as anesthetics wear off, but many studies and clinical guidelines report that the worst pain is most often in the broader early postoperative window (first 24-48 hours).

4. 48 to 60 hours after surgery: By this time most patients’ acute surgical pain has begun to decline; while some moderate pain may persist.

Take home points:

• Anticipate highest analgesic needs during the first 24–48 hours post-op and plan multimodal pain control accordingly.
• Early, effective pain control- scheduled nonopioids, regional techniques and rescue opioids- reduces complications (poor cough/incentive spirometry, delayed mobilization).

Obesity changes physiologic responses to surgery and increases certain postoperative risks. Fatty tissue has relatively poor blood supply and oxygenation, which predisposes to wound infection and delayed healing. Obese patients also have higher rates of respiratory complications, venous thromboembolism, and technical difficulties during the operation.

Rationale for correct answer:

2. Impaired wound healing: Obesity is associated with poorer wound healing and higher wound-infection rates because adipose tissue is less vascular, surgical wound tension is greater, and obesity is often accompanied by comorbidities (eg, diabetes) that impede healing.

Rationale for incorrect answers:

1. Hunger is not a complication specifically associated with obesity after surgery; postoperative appetite varies and is influenced more by anesthesia, analgesics, and ileus than by body weight alone.

3. Hemorrhage: Obesity by itself is not the primary predictor for postoperative bleeding; technical difficulty can increase operative time or risk.

4. Gas pains: Gas pains (postop abdominal gas/discomfort) are common after abdominal surgery but are not specifically more likely because of obesity; they relate more to bowel manipulation, anesthesia, and immobility.

Take home points:

• Obese surgical patients are at increased risk for impaired wound healing and wound infection.
• Nursing priorities include close wound assessment, infection prevention, and measures that support tissue healing.

In the immediate postoperative period, sudden or increasing wound drainage together with tachycardia, hypotension, oliguria, and mental status changes (anxiety, restlessness) strongly suggest hemorrhage and hypovolemic shock.

Rationale for correct answer:

4. Hemorrhage: Restlessness is an early sign of decreased cerebral perfusion; tachycardia and hypotension reflect compensatory and then decompensatory circulatory failure.

Rationale for incorrect answers:

1. Thrombophlebitis typically causes localized limb pain, redness, warmth, and swelling - not generalized hypotension, tachycardia, and increased drainage from a surgical wound.

2. Atelectasis presents with tachypnea, dyspnea, decreased breath sounds, and low-grade fever - it does not explain a sudden drop in blood pressure with increased wound drainage.

3. Infection usually develops later and is associated with localized redness, warmth, purulent drainage, and sometimes fever; acute hypotension and tachycardia with increased surgical site drainage point toward active bleeding rather than established infection.

Take home points:

Immediate actions when suspecting acute hemorrhage:

• maintain airway/breathing
• control visible bleeding
• increase IV access
• begin fluid/blood resuscitation per protocol
• notify the surgical team/rapid response.

Thrombophlebitis and deep-vein thrombosis often presents with localized pain, tenderness, warmth, and unilateral swelling of the calf or thigh. Nurses should perform focused limb assessment: inspect for erythema and asymmetry, palpate for warmth and tenderness, and document objective measurements (calf circumference at a fixed point) daily to detect changes.

Rationale for correct answer:

2. By documenting daily calf circumference measurements: Serial calf measurements (taken at the same spot on both legs) objectively detect increasing unilateral swelling - an important sign of thrombophlebitis/DVT.

Rationale for incorrect answers:

1. By palpating the skin over the tibia and fibula: Palpating over the bones doesn’t assess the soft-tissue signs of venous inflammation or thrombus.

3. By recording vital signs obtained four times a day: Vitals may show fever or tachycardia with complications, but they aren’t sensitive or specific for detecting early thrombophlebitis.

4. By noting difficulty with ambulation: Difficulty walking is nonspecific and may reflect pain from many causes; it’s useful to note but is not a reliable primary assessment for thrombophlebitis.

Take home points:

• Use objective, serial calf circumference measurements and compare with the opposite leg to detect swelling early.
• Look also for localized tenderness, warmth, redness, and any sudden change in the limb - these findings warrant immediate reporting and further evaluation.

Atelectasis is a common postoperative complication caused by shallow breathing and immobility. Interventions such as incentive spirometry and deep breathing exercises are the most effective preventive measures.

Rationale for correct answers:

3. Use of the incentive spirometer: The incentive spirometer encourages deep breathing, lung expansion, and mobilization of secretions, directly preventing atelectasis after surgery.

Rationale for incorrect answers:

1. Use of intermittent compression stockings: Compression stockings prevent venous stasis and DVT, not atelectasis.

2. Heel-toe flexion: Heel-toe flexion promotes circulation in the lower extremities but does not prevent pulmonary collapse.

4. Abdominal splinting when coughing: Splinting provides support and reduces pain while coughing, but by itself it does not ensure full lung expansion as effectively as incentive spirometry.

Take home points:

• Incentive spirometry is the primary intervention to prevent atelectasis.
• Circulatory-focused interventions (compression stockings, leg exercises) address DVT, not respiratory complications.

In the PACU the nurse’s first priority is airway (A in ABCs). Once the airway is patent, the nurse can suction if needed, insert or maintain an appropriate airway adjunct, and administer oxygen or escalate care.

Rationale for correct answer:

4. Reposition the client to keep the tongue forward: For a semiconscious patient the immediate priority is to open and maintain a patent airway (head-tilt–chin-lift or jaw-thrust as appropriate) so air can move. This maneuver is quick and noninvasive.

Rationale for incorrect answers:

1. Place a pillow under the client’s head: A pillow may flex the neck and worsen upper airway obstruction from the tongue falling back. It does not reliably open the airway.

2. Remove the oropharyngeal airway: Unless the airway is known to be causing obstruction or eliciting a gag/vomiting reflex, removing an airway when it is actually helping patency can make the problem worse.

3. Administer oxygen by mask: Important, but not first if the airway is obstructed. Oxygen will not relieve hypoxia if airway patency is not established.

Take home points:

• Always address airway patency first in a dyspneic, altered patient.
• Don’t remove airway adjuncts unless they are known to be causing gagging or obstruction.
• If dyspnea persists after positioning, proceed to suction, insert or adjust airway adjuncts, and give oxygen.

When advancing a postoperative patient from NPO to clear liquids, the nurse checks for signs the GI tract and protective reflexes have returned: no nausea/vomiting, presence of bowel sounds or passage of flatus, intact gag reflex, and stable vital signs.

Rationale for correct answer:

1. Does not complain of nausea or vomiting: Absence of nausea or vomiting reduces aspiration risk and indicates the patient is more likely to tolerate oral intake.

3. States passing flatus: Passing flatus is an objective sign of returning bowel motility (ileus resolving) and supports advancing diet to clear liquids.

Rationale for incorrect answers:

2. Pain level is maintained at a rating of 2-3 out of 10: Good pain control is desirable, but a moderate pain score alone doesn’t guarantee GI tract readiness or safe swallowing.

4. Ambulates with minimal assistance: Ambulation shows overall stability and helps GI motility, but it is not by itself a direct indicator that the GI tract can tolerate oral intake.

5. Expresses feeling “hungry”: Subjective and not sufficient. Hunger does not confirm bowel function or absence of aspiration risk and should not be the sole reason to advance diet.

Take home points:

• Advance to clear liquids when objective signs of GI function and tolerance are present.
• Subjective cues (feeling hungry) and general stability (ambulating) are helpful context but do not replace primary clinical indicators of GI readiness.

The priority is to remove nonabsorbable sutures without injuring newly formed tissue or introducing contamination. That means assessing the wound first, using appropriate technique and instruments, lifting the knot, cutting the stitch close to the skin, and extracting the suture so contaminated external material is not pulled back through the wound.

Rationale for correct answers:

2. Grasp the suture at the knot with a pair of forceps: Lift the knot gently with forceps to expose the loop, stabilize the stitch, and allow safe placement of scissors beneath the suture for cutting. This minimizes trauma to the wound edges.

3. Place the curved tip of the suture scissors under the suture as close to the skin as possible: Cutting close to the skin limits contamination and eases atraumatic removal.

5. Remove alternate sutures first: Removing every other suture first helps maintain some wound support and lets you check approximation/healing as you go; if edges separate, you can stop and notify the provider. If the wound is well healed, sometimes all may be removed at once.

Rationale for incorrect answers:

1. Use clean technique: Suture removal is usually a sterile procedure.

4.Pull the suture material that is visible beneath the skin during removal: You must not pull the contaminated visible external portion of the suture through underlying tissue- that would drag external contaminants into the wound.

Take home points:

• Cut close, pull carefully.
• Always cut the suture as close to the skin as possible and remove the suture in a way that prevents dragging contaminated external material back through subcutaneous tissue.

Preoperative anxiety is common; patients need empathy and a safe space to express fears. The nurse’s best immediate response acknowledges the feeling and opens a conversation so underlying concerns (fear of death, anesthesia, pain, loss of control) can be explored, corrected, and managed. Therapeutic communication (open-ended invitation, active listening) improves trust.

Rationale for correct answer:

2. “Let’s talk about how you are feeling.” Invites the patient to express concerns, shows empathy, and lets the nurse assess the intensity and content of the fear.

Rationale for incorrect answers:

1. “You have a wonderful doctor.” Diverts attention from the patient’s feelings and gives a vague reassurance rather than exploring fear.

3. “Everyone wakes up from surgery!” False reassurance; minimizes the patient’s worry and may undermine trust.

4. “Don’t worry, you will be just fine.” Dismissive; it shuts down emotional expression instead of addressing it.

Take home points:

• Use open-ended, empathetic statements that invite expression rather than offering premature reassurance.
• Exploring fears lets you assess need for teaching, more explanation from anesthesia, or anxiolytic interventions-don’t dismiss or minimize.

Patient-controlled analgesia (PCA) gives the patient autonomy to push a button to receive a preset dose of analgesic, commonly IV opioid, with programmed lockouts and limits to prevent overdose.

Rationale for correct answer:

4. Administer their own analgesics: PCA lets the patient self-administer preset doses (usually opioid or other analgesic) when needed, within safety limits.

Rationale for incorrect answers:

1. Be totally pain free: PCA improves timely pain control but does not guarantee total absence of pain; goals are acceptable pain relief and function.

2. Take unlimited amounts of medication: PCA devices are programmed with fixed dose, lockout interval, and maximum limits to prevent overdose.

3. Choose the type of pain medication: The clinician prescribes the medication and PCA settings; the patient cannot change the drug.

Take home points:

• PCA - patient-initiated analgesia within clinician-set dose and safety parameters.

• PCA can improve pain control and patient satisfaction but requires monitoring for sedation and respiratory depression and teaching the patient proper use.

Thoracic incisions limit chest wall excursion and make coughing painful, so patients breathe more shallowly and cannot clear secretions effectively. This predisposes them to atelectasis and postoperative pneumonia.

Rationale for correct answer:

1. Respiratory system: A thoracic incision (thoracotomy, thoracic surgery) impairs chest wall movement, causes pain with deep breathing and coughing, and often leads to shallow respirations and ineffective cough - all of which increase risk for atelectasis and pneumonia.

Rationale for incorrect answers:

2. Circulatory system: Major thoracic surgery can affect hemodynamics in some cases, but the most immediate and common postoperative complications after a thoracic incision are pulmonary.

3. Digestive system: Digestive complications are more commonly related to abdominal surgery. A thoracic incision does not directly impair bowel motility the way abdominal manipulation does.

4. Nervous system: Neurologic complications are not the principal concern specifically from a thoracic incision; while pain and anesthesia affect the nervous system, the primary system at direct risk is respiratory.

Take home points:

• After thoracic surgery prioritize respiratory assessment and interventions- incentive spirometry, splinting, analgesia, early mobilization.
• Pain control that permits deep breathing and coughing is essential to prevent atelectasis and pneumonia.

Postoperative gas pain commonly results from anesthetic effects, decreased bowel motility, swallowed air, and manipulation of the bowel. Promoting early and frequent ambulation, position changes, and encouraging passing flatus are the most effective nonpharmacologic measures.

Rationale for correct answer:

3. Encourage frequent ambulation: Ambulation stimulates intestinal motility and helps move trapped gas, reducing distention and discomfort. It’s a first-line, low-risk intervention.

Rationale for incorrect answers:

1. Cough and deep breathe every 2 hours: Coughing and deep breathing primarily prevent pulmonary complications (atelectasis) and do not directly relieve intestinal gas.

2. Maintain NPO status for 48 hours: Prolonged NPO is unnecessary for routine gas pain and may delay return of bowel function; early oral intake as tolerated and activity often help.

4. Take vital signs every 4 hours: Monitoring vitals is important for overall postop care but will not directly relieve gas pain.

Take home points:

• Early ambulation is the single most effective nursing intervention to relieve postoperative gas pain by stimulating bowel motility.
• Use multimodal measures - positioning, ambulation, analgesia to allow activity, and ordered medications such as simethicone.

Body image refers to an individual’s perception of their physical self. Surgery that alters visible body parts (face, breasts, limbs) or sexual/reproductive organs carries the highest psychosocial impact. Nurses must anticipate these concerns, provide support, and involve counseling when needed.

Rationale for correct answer:

1. 19-year-old woman, facial laceration: Adolescents and young adults are particularly vulnerable to changes in body image because appearance and social acceptance are critical at this stage of psychosocial development.

Rationale for incorrect answers:

2. 42-year-old woman, gallbladder surgery: While scars may form, they are often small and hidden; adults in this age group generally have a more stable self-concept and body image compared to adolescents.

3. 14-year-old boy, fractured clavicle repair: Although body image is important in adolescence, clavicle repairs usually result in minimal visible long-term changes and full functional recovery.

4. 52-year-old man, inguinal hernia repair: Body image changes are minimal with this procedure, and psychosocial adaptation at this age tends to be less influenced by appearance.

Take home points:

• Visible surgical changes (especially on the face or reproductive areas) increase risk for disturbed body image.
• Age and developmental stage influence how strongly clients react to body image changes - adolescents and young adults are at greater risk.

Normal aging decreases lung elasticity, chest wall compliance, and vital capacity. These changes make older adults more prone to hypoventilation, atelectasis, and respiratory infections after anesthesia. Nursing care must focus on pulmonary hygiene: turning, coughing, deep breathing, and using incentive spirometry.

Rationale for correct answer:

2. Turn, cough, and deep breathe every 4 hours: Reduced vital capacity in older adults increases the risk of atelectasis and pneumonia postoperatively. Encouraging frequent deep breathing and coughing expands alveoli, promotes secretion clearance, and improves oxygenation.

Rationale for incorrect answers:

1. Take and record vital signs every shift: Vital signs help monitor overall stability but do not directly address the physiologic change of reduced vital capacity.

3. Encourage increased intake of oral fluids: Fluids are important for hydration and mucous membrane health, but they don’t directly improve vital capacity.

4. Assess bowel sounds daily: Monitoring bowel function is important after surgery, but it does not address the pulmonary risks related to decreased lung function.

Take home points:

• Older adults have decreased lung reserve, making pulmonary complications more likely after surgery.
• Frequent pulmonary exercises (turn, cough, deep breathe, incentive spirometry) are the most effective interventions to prevent atelectasis and pneumonia.

After surgery, immobility increases the risk of venous stasis, leading to DVT and emboli. Preventive measures such as leg exercises, early ambulation, elastic stockings, and sequential compression devices are essential parts of postoperative nursing care.

Rationale for correct answer:

4. Increase venous return: Surgery and immobility increase the risk of venous stasis, which predisposes patients to deep vein thrombosis and pulmonary embolism. Leg exercises contract the muscles of the lower extremities, which act as a pump to improve circulation and venous return.

Rationale for incorrect answers:

1. Promote respiratory function: While respiratory function is an important concern postoperatively, leg exercises specifically target circulation in the lower extremities, not the lungs.

2. Maintain functional abilities: Early ambulation and mobility exercises are used to maintain muscle tone and prevent deconditioning.

3. Provide diversional activities: Leg exercises are not intended as recreation. While they may distract briefly, the primary purpose is physiological, not psychological.

Take home points:

• Leg exercises after surgery prevent venous stasis and thrombus formation by promoting blood flow and venous return.
• Patient education is critical - when patients understand why they need to do leg exercises, they are more likely to comply, reducing the risk of DVT and pulmonary embolism.

Certain chronic conditions (diabetes, obesity, respiratory impairment) predispose clients to complications such as infection, poor healing, and respiratory compromise. Identifying these risks allows the nurse to implement preventive measures.

Rationale for correct answers:

1. Obesity increases surgical risk because excess adipose tissue reduces blood supply to tissues, impairs wound healing, and increases strain on the respiratory and cardiovascular systems. It also makes positioning and anesthesia management more difficult.

3. Delayed wound healing: Diabetes interferes with tissue perfusion and impairs immune response, increasing the risk of delayed wound healing and postoperative infections.

4. Ineffective vital capacity: Obesity can restrict chest expansion, reduce lung volume, and impair effective ventilation. This puts the client at higher risk for atelectasis and hypoxemia postoperatively.

Rationale for incorrect answers:

2. Prolonged bleeding time: There’s no evidence in the scenario that this client has a bleeding disorder. Prolonged bleeding time is a concern with anticoagulant therapy or platelet dysfunction, not specifically linked to this patient.

5. Immobility secondary to height: Height alone is not a risk factor for immobility or surgical complications. Immobility is more commonly associated with obesity, fractures, or neurologic impairment.

Take home points:

• Obesity and diabetes significantly increase surgical risks due to poor wound healing, infection risk, and respiratory limitations.
• Risk assessment guides pre- and post-op nursing care e.g., strict glucose control, pulmonary hygiene, infection prevention.

Effective handoff communication reduces errors and ensures continuity of care. Tools like SBAR, active listening, and nonverbal cues are evidence-based methods to enhance safety in the perioperative setting.

Rationale for correct answers:

2.Using a standardized SBAR tool: SBAR (Situation, Background, Assessment, Recommendation) provides a structured, concise, and effective method for handoff communication, reducing errors.

3. Being responsive in using nonverbal communication techniques: Nonverbal cues such as nodding, eye contact, and attentiveness enhance understanding and ensure the receiver interprets the message accurately.

5. Listening to the OR nurse’s questions: Active listening ensures clarification, avoids misinterpretation, and allows for questions about critical client details.

Rationale for incorrect answers:

1.Documenting assessment findings in the medical record: Documentation is essential but does not ensure direct communication between nurses in different areas. Timely, verbal handoff is more effective for safe surgical care.

4. Giving specific information to a transport technician: Transport staff are not responsible for clinical handoff. Critical pre-op details must be directly communicated nurse-to-nurse.

Take home points:

• SBAR and active listening are gold standards for safe handoffs.
• Direct communication between responsible nurses is essential; documentation or delegation alone is not sufficient.

Older adults have predictable physiologic changes (pulmonary stiffness, reduced diaphragmatic movement, diminished airway reflexes, decreased renal perfusion, altered pharmacodynamics) that lower physiologic reserve and increase vulnerability to anesthesia and surgical stress.

Rationale for correct answers:

1. Stiffened lung tissue: Aging causes decreased lung elasticity and increased chest-wall stiffness, reducing pulmonary compliance and reserve. This increases the risk of hypoventilation, atelectasis, and postoperative pulmonary complications.

2. Reduced diaphragmatic excursion: Older adults often have weaker respiratory muscles and reduced chest-wall mobility, which limits diaphragmatic movement. This promotes shallow breathing and inability to clear secretions effectively.

4. Reduced blood flow to kidneys: Renal blood flow and glomerular filtration decline with age. Reduced renal perfusion decreases drug clearance and increases susceptibility to renal injury and fluid/electrolyte imbalances during and after surgery.

Rationale for incorrect answers:

3. Increased laryngeal reflexes: Aging typically reduces protective airway reflexes (gag/cough), which increases risk of aspiration.

5. Increased cholinergic transmission: Normal aging is associated with a decline in cholinergic neurons/transmission; increased cholinergic activity is not typical and would not explain common geriatric perioperative risks.

Take home points:

• Anticipate respiratory and renal vulnerabilities in elderly surgical patients.
• Many protective reflexes and neurotransmitter activities decline with age.

A saturated postoperative dressing with serosanguineous output and physiologic signs of compromise suggests active bleeding and evolving hypovolemia. Timely, systematic interventions can prevent progression to shock.

Rationale for correct answers:

1. Notify surgeon: Saturated dressing may indicate active bleeding; the surgeon must be informed immediately for orders (return to OR, exploratory measures) or further directives.

5. Reinforce the dressing: If a dressing is saturated, do not remove it (removing may disrupt clot); reinforce with additional sterile dressings and apply gentle pressure as ordered to help control external bleeding while arranging definitive care.

Rationale for incorrect answers:

2. Maintain the IV fluid infusion: Maintaining or increasing IV access/fluids preserves venous access for volume resuscitation or blood transfusion and helps stabilize hemodynamics while interventions are arranged.

4. Monitor the patient’s vital signs every 5 to 10 minutes: Frequent vital-sign monitoring detects hemodynamic deterioration early (tachycardia, hypotension, rising respiratory rate) and guides resuscitation decisions.

3. Provide 2 L/min oxygen via nasal cannula: Oxygen may be helpful if the patient shows hypoxia, but it does not stop bleeding or replace lost volume. It’s supportive care and not the highest-priority immediate action when active bleeding is suspected.

Take home points:

• Treat increasing wound drainage and hemodynamic changes as potential hemorrhage.
• Do not remove a saturated dressing unless specifically ordered.
• Reinforce over it and apply pressure; removing it may worsen bleeding and dislodge clots.

risk of complications. It reduces ventilation since the patient avoids deep breaths, leading to shallow breathing. Ineffective coughing due to pain results in retained pulmonary secretions, which predispose to atelectasis or pneumonia. Severe pain also reduces appetite by impairing gastrointestinal function.

Rationale for correct answers:

1. Delayed ambulation: Pain that is uncontrolled makes patients reluctant or unable to get out of bed. This can contribute to immobility complications such as deep vein thrombosis, pneumonia, or pressure injuries.

2. Reduced ventilation: Pain (especially abdominal or thoracic surgical pain) makes patients reluctant to take deep breaths. This can lead to shallow breathing, poor oxygen exchange, and hypoxemia. It increases the risk for respiratory complications.

4. Retained pulmonary secretions: Pain discourages effective coughing and deep breathing. As a result, secretions accumulate in the lungs, which can lead to atelectasis and secondary pneumonia.

5. Reduced appetite: Severe pain can activate stress responses and decrease gastrointestinal motility, leading to nausea, poor appetite, and delayed nutrition. Good pain control improves recovery by allowing earlier intake of food and fluids.

Rationale for incorrect answers:

3. Catheter-associated urinary tract infection: While UTIs are a postoperative risk, they are linked to indwelling catheter duration, not unmanaged pain. Pain control does not directly prevent or cause this complication.

Take home points:

• Poorly controlled pain impairs breathing, mobility, and nutrition.
• Effective pain management promotes faster recovery and prevents pulmonary and mobility complications.