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Reduction of Risk Potential

NCLEX Post-Op Care Practice Questions

Quick answer

Post-op care questions test whether you can spot a surgical complication early and act in the right order. They sit inside Reduction of Risk Potential, which is 9 to 15 percent of the exam, and post-op scenarios show up in that section more than any other single topic.

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Most of these questions are built the same way. A client is one hour, one day or three days out from surgery, something changes, and you have to decide what it means and what to do first. The timeline matters a lot. A fever on day one and a fever on day five point to different problems, and the exam expects you to know which one. The trap students fall into is treating every post-op question as a "call the surgeon" question. Sometimes calling is right, but usually there is a nursing action you must do before you pick up the phone, and that action is the answer they want.

Practice questions

1

A client arrives in the PACU after a hernia repair under general anesthesia. The client is unresponsive, snoring, and has an oxygen saturation of 91 percent. Which action should the nurse take first?

  1. AApply a non-rebreather mask at 15 L/min
  2. BTurn the client onto the side and perform a jaw thrust
  3. CNotify the anesthesia provider
  4. DIncrease the IV fluid rate
Show answer

Answer: B

Snoring in an unconscious post-anesthesia client means the tongue is falling back and partly blocking the airway. Repositioning onto the side and opening the airway with a jaw thrust fixes the cause and is something the nurse can do in seconds.

Why the others are wrong

Oxygen does nothing if the airway is blocked, so A comes after the airway is open. Calling anesthesia (C) is reasonable if repositioning fails but is not first. Fluids (D) do not address an obstructed airway.

2

Twenty minutes into a procedure under inhaled anesthesia, the client's end-tidal CO2 rises sharply, the jaw is rigid, and the temperature climbs to 103.5 F. Which medication should the nurse prepare?

  1. ADantrolene
  2. BNaloxone
  3. CFlumazenil
  4. DAcetaminophen
Show answer

Answer: A

Rising CO2, muscle rigidity (especially the jaw) and a fast temperature climb after a triggering anesthetic are the signs of malignant hyperthermia. Dantrolene is the only drug that stops the runaway calcium release in the muscle, and it must be given right away.

Why the others are wrong

Naloxone (B) reverses opioids and flumazenil (C) reverses benzodiazepines, and neither treats this crisis. Acetaminophen (D) will not touch a temperature driven by muscle hypermetabolism and wastes time.

3

On the fourth day after an abdominal surgery, a client coughs and says, "Something gave way." The nurse sees a loop of bowel protruding through the incision. Which action should the nurse take first?

  1. APush the bowel gently back into the wound
  2. BCover the area with sterile gauze soaked in normal saline
  3. CApply an abdominal binder
  4. DDocument the finding and continue monitoring
Show answer

Answer: B

This is evisceration. The first action is to keep the exposed bowel moist and protected with saline-soaked sterile gauze, then place the client in low Fowler's with the knees bent to take tension off the abdomen, and call the surgeon. The client will go back to the operating room.

Why the others are wrong

Never push the organs back (A), as that introduces infection and can injure the bowel. A binder (C) would press on exposed tissue. Documenting and waiting (D) ignores a surgical emergency.

4

A client is 36 hours post-op from a bowel resection and has a temperature of 100.9 F, shallow breathing and diminished breath sounds at both bases. Which cause should the nurse suspect first?

  1. AWound infection
  2. BDeep vein thrombosis
  3. CAtelectasis
  4. DUrinary tract infection
Show answer

Answer: C

A low-grade fever in the first 24 to 48 hours with shallow breathing and diminished bases is atelectasis until proven otherwise. The lungs are not fully expanding because of pain, anesthesia and lying still.

Why the others are wrong

Wound infection (A) usually appears around day 3 to 5 with redness and drainage at the site. A DVT (B) tends to show up later in the week with calf findings. A UTI (D) is more typical on day 3 to 5, often after a catheter has been in place.

5

A client who had a knee replacement eight hours ago has not voided since surgery and reports lower abdominal pressure. Which action should the nurse take first?

  1. AInsert an indwelling urinary catheter
  2. BScan the bladder with a portable ultrasound
  3. CEncourage the client to drink 500 mL of water
  4. DRestrict fluids until the client voids
Show answer

Answer: B

Anesthesia and opioids slow the bladder, and many post-op clients retain urine. Before doing anything invasive, measure how much is actually in the bladder. A bladder scan is quick, non-invasive and tells you whether a catheter is needed.

Why the others are wrong

Catheterization (A) may be the end result, but it carries infection risk and should follow a scan showing a large volume and an attempt to void. Pushing fluids (C) into a full bladder makes discomfort worse. Restricting fluids (D) makes no sense for a hydration-dependent surgical client.

6

A client is two days post-op from a colon resection. The abdomen is distended, no bowel sounds are heard in any quadrant after five minutes of listening, and the client has vomited twice. Which conclusion should the nurse draw?

  1. AThis is the expected pattern on post-op day two
  2. BThe client may have a paralytic ileus and the surgeon should be notified
  3. CThe client needs a bolus of IV fluid and a clear liquid tray
  4. DThe client should ambulate and then eat a regular diet
Show answer

Answer: B

Bowel sounds normally start to return within 24 to 72 hours after abdominal surgery. Absent sounds plus distention and vomiting on day two point to a paralytic ileus, which needs the surgeon's attention and usually an NG tube to decompress the stomach.

Why the others are wrong

Quiet bowel sounds alone can be normal on day one (A), but distention and vomiting are not. Giving oral liquids (C) to a client who is vomiting with no peristalsis adds to the problem. Walking helps, but a regular diet (D) with no bowel function is unsafe.

7

A client has a morphine PCA pump after a hysterectomy. The client's spouse asks, "Can I press the button for her when she falls asleep so she does not wake up in pain?" Which response by the nurse is correct?

  1. A"Yes, as long as you wait at least ten minutes between doses."
  2. B"Only if her pain score is above 5 when she wakes."
  3. C"No. Only the client should press the button, because she will stop pressing it if she gets too sleepy."
  4. D"Yes, the pump will lock out any extra doses."
Show answer

Answer: C

The safety of a PCA pump depends on the client controlling the dose. A sleepy client stops pressing, which protects her from oversedation. If someone else presses the button, that safeguard is gone.

Why the others are wrong

Options A and D both allow family dosing and are unsafe no matter what the lockout interval is. Option B still has the spouse deciding when to dose, which is the same problem.

8

A nurse is teaching a client how to cough and deep breathe after an open cholecystectomy. Which instruction should be included?

  1. A"Hold a pillow firmly over the incision while you cough."
  2. B"Cough only when you feel mucus in your throat to avoid straining the sutures."
  3. C"Lie flat on your back to take the deepest breath."
  4. D"Take one quick breath and cough as hard as you can."
Show answer

Answer: A

Splinting the incision with a pillow or folded blanket supports the wound, reduces pain and lets the client cough effectively enough to clear secretions. The client should sit up, take two or three slow deep breaths, then cough from the chest with the pillow pressed over the incision.

Why the others are wrong

Waiting for mucus (B) means not clearing the lungs often enough, and splinting protects the sutures anyway. Lying flat (C) limits lung expansion. A single quick breath (D) does not move air to the bases.

9

A client who had a hip replacement yesterday asks why the nurse keeps asking her to get out of bed when she is in pain. Which explanation by the nurse is best?

  1. A"Walking helps your blood flow so you do not get a clot in your legs, and it wakes up your bowels and lungs."
  2. B"The surgeon ordered it, so we have to follow the order."
  3. C"It keeps you from needing as much pain medicine."
  4. D"You need to be independent before you can go home."
Show answer

Answer: A

Early ambulation prevents the main post-op complications: venous stasis and DVT, atelectasis and pneumonia, and slow return of bowel function. Telling the client the actual reasons helps her see the walk as part of recovery instead of a chore.

Why the others are wrong

"Because it is ordered" (B) is not teaching. Less pain medication (C) is not a reliable or main benefit. Independence (D) is a discharge goal, not the reason for walking on day one.

10

A client is three days post-op from a pelvic surgery. The client suddenly grabs the chest, is breathing fast and says, "I can't catch my breath." Which action should the nurse take first?

  1. ARaise the head of the bed, start oxygen and call the rapid response team
  2. BLay the client flat and elevate the legs
  3. CGive the ordered PRN morphine for chest pain
  4. DObtain a 12-lead ECG and wait for the result
Show answer

Answer: A

Sudden chest pain with dyspnea in a post-op client is an emergency. The nurse's first moves are to sit the client up to help breathing, apply oxygen and get help fast. Rapid response brings the team and equipment to the bedside while the nurse stays with the client.

Why the others are wrong

Lying flat with legs up (B) makes breathing harder and is for hypovolemia, not respiratory distress. Morphine (C) can depress breathing and should not be the first step. An ECG (D) may be done, but waiting on it delays help.

Quick tips

  • In the PACU the order is always airway, breathing, circulation. If the client is unconscious, side-lying with the head slightly extended beats any oxygen device.
  • Learn the fever clock: days 1 to 2 lungs (atelectasis), days 3 to 5 urine or wound, days 5 and beyond think DVT. The exam will give you the day for a reason.
  • If something comes out of the incision, your hands do three things: cover with saline-soaked sterile gauze, position low Fowler's with knees bent, and call the surgeon. Nothing goes back in.
  • Rigid jaw plus a rising temperature during anesthesia is malignant hyperthermia. The answer is dantrolene, and the question will not wait for lab values.
  • When a post-op client cannot void, scan before you catheterize. When a post-op client has no bowel sounds with distention and vomiting, that is an ileus, not "normal recovery."

Related topics

FAQ

What is the first thing a nurse does when a client comes to the PACU?

Check the airway. Look for snoring, stridor or no chest movement, position the client on the side if they are still unconscious, and then move to breathing and circulation. Vital signs and the surgical site come after the airway is confirmed open.

How do you tell wound dehiscence from evisceration?

Dehiscence is the wound edges separating, often with a sudden gush of pink or serous fluid. Evisceration is when organs come through the opening. Both need the surgeon, but evisceration is a return-to-OR emergency and the exposed bowel must be covered with moist sterile gauze right away.

What causes a fever on post-op day one?

Almost always atelectasis. The lungs do not fully expand because of anesthesia, pain and shallow breathing. The fix is coughing, deep breathing, incentive spirometry and getting the client up. Fever from infection usually does not start until day three or later.

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