**The Surgical & Perioperative Vault: Pre-op, Intra-op,
and Post-op Nursing**
1. A patient is scheduled for an elective cholecystectomy. The patient reports taking aspirin 81 mg daily
for primary prevention. The nurse's priority action is to:
A) Administer the aspirin as usual on the morning of surgery
B) Notify the surgeon that the patient takes aspirin
C) Tell the patient to stop aspirin 24 hours before surgery
D) Instruct the patient to take a double dose of aspirin the day before surgery
💫RATIONALE✔️✔️: Aspirin inhibits platelet aggregation for 7-10 days and increases bleeding risk. The
surgeon should be notified; they may advise stopping aspirin 5-7 days before surgery if the risk of
stopping is low.
💫ANSWER✔️✔️: B) Notify the surgeon that the patient takes aspirin
---
2. A patient is 2 hours post-operative after a total knee replacement. The patient reports pain 8/10. The
nurse administers morphine 4 mg IV. One hour later, the patient reports pain 7/10 and is drowsy. What
is the priority action?
A) Administer a second dose of morphine
B) Notify the provider that pain is not controlled
C) Reassess pain in 30 minutes
D) Administer a non-opioid analgesic (acetaminophen)
💫RATIONALE✔️✔️: Pain reduction from 8/10 to 7/10 is inadequate. Notify the provider for possible dose
adjustment or addition of non-opioid analgesics. Do not give another dose without order.
💫ANSWER✔️✔️: B) Notify the provider that pain is not controlled
---
,3. A patient is 1 day post-operative after abdominal surgery. The nurse notes that the patient has not
passed flatus and has absent bowel sounds. What is the priority action?
A) Notify the provider of a possible ileus
B) Encourage ambulation and oral intake
C) Insert a nasogastric tube
D) Administer a laxative
💫RATIONALE✔️✔️: Absent bowel sounds and no flatus after abdominal surgery are common due to
postoperative ileus. Monitor and encourage ambulation; do not feed until bowel sounds return. NG tube
if vomiting or distention.
💫ANSWER✔️✔️: B) Encourage ambulation and oral intake
---
4. A patient is being prepared for a colonoscopy. Which instruction is most important?
A) "You must drink all of the bowel preparation solution as directed."
B) "You may eat a light breakfast the morning of the procedure."
C) "You can take your blood pressure medication with a sip of water."
D) "You will be asleep during the procedure and won't feel anything."
💫RATIONALE✔️✔️: Complete bowel preparation is critical for adequate visualization. Incomplete prep
may require cancellation or repeat procedure. Clear liquids only the day before; NPO after midnight.
💫ANSWER✔️✔️: A) "You must drink all of the bowel preparation solution as directed."
---
5. A patient is 6 hours post-operative after a hip replacement. The patient's vital signs are: BP 100/60,
HR 110, RR 24, SpO2 94% on room air. The patient reports pain 6/10. What is the priority action?
A) Administer prescribed opioid analgesic
B) Apply oxygen at 2 L/min via nasal cannula
C) Assess the surgical dressing for bleeding
D) Increase the IV fluid rate
💫RATIONALE✔️✔️: Tachycardia with borderline BP may indicate hypovolemia (bleeding). The nurse
should first assess the dressing and for signs of hemorrhage before administering pain medication.
,💫ANSWER✔️✔️: C) Assess the surgical dressing for bleeding
---
6. A patient is 1 day post-operative after a thyroidectomy. The patient reports tingling around the mouth
and fingers. What is the priority action?
A) Administer calcium gluconate IV
B) Assess Chvostek and Trousseau signs
C) Notify the provider of possible hypocalcemia
D) Check the patient's serum calcium level
💫RATIONALE✔️✔️: Tingling post-thyroidectomy suggests hypocalcemia from accidental parathyroid
injury. Assess for Chvostek sign (facial twitching on tapping) and Trousseau sign (carpal spasm with BP
cuff). Notify provider and prepare for calcium.
💫ANSWER✔️✔️: B) Assess Chvostek and Trousseau signs
---
7. A patient is 4 hours post-operative after a cesarean section. The patient's uterus is boggy and
deviated to the right. The patient has not voided since the catheter was removed 2 hours ago. What is
the priority action?
A) Massage the fundus firmly
B) Insert a Foley catheter
C) Administer oxytocin 10 units IM
D) Notify the provider of uterine atony
💫RATIONALE✔️✔️: A boggy, displaced uterus suggests a distended bladder. Insert a Foley catheter (or
straight catheterize) to empty the bladder. After emptying, the fundus should become firm.
💫ANSWER✔️✔️: B) Insert a Foley catheter
---
8. A patient is being discharged after an appendectomy. Which instruction is most important for
preventing wound infection?
A) "Keep the incision dry and covered for 48 hours."
B) "Report any redness, warmth, or drainage from the incision."
, C) "Shower with soap and water and pat the incision dry."
D) "Apply antibiotic ointment to the incision daily."
💫RATIONALE✔️✔️: Teaching the patient to report signs of infection (redness, warmth, drainage, fever) is
priority for early detection and treatment. Keeping the incision dry is also important but reporting is key.
💫ANSWER✔️✔️: B) "Report any redness, warmth, or drainage from the incision."
---
9. A patient is 2 hours post-operative after a carotid endarterectomy. The nurse notes that the patient's
blood pressure is 160/95 mmHg. What is the priority action?
A) Administer labetalol 10 mg IV as ordered
B) Notify the provider of hypertension
C) Recheck blood pressure in 15 minutes
D) Apply a warm compress to the neck
💫RATIONALE✔️✔️: Hypertension after carotid endarterectomy increases the risk of bleeding and
hyperperfusion syndrome. Notify provider for antihypertensive medication. Do not delay.
💫ANSWER✔️✔️: B) Notify the provider of hypertension
---
10. A patient is 1 day post-operative after a bowel resection. The patient's nasogastric (NG) tube is
draining 800 mL of greenish fluid in 8 hours. What is the priority action?
A) Irrigate the NG tube with normal saline
B) Notify the provider of high output
C) Document the output as expected
D) Clamp the NG tube to prevent dehydration
💫RATIONALE✔️✔️: NG output of 800 mL in 8 hours (100 mL/hr) is high and can lead to electrolyte
imbalances and hypovolemia. Notify provider for possible replacement fluids and electrolyte
monitoring.
💫ANSWER✔️✔️: B) Notify the provider of high output
---
and Post-op Nursing**
1. A patient is scheduled for an elective cholecystectomy. The patient reports taking aspirin 81 mg daily
for primary prevention. The nurse's priority action is to:
A) Administer the aspirin as usual on the morning of surgery
B) Notify the surgeon that the patient takes aspirin
C) Tell the patient to stop aspirin 24 hours before surgery
D) Instruct the patient to take a double dose of aspirin the day before surgery
💫RATIONALE✔️✔️: Aspirin inhibits platelet aggregation for 7-10 days and increases bleeding risk. The
surgeon should be notified; they may advise stopping aspirin 5-7 days before surgery if the risk of
stopping is low.
💫ANSWER✔️✔️: B) Notify the surgeon that the patient takes aspirin
---
2. A patient is 2 hours post-operative after a total knee replacement. The patient reports pain 8/10. The
nurse administers morphine 4 mg IV. One hour later, the patient reports pain 7/10 and is drowsy. What
is the priority action?
A) Administer a second dose of morphine
B) Notify the provider that pain is not controlled
C) Reassess pain in 30 minutes
D) Administer a non-opioid analgesic (acetaminophen)
💫RATIONALE✔️✔️: Pain reduction from 8/10 to 7/10 is inadequate. Notify the provider for possible dose
adjustment or addition of non-opioid analgesics. Do not give another dose without order.
💫ANSWER✔️✔️: B) Notify the provider that pain is not controlled
---
,3. A patient is 1 day post-operative after abdominal surgery. The nurse notes that the patient has not
passed flatus and has absent bowel sounds. What is the priority action?
A) Notify the provider of a possible ileus
B) Encourage ambulation and oral intake
C) Insert a nasogastric tube
D) Administer a laxative
💫RATIONALE✔️✔️: Absent bowel sounds and no flatus after abdominal surgery are common due to
postoperative ileus. Monitor and encourage ambulation; do not feed until bowel sounds return. NG tube
if vomiting or distention.
💫ANSWER✔️✔️: B) Encourage ambulation and oral intake
---
4. A patient is being prepared for a colonoscopy. Which instruction is most important?
A) "You must drink all of the bowel preparation solution as directed."
B) "You may eat a light breakfast the morning of the procedure."
C) "You can take your blood pressure medication with a sip of water."
D) "You will be asleep during the procedure and won't feel anything."
💫RATIONALE✔️✔️: Complete bowel preparation is critical for adequate visualization. Incomplete prep
may require cancellation or repeat procedure. Clear liquids only the day before; NPO after midnight.
💫ANSWER✔️✔️: A) "You must drink all of the bowel preparation solution as directed."
---
5. A patient is 6 hours post-operative after a hip replacement. The patient's vital signs are: BP 100/60,
HR 110, RR 24, SpO2 94% on room air. The patient reports pain 6/10. What is the priority action?
A) Administer prescribed opioid analgesic
B) Apply oxygen at 2 L/min via nasal cannula
C) Assess the surgical dressing for bleeding
D) Increase the IV fluid rate
💫RATIONALE✔️✔️: Tachycardia with borderline BP may indicate hypovolemia (bleeding). The nurse
should first assess the dressing and for signs of hemorrhage before administering pain medication.
,💫ANSWER✔️✔️: C) Assess the surgical dressing for bleeding
---
6. A patient is 1 day post-operative after a thyroidectomy. The patient reports tingling around the mouth
and fingers. What is the priority action?
A) Administer calcium gluconate IV
B) Assess Chvostek and Trousseau signs
C) Notify the provider of possible hypocalcemia
D) Check the patient's serum calcium level
💫RATIONALE✔️✔️: Tingling post-thyroidectomy suggests hypocalcemia from accidental parathyroid
injury. Assess for Chvostek sign (facial twitching on tapping) and Trousseau sign (carpal spasm with BP
cuff). Notify provider and prepare for calcium.
💫ANSWER✔️✔️: B) Assess Chvostek and Trousseau signs
---
7. A patient is 4 hours post-operative after a cesarean section. The patient's uterus is boggy and
deviated to the right. The patient has not voided since the catheter was removed 2 hours ago. What is
the priority action?
A) Massage the fundus firmly
B) Insert a Foley catheter
C) Administer oxytocin 10 units IM
D) Notify the provider of uterine atony
💫RATIONALE✔️✔️: A boggy, displaced uterus suggests a distended bladder. Insert a Foley catheter (or
straight catheterize) to empty the bladder. After emptying, the fundus should become firm.
💫ANSWER✔️✔️: B) Insert a Foley catheter
---
8. A patient is being discharged after an appendectomy. Which instruction is most important for
preventing wound infection?
A) "Keep the incision dry and covered for 48 hours."
B) "Report any redness, warmth, or drainage from the incision."
, C) "Shower with soap and water and pat the incision dry."
D) "Apply antibiotic ointment to the incision daily."
💫RATIONALE✔️✔️: Teaching the patient to report signs of infection (redness, warmth, drainage, fever) is
priority for early detection and treatment. Keeping the incision dry is also important but reporting is key.
💫ANSWER✔️✔️: B) "Report any redness, warmth, or drainage from the incision."
---
9. A patient is 2 hours post-operative after a carotid endarterectomy. The nurse notes that the patient's
blood pressure is 160/95 mmHg. What is the priority action?
A) Administer labetalol 10 mg IV as ordered
B) Notify the provider of hypertension
C) Recheck blood pressure in 15 minutes
D) Apply a warm compress to the neck
💫RATIONALE✔️✔️: Hypertension after carotid endarterectomy increases the risk of bleeding and
hyperperfusion syndrome. Notify provider for antihypertensive medication. Do not delay.
💫ANSWER✔️✔️: B) Notify the provider of hypertension
---
10. A patient is 1 day post-operative after a bowel resection. The patient's nasogastric (NG) tube is
draining 800 mL of greenish fluid in 8 hours. What is the priority action?
A) Irrigate the NG tube with normal saline
B) Notify the provider of high output
C) Document the output as expected
D) Clamp the NG tube to prevent dehydration
💫RATIONALE✔️✔️: NG output of 800 mL in 8 hours (100 mL/hr) is high and can lead to electrolyte
imbalances and hypovolemia. Notify provider for possible replacement fluids and electrolyte
monitoring.
💫ANSWER✔️✔️: B) Notify the provider of high output
---
