NCLEX post-operative care practice questions

After surgery, watch for the early signs of bleeding, infection, blood clots, pneumonia and ileus, and know which come first.

1. Question 1

   The day after a laparoscopic cholecystectomy, a client reports pain in the right shoulder. Vital signs are normal, and the abdomen is soft. What should the nurse tell the client?

   • A."This may mean you are having a heart attack."
   • B."The gas used to inflate your abdomen can irritate the diaphragm and cause shoulder pain. Walking helps it go away."
   • C."Your shoulder was injured from how you were positioned."
   • D."You should stay in bed until the pain goes away."
   Show answer and explanation

   Answer: B

   During laparoscopy, carbon dioxide inflates the abdomen. Leftover gas irritates the diaphragm, and the pain is felt in the shoulder. It usually goes away within 1 to 3 days. Walking and position changes help.

   • A. With normal vital signs and a typical surgical history, this pain is most likely from the gas used during surgery. Frightening the client is not appropriate.
   • B. Correct. Carbon dioxide left in the abdomen irritates the diaphragm, and the pain is felt in the shoulder. Walking helps the body absorb the gas.
   • C. Positioning injury is possible but much less likely. Referred gas pain is the common cause after laparoscopy.
   • D. Bed rest slows gas absorption and raises the risk of other complications. Walking is encouraged.

   Key concept: Shoulder pain after laparoscopic surgery is usually referred pain from leftover gas.

   Tip: Gas under the diaphragm talks through the shoulder.

2. Question 2

   A client is 3 days after an above-the-knee amputation. Which action should the nurse take to prevent a hip flexion contracture?

   • A.Keep a pillow under the residual limb at all times
   • B.Keep the head of the bed raised to 60 degrees most of the day
   • C.Have the client lie prone for 20 to 30 minutes several times a day
   • D.Place a pillow between the thighs while sitting
   Show answer and explanation

   Answer: C

   After a leg amputation, the hip tends to stay bent, which can lead to a contracture that makes walking with a prosthesis hard. The client lies prone several times a day if tolerated, avoids long periods of sitting and avoids pillows under the residual limb after the first day.

   • A. A pillow under the limb keeps the hip bent and promotes a flexion contracture.
   • B. Sitting up for long periods keeps the hip flexed.
   • C. Correct. Lying on the stomach stretches the hip flexor muscles and keeps the hip straight.
   • D. A pillow between the thighs causes abduction, which can lead to an abduction contracture.

   Key concept: Prevent hip flexion contracture after amputation by keeping the hip extended.

   Tip: Belly time keeps the hip straight.

3. Question 3

   On day 5 after an open abdominal surgery, a client coughs and says, "I felt something give way." The nurse sees loops of bowel coming through the incision. Which action should the nurse take first?

   • A.Gently push the bowel back into the abdomen
   • B.Help the client sit upright in a chair
   • C.Leave the room to call the surgeon
   • D.Cover the wound with sterile gauze moistened with sterile saline
   Show answer and explanation

   Answer: D

   Evisceration is a surgical emergency. The nurse stays with the client, covers the organs with sterile saline-moistened dressings, places the client in low Fowler position with knees flexed, and has someone notify the surgeon. The client will need to return to surgery.

   • A. The nurse must never try to replace the organs. This can injure the bowel and introduce infection.
   • B. Sitting upright increases pressure in the abdomen and can push more bowel out. The client should lie in low Fowler position with knees bent.
   • C. The nurse should stay with the client and use the call light or ask another person to call the surgeon.
   • D. Correct. A sterile, moist dressing keeps the exposed bowel from drying out and limits contamination until surgery.

   Key concept: Exposed organs must be kept moist and sterile. Never reinsert them.

   Tip: Evisceration: Stay, Cover moist, Knees up, Call for help.

4. Question 4

   A 5-year-old child returned from a tonsillectomy 4 hours ago. Which finding should the nurse report to the provider right away?

   • A.The child says the throat hurts when swallowing
   • B.The child has bad breath
   • C.The child does not want to drink much juice
   • D.The child swallows over and over while sleeping
   Show answer and explanation

   Answer: D

   Bleeding is the most serious complication after tonsillectomy. Because blood trickles down the throat, children often swallow it instead of spitting it out. Frequent swallowing, frequent throat clearing, vomiting of bright red blood and a rising pulse are warning signs.

   • A. Throat pain is expected after tonsillectomy and is treated with analgesics.
   • B. Bad breath is common during healing and is not urgent.
   • C. Children often drink less because of pain. The nurse encourages fluids but this is not an emergency.
   • D. Correct. Frequent swallowing suggests the child is swallowing blood from the surgical site. This is an early sign of hemorrhage.

   Key concept: After tonsillectomy, frequent swallowing is a sign of bleeding until proven otherwise.

   Tip: Gulp, gulp, gulp = blood.

5. Question 5

   An 82-year-old client is on day 2 after hip fracture surgery. The client was alert yesterday but is now confused, pulling at the IV line and does not know where they are. Which action should the nurse take first?

   • A.Apply soft wrist restraints
   • B.Check the SpO2 and vital signs
   • C.Give a dose of haloperidol
   • D.Tell the family this is likely dementia
   Show answer and explanation

   Answer: B

   Delirium is a sudden change in attention and thinking. In older adults after surgery, common causes include hypoxia, infection, fluid and electrolyte problems, pain, urinary retention and medicines. The nurse assesses oxygenation and vital signs first, then other causes, and notifies the provider.

   • A. Restraints can increase agitation and injury. They are a last resort and do not address the cause.
   • B. Correct. Sudden confusion in an older adult after surgery can be caused by hypoxia, infection, bleeding or pain. The nurse looks for a physical cause first.
   • C. An antipsychotic may be used later for severe agitation, but treating the behavior first can hide a serious cause.
   • D. Dementia develops slowly. A sudden change over hours points to delirium, which has a cause that must be found.

   Key concept: New confusion is a symptom, not a diagnosis. Look for the physical cause, starting with oxygen.

   Tip: Sudden confusion? Check the oxygen first.