A sedated patient in the PACU is making snoring sounds, and the chest rises with little air movement. What should the nurse do first?
Reposition the head and jaw to open the airway
✓
Increase the rate of the IV fluids
Give the next dose of IV pain medication
Recheck the surgical dressing for drainage
Correct Answer
Reposition the head and jaw to open the airway
Snoring respirations in a drowsy patient usually mean the relaxed tongue and soft tissues are partly blocking the upper airway, so repositioning the head and jaw opens it, and an oral or nasopharyngeal airway can be added if needed. Airway comes before every other assessment. Increasing the rate of the IV fluids does nothing for an obstructed airway. Giving the next dose of IV pain medication would deepen sedation and worsen the obstruction. Rechecking the surgical dressing for drainage is a later step, needed only after the airway is open.
Category: PACU Recovery
Question 2
A drowsy patient in the PACU suddenly begins to vomit. What is the nurse's immediate action?
Lay the patient flat on the back
Turn the patient onto the side
✓
Raise the legs on pillows
Offer sips of clear liquid
Correct Answer
Turn the patient onto the side
Turning a drowsy patient onto the side lets vomitus drain out of the mouth instead of being inhaled, and suction can then clear what remains. Laying the patient flat on the back makes it more likely that vomitus will enter the airway. Raising the legs on pillows does nothing to protect the airway. Offering sips of clear liquid is unsafe, because fluid given while the patient is vomiting adds to the risk of inhaling it.
Category: PACU Recovery
Question 3
Which finding shows that a patient is ready to leave the PACU?
Pain that still needs frequent IV opioid doses
Vomiting with each change of position
Alertness and orientation back to the patient's usual level
✓
Blood pressure that keeps drifting lower
Correct Answer
Alertness and orientation back to the patient's usual level
Before transfer or discharge, the patient should have recovered from anesthesia with alertness and orientation at baseline, along with stable vital signs and effective pain control. Pain that still needs frequent IV opioid doses shows that pain is not yet controlled. Vomiting with each change of position shows that nausea is not managed. Blood pressure that keeps drifting lower is unstable and needs evaluation before any transfer.
Category: PACU Recovery
Question 4
A patient going home after same-day surgery asks for a dose of IV pain medication just before leaving. Why does the nurse avoid giving it?
IV pain medicine acts too slowly to help on the ride home
IV medicine loses its effect once the patient starts moving
The IV route is reserved for patients who have a fever
The patient would need monitoring afterward for respiratory depression
✓
Correct Answer
The patient would need monitoring afterward for respiratory depression
IV opioids act quickly and can slow breathing, so a patient who receives one must be observed afterward; giving it right before discharge would send the patient home during the period of greatest risk, and oral analgesics are used instead. The idea that IV pain medicine acts too slowly to help on the ride home is wrong, because the IV route acts fastest. IV medicine does not lose its effect once the patient starts moving. The IV route is not reserved for patients who have a fever; that claim has no basis in pain management.
Category: Postoperative Pain
Question 5
A patient who speaks little English is grimacing after an appendectomy and cannot use the numeric pain scale. What should the nurse do?
Use a picture-based faces scale and request a medical interpreter
✓
Ask the patient's young child to interpret the pain rating
Judge the pain from the vital signs alone
Wait to treat pain until an English-speaking relative arrives
Correct Answer
Use a picture-based faces scale and request a medical interpreter
A picture-based faces scale lets the patient point to the face that matches the pain without relying on words, and a trained medical interpreter then confirms the details accurately. Asking the patient's young child to interpret the pain rating is inappropriate and invites errors. Judging the pain from the vital signs alone misses pain that does not change vital signs. Waiting to treat pain until an English-speaking relative arrives leaves the patient suffering needlessly.
Category: Postoperative Pain
Question 6
On the first day after surgery, which finding needs prompt follow-up by the nurse?
Mild redness along the edges of the incision
Diminished breath sounds with a rising need for oxygen
✓
Fatigue and soreness at the incision
Mild nausea after the first meal
Correct Answer
Diminished breath sounds with a rising need for oxygen
Diminished breath sounds together with an increasing oxygen requirement point to a developing respiratory complication such as atelectasis or pneumonia and call for immediate action. Mild redness along the edges of the incision is part of the expected early inflammatory response. Fatigue and soreness at the incision are common after surgery. Mild nausea after the first meal is usually expected and is treated if it persists or worsens.
Category: Respiratory and Clot Complications
Question 7
While waking in the PACU, a patient is briefly confused about where they are and then reorients. Which explanation fits this finding?
A surgical site infection
A pulmonary embolism
Lingering effects of the anesthetic agents
✓
A paralytic ileus
Correct Answer
Lingering effects of the anesthetic agents
Mild, short-lived confusion right after surgery commonly comes from residual anesthesia and clears as the drugs wear off; confusion that persists needs evaluation for problems such as cerebral hypoxia. A surgical site infection takes longer to develop and shows at the incision. A pulmonary embolism causes sudden chest pain and shortness of breath. A paralytic ileus causes abdominal distension, nausea and absent bowel sounds.
Category: PACU Recovery
Question 8
A patient coughs after abdominal surgery, and the nurse finds the incision edges pulled apart with underlying tissue visible. What should the nurse do?
Pull the edges together with adhesive strips
Help the patient walk to relieve the strain
Apply a warm compress to improve blood flow
Cover the wound with a sterile dressing and notify the surgeon
✓
Correct Answer
Cover the wound with a sterile dressing and notify the surgeon
Separation of the wound edges is dehiscence: the nurse covers the wound with a sterile dressing, keeps the patient calm and still to avoid further strain, and notifies the surgeon right away. Pulling the edges together with adhesive strips is not an appropriate nursing fix for an opened surgical wound. Helping the patient walk to relieve the strain adds stress to the weakened incision. Applying a warm compress to improve blood flow is not sterile and delays the surgical evaluation the patient needs.
Category: Wound and Infection Care
Question 9
A patient's surgical dressing is soaked with bright red blood, the blood pressure is falling and the heart rate is rising. What is the nurse's first action?
Apply firm pressure over the bleeding site
✓
Remove the dressing to measure the wound
Document the amount of drainage
Offer the patient oral fluids
Correct Answer
Apply firm pressure over the bleeding site
These findings suggest postoperative hemorrhage. Direct pressure slows the bleeding while the nurse stays with the patient, calls the surgeon and prepares for IV fluids, blood products and a possible return to surgery. Removing the dressing to measure the wound wastes time and can increase bleeding. Documenting the amount of drainage comes after the patient is stabilized. Offering the patient oral fluids is unsafe when the patient may need to return to surgery.
Category: Bleeding and Hemodynamics
Question 10
After abdominal surgery, a patient has a distended abdomen with nausea and vomiting and is diagnosed with a paralytic ileus. Which assessments does the nurse trend to judge whether the ileus is resolving?
Breath sounds and oxygen saturation
Bowel sounds and abdominal girth
✓
Urine output and bladder volume
Incision edges and drainage
Correct Answer
Bowel sounds and abdominal girth
Paralytic ileus is a temporary loss of intestinal motility, so returning bowel sounds and a shrinking abdominal girth show that peristalsis is recovering; the nurse also encourages ambulation, gives IV fluids and manages a nasogastric tube if ordered. Breath sounds and oxygen saturation track respiratory complications rather than bowel function. Urine output and bladder volume track urinary retention. Incision edges and drainage show how the wound is healing, not how the bowel is moving.
Category: Gastrointestinal Complications
Question 11
Several days after hip surgery, a patient develops sudden chest pain, rapid breathing, a racing heart and blood-tinged sputum. Which complication do these findings suggest?
Atelectasis
Pneumonia
Pulmonary embolism
✓
Paralytic ileus
Correct Answer
Pulmonary embolism
Sudden chest pain, tachypnea, tachycardia and coughing up blood after surgery point to a clot that has traveled to the lungs, a pulmonary embolism, which calls for a rapid response. Atelectasis causes diminished breath sounds and lower oxygen saturation without sudden chest pain. Pneumonia usually develops more gradually, with fever, crackles and purulent sputum. Paralytic ileus affects the bowel and causes abdominal distension and absent bowel sounds.
Category: Respiratory and Clot Complications
Question 12
Since surgery, a patient has not voided, reports lower abdominal discomfort and has a firm bladder above the pubic bone. Which action gives objective data on how much urine is retained?
Insert an indwelling catheter right away
Limit the patient's fluid intake
Measure the abdominal girth
Perform a bladder scan
✓
Correct Answer
Perform a bladder scan
A portable bladder scanner uses ultrasound to estimate the volume of urine without a catheter, so it confirms retention noninvasively before next steps are chosen. Inserting an indwelling catheter right away skips noninvasive measures and adds infection risk. Limiting the patient's fluid intake does not empty the bladder. Measuring the abdominal girth tracks bowel distension, not bladder volume.
Category: Urinary Retention
Question 13
Which patient has the greatest risk of urinary retention after surgery?
A patient who had pelvic surgery under epidural anesthesia
✓
A patient who had a skin lesion removed under local anesthesia
A patient who had a wrist fracture repaired with a nerve block
A patient who had a shoulder repaired under general anesthesia
Correct Answer
A patient who had pelvic surgery under epidural anesthesia
Lower abdominal or pelvic surgery, epidural anesthesia and a history of urinary problems all raise the risk of postoperative urinary retention, and this patient has two of those risk factors. A patient who had a skin lesion removed under local anesthesia has no surgery or anesthesia near the bladder's nerve supply. A patient who had a wrist fracture repaired with a nerve block has only the arm numbed. A patient who had a shoulder repaired under general anesthesia has some risk from anesthesia but no pelvic surgery or epidural.
Category: Urinary Retention
Question 14
A patient develops a fever the evening after surgery. Along with the ordered fever-reducing medication, which comfort measure is appropriate?
Add warm blankets to prevent chills
Remove extra blankets and apply cool washcloths
✓
Restrict oral fluids until the fever breaks
Raise the room temperature
Correct Answer
Remove extra blankets and apply cool washcloths
Removing excess linens and clothing and placing cool washcloths on the forehead or feet help the body release heat, while the nurse also looks for a cause such as infection or a respiratory complication. Adding warm blankets to prevent chills traps heat. Restricting oral fluids until the fever breaks risks dehydration, because fever increases fluid loss. Raising the room temperature makes heat loss harder.
Category: Wound and Infection Care
Question 15
Which patient needs the closest monitoring of oxygenation while receiving opioids after surgery?
A patient with a history of migraines
A patient with mild knee osteoarthritis
A patient with obstructive sleep apnea
✓
A patient with seasonal allergies
Correct Answer
A patient with obstructive sleep apnea
In obstructive sleep apnea the upper airway already collapses during sleep, and opioids and residual anesthesia relax airway muscles further and blunt the drive to breathe, so oxygenation is watched closely. A patient with a history of migraines has no added airway risk. A patient with mild knee osteoarthritis has no condition that affects breathing. A patient with seasonal allergies does not have an obstructive breathing disorder during sleep.
Category: Respiratory and Clot Complications
Question 16
After surgery, a patient's blood pressure and heart rate are above baseline. The patient is grimacing and rates the incision pain as severe. Which cause should the nurse address?
Hemorrhage
Dehydration
Excess opioid effect
Uncontrolled pain
✓
Correct Answer
Uncontrolled pain
Pain triggers a stress response that raises blood pressure and heart rate, and the grimacing and severe pain rating point to it, so the nurse treats the pain and rechecks the vital signs. Hemorrhage typically lowers the blood pressure as the heart rate rises. Dehydration also tends to lower the blood pressure. Excess opioid effect causes sedation, slow breathing and lower blood pressure.
Category: Bleeding and Hemodynamics
Question 17
A postoperative patient is hypotensive with dry mucous membranes and low urine output, and the lungs are clear. Which order does the nurse anticipate?
An IV fluid bolus
✓
An IV diuretic
Fluid restriction
A vasodilator
Correct Answer
An IV fluid bolus
Hypotension with signs of a fluid deficit is treated by restoring volume, typically with a bolus, a large volume of IV fluid given quickly, while the nurse watches for signs of overload. An IV diuretic removes fluid and would worsen the hypotension. Fluid restriction deepens the deficit. A vasodilator would lower the blood pressure further.
Category: Bleeding and Hemodynamics
Question 18
Which change at home should a patient report to the surgeon after discharge?
Mild itching along the healing incision
Increasing redness, warmth and drainage at the incision
✓
Tiredness during the first days at home
Slight bruising near the incision that is fading
Correct Answer
Increasing redness, warmth and drainage at the incision
Spreading redness, warmth, swelling and increasing or purulent drainage are signs of a surgical site infection and should be reported promptly. Mild itching along the healing incision is a common part of healing. Tiredness during the first days at home is expected after surgery. Slight bruising near the incision that is fading shows resolution rather than a new problem.
Category: Wound and Infection Care
Question 19
Why does the PACU nurse's handoff include the patient's orientation before surgery as well as now?
So neurological checks can be stopped on the unit
So the patient can be scheduled for discharge sooner
So the receiving nurse can recognize later changes in mental status
✓
So the family can be asked to make care decisions
Correct Answer
So the receiving nurse can recognize later changes in mental status
Knowing both the baseline and the current level of consciousness lets the receiving nurse tell an expected state from a new change, such as confusion that could signal low oxygen or an adverse drug reaction. Stopping neurological checks on the unit is not the purpose, because checks continue after transfer. Scheduling the patient for discharge sooner is not what this information is for. Asking the family to make care decisions is not appropriate for a patient who is able to decide.
Category: PACU Recovery
Question 20
A postoperative patient suddenly becomes hypotensive and starts breathing rapidly. What does the nurse do first?
Draw blood for a complete blood count
Ask the patient to rate the pain
Encourage use of the incentive spirometer
Assess airway, breathing and circulation
✓
Correct Answer
Assess airway, breathing and circulation
Acute hypotension or tachypnea calls for an immediate airway, breathing and circulation assessment, followed by repositioning or oxygen as needed, a check of the surgical site for bleeding and a call to the provider. Drawing blood for a complete blood count may be ordered later but does not stabilize the patient. Asking the patient to rate the pain is part of assessment but not the priority. Encouraging use of the incentive spirometer does not address a sudden change in condition.
Category: Bleeding and Hemodynamics