CSFA Postoperative Patient Management 3 — Questions and Answers
Question 1: When assessing a postoperative patient's pain using the numeric rating scale (NRS), the surgeon has ordered analgesics for pain rated 7 or above. A patient rates pain at 8 but appears calm and is watching TV. The surgical first assistant should:
- Administer the analgesic as ordered based on the patient's self-report (Correct answer)
- Withhold the analgesic because behavioral cues suggest mild pain
- Reassess in 30 minutes before administering
- Contact the surgeon to verify the order
Correct answer: Administer the analgesic as ordered based on the patient's self-report
Self-report is the gold standard for pain assessment; behavioral cues do not override the patient's rating, and the analgesic should be given per the order.
Question 2: A patient who underwent total knee replacement is on a multimodal pain regimen including scheduled acetaminophen, celecoxib, and PRN oxycodone. This approach is designed primarily to:
- Minimize opioid consumption by targeting multiple pain pathways (Correct answer)
- Eliminate the need for any opioid medications postoperatively
- Reduce the risk of acetaminophen hepatotoxicity
- Comply with hospital formulary requirements
Correct answer: Minimize opioid consumption by targeting multiple pain pathways
Multimodal analgesia combines agents with different mechanisms to achieve superior pain control while reducing opioid-related side effects.
Question 3: Which postoperative complication presents with sudden pleuritic chest pain, dyspnea, tachycardia, and decreased breath sounds on one side following a subclavian central line insertion?
- Pneumothorax (Correct answer)
- Pulmonary embolism
- Myocardial infarction
- Hemothorax
Correct answer: Pneumothorax
Pneumothorax from central line insertion presents with unilateral decreased breath sounds, pleuritic pain, and respiratory distress.
Question 4: A postoperative patient develops confusion, agitation, and visual hallucinations on postoperative day 2 after a prolonged orthopedic surgery. The MOST likely diagnosis in an elderly patient is:
- Postoperative delirium (Correct answer)
- Alcohol withdrawal
- Opioid toxicity
- Stroke
Correct answer: Postoperative delirium
Postoperative delirium is the most common neurologic complication in elderly surgical patients, typically peaking on POD 1-3.
Question 5: Which intervention is MOST effective in preventing postoperative deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty?
- Combination of pharmacologic anticoagulation and mechanical compression devices (Correct answer)
- Sequential compression devices alone
- Early ambulation alone
- Aspirin 81 mg daily alone
Correct answer: Combination of pharmacologic anticoagulation and mechanical compression devices
Combined pharmacologic and mechanical prophylaxis provides superior DVT prevention compared to either modality used alone in high-risk orthopedic procedures.
Question 6: A patient reports feeling a 'pop' and notices a pink watery discharge from their abdominal wound on postoperative day 5. The MOST likely complication is:
- Wound dehiscence with evisceration risk (Correct answer)
- Normal serosanguineous drainage
- Surgical site infection with abscess
- Hematoma formation
Correct answer: Wound dehiscence with evisceration risk
A 'popping' sensation followed by salmon-colored (serosanguineous) discharge is a classic presentation of fascial dehiscence requiring immediate wound assessment.
Question 7: Postoperative nausea and vomiting (PONV) is MOST strongly associated with which combination of patient and surgical factors?
- Female sex, non-smoker, history of PONV, and use of postoperative opioids (Correct answer)
- Male sex, obese, long surgery duration, and spinal anesthesia
- Age over 65, preoperative anxiety, and regional anesthesia
- Pediatric patient, laparoscopic surgery, and TIVA technique
Correct answer: Female sex, non-smoker, history of PONV, and use of postoperative opioids
The Apfel score identifies female sex, non-smoking status, history of PONV/motion sickness, and postoperative opioid use as the four major PONV risk factors.
CSFA Postoperative Patient Management 3
When assessing a postoperative patient's pain using the numeric rating scale (NRS), the surgeon has ordered analgesics for pain rated 7 or above.
A patient rates pain at 8 but appears calm and is watching TV.
The surgical first assistant should: