CSFA Postoperative Patient Management 4 — Questions and Answers
Question 1: A patient's postoperative chest X-ray shows a wedge-shaped density in the right lower lobe. Combined with tachycardia, dyspnea, and elevated D-dimer, this presentation is MOST consistent with:
- Pulmonary embolism with Hampton's hump sign (Correct answer)
- Hospital-acquired pneumonia
- Atelectasis
- Pleural effusion
Correct answer: Pulmonary embolism with Hampton's hump sign
A Hampton's hump (wedge-shaped pleural-based density) in the setting of tachycardia and elevated D-dimer is a classic radiographic sign of pulmonary infarction from embolism.
Question 2: When educating a patient about incentive spirometry after open abdominal surgery, the surgical first assistant should instruct the patient to:
- Use it 10 times every 1-2 hours while awake, holding the breath at peak inhalation (Correct answer)
- Use it only when experiencing shortness of breath
- Exhale forcefully into the device to expand the lungs
- Use it at bedtime only to prevent respiratory fatigue
Correct answer: Use it 10 times every 1-2 hours while awake, holding the breath at peak inhalation
Incentive spirometry should be performed frequently while awake (every 1-2 hours) with sustained maximal inspiration to prevent atelectasis.
Question 3: A postoperative patient with a T6 spinal cord injury develops a sudden severe headache, hypertension (BP 210/110), bradycardia, and profuse diaphoresis above the injury level. The PRIORITY action is:
- Identify and remove the noxious stimulus (check catheter, bowel distension) (Correct answer)
- Administer IV antihypertensive medication immediately
- Place patient flat in bed and call a code
- Administer sublingual nitroglycerin
Correct answer: Identify and remove the noxious stimulus (check catheter, bowel distension)
Autonomic dysreflexia is a medical emergency triggered by noxious stimuli below the injury; removing the trigger (commonly bladder distension or pressure) is the first priority.
Question 4: Which postoperative electrolyte imbalance is MOST commonly associated with cardiac arrhythmias and is a known risk following prolonged nasogastric suctioning?
- Hypokalemia (Correct answer)
- Hypernatremia
- Hypocalcemia
- Hypermagnesemia
Correct answer: Hypokalemia
Prolonged NG suctioning removes gastric fluid rich in potassium and hydrogen ions, leading to hypokalemia and metabolic alkalosis that predispose to arrhythmias.
Question 5: A patient who had a Whipple procedure (pancreaticoduodenectomy) 3 days ago develops fever, leukocytosis, and a new onset of abdominal pain. Drain amylase levels are elevated 3x the upper limit of normal. This is MOST consistent with:
- Pancreatic fistula/leak (Correct answer)
- Wound infection
- Delayed gastric emptying
- Intra-abdominal abscess
Correct answer: Pancreatic fistula/leak
Elevated drain amylase greater than 3x the upper limit of normal on postoperative day 3 or later is the diagnostic criterion for a postoperative pancreatic fistula.
Question 6: The Aldrete score used for PACU discharge decisions evaluates which five parameters?
- Activity, respiration, circulation, consciousness, and oxygen saturation (Correct answer)
- Pain, nausea, blood pressure, consciousness, and urine output
- Activity, pain, respiration, temperature, and oxygen saturation
- Respiration, circulation, temperature, activity, and surgical site
Correct answer: Activity, respiration, circulation, consciousness, and oxygen saturation
The modified Aldrete score assesses activity level, respiratory effort, circulation (BP), consciousness, and oxygen saturation to determine PACU discharge readiness.
Question 7: A patient in the PACU who received spinal anesthesia for an inguinal hernia repair is unable to move their legs 3 hours postoperatively. The MOST appropriate action is:
- Monitor and document, as motor block resolution after spinal anesthesia can take 2-4 hours (Correct answer)
- Call a code stroke and activate the stroke team immediately
- Reposition the patient and encourage leg movement exercises
- Administer neostigmine to reverse the block
Correct answer: Monitor and document, as motor block resolution after spinal anesthesia can take 2-4 hours
Spinal anesthesia can produce motor blockade lasting 2-4 hours depending on the agent used; this is expected and requires monitoring, not emergency intervention in the absence of other neurologic signs.
CSFA Postoperative Patient Management 4
A patient's postoperative chest X-ray shows a wedge-shaped density in the right lower lobe.
Combined with tachycardia, dyspnea, and elevated D-dimer, this presentation is MOST consistent with: