CSFA Postoperative Patient Management 5 — Questions and Answers
Question 1: Which postoperative complication is MOST associated with unilateral leg swelling, warmth, and a positive Homans' sign in a patient who had a 6-hour pelvic surgery?
- Deep vein thrombosis (DVT) (Correct answer)
- Superficial thrombophlebitis
- Lymphedema
- Compartment syndrome
Correct answer: Deep vein thrombosis (DVT)
Prolonged pelvic surgery causes venous stasis, and DVT presents with unilateral limb swelling, warmth, erythema, and calf pain with dorsiflexion (Homans' sign).
Question 2: A patient 6 hours after a laparoscopic cholecystectomy complains of right shoulder pain. The surgical first assistant should recognize this as:
- Referred pain from residual CO2 irritating the diaphragm (Correct answer)
- Signs of acute myocardial infarction requiring ECG
- Incisional pain radiating to the shoulder
- Pneumothorax causing referred pain
Correct answer: Referred pain from residual CO2 irritating the diaphragm
Residual carbon dioxide gas after laparoscopy irritates the diaphragm, which refers pain to the right shoulder via the phrenic nerve (C3-C5).
Question 3: When performing a postoperative surgical wound assessment, which finding requires IMMEDIATE notification of the surgeon?
- Wound edges separating with visible bowel loops (evisceration) (Correct answer)
- Small amount of serosanguineous drainage on the dressing
- Mild periincisional erythema limited to 1 cm
- Slight edema at wound edges on postoperative day 2
Correct answer: Wound edges separating with visible bowel loops (evisceration)
Evisceration (protrusion of abdominal organs through the wound) is a surgical emergency requiring immediate coverage with a sterile moist dressing and surgeon notification.
Question 4: A postoperative patient on a beta-blocker develops a heart rate of 48 bpm, blood pressure of 88/54 mmHg, and is symptomatic with dizziness. The MOST appropriate pharmacologic intervention is:
- Atropine IV for symptomatic bradycardia (Correct answer)
- Metoprolol IV to support cardiac conduction
- Digoxin to improve contractility
- Amiodarone for rate control
Correct answer: Atropine IV for symptomatic bradycardia
Atropine is the first-line treatment for symptomatic bradycardia by blocking vagal tone to increase heart rate.
Question 5: Following a thyroidectomy, a patient develops perioral numbness, tingling of the fingertips, and a positive Chvostek's sign. These findings are MOST consistent with:
- Hypocalcemia due to parathyroid gland injury (Correct answer)
- Hypocalcemia due to thyroid hormone deficiency
- Hyperkalemia from blood transfusion
- Hypomagnesemia from excessive diuresis
Correct answer: Hypocalcemia due to parathyroid gland injury
Inadvertent parathyroid removal or devascularization during thyroidectomy causes hypocalcemia, which presents with perioral numbness, tetany, and a positive Chvostek's sign.
Question 6: A patient with a history of obstructive sleep apnea (OSA) is recovering from a tonsillectomy under general anesthesia. Which postoperative precaution is MOST important?
- Continuous pulse oximetry monitoring and positioning in semi-Fowler's or lateral position (Correct answer)
- Aggressive opioid administration for pain control
- Immediate CPAP application regardless of oxygen saturation
- Early discharge to home within 2 hours per ERAS protocol
Correct answer: Continuous pulse oximetry monitoring and positioning in semi-Fowler's or lateral position
OSA patients are at high risk for respiratory obstruction postoperatively; continuous monitoring and non-supine positioning reduce airway collapse and hypoxia risk.
Question 7: Which assessment tool is MOST appropriate for evaluating pain in an intubated, sedated postoperative ICU patient who cannot self-report?
- Behavioral Pain Scale (BPS) or Critical Care Pain Observation Tool (CPOT) (Correct answer)
- Numeric Rating Scale (NRS 0-10)
- Visual Analog Scale (VAS)
- Wong-Baker FACES Pain Scale
Correct answer: Behavioral Pain Scale (BPS) or Critical Care Pain Observation Tool (CPOT)
The BPS and CPOT are validated behavioral observational tools designed specifically for assessing pain in non-verbal, sedated critically ill patients.
CSFA Postoperative Patient Management 5
Which postoperative complication is MOST associated with unilateral leg swelling, warmth, and a positive Homans' sign in a patient who had a 6-hour pelvic surgery?