SINGSON, KRISTINE DONDE C.

BSN 3-A6
Medical Surgical Nursing 1 – Lecture
Session #3: Postoperative Nursing Care
CHECK FOR UNDERSTANDING (60 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be
given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in
you answer/ratio is not allowed. You are given 60 minutes for this activity:

Case Study: Read and examine the case thoroughly.

Patient Profile: S.B., a 28-year-old female school teacher, is admitted to the PACU following a
cystoscopy for recurrent bladder infections and hematuria. The procedure was scheduled as
outpatient surgery and was performed under IV sedation.

Postoperative Orders
✔ Vital signs per routine

✔ Discontinue IV before discharge

✔ Patient to void before discharge

✔ Cipro 500 mg PO every 6 hr. for 10 days

✔ Tylenol #3 1–2 tabs every 3–4 hr. PRN for pain

✔ Patient to call office to schedule follow-up appointment

Discussion Questions
1. Priority Decision: What priority nursing actions will be required to progress S.B. toward discharge?
Answer: Priority nursing actions for this patient are orienting as the patient recovers from the sedating
medication, promoting voiding, and providing oral fluids and intake.

2. What precautions will be required in ambulating S.B. after surgery?

Answer: Syncope is possible because of the effects of the drug and instrumentation of the bladder.
The patient should be slowly progressed to ambulation by elevating the head of the bed, then
dangling the legs, and then standing at the side of the bed before attempting ambulation.

3. What problems might interfere with discharging S.B. home in a timely manner?
Answer: Inability to void is the most likely problem. The patient could also have respiratory depression
or unstable vital signs because of the effects of the drugs or have complications such as bladder
bleeding.

4. How will the nurse determine that S.B.is ready to be discharged home?
Answer: The nurse can determine this by using standard discharge criteria for PACUs—stable vital
signs, awake and oriented, no excessive bleeding or drainage, and no respiratory depression—in
addition to the specific criteria ordered for this patient.

5. What are the unique needs of discharging a patient home as opposed to a clinical unit?
Answer: In an outpatient setting, the patient also needs to be alert and ambulatory with the ability to
provide self-care near the level of preoperative functioning. Postoperative pain, nausea, and vomiting
must be controlled and the patient must be accompanied by an adult to drive her home. No opioids
should have been given for 30 minutes before discharge.

6.Priority Decision: Based on the data presented, what are the priority nursing diagnoses?
Answer: Based on the data above, the priority nursing diagnoses are risk for injury related to sedation,
and Acute pain related to bladder irritation.

Multiple Choice

1. What does progression of patients through various phases of care in a post anesthesia care unit
(PACU) primarily depend on?

a. Condition of patient
b. Type of anesthesia used
c. Preference of surgeon
d. Type of surgical procedure
ANSWER: A
RATIO: Although some surgical procedures and drug administration require more intensive
postanesthesia care, how fast and through which levels of care patients are moved depend on the
condition of the patient. 

2. Priority Decision: Upon admission of a patient to the PACU, the nurse’s priority assessment is

a. vital signs.
b. surgical site.
c. respiratory adequacy.
d. level of consciousness.
ANSWER: C
RATIO: Physiologic status of the patient is always prioritized with regard to airway; breathing, and
circulation, and respiratory adequacy is the first assessment priority of the patient on admission to the
PACU from the operating room.

3. How is the initial information given to the PACU nurses about the
surgical patient?

a. A copy of the written operative report

b. A verbal report from the circulating nurse
c. A verbal report from the anesthesia care provider (ACP)
d. An explanation of the surgical procedure from the surgeon
ANSWER: C
RATIO: The admission of the patient to the PACU is a joint effort between the ACP, who is responsible
for supervising the postanesthesia recovery of the patient, and the PACU nurse, who provides care
during anesthesia recovery.

4. To prevent agitation during the patient’s recovery from anesthesia, when should the nurse begin
orientation explanations?

a. When the patient is awake

b. When the patient first arrives in the PACU
c. When the patient becomes agitated or frightened
d. When the patient can be aroused and recognizes where he or she is
ANSWER: B
RATIO: Even before patients awaken from anesthesia, their sense of hearing returns and all activities
should be explained by the nurse from the time of admission to the PACU to assist in orientation and
decrease confusion.

5. What is included in the routine assessment of the patient’s cardiovascular function on

admission to the PACU?

a. Monitoring arterial blood gases

b. Electrocardiographic (ECG) monitoring
c. Determining fluid and electrolyte status
d. Direct arterial blood pressure monitoring
ANSWER: B
RATIO: ECG monitoring is performed on patients to assess initial cardiovascular problems during
anesthesia recovery. Fluid and electrolyte status is an indication of renal function and determinations
of arterial blood gases and direct arterial blood pressure monitoring are used only in special
cardiovascular or respiratory problems.

6. With what are the postoperative respiratory complications of atelectasis and aspiration of gastric
contents associated?

a. Hypoxemia
b. Hypercapnia
c. Hypoventilation
d. Airway obstruction
ANSWER: A
RATIO: Hypoxemia occurs with atelectasis and aspiration as well as pulmonary edema, pulmonary
embolism, and bronchospasm. Hypercapnia is caused by decreased removal of CO2 from the
respiratory system that could occur with airway obstruction or hypoventilation. 

7. To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious,

what will the nurse do?

a. Encourage deep breathing

b. Elevate the head of the bed
c. Administer oxygen per mask
d. Position the patient in a side-lying position
ANSWER: D
RATIO: An unconscious or semiconscious patient should be placed in a lateral position to protect the
airway from obstruction by the tongue.

8. Priority Decision: To promote effective coughing, deep breathing, and ambulation in the postoperative
patient, what is most important for the nurse to do?

a. Teach the patient-controlled breathing

b. Explain the rationale for these activities
c. Provide adequate and regular pain medication
d. Use an incentive spirometer to motivate the patient
ANSWER: C
RATIO: Incisional pain is often the greatest deterrent to patient participation in effective ventilation
and ambulation and adequate and regular analgesic medications should be provided to encourage
these activities. 

9. While assessing a patient in the PACU, the nurse finds that the patient’s blood pressure is below the
preoperative baseline. The nurse determines that the patient has residual vasodilating effects of
anesthesia when what is assessed?

a. A urinary output >30 mL/hr.

b. An oxygen saturation of 88%
c. A normal pulse with warm, dry, pink skin
d. A narrowing pulse pressure with normal pulse
ANSWER: C
RATIO: Hypotension with normal pulse and skin assessment is typical of residual vasodilating effects of
anesthesia and requires continued observation. 

10. Priority Decision: A patient in the PACU has emergence delirium manifested by agitation and
thrashing. What should the nurse assess for first in the patient?

a. Hypoxemia
b. Neurologic injury
c. Distended bladder
d. Cardiac dysrhythmias
ANSWER: A
RATIO: The most common cause of emergence delirium is hypoxemia and initial assessment should
evaluate respiratory function.