Unit 4.4: Perioperative and Surgical Care

• Topic 01

  Preoperative Assessment and Fasting Guidelines

  45 questions
• Topic 02

  WHO Surgical Safety Checklist

  30 questions
• Topic 03

  Postoperative Monitoring

  30 questions
• Topic 04

  Wound Care, Drain Management, and Early Mobilisation

  45 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. A 58-year-old patient is 2 days post-anterior resection for rectal cancer. They have a midline abdominal wound, a pelvic drain in situ, a urinary catheter, and a peripheral IV cannula. On assessment, blood pressure lying is 124/78 mmHg and standing is 96/60 mmHg. They report dizziness when standing. Pain is 4/10 and analgesia was administered 20 minutes ago. The ERAS protocol targets standing and walking to the corridor. Which is the MOST appropriate nursing action?

   • A
     Do not mobilise to the corridor yet; the orthostatic hypotension (BP drop >20 mmHg systolic on standing) requires assessment — sit the patient on the bed edge, allow BP to stabilise, and reassess lying/standing BP before attempting further mobilisation
     Correct answer
   • B
     Give IV fluid bolus before mobilisation to address the hypotension, then proceed with corridor ambulation as per ERAS target
   • C
     Inform physiotherapy that the patient is not safe to mobilise and document this; no further nursing mobilisation attempts should occur until medical review
   • D
     Sit the patient out of bed in a chair and count this as meeting the ERAS mobilisation target; standing mobility is not required if orthostatic hypotension is present
   Explanation

   Orthostatic hypotension (systolic BP drop of >20 mmHg on standing) is a specific mobilisation barrier requiring stepwise management. The nurse should: pause progression to the corridor; sit the patient on the bed edge to allow cardiovascular adjustment; assess for dehydration (a common postoperative cause); re-check standing BP after 2–3 minutes in the seated position; and attempt standing again when BP has stabilised.

   Equipment (drain, catheter, IV) can be managed portably and should not prevent mobilisation once haemodynamic safety is established. An immediate IV fluid bolus requires medical prescription. Abandoning mobilisation without stepwise assessment is overly restrictive and inconsistent with ERAS principles.

2. What target SpO2 range is recommended for most postoperative adult patients receiving supplemental oxygen?

   • A
     94–98%
     Correct answer
   • B
     99–100%
   • C
     88–92%
   • D
     80–85%
   Explanation

   For most postoperative adult patients, the target SpO2 range is 94–98% when receiving supplemental oxygen. This reflects adequate oxygenation without the risks of hyperoxia. The lower target of 88–92% applies only to patients at risk of hypercapnic respiratory failure (such as those with COPD, severe obesity hypoventilation, or other Type 2 respiratory conditions) and uses NEWS2 Scale 2. Achieving SpO2 above 98% routinely is not recommended and may mask hypoventilation.

3. An infant is scheduled for a procedure under general anaesthesia at 09:00. The parents ask when they must stop giving infant formula. Which instruction is correct?

   • A
     Stop infant formula feeds at 03:00 (6 hours before the procedure)
     Correct answer
   • B
     Stop formula feeds at 05:00 (4 hours before the procedure)
   • C
     Stop all feeds including breast milk at 03:00
   • D
     Stop formula feeds at midnight regardless of procedure time
   Explanation

   Infant formula requires a 6-hour fast, the same as cow's milk and solid food, because its higher fat and protein content means it empties from the stomach more slowly than breast milk or clear fluids. For a 09:00 procedure, formula must stop by 03:00.

   Breast milk would require stopping by 05:00 (4-hour fast), not formula. The 2-hour rule applies only to clear fluids.