In the recovery room, a patient who is still drowsy after general anaesthesia develops snoring respirations and the SpO2 falls from 97% to 89%. What is the nurse's first action?

Perform a jaw thrust to open the airway

Turn up the oxygen and recheck in 10 minutes

Give the prescribed naloxone injection

Increase the IV fluid infusion rate

A 30-year-old electrician has small entry and exit wounds after a high-voltage injury. Six hours later his urine is dark red-brown and the dipstick is positive for blood with no red cells on microscopy. The nurse should expect to:

Increase IV fluids to keep urine output about 75-100 mL/h

Calculate fluids from the visible burn area alone

Restrict fluids because the small wounds need little replacement

Give a diuretic and reduce the IV fluid rate

On the fifth day after a laparotomy, an obese patient coughs and says, 'Something gave way.' The nurse sees loops of bowel through the opened wound. What should the nurse do first?

Cover the wound with sterile saline-soaked dressings

Push the bowel back gently with gloved hands

Sit the patient upright and encourage coughing

Apply a dry dressing and a tight abdominal binder

Perioperative care, wounds and burns

26 AIIMS NORCET (Nursing Officer) practice questions on Perioperative care, wounds and burns, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
By the CDC NHSN surveillance definition, a deep surgical site infection after a procedure with an implant such as a hip prosthesis can be counted if it appears within:
1. A7 days
2. B90 days
3. C30 days
4. D1 year
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Answer: B · 90 days
For superficial incisional infections, and for most procedures without implants, the NHSN surveillance window is 30 days. For deep incisional and organ/space infections after selected procedures, many of which involve implants such as joint prostheses, the window is 90 days. Earlier definitions used 1 year for implants, which is why that figure is still seen in older books. Nurses teach patients to report wound redness, pain or discharge even weeks after discharge.
- A: 7 days is far too short; many infections appear after discharge.
- C: 30 days is the window for superficial infections and non-implant procedures.
- D: 1 year was the older implant window and has been replaced.
Question 2 · Medium
In the recovery room, a patient who is still drowsy after general anaesthesia develops snoring respirations and the SpO2 falls from 97% to 89%. What is the nurse's first action?
1. APerform a jaw thrust to open the airway
2. BTurn up the oxygen and recheck in 10 minutes
3. CGive the prescribed naloxone injection
4. DIncrease the IV fluid infusion rate
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Answer: A · Perform a jaw thrust to open the airway
Snoring in a drowsy post-anaesthetic patient means partial airway obstruction, most often from the relaxed tongue falling back against the pharynx. A jaw thrust or head tilt-chin lift lifts the tongue and opens the airway at once, and an oropharyngeal airway may then be inserted. Oxygen helps only once the airway is open. Naloxone is considered if opioid depression persists after the airway is cleared.
- B: More oxygen cannot reach the lungs past an obstructed airway.
- C: Naloxone does not relieve obstruction by the tongue; the airway comes first.
- D: IV fluids do not treat an obstructed airway.
Question 3 · Hard
After an appendicectomy, a 25 kg child is kept nil by mouth. Using the Holliday-Segar (4-2-1) method, what hourly maintenance IV rate is needed?
1. A65 mL/h
2. B60 mL/h
3. C70 mL/h
4. D104 mL/h
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Answer: A · 65 mL/h
The 4-2-1 rule gives 4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg and 1 mL/kg/h for each kg above 20. For 25 kg: 40 + 20 + 5 = 65 mL/h. The daily method gives the same result: 1,000 + 500 + 100 = 1,600 mL/day, which is about 65 mL/h. Extra losses, such as from a nasogastric tube, are replaced separately.
- B: 60 mL/h stops at 20 kg and leaves out the last 5 kg.
- C: 70 mL/h uses 2 mL/kg instead of 1 mL/kg for the kg above 20.
- D: 104 mL/h applies 100 mL/kg/day to all 25 kg.
Question 4 · Hard
A 30-year-old electrician has small entry and exit wounds after a high-voltage injury. Six hours later his urine is dark red-brown and the dipstick is positive for blood with no red cells on microscopy. The nurse should expect to:
1. ACalculate fluids from the visible burn area alone
2. BRestrict fluids because the small wounds need little replacement
3. CIncrease IV fluids to keep urine output about 75-100 mL/h
4. DGive a diuretic and reduce the IV fluid rate
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Answer: C · Increase IV fluids to keep urine output about 75-100 mL/h
A positive blood dipstick with no red cells means myoglobin from damaged muscle, which is common after high-voltage injury because the current destroys deep tissue. Myoglobin can block the renal tubules and cause acute kidney injury. Fluids are increased to keep urine output higher than for thermal burns, about 75-100 mL/h in adults, until the urine clears. The small skin wounds greatly underestimate the injury, and cardiac monitoring is also needed.
- A: TBSA alone underestimates fluid needs in electrical injury.
- B: The small surface wounds underestimate deep muscle damage and fluid need.
- D: Reducing fluids increases the risk of myoglobin blocking the tubules.
Question 5 · Medium
On the fifth day after a laparotomy, an obese patient coughs and says, 'Something gave way.' The nurse sees loops of bowel through the opened wound. What should the nurse do first?
1. APush the bowel back gently with gloved hands
2. BSit the patient upright and encourage coughing
3. CApply a dry dressing and a tight abdominal binder
4. DCover the wound with sterile saline-soaked dressings
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Answer: D · Cover the wound with sterile saline-soaked dressings
This is wound dehiscence with evisceration, a surgical emergency. The exposed bowel is covered at once with sterile dressings moistened with normal saline to keep it from drying and becoming ischaemic. The patient is placed in low Fowler's position with knees flexed to reduce tension, kept nil by mouth and the surgeon is called. The nurse stays with the patient and watches for shock.
- A: Replacing bowel risks injury and infection and is done only by the surgeon.
- B: Coughing and an upright posture raise abdominal pressure and worsen the evisceration.
- C: Dry dressings stick to and damage the bowel.
Question 6 · Medium
Fifteen minutes after a spinal anaesthetic for a caesarean section, the most common complication the nurse should watch for is:
1. APost-spinal headache
2. BUrinary retention
3. CHypotension
4. DRespiratory arrest
Answer and explanation in LearnFree account
Question 7 · Easy
Using the adult rule of nines, the burn area assigned to one entire upper limb is:
1. A4.5%
2. B18%
3. C9%
4. D1%
Answer and explanation in LearnFree account
Question 8 · Easy
The headache that follows spinal anaesthesia, typically worse on sitting up and relieved by lying flat, is caused by:
1. ASpread of local anaesthetic to the brain
2. BA rise in intracranial pressure
3. CLeakage of CSF through the dural puncture
4. DAllergy to the local anaesthetic agent
Answer and explanation in LearnFree account
Question 9 · Medium
A patient has a circumferential full-thickness burn of the left forearm. Which finding should the nurse report immediately?
1. AA urine output of 60 mL in the last hour
2. BAbsent radial pulse with numb fingers
3. CSwelling of the burned area
4. DWhite, leathery skin that is painless
Answer and explanation in LearnFree account
Question 10 · Easy
Who is responsible for explaining the operation and its risks to the patient while obtaining surgical consent?
1. AThe patient's next of kin
2. BThe ward nurse in charge
3. CThe surgeon performing the procedure
4. DThe scrub nurse in the operation theatre
Answer and explanation in LearnFree account
Question 11 · Medium
The preoperative checklist shows that a patient was given intramuscular pethidine as premedication 20 minutes ago, but the consent form is still unsigned. What should the nurse do?
1. ASend the patient to theatre and sign there
2. BHave the spouse sign the consent instead
3. CInform the surgeon that consent was not obtained
4. DAsk the patient to sign the form now
Answer and explanation in LearnFree account
Question 12 · Hard
An adult has burns over the whole right arm, the entire front of the trunk and the perineum. By the rule of nines, what is the burned body surface area?
1. A28%
2. B19%
3. C37%
4. D27%
Answer and explanation in LearnFree account
Question 13 · Hard
An infant has scalds over the whole head and neck and both entire arms. Using the paediatric rule of nines (head 18%, each leg 14%), what is the burned area?
1. A27%
2. B46%
3. C36%
4. D54%
Answer and explanation in LearnFree account
Question 14 · Medium
On the first day after an upper abdominal operation, a patient has a temperature of 38 °C, diminished breath sounds at the lung bases and a clean wound. The most appropriate nursing action is to:
1. ARemove the wound dressing and inspect the incision for pus
2. BKeep the patient flat and limit movement
3. CEncourage deep breathing and incentive spirometry
4. DRestrict oral fluids to reduce secretions
Answer and explanation in LearnFree account
Question 15 · Easy
The drug used to treat malignant hyperthermia during anaesthesia is:
1. AParacetamol
2. BNeostigmine
3. CDantrolene
4. DSuccinylcholine
Answer and explanation in LearnFree account
Question 16 · Easy
A large pressure ulcer left open to fill from the base with granulation tissue heals by:
1. ATertiary intention
2. BSecondary intention
3. CDelayed primary closure
4. DPrimary intention
Answer and explanation in LearnFree account
Question 17 · Medium
Ringer's lactate is preferred to colloids for resuscitating major burns during the first 24 hours because:
1. ARinger's lactate restores plasma proteins faster
2. BColloids lower the risk of pulmonary oedema
3. CCrystalloids stay longer inside the blood vessels
4. DCapillary leak lets colloids escape into the tissues
Answer and explanation in LearnFree account
Question 18 · Medium
During fluid resuscitation of an adult with major burns, which finding best indicates that fluid replacement is adequate?
1. AHeart rate of 125 beats/min
2. BCentral venous pressure of 20 cmH2O
3. CUrine output of 0.5-1 mL/kg/h
4. DSerum sodium of 150 mmol/L
Answer and explanation in LearnFree account
Question 19 · Medium
A man rescued from a burning room has facial burns, singed nasal hair, a hoarse voice and black sputum. What is the nurse's priority?
1. AApply cool dressings to the face
2. BPrepare for early intubation
3. CGive intramuscular tetanus toxoid
4. DCalculate fluids by the Parkland formula
Answer and explanation in LearnFree account
Question 20 · Easy
For a healthy adult having elective surgery under general anaesthesia, clear fluids may usually be allowed until how long before induction?
1. A12 hours
2. B6 hours
3. C8 hours
4. D2 hours
Answer and explanation in LearnFree account
Question 21 · Hard
Four hours after a laparotomy for a ruptured spleen, a patient has pulse 128/min, BP 86/54 mmHg (pre-operative 120/80), cool clammy skin, urine 15 mL/h for 2 hours, a dry wound dressing and an increasing abdominal girth. The most likely complication is:
1. APulmonary embolism
2. BIntra-abdominal haemorrhage
3. CParalytic ileus
4. DSeptic shock
Answer and explanation in LearnFree account
Question 22 · Hard
A 70 kg man with 40% total body surface area burns arrives 2 hours after the injury. Using the Parkland formula, at what rate should Ringer's lactate run for the rest of the first 8 hours after the burn?
1. A933 mL/h
2. B1,400 mL/h
3. C467 mL/h
4. D700 mL/h
Answer and explanation in LearnFree account
Question 23 · Medium
Three days after a total knee replacement, a patient has pain and swelling in the opposite calf, which is warm to touch. The nurse should:
1. AMassage the calf to relieve the pain
2. BKeep the patient in bed and inform the doctor
3. CWalk the patient to improve the circulation
4. DApply a tight crepe bandage to the calf
Answer and explanation in LearnFree account
Question 24 · Easy
When hair must be removed from the operative site, the method that best reduces the risk of surgical site infection is:
1. ADepilatory cream applied by the patient
2. BA razor shave the night before
3. CA razor shave in the operation theatre
4. DElectric clippers just before surgery
Answer and explanation in LearnFree account
Question 25 · Hard
On the fifth day after hip fracture surgery, a patient suddenly becomes anxious and breathless, with sharp chest pain, pulse 120/min, respirations 30/min and SpO2 86% on room air. What should the nurse do first?
1. AMassage the legs to improve venous return
2. BEncourage the patient to walk slowly
3. CRaise the head of the bed and give oxygen
4. DLay the patient flat with legs elevated
Answer and explanation in LearnFree account

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Perioperative care, wounds and burns

By the CDC NHSN surveillance definition, a deep surgical site infection after a procedure with an implant such as a hip prosthesis can be counted if it appears within:

In the recovery room, a patient who is still drowsy after general anaesthesia develops snoring respirations and the SpO2 falls from 97% to 89%. What is the nurse's first action?

After an appendicectomy, a 25 kg child is kept nil by mouth. Using the Holliday-Segar (4-2-1) method, what hourly maintenance IV rate is needed?

A 30-year-old electrician has small entry and exit wounds after a high-voltage injury. Six hours later his urine is dark red-brown and the dipstick is positive for blood with no red cells on microscopy. The nurse should expect to:

On the fifth day after a laparotomy, an obese patient coughs and says, 'Something gave way.' The nurse sees loops of bowel through the opened wound. What should the nurse do first?

Fifteen minutes after a spinal anaesthetic for a caesarean section, the most common complication the nurse should watch for is:

Using the adult rule of nines, the burn area assigned to one entire upper limb is:

The headache that follows spinal anaesthesia, typically worse on sitting up and relieved by lying flat, is caused by:

A patient has a circumferential full-thickness burn of the left forearm. Which finding should the nurse report immediately?

Who is responsible for explaining the operation and its risks to the patient while obtaining surgical consent?

The preoperative checklist shows that a patient was given intramuscular pethidine as premedication 20 minutes ago, but the consent form is still unsigned. What should the nurse do?

An adult has burns over the whole right arm, the entire front of the trunk and the perineum. By the rule of nines, what is the burned body surface area?

An infant has scalds over the whole head and neck and both entire arms. Using the paediatric rule of nines (head 18%, each leg 14%), what is the burned area?

On the first day after an upper abdominal operation, a patient has a temperature of 38 °C, diminished breath sounds at the lung bases and a clean wound. The most appropriate nursing action is to:

The drug used to treat malignant hyperthermia during anaesthesia is:

A large pressure ulcer left open to fill from the base with granulation tissue heals by:

Ringer's lactate is preferred to colloids for resuscitating major burns during the first 24 hours because:

During fluid resuscitation of an adult with major burns, which finding best indicates that fluid replacement is adequate?

A man rescued from a burning room has facial burns, singed nasal hair, a hoarse voice and black sputum. What is the nurse's priority?

For a healthy adult having elective surgery under general anaesthesia, clear fluids may usually be allowed until how long before induction?

Four hours after a laparotomy for a ruptured spleen, a patient has pulse 128/min, BP 86/54 mmHg (pre-operative 120/80), cool clammy skin, urine 15 mL/h for 2 hours, a dry wound dressing and an increasing abdominal girth. The most likely complication is:

A 70 kg man with 40% total body surface area burns arrives 2 hours after the injury. Using the Parkland formula, at what rate should Ringer's lactate run for the rest of the first 8 hours after the burn?

Three days after a total knee replacement, a patient has pain and swelling in the opposite calf, which is warm to touch. The nurse should:

When hair must be removed from the operative site, the method that best reduces the risk of surgical site infection is:

On the fifth day after hip fracture surgery, a patient suddenly becomes anxious and breathless, with sharp chest pain, pulse 120/min, respirations 30/min and SpO2 86% on room air. What should the nurse do first?