In the WHO Surgical Safety Checklist, the 'Sign In' part is completed:

Before induction of anaesthesia

Before the patient leaves theatre

After shifting to the recovery room

Perioperative care, fluids and immunity

25 Kerala PSC Staff Nurse Gr II practice questions on Perioperative care, fluids and immunity, 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
The main cation of the intracellular fluid is:
1. AMagnesium
2. BChloride
3. CPotassium
4. DSodium
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Answer: C · Potassium
About 98% of the body's potassium lies inside the cells, kept there by the sodium-potassium pump. Sodium is the main cation outside the cells. Because so little potassium is in the plasma, small changes in serum potassium have large effects on heart and muscle.
- A: Magnesium is found inside cells but in far smaller amounts than potassium.
- B: Chloride is an anion, not a cation.
- D: Sodium is the main cation of the extracellular fluid.
Question 2 · Medium
When a patient arrives in the post-anaesthesia care unit, what is the nurse's first assessment?
1. AAmount of urine output
2. BLevel of consciousness
3. CCondition of the dressing
4. DPatency of the airway
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Answer: D · Patency of the airway
After general anaesthesia the tongue may fall back and secretions or vomit may block the airway, so airway and breathing are checked first. Then the nurse assesses circulation, consciousness, the wound and drains, and pain. The patient is usually placed on the side unless contraindicated to keep the airway clear.
- A: Urine output is monitored later and is not the first priority.
- B: Consciousness is assessed after airway, breathing and circulation.
- C: The dressing is checked after the ABCs are secured.
Question 3 · Medium
In the WHO Surgical Safety Checklist, the 'Sign In' part is completed:
1. ABefore the skin incision
2. BBefore induction of anaesthesia
3. CBefore the patient leaves theatre
4. DAfter shifting to the recovery room
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Answer: B · Before induction of anaesthesia
The checklist has three parts. Sign In, before induction, confirms identity, site, procedure, consent, site marking, the anaesthesia check, allergies, airway risk and expected blood loss. Time Out comes just before skin incision, and Sign Out before the patient leaves the theatre, covering counts of instruments, sponges and needles and specimen labelling.
- A: Before skin incision is the Time Out.
- C: Before leaving theatre is the Sign Out.
- D: The checklist is completed inside the theatre, not in recovery.
Question 4 · Medium
During surgery under general anaesthesia, a rising end-tidal CO2, muscle rigidity and tachycardia followed by high fever suggest malignant hyperthermia. The specific drug is:
1. ANeostigmine
2. BNaloxone
3. CIntravenous paracetamol
4. DDantrolene sodium
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Answer: D · Dantrolene sodium
Malignant hyperthermia is an inherited muscle disorder triggered by volatile anaesthetics and succinylcholine. Uncontrolled calcium release in muscle causes rigidity, high CO2 production and a rapid rise in temperature. Dantrolene stops the calcium release; the trigger is stopped, the patient is cooled and given 100% oxygen.
- A: Neostigmine reverses non-depolarising muscle relaxants.
- B: Naloxone reverses opioids.
- C: Paracetamol does not act on the muscle cause of the fever.
Question 5 · Easy
Antibodies are produced and secreted by:
1. AMacrophages
2. BNeutrophils
3. CHelper T cells
4. DPlasma cells
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Answer: D · Plasma cells
When a B lymphocyte meets its antigen, usually with help from T helper cells, it multiplies and turns into plasma cells. Plasma cells secrete large amounts of antibody of one specificity. Some B cells become memory cells, which give the quick, strong response on a second exposure or after a booster dose.
- A: Macrophages present antigen and engulf microbes.
- B: Neutrophils engulf bacteria and do not make antibodies.
- C: Helper T cells assist B cells but do not make antibodies.
Question 6 · Easy
In the first few hours after an abdominal operation, the earliest sign of internal bleeding is usually:
1. AA falling blood pressure
2. BA rising pulse rate
3. CA rising temperature
4. DSlow, deep breathing
Answer and explanation in LearnFree account
Question 7 · Medium
Early ambulation after surgery is encouraged mainly to prevent:
1. AParalytic ileus pain
2. BDeep vein thrombosis
3. CSurgical site infection
4. DWound dehiscence
Answer and explanation in LearnFree account
Question 8 · Easy
On a sterile field set up in the operation theatre, which area is considered unsterile?
1. AThe centre of the draped tray
2. BItems placed by sterile forceps
3. CSterile drape above table level
4. DThe outer 2.5 cm (1 inch) border
Answer and explanation in LearnFree account
Question 9 · Hard
Two hours after a transurethral resection of the prostate with large-volume glycine bladder irrigation, a 70-year-old man becomes confused and nauseated, with pulse 52/min. Serum sodium is 119 mEq/L. The most likely cause is:
1. AHypernatraemia from saline infusion
2. BHypoglycaemia from prolonged fasting
3. CDilutional hyponatraemia from absorbed irrigation fluid
4. DClot retention in the bladder
Answer and explanation in LearnFree account
Question 10 · Hard
Four hours after a cholecystectomy, a patient is restless, with cold clammy skin, pulse 124/min, BP 88/60 mmHg and a soaked abdominal dressing. Which complication is most likely?
1. ASeptic shock from wound infection
2. BHypovolaemic shock from haemorrhage
3. CPulmonary embolism from a leg clot
4. DNeurogenic shock from spinal anaesthesia
Answer and explanation in LearnFree account
Question 11 · Easy
In myasthenia gravis, the autoantibodies are directed against the:
1. AThyroid stimulating hormone receptors
2. BMyelin of motor nerves
3. CPancreatic beta cells
4. DAcetylcholine receptors
Answer and explanation in LearnFree account
Question 12 · Medium
All of the following are signs of fluid volume excess EXCEPT:
1. ADistended neck veins
2. BRising haematocrit
3. CCrackles in the lungs
4. DBounding pulse
Answer and explanation in LearnFree account
Question 13 · Hard
A 30-year-old man has had severe diarrhoea for 3 days. ABG: pH 7.29, PaCO2 30 mmHg, HCO3 15 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3 22-26). The interpretation is:
1. AFully compensated metabolic acidosis
2. BUncompensated metabolic acidosis
3. CPartly compensated respiratory alkalosis
4. DPartly compensated metabolic acidosis
Answer and explanation in LearnFree account
Question 14 · Hard
On the third day after a hip replacement, a patient suddenly develops sharp chest pain, breathlessness and anxiety. Pulse is 120/min, RR 30/min and SpO2 86% on room air. Which complication is most likely?
1. AAtelectasis
2. BPostoperative pneumonia
3. CPulmonary embolism
4. DWound infection
Answer and explanation in LearnFree account
Question 15 · Easy
Written informed consent for an operation must be signed by the patient:
1. AOn the morning after the operation is done
2. BBefore any sedative premedication is given
3. COnly after reaching the operation theatre
4. DAfter the anaesthetist starts the IV line
Answer and explanation in LearnFree account
Question 16 · Easy
The sterile area of a scrubbed nurse's surgical gown is the:
1. AWhole gown, front and back, up to the hem
2. BNeckline, shoulders and the underarm area
3. CBack of the gown from the shoulders down to the waist
4. DFront from chest to table level, and sleeves
Answer and explanation in LearnFree account
Question 17 · Medium
By current anaesthesia fasting guidelines, a healthy adult for elective surgery may drink clear fluids until:
1. AThe midnight before surgery
2. B8 hours before anaesthesia
3. C2 hours before anaesthesia
4. D6 hours before anaesthesia
Answer and explanation in LearnFree account
Question 18 · Medium
In an adult after major surgery, the nurse should report urine output that falls below:
1. A60 mL per hour
2. B100 mL per hour
3. C10 mL per hour
4. D30 mL per hour
Answer and explanation in LearnFree account
Question 19 · Medium
In severe hyperkalaemia, IV calcium gluconate is usually given first because it:
1. AIncreases potassium loss in urine
2. BRemoves potassium through the bowel
3. CMoves potassium into the cells
4. DStabilises the cardiac cell membrane
Answer and explanation in LearnFree account
Question 20 · Easy
A butterfly-shaped (malar) rash across the cheeks and nose is characteristic of:
1. ASystemic lupus erythematosus
2. BRheumatoid arthritis
3. CPsoriasis
4. DScleroderma
Answer and explanation in LearnFree account
Question 21 · Hard
A 24-hour order of 2,400 mL of IV fluid is to run through a set that delivers 15 drops/mL. The flow rate should be:
1. A17 drops per minute
2. B33 drops per minute
3. C100 drops per minute
4. D25 drops per minute
Answer and explanation in LearnFree account
Question 22 · Medium
Rheumatoid factor, found in most patients with rheumatoid arthritis, is an autoantibody directed against the:
1. ADouble-stranded DNA
2. BFc portion of IgG
3. CSynovial collagen
4. DAcetylcholine receptor
Answer and explanation in LearnFree account
Question 23 · Easy
For pelvic surgery, the patient is tilted head-down so that the intestines fall away from the pelvis. This is the:
1. AFowler's position
2. BLithotomy position
3. CTrendelenburg position
4. DSims' position
Answer and explanation in LearnFree account
Question 24 · Medium
To protect an abdominal incision when the patient coughs after surgery, the nurse teaches him to:
1. ALoosen the abdominal binder first
2. BSplint the wound with a pillow
3. CHold his breath and avoid coughing
4. DLie flat and cough lying down
Answer and explanation in LearnFree account
Question 25 · Easy
HIV causes immune deficiency mainly by destroying:
1. ARed blood cells
2. BCD8 cytotoxic T cells
3. CB lymphocytes
4. DCD4 helper T lymphocytes
Answer and explanation in LearnFree account

Perioperative care, fluids and immunity

The main cation of the intracellular fluid is:

When a patient arrives in the post-anaesthesia care unit, what is the nurse's first assessment?

In the WHO Surgical Safety Checklist, the 'Sign In' part is completed:

During surgery under general anaesthesia, a rising end-tidal CO2, muscle rigidity and tachycardia followed by high fever suggest malignant hyperthermia. The specific drug is:

Antibodies are produced and secreted by:

In the first few hours after an abdominal operation, the earliest sign of internal bleeding is usually:

Early ambulation after surgery is encouraged mainly to prevent:

On a sterile field set up in the operation theatre, which area is considered unsterile?

Two hours after a transurethral resection of the prostate with large-volume glycine bladder irrigation, a 70-year-old man becomes confused and nauseated, with pulse 52/min. Serum sodium is 119 mEq/L. The most likely cause is:

Four hours after a cholecystectomy, a patient is restless, with cold clammy skin, pulse 124/min, BP 88/60 mmHg and a soaked abdominal dressing. Which complication is most likely?

In myasthenia gravis, the autoantibodies are directed against the:

All of the following are signs of fluid volume excess EXCEPT:

A 30-year-old man has had severe diarrhoea for 3 days. ABG: pH 7.29, PaCO2 30 mmHg, HCO3 15 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3 22-26). The interpretation is:

On the third day after a hip replacement, a patient suddenly develops sharp chest pain, breathlessness and anxiety. Pulse is 120/min, RR 30/min and SpO2 86% on room air. Which complication is most likely?

Written informed consent for an operation must be signed by the patient:

The sterile area of a scrubbed nurse's surgical gown is the:

By current anaesthesia fasting guidelines, a healthy adult for elective surgery may drink clear fluids until:

In an adult after major surgery, the nurse should report urine output that falls below:

In severe hyperkalaemia, IV calcium gluconate is usually given first because it:

A butterfly-shaped (malar) rash across the cheeks and nose is characteristic of:

A 24-hour order of 2,400 mL of IV fluid is to run through a set that delivers 15 drops/mL. The flow rate should be:

Rheumatoid factor, found in most patients with rheumatoid arthritis, is an autoantibody directed against the:

For pelvic surgery, the patient is tilted head-down so that the intestines fall away from the pelvis. This is the:

To protect an abdominal incision when the patient coughs after surgery, the nurse teaches him to:

HIV causes immune deficiency mainly by destroying: