POST OPERATIVE WARD
SCENARIO-1
COMPREHENSIVE POST-OPERATIVE CARE AND NURSING
PRIORITIES
Mr. Suresh, a 54-year-old patient, underwent open bowel resection 8 hours ago. During
assessment, the nursing student notes the following:
Pain score: 8/10
RR: 30/min (shallow breathing)
SpO₂: 94% on room air
Patient refuses to cough and mobilize due to pain
Abdomen mildly distended
Bowel sounds absent
The patient states, “If I move, my stitches will open.”
Q1. What is the MOST appropriate nursing interpretation?
A. Normal post-operative recovery only
B. Increased risk for respiratory complications due to inadequate lung expansion
C. Immediate bowel perforation
D. Stable condition with no concern
Correct Answer: B
Q2. Which nursing action should be prioritized FIRST?
A. Encourage immediate ambulation without assessment
B. Assess pain and implement prescribed pain management measures
C. Begin oral feeding
D. Remove oxygen support
Correct Answer: B
Q3. Why is encouraging coughing and deep breathing important in this patient?
A. Prevent respiratory complications and improve ventilation
B. Reduce abdominal swelling only
C. Promote bowel elimination directly
D. Increase patient comfort only
Correct Answer: A
Q4. Which statement by the student nurse reflects correct teaching?
A. “Movement will damage the surgical wound.”
B. “Supporting the incision can help you move more comfortably.”
C. “Remain in bed until discharge.”
D. “Pain means healing is delayed.”
Correct Answer: B
Q5. Which outcome best indicates effective post-operative care?
A. Patient remains immobile
B. Pain reduced and patient participates in breathing and movement
C. Patient sleeps continuously
D. Respiratory rate increases further
Correct Answer: B
SCENARIO-2
DRAIN CARE AND CLINICAL INTERPRETATION
Mrs. Meena underwent abdominal hysterectomy and has a closed suction drain. During
assessment:
Drain output decreased from 90 mL to 5 mL in 1 hour
Dressing appears tense and mildly soaked
Patient reports increasing pressure at incision site
Temperature: 37.9°C
Q1. What should the nursing student suspect FIRST?
A. Drain may not be functioning effectively
B. Recovery is complete
C. Improved wound healing
D. Normal response to surgery
Correct Answer: A
Q2. Which finding requires immediate attention?
A. Mild temperature elevation
B. Patient discomfort with reduced drain output and dressing tension
C. Stable blood pressure
D. Dry skin
Correct Answer: B
Q3. What is the MOST appropriate nursing action?
A. Remove the drain independently
B. Assess drain patency and report findings
C. Ignore because output is low
D. Change dressing repeatedly
Correct Answer: B
Q4. Which observation must always be documented?
A. Drain amount, color, and wound assessment
B. Visitor count
C. Bed number only
D. Meal preference
Correct Answer: A
Q5. Why is monitoring drain output clinically important?
A. Evaluates healing and identifies complications early
B. Improves nutrition
C. Decreases documentation
D. Prevents mobilization
Correct Answer: A
SCENARIO-3
MONITORING SIGNS OF POST-OPERATIVE COMPLICATIONS
A 63-year-old patient underwent gastric surgery. Twelve hours later, the nursing student
records:
Pulse: 126/min
BP: 88/54 mmHg
Urine output: 15 mL/hr
Increasing abdominal girth
Cold clammy skin
Restlessness
Q1. Which complication should be considered FIRST?
A. Circulatory compromise requiring urgent evaluation
B. Normal recovery
C. Anxiety disorder
D. Mild dehydration only
Correct Answer: A
Q2. Which assessment finding is the strongest indicator of deterioration?
A. Restlessness alone
B. Increased abdominal girth with hypotension
C. Age above 60 years
D. Patient communication
Correct Answer: B
Q3. Which nursing action demonstrates appropriate prioritization?
A. Continue routine care
B. Escalate findings immediately while reassessing ABC status
C. Start oral feed
D. Delay reassessment until next round
Correct Answer: B
Q4. Why should urine output be monitored closely?
A. It reflects organ perfusion status
B. It reduces pain
C. It improves nutrition
D. It prevents fever
Correct Answer: A
Q5. Which outcome suggests improvement?
A. Stable BP and improving urine output
B. Continued tachycardia
C. Persistent restlessness
D. Increasing abdominal distension
Correct Answer: A
SCENARIO-4
TEST FEED AND SURGICAL DRESSING
Mr. Daniel underwent bowel surgery. After bowel sounds return, test feeding is ordered.
The student initiates feeding and later observes:
Mild nausea
No vomiting
Surgical dressing has new serosanguineous staining extending outward
Q1. Which action regarding feeding is MOST appropriate?
A. Continue large-volume feeding
B. Pause, reassess tolerance, and report if symptoms progress
C. Stop all intake permanently
D. Encourage heavy meals
Correct Answer: B
Q2. Increasing wound staining should be interpreted as:
A. Always normal
B. A finding requiring assessment and monitoring
C. Dressing success
D. Adequate nutrition
Correct Answer: B
Q3. Which assessment is MOST important before advancing diet?
A. Presence of bowel function and tolerance
B. Patient age
C. Weight only
D. Dressing color only
Correct Answer: A
Q4. Which nursing principle applies during dressing assessment?
A. Aseptic technique and comparison with previous observations
B. Open wound exposure
C. Delay assessment
D. Touching wound directly
Correct Answer: A
Q5. Which finding requires urgent reporting?
A. Progressive dressing soakage with patient discomfort
B. Intact dressing
C. Minimal stain unchanged
D. Mild hunger
Correct Answer: A
SCENARIO-5
VENTILATOR CARE
Mr. Joseph remains mechanically ventilated after thoracic surgery. During assessment:
SpO₂ falls from 97% to 90%
Increased respiratory effort observed
Ventilator alarm activates
Secretions noted in airway
Patient becomes agitated
Q1. What should the student recognize FIRST?
A. Possible impaired oxygenation requiring immediate assessment
B. Normal post-operative anxiety
C. Recovery progression
D. Expected alarm behavior
Correct Answer: A
Q2. Which nursing action should occur FIRST?
A. Assess airway patency and patient condition
B. Silence alarm permanently
C. Reduce oxygen
D. Delay intervention
Correct Answer: A
Q3. Which assessment finding most strongly suggests airway obstruction?
A. Secretions with reduced oxygen saturation
B. Stable BP
C. Warm extremities
D. Normal urine output
Correct Answer: A
Q4. Why should ventilated patients receive frequent oral care?
A. Reduce risk of respiratory infection
B. Improve appetite only
C. Reduce documentation
D. Improve mobility only
Correct Answer: A
Q5. Which outcome best demonstrates effective nursing care?
A. Improved oxygen saturation and reduced respiratory distress
B. Patient sleeping only
C. No documentation
D. Reduced monitoring
Correct Answer: A
SCENARIO-6
POST-OPERATIVE MONITORING AND COMPLICATION
RECOGNITION
Mr. Dinesh, a 58-year-old male, is 6 hours post exploratory laparotomy under general
anesthesia. He has a history of hypertension and type 2 diabetes. On arrival to the post-
operative ward, his observations were stable. During the evening assessment, the
internship nursing student records:
- Pulse: 124/min
- BP: 92/58 mmHg
- RR: 28/min (shallow)
- SpO₂: 93% on 3 L/min oxygen
- Urine output: 20 mL over the last hour
- Surgical drain output increased from 40 mL to 180 mL in one hour (bright red)
- Patient appears restless and repeatedly says, “I feel something is wrong.”
The nursing student reports to the staff nurse and is asked to continue assessment.
Q1. Based on the overall clinical picture, which nursing interpretation is MOST appropriate?
A. Expected post-anesthesia response
B. Early indicators of hypovolemic compromise secondary to possible bleeding
C. Normal pain response
D. Psychological anxiety only
Correct Answer: B
Q2. Which assessment finding should receive the HIGHEST priority?
A. Restlessness
B. Reduced urine output
C. Increased bright red drain output with hypotension
D. Respiratory rate 28/min
Correct Answer: C
Q3. What is the MOST appropriate immediate nursing action?
A. Reassure the patient and reassess after 30 minutes
B. Continue routine observations only
C. Perform focused reassessment, maintain IV access, and escalate immediately
D. Start oral fluids
Correct Answer: C
Q4. The reduced urine output in this patient MOST likely indicates:
A. Improved renal conservation
B. Reduced renal perfusion due to circulatory compromise
C. Expected diabetic response
D. Normal post-operative adaptation
Correct Answer: B
Q5. Which outcome would BEST indicate that interventions are effective?
A. Patient reports less anxiety only
B. Pulse decreases, BP stabilizes, urine output improves
C. Patient sleeps comfortably
D. Drain output remains unchanged
Correct Answer: B
SCENARIO-7
VENTILATOR CARE AND CLINICAL DECISION-MAKING
Mrs. Priya, 61 years old, underwent thoracic surgery and remains mechanically
ventilated in the post-operative ward. Ventilator settings remain unchanged. During
observation, the student notes:
- SpO₂ dropped from 98% to 89%
- Peak airway pressure alarm activated
- RR increased
- Breath sounds reduced on the right side
- Patient appears restless and attempts to reach the tube
The nursing student must decide priorities before the physician arrives.
Q1. What should the nursing student recognize FIRST?
A. Equipment issue only
B. Possible airway or ventilation compromise requiring immediate assessment
C. Expected recovery pattern
D. Anxiety due to environment
Correct Answer: B
Q2. Which intervention is MOST appropriate initially?
A. Silence alarm and continue observation
B. Assess airway, tube position, oxygenation, and patient condition
C. Lower oxygen concentration
D. Encourage deep breathing
Correct Answer: B
Q3. Which assessment finding MOST strongly supports inadequate ventilation?
A. Restlessness and reduced SpO₂
B. Dry oral mucosa
C. Closed eyes
D. Warm skin
Correct Answer: A
Q4. Why should ventilator alarms never be treated as equipment failure alone?
A. They increase workload
B. They may represent a life-threatening patient change
C. They disturb the patient
D. They delay documentation
Correct Answer: B
Q5. Which nursing action contributes MOST to prevention of ventilator-associated
complications?
A. Limiting communication
B. Consistent oral care and airway management
C. Restricting repositioning
D. Reducing monitoring frequency
Correct Answer: B