9 original SNLE questions on surgical nursing, each with an explanation for all four options. Part of Adult Nursing, worth 40% of the Saudi Nursing Licensure Examination.
Q01 / 09hard0 correct
Adult Nursinghardq006
Two days after a total thyroidectomy, a patient reports tingling around the mouth and in the fingertips. On assessment, carpal spasm occurs when the blood pressure cuff is inflated. Which action should the nurse take first?
All 9 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Surgical nursing · hard
Two days after a total thyroidectomy, a patient reports tingling around the mouth and in the fingertips. On assessment, carpal spasm occurs when the blood pressure cuff is inflated. Which action should the nurse take first?
ANotify the physician and prepare to administer intravenous calcium gluconate
BReassure the patient that paresthesia is an expected postoperative finding
CAdminister the scheduled levothyroxine dose several hours early
DEncourage deep breathing into a paper bag to correct respiratory alkalosis
Show the answer and why the others fail
Answer: A. Notify the physician and prepare to administer intravenous calcium gluconate
A — correct
Perioral and digital paresthesia with a positive Trousseau sign indicates acute hypocalcemia from inadvertent parathyroid injury or removal. This can progress to laryngospasm and tetany, so urgent calcium replacement is required.
B
These are not benign findings; dismissing them delays treatment of a potentially life-threatening electrolyte emergency.
C
Levothyroxine replaces thyroid hormone and has no effect on serum calcium; it does not treat this emergency.
D
This addresses hyperventilation-induced symptoms, which is not the mechanism here; the post-thyroidectomy context points strongly to true hypocalcemia.
TakeawayPerioral tingling plus Trousseau or Chvostek sign after thyroidectomy signals hypocalcemia from parathyroid injury — anticipate IV calcium and watch for laryngospasm.
Surgical nursing · medium
A nurse is caring for a patient who had a chest tube inserted 2 hours ago for a spontaneous pneumothorax. The drainage system is a wet suction system with the suction control chamber set to 20 cm H2O, and the wall suction is adjusted to produce gentle continuous bubbling in that chamber. Which assessment finding indicates an air leak?
ASerosanguineous drainage in the collection chamber
BContinuous bubbling in the water seal chamber
CContinuous gentle bubbling in the suction control chamber
DFluid fluctuation in the water seal chamber with respirations
Show the answer and why the others fail
Answer: B. Continuous bubbling in the water seal chamber
A
Serosanguineous drainage is an expected finding after chest tube insertion and does not indicate an air leak.
B — correct
Continuous bubbling in the water seal chamber indicates an air leak, either from the patient's pleural space or a system leak. This finding requires further assessment to determine the source and appropriate intervention.
C
Continuous gentle bubbling in the suction control chamber is an expected finding in a wet suction system, indicating that the prescribed suction level is being maintained.
D
Fluid fluctuation (tidaling) in the water seal chamber is a normal finding that reflects changes in intrapleural pressure during the respiratory cycle.
TakeawayIn a chest drainage system, continuous bubbling in the water seal chamber indicates an air leak, which may be from the patient's pleural space or a system leak. Gentle, continuous bubbling in the suction control chamber of a wet suction system is expected and confirms that suction is being applied. Tidaling (fluid fluctuation) in the water seal chamber is a normal finding.
Surgical nursing · medium
A 65-year-old male patient is 12 hours post-operative following a laparoscopic cholecystectomy. He has a history of hypertension and obesity. He is alert and oriented, and his vital signs are stable. He has sequential compression devices (SCDs) in place and has been performing ankle pumps as instructed. The nurse notes that he has not yet ambulated and is reluctant to move due to incisional pain. Which of the following nursing actions is the priority to prevent venous thromboembolism?
AEnsure the sequential compression devices are properly fitted and functioning.
BAdminister prescribed opioid analgesic and encourage deep breathing exercises.
CAssist the patient to ambulate in the hallway after ensuring adequate pain control.
DInstruct the patient to continue ankle pumps and leg exercises every hour while awake.
Show the answer and why the others fail
Answer: C. Assist the patient to ambulate in the hallway after ensuring adequate pain control.
A
SCDs are already in place; ensuring they are functioning is important but is a lower priority than ambulation for a patient who is able to walk, as ambulation provides superior VTE prophylaxis.
B
Administering an analgesic may reduce pain and facilitate ambulation, but it does not directly prevent VTE. The priority is to mobilize the patient once pain is controlled.
C — correct
Early ambulation is the most effective nursing intervention to prevent VTE by promoting venous return and reducing stasis, especially in a patient with risk factors like obesity and age. Pain control is a prerequisite, but the action of ambulation is the priority.
D
Leg exercises reduce venous stasis but are less effective than ambulation. The patient is already performing them, so reinforcing this is not the priority when ambulation is possible.
TakeawayEarly ambulation is the most effective nursing intervention to prevent venous thromboembolism in stable postoperative patients.
Surgical nursing · medium
A 35-year-old patient is in the post-anesthesia care unit following an appendectomy under general anesthesia. The patient suddenly develops muscle rigidity, a heart rate of 130 beats/min, and a temperature of 39.2°C (102.5°F). Which action should the nurse take first?
AAdminister acetaminophen as prescribed.
BNotify the surgeon immediately.
CAdminister dantrolene as prescribed.
DApply a cooling blanket to reduce the temperature.
Show the answer and why the others fail
Answer: C. Administer dantrolene as prescribed.
A
Acetaminophen is an antipyretic but will not treat the underlying hypermetabolic crisis of malignant hyperthermia; it is not the priority intervention.
B
While the surgeon should be informed, the nurse's immediate priority is to administer dantrolene to treat the life-threatening malignant hyperthermia.
C — correct
Dantrolene is the specific antidote for malignant hyperthermia, a life-threatening reaction to certain anesthetics. It must be given immediately to halt the hypermetabolic process.
D
Cooling measures are supportive but not the first priority; dantrolene administration is critical to stop the underlying crisis.
TakeawayMalignant hyperthermia is a life-threatening hypermetabolic crisis triggered by certain anesthetics; the priority intervention is immediate administration of dantrolene.
Surgical nursing · medium
A nurse is caring for a client who is 4 days post-operative following an exploratory laparotomy. The client reports a sudden 'popping' sensation at the incision site. Upon inspection, the nurse notes a small amount of serosanguineous drainage and a visible loop of bowel protruding through the wound. Which action should the nurse take first?
ACover the wound with sterile saline-soaked gauze.
BPlace the client in a high Fowler's position.
CApply a sterile abdominal binder to support the wound.
DNotify the surgeon immediately.
Show the answer and why the others fail
Answer: A. Cover the wound with sterile saline-soaked gauze.
A — correct
The priority is to protect the exposed bowel from drying and contamination by covering it with sterile saline-soaked dressings, then notify the surgeon immediately.
B
High Fowler's position increases intra-abdominal pressure and tension on the wound; the client should be placed in a low Fowler's or supine position with knees bent to reduce tension.
C
Applying a binder over protruding viscera can cause pressure and further injury; it is not the initial action for evisceration.
D
While the surgeon must be notified promptly, the nurse's first action is to protect the protruding viscera with sterile saline-soaked gauze to prevent tissue damage and infection.
TakeawayFor wound evisceration, immediately cover the protruding organs with sterile saline-soaked gauze, then place the client in a low Fowler's position with knees bent, and notify the surgeon.
Surgical nursing · medium
A 55-year-old patient is 8 hours post-abdominal surgery. The patient reports suprapubic discomfort and has not voided since the indwelling catheter was removed 6 hours ago. The nurse palpates a distended bladder. Which action should the nurse take first?
AInsert an indwelling urinary catheter.
BPerform a bladder scan to assess urine volume.
CAdminister the prescribed analgesic for discomfort.
DEncourage the patient to increase oral fluid intake.
Show the answer and why the others fail
Answer: B. Perform a bladder scan to assess urine volume.
A
Inserting a catheter is an invasive procedure that should be performed only after confirming urinary retention through non-invasive assessment, such as a bladder scan.
B — correct
A bladder scan is a non-invasive, evidence-based first step to objectively confirm urinary retention and determine the need for catheterization.
C
While pain management is important, it does not address the underlying problem of suspected urinary retention and may delay necessary intervention.
D
Encouraging fluids may worsen bladder distention if the patient is already retaining urine and unable to void.
TakeawayUse a bladder scan to confirm urinary retention before considering catheterization in postoperative patients.
Surgical nursing · medium
A patient who underwent an open colectomy 48 hours ago reports nausea and abdominal bloating. The nurse notes a firm, distended abdomen and absent bowel sounds. A nasogastric tube is in place, draining minimal bilious fluid, and is connected to low intermittent suction. Which action should the nurse take?
ARemove the nasogastric tube and encourage oral fluid intake.
BMaintain nasogastric suction and keep the patient NPO.
CIrrigate the nasogastric tube with 30 mL of normal saline.
DClamp the nasogastric tube and reassess bowel sounds in 4 hours.
Show the answer and why the others fail
Answer: B. Maintain nasogastric suction and keep the patient NPO.
A
Removing the NG tube and starting oral intake before bowel function returns would exacerbate distention and nausea, increasing the risk of vomiting and aspiration.
B — correct
The presentation is consistent with postoperative ileus. Management includes NPO status, nasogastric decompression, and monitoring for return of bowel function (flatus or stool) rather than relying solely on bowel sounds.
C
Irrigation is not indicated because the tube is draining and patent; unnecessary irrigation can cause discomfort and does not treat the underlying ileus.
D
Clamping the tube while the patient has distention and absent bowel sounds may worsen nausea and increase the risk of vomiting; return of bowel function should be confirmed by flatus or stool before clamping.
TakeawayPostoperative ileus is common after abdominal surgery. Management includes NPO status, nasogastric decompression, and monitoring for return of bowel function (flatus or stool) rather than relying solely on bowel sounds.
Surgical nursing · medium
A 28-year-old patient who underwent open reduction and internal fixation of a tibial fracture 12 hours ago reports severe, unrelieved calf pain despite receiving prescribed morphine. The surgical dressing is not constrictive, and the leg is positioned at heart level. The nurse notes pale toes, capillary refill of 4 seconds, and numbness. What should the nurse do first?
AElevate the leg on two pillows.
BApply an ice pack to the affected area.
CAdminister another dose of morphine as prescribed.
DNotify the surgeon immediately.
Show the answer and why the others fail
Answer: D. Notify the surgeon immediately.
A
Elevating the leg above heart level reduces arterial perfusion pressure and can exacerbate ischemia. The limb should be kept at heart level, not elevated above it.
B
Cold application causes vasoconstriction, which can further reduce blood flow to an already ischemic limb and worsen compartment syndrome. Ice is contraindicated.
C
Additional opioid analgesia may mask ischemic pain but does not treat the underlying compartment syndrome, which requires prompt surgical intervention.
D — correct
The patient's severe unrelieved pain, paresthesia, and perfusion changes are consistent with acute compartment syndrome, a surgical emergency. After ensuring no external compression, the priority is to notify the surgeon for possible fasciotomy.
TakeawaySevere pain unrelieved by analgesia and paresthesia are early signs of compartment syndrome; pallor and delayed capillary refill are late signs. After ensuring no constrictive dressings and maintaining the limb at heart level, immediate surgical notification is essential.
Surgical nursing · medium
A 68-year-old male returns to the surgical unit after a transurethral resection of the prostate (TURP). He has a three-way Foley catheter with continuous bladder irrigation (CBI) infusing normal saline. Two hours postoperatively, the nurse notes the urinary drainage is bright red with visible clots, and the patient reports suprapubic pain and a sensation of bladder fullness. Vital signs are stable. What should the nurse do first?
AManually irrigate the catheter to remove clots.
BIncrease the rate of the continuous bladder irrigation.
CAdminister the prescribed antispasmodic medication.
DNotify the surgeon of the bright red drainage.
Show the answer and why the others fail
Answer: A. Manually irrigate the catheter to remove clots.
A — correct
Suprapubic pain, bladder fullness, and visible clots indicate catheter obstruction, which can lead to bladder distension and increased bleeding; manual irrigation is the priority to clear clots and restore patency.
B
Increasing the irrigation rate may help prevent further clot formation but will not clear existing clots that are already obstructing the catheter; manual irrigation is required first to restore patency.
C
Antispasmodics relieve bladder spasms, but the underlying cause is likely catheter obstruction from clots; giving medication without relieving the obstruction could lead to bladder distension and increased bleeding.
D
While the surgeon should be informed of active bleeding, the immediate nursing priority is to ensure catheter patency; manual irrigation should be attempted first, and the surgeon notified if the obstruction cannot be cleared or bleeding persists.
TakeawayAfter TURP, suprapubic pain, bladder fullness, and visible clots in the drainage suggest catheter obstruction; the nurse's first action is manual irrigation to clear the catheter and prevent complications such as bladder distension and increased bleeding.