Top Tips for Mastering the OIIQ-RN March 2025 Exam Surgery Section

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• Surgery

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• Maternal and Child Health

  
  

With 12 live online classes every Monday, Tuesday, and Thursday from 9 AM to 12 PM, our expert instructor, Jim, is here to guide you. An IEN graduate and top of his class from John Abbott College in 2012, Jim has 12 years of teaching experience and an extensive background in the OIIQ exam styles, including OSCE, short answers, and multiple-choice questions.

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After working at Saint Anne Veterans Hospital, Jim moved to the beautiful countryside of Shefford, Quebec, to focus solely on helping students achieve their goals and to spend more time with his loved ones.

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Introducing the OIIQ March 2025 Exam Cheat Sheet!

I am excited to share with you my specially created Cheat Sheet designed to help you prepare for the upcoming March 2025 OIIQ exam. This resource is tailored based on the exam themes, focusing on the most common topics and questions you may encounter.

Important Notes about the Cheat Sheet:

• Practice Tool Only: Please remember that this cheat sheet is not a collection of official exam questions. Instead, it serves as a practice guide to help you familiarize yourself with potential answers and topics relevant to the exam theme.

• Format: The content is not structured as multiple-choice questions and is not designed to assess your critical thinking skills.

• Purpose: The primary goal of the cheat sheet is to enhance your understanding of the material and prepare you for the types of questions you may face in the exam.

  
  

Use this cheat sheet as a valuable study aid to boost your confidence and readiness for the OIIQ exam!

NOTE: "The Cheat Sheet (Top Tips for Mastering the OIIQ-RN March 2025 Exam Surgery Section) will be continuously updated, so feel free to visit anytime!"

Top Tips for Mastering the OIIQ-RN March 2025 Exam Surgery Section

SURGERY OIIQ MARCH 2025 EXAM

Responding to Evisceration	Cover the protruding organs with sterile saline-soaked gauze. Evisceration is a medical emergency. The primary concern is to protect the exposed organs by keeping them moist with sterile saline-soaked gauze and preventing further injury.
Preventing Dehiscence or Evisceration	Teach the patient to splint the incision while coughing. Splinting the incision (e.g., holding a pillow against the wound) reduces the stress and pressure on the surgical site during activities like coughing or sneezing, which helps prevent dehiscence.
High-Risk Patients for Dehiscence or Evisceration	Obese, Malnourished or Underweight, Diabetic, Immunocompromised, Older adults, Smokers, Abdominal surgeries, Chronic conditions (e.g., COPD, CKD)
Identifying Dumping Syndrome. A patient is recovering from a partial gastrectomy. Thirty minutes after eating, he report nausea, abdominal cramping, dizziness, and sweating. The heart rate is elevated.	Dumping syndrome occurs when food moves too quickly from the stomach into the small intestine, often following gastric surgery. Symptoms typically appear 15–30 minutes after eating and include nausea, abdominal cramping, dizziness, sweating, and tachycardia.
Preventing Dumping Syndrome	Patients with dumping syndrome should eat small, frequent meals that are high in protein and low in simple carbohydrates to slow gastric emptying. Drinking fluids with meals can worsen symptoms by increasing the speed of gastric emptying. Large meals exacerbate symptoms, and high-sugar foods can trigger symptoms by causing a rapid shift of fluid into the intestines.
Recognizing Late Dumping Syndrome	Late dumping syndrome occurs 1–3 hours after eating due to a rapid rise in blood glucose, which triggers an excessive insulin response. This leads to hypoglycemia, causing symptoms such as dizziness, sweating, and confusion. Early dumping syndrome (fluid shifts) typically occurs 15–30 minutes after eating.
Dietary Recommendations for Dumping Syndrome	Lying down after meals slows gastric emptying, which can help prevent the rapid dumping of stomach contents into the small intestine. High-fat foods are generally well-tolerated and not restricted in dumping syndrome. Drinking water before meals increases the risk of symptoms by speeding up gastric emptying. Complex carbohydrates can still cause symptoms if consumed in excess.
Pharmacological Management for Dumping Syndrome	Octreotide, a somatostatin analog, slows gastric emptying and inhibits the release of insulin, effectively reducing symptoms of both early and late dumping syndrome.
Purpose of an Abdominal Binder	"The binder supports the incision and prevents strain on your abdominal muscles." An abdominal binder provides support to the abdominal muscles and reduces strain on the surgical site during movement, coughing, or deep breathing. It also helps reduce the risk of dehiscence.
Contraindications for Abdominal Binders	A patient with severe abdominal distention or bowel obstruction. Abdominal binders are contraindicated in patients with severe abdominal distention or bowel obstruction, as they can worsen pressure on the abdomen and cause complications. Drainage from a surgical site or the presence of surgical drains are not absolute contraindications, as the binder can be adjusted to accommodate these situations.
Applying an Abdominal Binder	Ensure the binder is applied snugly but does not interfere with breathing. The abdominal binder should be snug enough to provide support and prevent strain on the incision but not so tight that it restricts breathing or circulation. Applying it loosely will not provide effective support. The binder should cover the abdominal area, not the chest, and should ideally be applied directly to the skin or over a thin dressing, not a bulky gown.
Monitoring After Application of Abdominal Binder	Assess the patient’s respiratory effort and oxygen saturation. The priority after applying an abdominal binder is to ensure it is not restricting the patient's ability to breathe effectively. Respiratory compromise is a potential complication if the binder is too tight.
Postoperative Positioning after Craniotomy. A patient who is postoperative day 1 after a craniotomy for removal of a brain tumor in the right frontal lobe. The patient is lying flat in bed.	Elevate the head of the bed to 30 degrees to promote venous drainage. After a craniotomy, the head of the bed should typically be elevated 30 degrees to facilitate venous drainage, reduce intracranial pressure (ICP), and promote healing. Lying flat increases ICP, and the Trendelenburg position is contraindicated due to its potential to raise ICP further. Turning onto the operative side may increase pressure on the surgical site.
Monitoring for Complications after Craniotomy. Clear drainage from the nose.	Clear drainage from the nose after a craniotomy may indicate cerebrospinal fluid (CSF) leakage, which requires immediate intervention to prevent infection (e.g., meningitis) and address potential complications like a dural tear.
Seizure Prophylaxis after Craniotomy.	Example: levetiracetam (Keppra) "This medication helps prevent seizures, which are a common complication after brain surgery." Seizures are a common complication following a craniotomy, particularly if the surgery involved manipulation of the brain tissue. Antiepileptic medications like levetiracetam are used to prevent seizures.
Reducing Intracranial Pressure (ICP)	Maintain a quiet environment with minimal stimulation. A quiet, low-stimulation environment helps reduce agitation and prevents an increase in intracranial pressure. AVOID: Rapid IV fluid administration can cause cerebral edema. Forceful coughing increases ICP, and high Fowler’s position can impair venous drainage and increase ICP.
Recognizing Early Signs of Increased ICP	Confusion, worsening headache, and blurred vision. Worsening headache, blurred vision, and lethargy are early signs of increased intracranial pressure (ICP), which is a medical emergency. Prompt notification of the healthcare provider is necessary to prevent further complications, such as brain herniation.
Post-Operative Positioning (Lumbar laminectomy)	Supine with a pillow under the knees or side-lying with knees slightly bent to reduce pressure on the spine.
Purpose of Surgery (Laminectomy)	Examples: Herniated disc, spinal stenosis, or nerve root compression.
Neurological Assessments (After a cervical laminectomy, the nurse notices the patient has weak hand grasps bilaterally. What is the priority action?)	Notify the surgeon immediately; this may indicate spinal cord or nerve compression.
Pain Management. A patient reports pain radiating down their leg after a lumbar discectomy. How should the nurse respond?	Assess for signs of nerve damage or reherniation and notify the physician.
What signs indicate a cerebrospinal fluid (CSF) leak after a laminectomy?	Clear drainage at the surgical site or severe headache when sitting upright.
Which nursing interventions can reduce the risk of DVT after spinal surgery?	Encourage early ambulation, use compression stockings, or administer anticoagulants as prescribed.
Mobility and Activity Restrictions after a lumbar discectomy	Patients are typically restricted from heavy lifting for several weeks to months.
A patient reports new onset of bowel and bladder incontinence after a laminectomy. What is the nurse's priority action?	Notify the physician immediately; this could indicate cauda equina syndrome.
What instructions should the nurse provide to a patient regarding incision care after a discectomy?	Keep the incision clean and dry, avoid soaking in water, and report signs of redness, swelling, or drainage.
Spinal Precautions. What instruction should the nurse include to prevent strain on the spine after a lumbar laminectomy?	Use a log-rolling technique when changing positions.
Assistive Devices. Teachings to a patient about wearing a lumbar brace after surgery.	Wear the brace when sitting or standing but can remove it while lying down.
Recognizing the signs and symptoms of dislocation post-THR.	Severe hip pain, shortening of the affected leg, external rotation of the leg and inability to move the hip.
Positioning to Prevent Dislocation. Which position should the nurse avoid when caring for a patient post-total hip replacement?	Hip flexion greater than 90°, adduction, or internal rotation of the hip.
Positioning to Prevent Dislocation. What should the nurse teach the patient about sleeping positions after a total hip replacement?	Use an abduction pillow and sleep on the non-operative side if permitted by the surgeon.
Post-Operative Mobility.	Use a raised toilet seat and chairs with armrests to avoid flexing the hip beyond 90°.
What should the nurse teach the patient about stair climbing after hip replacement surgery?	Lead with the non-operative leg going up and the operative leg going down. Remember: "Good leg goes to heaven (up), Bad leg goes to hell (down)"
What is the priority intervention to prevent DVT after total hip replacement surgery?	Encourage early ambulation, administer prescribed anticoagulants, and use compression devices.
What are the signs of infection after total hip replacement?	Redness, warmth, swelling, fever, and purulent drainage.
Teaching to a patient on how to use a walker after a total hip replacement. What instruction should the nurse include?	Advance the walker first, then move the operative leg forward, followed by the non-operative leg.
What to avoid to prevent Hip Flexion Beyond 90°.	Examples: Sitting in a low chair, bending forward to tie shoes, or crossing legs at the knees.
Rehabilitation and Home Care. What modifications should a patient make at home after a total hip replacement?	Install raised toilet seats, avoid rugs, and use grab bars in the bathroom.
What activity should the nurse caution against during recovery from total hip replacement surgery?	High-impact activities such as running or jumping.
Pain Management. A patient complains of discomfort in the hip joint after a total hip replacement. What should the nurse do first?	Assess the site for signs of dislocation, infection, or other complications, and administer prescribed analgesics as needed.
What is the priority assessment for a patient after a total hip replacement?	Neurovascular checks (e.g., capillary refill, pulses, sensation, and movement) to ensure proper circulation to the affected limb.
Post-Operative Stump Care (amputation)	Wash the limb daily with mild soap and water, keep it dry, and inspect for redness, swelling, or open areas.
What is the purpose of wrapping the residual limb with an elastic bandage?	To shape the limb for prosthesis and reduce swelling.
Phantom Limb Pain	Reassure the patient that phantom limb pain is common and administer prescribed medications like analgesics, anticonvulsants, or antidepressants.
Non-pharmacological interventions that can help relieve phantom limb pain	Mirror box therapy, relaxation techniques, or massage of the residual limb.
Positioning to Prevent Contractures. (below-the-knee amputation)	Avoid prolonged sitting and elevate the stump briefly after surgery to reduce swelling, but ensure the limb is kept flat on the bed to prevent hip or knee contractures.
What is the best position to prevent hip flexion contractures after an above-the-knee amputation?	Lie prone for 30 minutes several times a day.
Psychosocial Support. A patient expresses feelings of hopelessness after an amputation. What is the nurse's best response?	Provide emotional support, encourage the patient to express their feelings, and offer resources such as support groups or counseling.
Example of statement by the patient indicates they are adjusting to the amputation.	"I’m learning to use my prosthesis and manage my daily activities."
What should the nurse teach a patient about prosthesis care?	Ensure proper fit, clean the prosthesis daily, and inspect the residual limb for signs of pressure or irritation.
What signs and symptoms of infection should a nurse teach a patient with an amputation to monitor for?	Redness, swelling, warmth, drainage, and fever.
How can the nurse help prevent skin breakdown in a patient with an amputation?	Teach proper stump hygiene, use appropriate padding in the prosthesis, and encourage frequent position changes.
What is the best method to reduce edema in the residual limb immediately after surgery?	Elevate the limb for the first 24–48 hours, then keep it flat to prevent contractures.
Why is an elastic compression bandage applied to the residual limb?	To reduce swelling and shape the limb for prosthesis fitting.
Preventing and Managing Hemorrhage. A patient is post-op from a below-the-knee amputation and has a sudden increase in drainage on the dressing. What is the nurse’s priority action?	Apply pressure to the site, elevate the limb, and notify the provider immediately.
Which assistive device is best for a patient learning to ambulate after an amputation?	A walker or crutches, depending on their balance and strength.
What is the nurse's priority teaching for a patient learning to use a wheelchair after a lower extremity amputation?	Teach the patient how to prevent tipping by positioning the wheelchair correctly and balancing their weight.
A patient avoids looking at their residual limb after surgery. What should the nurse do?	Encourage the patient to gradually explore their feelings and look at the limb when they are ready, offering support and reassurance.
What is the most therapeutic response to a patient saying, “I don’t feel like myself anymore” after an amputation?	"It’s normal to feel this way. Let’s talk about what’s been hardest for you."
Purpose of Chest Tubes (hemothorax).	To drain blood from the pleural space and restore negative pressure.
What is the purpose of the water seal chamber in a chest drainage system?	To prevent air from entering the pleural space while allowing air and fluid to escape.
How should the suction control chamber function when connected to wall suction?	Gentle bubbling should be present, indicating proper suction.
The nurse notices continuous bubbling in the water seal chamber. What should the nurse do?	Check for an air leak in the system and notify the physician if needed.
How should the nurse assess for proper chest tube placement and function?	Monitor drainage, check for tidaling in the water seal chamber, and assess respiratory status.
A chest tube drainage system shows 150 mL of bright red blood in the first hour post-insertion. What should the nurse do?	Notify the physician immediately; this may indicate hemorrhage. 50–100 mL/hour of serosanguineous (pinkish, watery) drainage is typically considered within the normal range immediately after chest tube insertion. More than 100–200 mL/hour of bright red blood (or consistent heavy output) may indicate active bleeding (e.g., hemorrhage) and requires immediate notification of the provider. Sudden large increases in drainage output should also be reported. Drainage should gradually decrease over time. Bright red drainage that transitions to serosanguineous and then to yellowish or clear is normal. Monitor trends in drainage output and assess for other symptoms of complications, such as hypotension or tachycardia, which may indicate hypovolemia.
What type of drainage is expected in a patient with a chest tube for a pneumothorax?	Minimal or no drainage; the primary issue is air removal.
What should the nurse do if a chest tube is accidentally dislodged?	Cover the site with a sterile occlusive dressing and tape it on three sides to prevent a tension pneumothorax, then notify the provider.
The nurse notes crepitus (subcutaneous emphysema) around the chest tube insertion site. What is the priority action?	Monitor the extent and notify the physician if it progresses or becomes severe.
What intervention can help prevent blockage in the chest tube?	Ensure the tubing is free of kinks and dependent loops, and avoid milking or stripping the tube unless ordered.
How can the nurse prevent infection at the chest tube insertion site?	Perform sterile dressing changes and monitor for signs of infection like redness, warmth, or drainage.
Which position is most appropriate for a patient with a chest tube?	Semi-Fowler's or high-Fowler's position to promote lung expansion and drainage.
How should the patient be positioned during chest tube insertion?	Sitting upright or side-lying with the arm on the affected side raised.
What should the nurse teach a patient about activity while a chest tube is in place?	Encourage deep breathing, coughing, and incentive spirometry while avoiding pulling on the chest tube.
Clamping the chest tube.	Chest tubes should not be clamped unless ordered by the physician.
Continuous bubbling is observed in the water seal chamber. How should the nurse respond?	Assess the tubing connections for leaks and notify the physician if necessary.
What should the nurse teach the patient before chest tube removal?	Perform the Valsalva maneuver during removal to prevent air from entering the pleural space.
What is the nurse's priority after chest tube removal?	Apply a sterile occlusive dressing and monitor for signs of respiratory distress or pneumothorax.
What is the nurse's first action if the chest drainage system is knocked over?	Upright the system, check the water seal level, and ensure it is functioning properly.
What should the nurse do if the chest tube becomes disconnected from the drainage system (system was damage)?	Submerge the end of the chest tube in sterile water to create a temporary water seal and notify the physician.
What is the purpose of an urostomy/ileal conduit?	To divert urine from the kidneys through a segment of the intestine to a stoma, bypassing the bladder due to conditions such as bladder cancer or neurogenic bladder.
What type of urine output is expected with an ileal conduit?	Continuous drainage of urine through the stoma, often mixed with mucus from the intestinal segment.
What should a healthy stoma look like?	Pink, moist, and slightly raised above the skin surface.
What is the nurse’s priority if the stoma appears pale or bluish?	Notify the physician mmediately as this may indicate impaired blood flow to the stoma.
What intervention should the nurse teach to prevent peristomal skin breakdown?	Use a properly fitting pouch, clean the skin with warm water, and apply a skin barrier before attaching the pouch.
A patient reports redness and irritation around the stoma. What is the nurse’s best action?	Assess for leakage, ensure the appliance fits correctly, and apply a protective skin barrier.
How much urine output is expected from an ileal conduit?	At least 30 mL/hour; less than this may indicate dehydration or obstruction.
The patient’s urine from the ileal conduit contains thick mucus. What should the nurse do?	Reassure the patient that this is normal and encourage increased fluid intake to prevent mucus plugs.
What are signs of infection in a patient with an ileal conduit?	Cloudy or foul-smelling urine, fever, and redness or drainage around the stoma.
What should the nurse teach the patient about reducing infection risk?	Empty the pouch when it is one-third full, maintain a clean pouch system, and increase fluid intake.
How often should the patient change their urostomy pouch?	Every 3–5/7 days or sooner if there is leakage.
What type of pouch is best for a patient with an ileal conduit?	A drainable pouch with a secure seal to accommodate continuous urine output.
A patient expresses embarrassment about living with a urostomy. What is the nurse’s best response?	Offer emotional support, encourage participation in a urostomy support group, and provide resources for lifestyle adjustments.
When to empty the urostomy pouch?	One-third full to avoid leakage
A patient with an ileal conduit has no urine output for the past 2 hours. What is the nurse’s priority action?	Assess for signs of obstruction or dehydration and notify the physician immediately.
The nurse notices leakage from the urostomy pouch. What is the best intervention?	Remove the pouch, clean the area, and apply a new appliance with a proper fit.
What should the nurse include in discharge teaching for a patient with an ileal conduit?	Clean the stoma and change the appliance as needed. Drink plenty of fluids to flush mucus and reduce the risk of infection. Monitor for signs of infection or stoma complications.
Patient teaching about adhesive tape for urostomy.	Only use skin-safe adhesive products designed for stoma care.
What activities can a patient with a urostomy safely participate in?	Most activities, including swimming, with proper precautions and use of a waterproof pouch.
What dietary recommendations should the nurse provide?	Encourage fluids, avoid foods that can cause strong urine odors (e.g., asparagus, fish), and monitor for foods that increase mucus production.
What is the purpose of a nephrectomy?	To remove a diseased or non-functioning kidney, treat renal cancer, or address severe trauma or infections.
Which lab tests are important before a nephrectomy?	Kidney function tests (e.g., BUN, creatinine), complete blood count (CBC), coagulation studies, and electrolyte levels.
A patient has just returned from a nephrectomy. What is the nurse’s priority assessment?	Monitor vital signs and urine output closely for signs of bleeding or impaired kidney function.
How much urine output should be expected after a nephrectomy?	At least 30 mL/hour from the remaining kidney.
What lab values should the nurse monitor in a patient after nephrectomy?	Serum creatinine, BUN, and electrolytes.
What foods should a patient with one kidney avoid?	High-protein diets, excessive sodium, and foods that can lead to kidney strain.
What is the most important teaching point for a patient with one functioning kidney after nephrectomy?	Avoid nephrotoxic substances, such as NSAIDs or excessive alcohol, and stay hydrated.
A patient post-nephrectomy has a blood pressure of 85/50 mmHg and reports dizziness. What is the nurse’s priority action?	Assess for signs of hemorrhage and notify the provider immediately.
What is the purpose of a percutaneous nephrostomy?	To bypass a urinary obstruction (e.g., kidney stones, tumors) and allow urine to drain directly from the kidney.
What teaching should the nurse provide to a patient before a percutaneous nephrostomy?	Explain the procedure, ensure informed consent, and advise the patient that sedation or local anesthesia will be used.
What is the priority nursing intervention after a percutaneous nephrostomy tube placement?	Ensure the nephrostomy tube is patent, secure, and properly draining.
A patient with a nephrostomy reports no urine output for the past 2 hours. What is the nurse’s first action?	Check for kinks or obstructions in the nephrostomy tubing and notify the physician if unresolved.
What is a major complication of a nephrostomy tube?	Infection or blockage of the tube.
A patient reports flank pain after nephrostomy tube placement. What is the nurse’s best action?	Assess for tube obstruction or infection and administer prescribed analgesics. If the physician clamped the tube, unclamp the tube and notify the physician.
What non-pharmacological interventions can help reduce discomfort after nephrectomy?	Position the patient with the operative side up, provide support when moving, and encourage deep breathing exercises.
What is the best way to prevent infection at the nephrostomy tube site?	Perform sterile dressing changes and keep the site clean and dry.
What should the nurse assess at the nephrostomy tube site?	Redness, swelling, drainage, or signs of infection.
What should the nurse teach a patient with a nephrostomy tube about home care?	Flush the tube as prescribed to prevent blockage. Keep the drainage bag below the level of the kidney. Report signs of infection or blockage (e.g., fever, decreased output, pain).
A patient expresses fear about living with only one kidney. What is the nurse’s best response?	Provide reassurance and educate about lifestyle adjustments for maintaining kidney health.
What dietary advice should the nurse give a patient with a nephrostomy?	Increase fluid intake to prevent blockage and promote drainage.
What imaging might be necessary for a patient with a nephrostomy?	X-ray or ultrasound to confirm tube placement and assess for obstructions.
What is the purpose of an ileostomy?	An ileostomy diverts stool through an opening (stoma) in the abdomen after removing or bypassing part of the colon, often for conditions like ulcerative colitis, Crohn's disease, or cancer.
What type of stool is expected from an ileostomy?	Liquid stool, as the large intestine (where water is absorbed) is bypassed.
What does a healthy stoma look like?	Pink to red, moist, and slightly raised.
What should the nurse do if the stoma appears pale or bluish?	Notify the physician immediately as it may indicate compromised blood flow.
What is the best way to prevent skin breakdown around an ileostomy?	Use a properly fitted appliance, clean the skin with warm water, and apply a skin barrier before attaching the pouch.
A patient reports redness and irritation around the stoma. What should the nurse assess?	Check for leaks in the appliance and ensure it fits securely.
What is the normal output from an ileostomy in the first few days post-op?	High output (up to 1,000–1,800 mL/day), which will gradually decrease as the body adjusts.
What should the nurse do if an ileostomy produces no output for several hours?	Assess for signs of obstruction, such as abdominal pain, nausea, or bloating, and notify the physician.
What are signs of ileostomy obstruction?	Abdominal cramping, nausea, bloating, and absence of output.
What is the priority intervention for a patient with dehydration after ileostomy surgery?	Encourage oral fluids, administer IV fluids as prescribed, and monitor electrolytes.
Why is a patient with an ileostomy at risk for dehydration?	The large intestine, where water absorption occurs, is bypassed, leading to increased fluid loss.
What are signs of electrolyte imbalance in a patient with an ileostomy?	Muscle weakness, irregular heartbeat, or confusion (e.g., due to low potassium or sodium).
What foods should a patient avoid after ileostomy surgery?	High-fiber (roughage) or difficult-to-digest foods (e.g., corn, nuts, popcorn, raw vegetables) to prevent blockages.
What should the nurse teach about fluid intake?	Drink at least 8–10 glasses of water daily to prevent dehydration.
A patient expresses embarrassment about their ileostomy. What is the nurse’s best response?	Acknowledge their feelings, provide reassurance, and suggest joining a support group for patients with ostomies.
How often should a patient change their ileostomy appliance?	Every 3–5/7 days or sooner if there is leakage.
What should the nurse teach about emptying the ileostomy pouch?	Empty it when it is one-third full to prevent leaks.
What activities can a patient with an ileostomy safely participate in?	Most activities, including swimming and sports, with proper precautions.
What signs indicate the need for follow-up care to a patient with ileostomy?	Persistent stoma bleeding, dramatic changes in output, or signs of infection (e.g., fever, redness around the stoma).
What is the purpose of a Jackson-Pratt (JP) drain?	To provide closed-suction drainage of fluids from surgical sites, preventing fluid accumulation and promoting healing.
Why is a Penrose drain used?	To allow passive drainage of fluid from a wound into an absorbent dressing.
How does a Hemovac drain differ from a Jackson-Pratt drain?	Both are closed-suction systems, but the Hemovac is larger and typically used for procedures with higher fluid output, such as orthopedic or abdominal surgeries.
What type of drain is used to promote bile drainage after gallbladder surgery?	A T-tube drain is used to facilitate bile drainage after common bile duct surgery.
How should the nurse care for a Jackson-Pratt (JP) drain?	Empty the drain when it is one-third to one-half full, compress the bulb before closing to maintain suction, and document the amount and characteristics of the output.
How should the nurse position a Penrose drain?	Ensure the drain is secured in place with a safety pin to prevent it from slipping into the wound.
What is the expected drainage from a T-tube in the first 24 hours post-op?	Approximately 300–500 mL of greenish-brown bile. This amount should gradually decrease over time.
The nurse notes that the output from a Hemovac drain has decreased from 150 mL to 10 mL in 8 hours. What is the priority action?	Assess for drain blockage or kinks in the tubing.
A patient with a Penrose drain develops redness and warmth around the insertion site. What is the nurse’s priority action?	Notify the provider, as these are signs of infection.
What is a potential complication of a blocked T-tube drain?	Jaundice or bile leakage, as bile backs up into the liver or surrounding tissues.
What should the nurse include when documenting wound drainage?	Type, color, consistency, amount, and any odor.
A Hemovac drain was emptied, and 200 mL of serosanguinous fluid was recorded. What additional information should the nurse document?	Time of emptying, patency of the drain, and any changes in output characteristics.
What is the nurse’s priority action before removing a Jackson-Pratt drain?	Verify the physician’s order and instruct the patient about the procedure to reduce anxiety.
When can a T-tube be removed after bile duct surgery?	Typically, when bile output decreases and imaging confirms no obstruction.
What instructions should the nurse provide to a patient with a JP drain at discharge?	Empty the drain when it is one-third to one-half full. Wash hands before and after handling the drain. Keep the insertion site clean and dry. Notify the provider if there is redness, swelling, or foul-smelling drainage.
What should a patient with a T-tube drain avoid?	Avoid pulling or twisting the tube and ensure the drainage bag is below the level of the abdomen.
What type of drainage is expected from a Penrose drain?	Serosanguinous or serous drainage.
How much output is normal for a Hemovac drain in the first 24 hours post-surgery?	Typically 500 mL or less, depending on the procedure.
How can the nurse minimize the risk of infection in a patient with a JP drain?	Use sterile technique when emptying the drain and change dressings as needed.
What are signs of infection related to a wound drain?	Fever, purulent drainage, increased redness, and swelling at the site.
What is the purpose of a cuffed tracheostomy tube?	To prevent aspiration and provide a closed system for mechanical ventilation.
When is a fenestrated tracheostomy tube used?	To allow speech and facilitate weaning from the tracheostomy.
How long should each suction attempt last?	No more than 10–15 seconds to prevent hypoxia.
What should the nurse do before suctioning a tracheostomy?	Hyperoxygenate the patient to prevent desaturation.
How often should tracheostomy care be performed?	At least once per shift or as needed to prevent infection and maintain patency.
What is the most common complication in the first 24 hours after tracheostomy insertion?	Bleeding and airway obstruction.
What should the nurse do if the tracheostomy tube becomes dislodged?	Insert a replacement tube or use a resuscitation bag to ventilate via the stoma and call for help immediately.
What are signs of tracheostomy infection?	Redness, swelling, warmth, purulent drainage, and fever.
What is the priority action if a patient with a tracheostomy develops respiratory distress?	Assess the airway for obstruction, suction if needed, and ensure the tracheostomy tube is patent.
Why is humidification important for a patient with a tracheostomy?	To prevent drying of secretions, which can cause blockages and impair airway patency.
What can the nurse do to ensure proper humidification?	Use a heated humidifier or provide a tracheostomy collar with humidified oxygen.
How can a patient with a tracheostomy communicate?	Use of a communication board, writing, or a speaking valve like a Passy-Muir valve (if appropriate).
When is a speaking valve contraindicated?	When the tracheostomy tube has an inflated cuff, as this blocks airflow to the vocal cords.
Why are patients with a tracheostomy at risk for aspiration?	The presence of the tube may impair swallowing reflexes.
What is the priority intervention when feeding a patient with a tracheostomy?	Ensure the cuff is inflated if ordered, keep the patient in a high Fowler's position, and monitor for choking.
What should a caregiver do if the tracheostomy tube is accidentally dislodged at home?	Insert the spare tracheostomy tube (if trained) or call emergency services.
What is the most important step after inserting an NG tube?	Confirm placement with an X-ray before using the tube.
What are the primary purposes of an NG tube?	Decompression of the stomach, administration of medications or nutrition, and removal of gastric contents.
What condition commonly requires NG tube placement?	Bowel obstruction, to decompress the stomach and prevent vomiting.
What is the most accurate way to verify NG tube placement initially?	X-ray confirmation.
How should the nurse position the patient for NG tube insertion?	High Fowler’s position to reduce the risk of aspiration and aid in tube passage.
What should the nurse instruct the patient to do during NG tube insertion?	Sip water and swallow to help advance the tube into the stomach.
What should the nurse do before administering medications through an NG tube?	Verify tube placement by checking the pH of aspirated gastric contents (pH <5.5).
How should the nurse administer medications through an NG tube?	Crush medications (if allowed), dilute them with water, flush the tube with 30 mL of water before and after each medication, and administer one medication at a time.
What is the nurse's priority when administering enteral feedings?	Keep the head of the bed elevated to at least 30–45 degrees to prevent aspiration.
How often should the nurse flush an NG tube?	Every 4–6 hours for continuous feedings or before and after intermittent feedings/medication administration.
What should the nurse do if the NG tube becomes clogged?	Attempt to flush the tube with warm water or an approved solution, and notify the physician if unsuccessful.
What is the expected color of NG tube drainage in the first 24 hours after gastric surgery?	Dark brown or coffee-ground appearance, which indicates old blood.
What should the nurse do if NG tube output is bright red?	Notify the physician immediately, as this could indicate active bleeding.
What are signs of NG tube displacement?	Gagging, coughing, decreased drainage, or the patient reporting difficulty breathing.
What is the priority action if the patient develops respiratory distress during NG tube insertion?	Stop the procedure, withdraw the tube, and assess the patient.
What are common complications of NG tubes?	Nasal irritation, esophageal trauma, aspiration, and tube blockage.
What should the nurse do before removing an NG tube?	Verify the physician's order, flush the tube with 10–20 mL of water or air, and instruct the patient to take a deep breath and hold it during removal.
What is the priority action after removing an NG tube?	Assess for nausea, vomiting, or abdominal distention, which may indicate unresolved gastric issues.
What should the nurse teach a patient with a temporary NG tube?	The purpose of the tube, how to report discomfort, and the importance of keeping the head elevated to reduce aspiration risk.
What should a caregiver monitor for in a patient with an NG tube at home?	Signs of infection, dislodgement, or blocked tubing.
Can the insertion of an NG tube be delegated to a licensed practical nurse (LPN)?	Yes, depending on the facility's policies, but this is under the LPN's scope of practice.
What should the nurse do if a patient with an NG tube for decompression vomits?	Assess the patency of the tube and suction if necessary.
What is the priority action if the NG tube accidentally comes out?	Notify the physician and prepare for reinsertion, unless contraindicated.
What is the primary purpose of TPN?	To provide complete nutrition intravenously when the gastrointestinal tract is non-functional or needs rest.
Which condition most commonly requires TPN?	Conditions like short bowel syndrome, severe malabsorption, or prolonged bowel rest due to pancreatitis or bowel obstruction.
What are the main components of TPN?	Carbohydrates (dextrose), proteins (amino acids), lipids, electrolytes, vitamins, and trace elements.
What should the nurse monitor closely when administering a high-dextrose TPN solution?	Blood glucose levels for hyperglycemia.
What type of IV line is required for TPN administration?	A central venous catheter (e.g., PICC line, subclavian, or internal jugular line) due to the high osmolarity of TPN.
What is the recommended infusion rate for TPN?	Start slowly and gradually increase based on patient tolerance to avoid complications like hyperglycemia.
How often should blood glucose levels be checked during TPN therapy?	Every 4–6 hours, especially at the start of therapy or with dosage adjustments.
What is the priority nursing action if a patient develops hyperglycemia while receiving TPN?	Notify the physician, monitor glucose levels, and anticipate orders for insulin therapy.
What is the most common complication of TPN?	Infection, particularly catheter-related bloodstream infections.
How can the nurse prevent air embolism during TPN therapy?	Ensure proper clamping of the catheter during tubing changes and have the patient perform the Valsalva maneuver if necessary
What are signs of a central line infection in a patient receiving TPN?	Fever, chills, redness or drainage at the catheter site, and elevated white blood cell count.
What is the nurse's priority if a catheter-related infection is suspected?	Notify the physician, obtain blood cultures, and follow aseptic technique during dressing changes.
Which electrolyte imbalance is commonly seen in the first few days of TPN therapy?	Hypokalemia or hypophosphatemia due to refeeding syndrome.
What are the signs of refeeding syndrome?	Muscle weakness, fatigue, arrhythmias, and electrolyte disturbances (low potassium, phosphate, and magnesium).
How should lipid emulsions be administered with TPN?	Through a separate IV line or Y-connector below the TPN filter to prevent contamination.
What is a common side effect of lipid infusion?	Fever, chills, or allergic reactions. NOTE: Monitor for fat embolism
Why should TPN be tapered gradually rather than stopped abruptly?	To prevent hypoglycemia, as the pancreas continues to release insulin in response to the high dextrose concentration.
What dietary progression should occur after discontinuing TPN?	Gradual reintroduction of oral or enteral feeding based on gastrointestinal function.
What should a patient report while receiving TPN at home?	Signs of infection (fever, redness, swelling), catheter dislodgement, or abnormal blood glucose readings.
Why is daily weight monitoring important during TPN therapy?	To assess fluid balance and nutritional status.
What should the nurse do if the TPN bag runs out and a new one is not available?	Hang a bag of 10% dextrose in water (D10W) to prevent hypoglycemia.
How often should the TPN tubing and bag be changed?	Every 24 hours using aseptic technique.
Which lab values are essential to monitor during TPN therapy?	Blood glucose, electrolytes, liver function tests, albumin, and prealbumin levels.
What does a decreasing albumin level indicate during TPN therapy?	Poor protein status or worsening malnutrition.
What should the nurse do if a patient develops shortness of breath while receiving TPN?	Assess for signs of air embolism and notify the physician.
What is the nurse’s priority if a TPN solution appears cloudy or has particles?	Do not administer the solution and notify the pharmacy immediately.
What is the primary goal of multimodal analgesia?	To enhance pain relief by combining medications and techniques that target different pain pathways, thereby reducing opioid use and minimizing side effects.
Which patient population benefits most from multimodal analgesia?	Surgical patients, those with chronic pain, and patients at high risk for opioid-related side effects.
Which classes of medications are commonly used in multimodal analgesia?	NSAIDs (e.g., ibuprofen), acetaminophen, local anesthetics, anticonvulsants (e.g., gabapentin), antidepressants (e.g., amitriptyline), and opioids.
What is an example of a nonpharmacologic method used in multimodal analgesia?	Techniques such as physical therapy, acupuncture, or heat/cold application.
What is the primary advantage of multimodal analgesia in postoperative patients?	It reduces the need for opioids, thereby decreasing the risk of opioid-related side effects such as respiratory depression, nausea, and constipation.
How does combining acetaminophen and ibuprofen contribute to opioid sparing?	They provide synergistic pain relief by targeting different pain mechanisms, allowing for lower doses of opioids.
What is the nurse’s priority when administering multiple medications as part of multimodal analgesia?	Monitor for drug interactions, overlapping side effects, and effectiveness of pain relief.
How should the nurse evaluate the effectiveness of multimodal analgesia?	By assessing the patient’s pain level, functional ability, and side effects.
What should the nurse do if a patient is prescribed both NSAIDs and acetaminophen?	Verify the dosing schedule to prevent exceeding the maximum daily dose of acetaminophen (4000 mg/day) and monitor for gastrointestinal side effects from NSAIDs.
What is the recommended route of administration for multimodal analgesia in the immediate postoperative period?	A combination of IV and oral routes, transitioning to oral as the patient’s condition stabilizes.
What should the nurse teach a patient about taking multiple pain medications?	The purpose of combining medications, potential side effects, and the importance of adhering to the prescribed regimen.
Why is it important for patients to report worsening pain despite multimodal analgesia?	It may indicate inadequate pain control or a complication requiring further evaluation.
What is the nurse’s priority if a patient receiving multimodal analgesia develops gastrointestinal bleeding?	Discontinue NSAIDs and notify the physician immediately.
What are common side effects of gabapentin in multimodal analgesia?	Drowsiness, dizziness, and peripheral edema.
Which patient population requires caution when using NSAIDs as part of multimodal analgesia?	Patients with a history of peptic ulcers, renal impairment, or cardiovascular disease.
Why is multimodal analgesia beneficial for elderly patients?	It reduces the need for high-dose opioids, minimizing the risk of sedation and falls.
What nonpharmacologic interventions can complement multimodal analgesia?	Relaxation techniques, physical therapy, massage, or transcutaneous electrical nerve stimulation (TENS).
Why are nonpharmacologic methods important in multimodal analgesia?	They enhance pain control without increasing medication-related side effects.
How does the nurse determine if multimodal analgesia is effective?	By assessing the patient’s pain level, ability to participate in activities, and absence of significant side effects.
What should the nurse do if a patient reports inadequate pain relief with multimodal analgesia?	Reassess the pain, evaluate the medication regimen, and notify the provider for potential adjustments.
What is the nurse’s priority if a patient on multimodal analgesia shows signs of respiratory depression?	Administer oxygen, assess sedation levels, and prepare to give naloxone if opioids are part of the regimen.
What should the nurse monitor for in a patient receiving local anesthetics as part of multimodal analgesia?	Signs of local anesthetic systemic toxicity (LAST), such as tinnitus, metallic taste, or seizures.
What is the nurse’s priority before initiating a blood transfusion?	Verify the patient’s identity, blood type, crossmatch compatibility, and physician’s order.
What baseline assessments should the nurse perform before starting a transfusion?	Vital signs (temperature, blood pressure, heart rate, respiratory rate), lung sounds, and checking for any previous history of transfusion reactions.
What is the maximum time allowed for administering one unit of blood?	4 hours to prevent bacterial growth.
What size IV catheter is recommended for blood transfusions?	18–20 gauge for rapid infusion; smaller gauges (22–24) can be used for slow infusions in less urgent cases.
Why is normal saline (0.9% NaCl) the only fluid compatible with blood products?	To prevent hemolysis caused by hypotonic or hypertonic solutions.
How often should the nurse monitor vital signs during a blood transfusion?	Before the transfusion, 15 minutes after starting, and then at regular intervals (e.g., every 30–60 minutes) until completion.
Why should the nurse remain with the patient for the first 15 minutes of a transfusion?	To monitor for immediate transfusion reactions, which are most likely to occur during this time.
What is the nurse’s priority if a patient develops chills, fever, and hypotension during a blood transfusion?	Stop the transfusion immediately, maintain IV access with normal saline, and notify the provider.
What are signs of a hemolytic transfusion reaction?	Fever, chills, back pain, hematuria, tachycardia, and hypotension.
What is the nurse’s first action if a patient develops signs of fluid overload during a transfusion?	Slow or STOP the transfusion, elevate the head of the bed, and notify the physician.
What type of blood product is used to treat a patient with a clotting disorder like hemophilia?	Fresh frozen plasma or cryoprecipitate.
What is the purpose of albumin transfusions?	To expand blood volume in hypovolemic patients or to treat hypoalbuminemia.
Which blood type is considered the universal donor?	O negative.
Which blood type is considered the universal recipient?	AB positive.
What should the nurse do if a patient with Rh-negative blood is accidentally given Rh-positive blood?	Monitor closely for hemolytic reactions and notify the physician.
What delayed complication should the nurse monitor for after a blood transfusion?	Delayed hemolytic reaction, characterized by jaundice, anemia, or fever days after the transfusion.
What should the nurse assess after a transfusion for a patient with chronic kidney disease?	Signs of hyperkalemia, as stored blood may contain high levels of potassium.
What information should the nurse document after a blood transfusion?	Type and volume of blood product, start and end times, vital signs, patient’s response, and any adverse reactions.
Why is it important to record the blood unit number in the patient’s medical record?	For traceability in case of a transfusion reaction or recall.
What should the nurse teach a patient to report during a blood transfusion?	Chills, itching, difficulty breathing, or back pain.
Why is it important to inform the patient about potential febrile non-hemolytic reactions?	To reassure them that mild fever or chills can occur due to white blood cell antibodies but is not life-threatening.
What is leukocyte-reduced blood, and why is it used?	Blood with reduced white blood cells to minimize febrile reactions or CMV transmission in immunocompromised patients.
What action should the nurse take when transfusing cold blood to a hypothermic patient?	Warm the blood using an approved blood warmer to prevent cardiac arrhythmias.
What is the primary purpose of epidural anesthesia during labor?	To provide pain relief while allowing the patient to remain awake and participate in the birthing process.
Which procedures commonly involve epidural anesthesia?	Labor and delivery, cesarean sections, lower abdominal, pelvic, or lower extremity surgeries.
Where is the epidural catheter placed?	In the epidural space of the lumbar spine (usually between L3 and L4 or L4 and L5).
What position is most commonly used during epidural insertion?	Sitting or side-lying with the back arched to widen the intervertebral spaces.
Which condition is a contraindication to epidural anesthesia?	Coagulopathy (e.g., low platelet count), infection at the injection site, or severe hypovolemia.
Why is an epidural not recommended for a patient with increased intracranial pressure?	It may worsen neurological status by altering cerebrospinal fluid dynamics.
What should the nurse assess before epidural anesthesia is administered?	Baseline vital signs, coagulation studies, allergies, and fluid volume status.
Why is an IV fluid bolus often given before epidural anesthesia?	To prevent hypotension caused by vasodilation from the anesthetic.
What is the nurse’s priority during epidural placement?	Monitor the patient for signs of pain, paresthesia, or hypotension.
Why is it important to monitor fetal heart rate during labor epidural placement?	Hypotension in the mother can lead to decreased placental perfusion, affecting the fetus.
What is the nurse’s first action if a patient receiving an epidural develops hypotension?	Increase IV fluids, position the patient in a left lateral position, and notify the physician.
What is a sign of accidental dural puncture during epidural placement?	Severe headache (post-dural puncture headache) that worsens when sitting or standing.
What are signs of epidural hematoma?	Severe back pain, motor weakness, or sensory loss below the level of the epidural.
What should the nurse assess after the epidural is initiated?	Pain relief, blood pressure, motor strength, sensation, and signs of adverse effects.
What is the priority if a patient reports difficulty breathing after receiving an epidural?	Assess for high spinal anesthesia and prepare for respiratory support if necessary.
What should the nurse check during continuous epidural infusion?	Catheter site for leakage or infection, infusion pump settings, and patient’s sensory and motor function.
What is the nurse’s role if the patient reports inadequate pain relief during epidural infusion?	Verify catheter patency, assess medication dosage, and notify the anesthesiologist
How long should a patient remain in bed after the epidural is discontinued?	Until motor and sensory function have fully returned.
What is the nurse’s priority if a patient reports severe headache after epidural removal?	Encourage fluid intake, position the patient supine, and notify the physician (possible epidural blood patch may be required).
What should the nurse teach a patient about the sensations they might experience during an epidural?	A feeling of pressure or mild discomfort during insertion, but no severe pain.
Why is it important to inform patients not to ambulate without assistance after an epidural?	Due to possible motor weakness and altered sensation, which increases the risk of falls.
Why is epidural anesthesia preferred over general anesthesia for cesarean delivery?	It allows the mother to remain awake, decreases risks associated with general anesthesia, and provides post-operative pain relief.
What action should the nurse take if epidural anesthesia affects only one side of the body?	Reposition the patient to improve anesthetic distribution.
Which medications are commonly administered through an epidural catheter?	Local anesthetics (e.g., bupivacaine, lidocaine) and opioids (e.g., fentanyl, morphine).
What is the primary advantage of adding opioids to an epidural anesthetic?	Enhanced pain relief at lower doses of local anesthetics, reducing motor block.