Postoperative complications NCLEX-RN Practice Questions help you sharpen critical thinking around assessing and preventing complications after surgery. This topic sits in the Reduction of Risk Potential domain and focuses on detecting early warning signs, choosing priority actions, and safely implementing interventions. In the immediate postoperative period and beyond, nurses must anticipate issues like airway compromise, hemorrhage, hypoxia, thromboembolism, delirium, urinary retention, ileus, wound dehiscence/evisceration, infection, and medication-related adverse effects. The following practice questions simulate real NCLEX-RN difficulty, requiring interpretation of assessment trends, safe use of devices (e.g., drains, catheters, PCA), and evidence-based responses to emergencies. Use these items to refine your ability to prioritize, reduce risk, and communicate urgent findings for optimal postoperative outcomes.
Q1. A client arrives to the PACU after general anesthesia with noisy, snoring respirations and use of accessory muscles. Oxygen saturation is 88% on 3 L/min nasal cannula. What is the nurse’s priority action?
- Increase oxygen to 6 L/min via nasal cannula
- Reposition the head and perform a jaw-thrust to open the airway
- Call the anesthesia provider immediately
- Prepare for emergent intubation
Correct Answer: Reposition the head and perform a jaw-thrust to open the airway
Q2. A postoperative client in the PACU is pale, cool, and diaphoretic with a blood pressure of 84/50 mm Hg and pulse 124/min. Which initial action is most appropriate?
- Administer an opioid for pain control
- Assess the surgical site and drains for bleeding
- Place the client in high-Fowler’s position
- Discontinue IV fluids to prevent overload
Correct Answer: Assess the surgical site and drains for bleeding
Q3. On postoperative day 1 after abdominal surgery, a client has fine crackles at the lung bases, a temperature of 37.9°C (100.2°F), and shallow respirations. Which intervention is the priority?
- Encourage incentive spirometry 10 times every hour while awake
- Restrict fluids to reduce pulmonary congestion
- Administer antipyretics and recheck temperature in 4 hours
- Place on bedrest until afebrile
Correct Answer: Encourage incentive spirometry 10 times every hour while awake
Q4. A client on postoperative day 2 after open cholecystectomy reports increasing abdominal distention, nausea, and no passage of flatus. Bowel sounds are absent. Which order should the nurse anticipate?
- Advance diet to full liquids as tolerated
- Insert a nasogastric tube and connect to low intermittent suction
- Administer a stimulant laxative
- Encourage early ambulation but continue regular diet
Correct Answer: Insert a nasogastric tube and connect to low intermittent suction
Q5. On postoperative day 3 after colon resection, a client’s incision is reddened with purulent drainage and the client is febrile. What is the best initial nursing action?
- Administer broad-spectrum antibiotics immediately
- Obtain a wound culture using sterile technique
- Apply an occlusive dressing to seal the wound
- Discontinue ambulation to reduce contamination
Correct Answer: Obtain a wound culture using sterile technique
Q6. A client with a Jackson-Pratt (JP) drain after thyroidectomy has a sudden increase in bright red output from 20 mL/hr to 180 mL/hr. Blood pressure drops to 92/58 mm Hg. What is the priority action?
- Empty and compress the JP bulb to restore suction
- Notify the surgeon and prepare for possible return to the OR
- Document the finding and recheck in one hour
- Discontinue the drain to reduce blood loss
Correct Answer: Notify the surgeon and prepare for possible return to the OR
Q7. Which postoperative intervention most effectively reduces the risk of venous thromboembolism (VTE) in a hemodynamically stable client?
- Applying warm compresses to the calves every 4 hours
- Encouraging early ambulation and use of sequential compression devices
- Maintaining the legs elevated above the heart at all times
- Restricting fluids to reduce edema
Correct Answer: Encouraging early ambulation and use of sequential compression devices
Q8. A postoperative client receiving IV morphine is difficult to arouse with a respiratory rate of 8/min and oxygen saturation of 88%. What is the nurse’s priority action?
- Administer naloxone per standing order
- Apply a warm blanket to stimulate arousal
- Increase IV fluids to improve perfusion
- Offer sips of water and reassess in 15 minutes
Correct Answer: Administer naloxone per standing order
Q9. An older adult becomes acutely confused and restless two hours after surgery. Which assessment should the nurse perform first?
- Assess oxygen saturation and respiratory status
- Assess last bowel movement and bowel sounds
- Review preoperative medication history
- Perform a Mini-Mental State Examination
Correct Answer: Assess oxygen saturation and respiratory status
Q10. A client has a Foley catheter after pelvic surgery. In the last 2 hours, urine output totals 20 mL. The abdomen is firm and suprapubic area is distended. What should the nurse do first?
- Clamp the catheter and reassess in one hour
- Irrigate the catheter and assess for kinks or obstruction
- Increase the IV infusion rate to 200 mL/hr
- Administer a loop diuretic as prescribed
Correct Answer: Irrigate the catheter and assess for kinks or obstruction
Q11. A client reports a sudden “popping” at the abdominal incision while coughing. The wound edges have separated, and serosanguinous drainage is present; viscera are not visible. What is the priority action?
- Apply sterile saline-moistened gauze to the wound and flex the knees
- Pack the wound tightly with dry sterile gauze
- Place the client in high-Fowler’s position
- Remove the staples to reduce tension
Correct Answer: Apply sterile saline-moistened gauze to the wound and flex the knees
Q12. In the PACU after thoracic surgery, a client has severe dyspnea, absent breath sounds on the right, tracheal deviation to the left, and hypotension. What is the nurse’s priority action?
- Administer a bronchodilator via nebulizer
- Call the rapid response team and prepare for needle decompression
- Increase oxygen to 6 L/min via nasal cannula
- Place the client in Trendelenburg position
Correct Answer: Call the rapid response team and prepare for needle decompression
Q13. On postoperative day 2 after subtotal gastrectomy with NG tube in place, the nurse notes 350 mL of bright red drainage in the canister over two hours. What is the best action?
- Document as expected postoperative drainage
- Irrigate the NG tube with 60 mL of air
- Notify the surgeon of possible upper GI bleeding
- Increase suction to high continuous
Correct Answer: Notify the surgeon of possible upper GI bleeding
Q14. A client just received spinal anesthesia and now reports a severe frontal headache when sitting up. Blood pressure and neurological exam are stable. Which nursing action is appropriate?
- Keep the client supine and encourage oral fluids and caffeine
- Place the client in high-Fowler’s position to reduce pressure
- Ambulate the client to improve CSF circulation
- Restrict fluids to minimize intracranial pressure
Correct Answer: Keep the client supine and encourage oral fluids and caffeine
Q15. A hypothermic client arrives to the PACU after a long procedure. Why is active rewarming a priority?
- Hypothermia reduces urine output and prevents AKI
- Hypothermia increases postoperative insulin levels
- Hypothermia impairs coagulation and increases infection risk
- Hypothermia causes rebound hyperthermia in 1–2 hours
Correct Answer: Hypothermia impairs coagulation and increases infection risk
Q16. In the PACU, a client becomes tachycardic, rigid, and hypercapnic with rapidly rising temperature after volatile anesthesia. What is the priority intervention?
- Administer dantrolene and initiate active cooling measures
- Give acetaminophen and apply ice packs to the axillae
- Increase opioid dosing to reduce muscle rigidity
- Place the client under a warming blanket
Correct Answer: Administer dantrolene and initiate active cooling measures
Q17. A postoperative client asks when they can start eating after bowel surgery. Which finding best indicates readiness to advance diet?
- Absence of nausea and ability to swallow pills
- Passing flatus and presence of bowel sounds
- Stable hemoglobin and hematocrit
- Urine output at least 30 mL/hr
Correct Answer: Passing flatus and presence of bowel sounds
Q18. After bariatric surgery, a client develops tachycardia, hypotension, fever, and severe left shoulder pain on postoperative day 1. What complication is most concerning?
- Postoperative urinary retention
- Anastomotic leak
- Dumping syndrome
- Gallstone formation
Correct Answer: Anastomotic leak
Q19. Following a thyroidectomy, a client reports perioral tingling and has a positive Chvostek sign. What is the nurse’s priority action?
- Administer IV calcium gluconate as prescribed
- Encourage deep breathing and coughing exercises
- Increase the rate of the maintenance IV fluids
- Give oral calcium carbonate tablets
Correct Answer: Administer IV calcium gluconate as prescribed
Q20. A client is receiving continuous bladder irrigation (CBI) after TURP. The urine is bright red with large clots and the client reports suprapubic pain. What is the appropriate nursing action?
- Stop the irrigation and clamp the catheter
- Increase the irrigation rate and notify the provider
- Encourage fluid restriction to reduce bleeding
- Remove the catheter to relieve obstruction
Correct Answer: Increase the irrigation rate and notify the provider
Q21. A client with a tight postoperative cast reports severe pain unrelieved by opioids and has pallor and paresthesias in the extremity. What is the priority intervention?
- Elevate the limb above heart level and apply ice
- Notify the surgeon, loosen external dressings, and keep limb at heart level
- Encourage active range-of-motion exercises
- Administer another opioid dose and reassess in 30 minutes
Correct Answer: Notify the surgeon, loosen external dressings, and keep limb at heart level
Q22. Which instruction helps prevent hip dislocation after total hip arthroplasty?
- Cross legs at the ankles to reduce tension
- Avoid hip flexion beyond 90 degrees and use an abduction pillow
- Sleep on the operative side to stabilize the joint
- Keep knees and feet together when sitting
Correct Answer: Avoid hip flexion beyond 90 degrees and use an abduction pillow
Q23. The nurse educates a client at risk for wound dehiscence after abdominal surgery. Which statement indicates correct understanding?
- “I will hold a pillow over my incision when I cough or sneeze.”
- “I should strain to have a bowel movement to avoid laxatives.”
- “I will remove my binder when I walk to increase mobility.”
- “I can lift up to 25 pounds if I feel no pain.”
Correct Answer: “I will hold a pillow over my incision when I cough or sneeze.”
Q24. Which statement shows safe use of a patient-controlled analgesia (PCA) pump after surgery?
- “If I’m sleepy, my spouse can press the button for me.”
- “I should press the button as soon as I feel pain starting.”
- “I’ll wait until pain is severe before pressing the button.”
- “I should press the button every 10 minutes to prevent pain.”
Correct Answer: “I should press the button as soon as I feel pain starting.”
Q25. A postoperative client vomits and becomes drowsy while supine. What should the nurse do first to reduce aspiration risk?
- Place the client in a lateral recovery position
- Offer antiemetic medication orally
- Insert a nasogastric tube immediately
- Sit the client upright to 90 degrees
Correct Answer: Place the client in a lateral recovery position
Q26. A client one week after gastric surgery reports dizziness, palpitations, and diarrhea 20 minutes after meals. Which teaching is appropriate?
- “Increase simple carbohydrates and drink fluids with meals.”
- “Eat small, frequent, high-protein meals and avoid fluids with meals.”
- “Choose high-fiber meals and walk immediately after eating.”
- “Increase caffeine intake to improve gastric emptying.”
Correct Answer: “Eat small, frequent, high-protein meals and avoid fluids with meals.”
Q27. On postoperative day 2, a client has productive cough, tachypnea, and oxygen saturation of 89% on room air. Which action is most appropriate initially?
- Obtain a sputum culture before starting antibiotics
- Apply supplemental oxygen and encourage pulmonary hygiene
- Start IV fluids at 200 mL/hr to loosen secretions
- Restrict movement to conserve energy
Correct Answer: Apply supplemental oxygen and encourage pulmonary hygiene
Q28. A nurse is caring for a postoperative client with a JP drain. Which action promotes correct function?
- Keep the bulb fully expanded before closing the plug
- Compress the bulb before closing the plug to create suction
- Clamp the drain when ambulating to prevent backflow
- Raise the drain above the level of the incision
Correct Answer: Compress the bulb before closing the plug to create suction
Q29. The nurse suspects pulmonary embolism in a postoperative client. Which assessment finding most strongly supports this diagnosis?
- Unilateral calf swelling and warmth
- Sudden dyspnea, pleuritic chest pain, and tachycardia
- Low-grade fever and mild crackles
- Productive cough with green sputum
Correct Answer: Sudden dyspnea, pleuritic chest pain, and tachycardia
Q30. A client post–abdominal surgery has 650 mL of dark amber urine output over the past 8 hours. The client weighs 70 kg. What is the best nursing action?
- Continue current plan; urine output is adequate
- Bolus 500 mL isotonic fluids immediately
- Restrict fluids due to concentrated urine
- Notify the provider for possible acute kidney injury
Correct Answer: Continue current plan; urine output is adequate
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