Welcome to your 4. 💧 Perioperative Fluids, Nutrition, Recovery & Pain Care Arena — 40 Integrated MCQs
1.
Which set of observations is most useful for routine detection of early postoperative deterioration?
2.
A patient is drinking adequately, has stable observations and has no significant ongoing losses after an uncomplicated operation. What is the most appropriate change to the fluid plan?
3.
Before surgery, a patient reports vomiting for two days. Which information is most useful when assessing the patient’s fluid requirement?
4.
A patient has prolonged vomiting before an operation. Which blood test is particularly relevant to the fluid and electrolyte assessment?
5.
A patient can swallow safely after surgery but is eating too little to meet nutritional needs. Which method should be considered first?
6.
A patient who has been largely immobile after surgery develops swelling and tenderness in one calf. Which complication should be considered?
7.
A surgical unit is reviewing its enhanced recovery pathway. Patients routinely remain without food or drink longer than clinically required before and after elective surgery. Which change is most consistent with enhanced recovery principles?
8.
A patient cannot swallow safely, but the gastrointestinal tract is functioning. Which route can provide nutritional support?
9.
A severely malnourished patient develops a marked fall in serum phosphate soon after nutritional support begins. Which complication does this suggest?
10.
A patient becomes restless several hours after a urinary catheter is removed. They have lower abdominal discomfort and have been unable to pass urine. Which complication is most likely?
11.
A patient receiving feed through a nasogastric tube develops coughing and breathlessness during feeding. Which complication is the immediate concern?
12.
Five days after bowel surgery, a patient has persistent tachycardia, fever and increasing abdominal pain. The abdomen is tender despite apparently satisfactory wound healing. Which complication needs urgent assessment?
13.
A patient says pain is mild while resting but cannot cough comfortably after abdominal surgery. What should the pain assessment include?
14.
On the fourth postoperative day, a patient suddenly develops breathlessness and pleuritic chest pain. Oxygen saturation falls, and the pulse is 118/min. Which complication is the priority concern?
15.
A surgical patient begins parenteral nutrition. Which metabolic measurement should be checked regularly, particularly during initiation?
16.
After major abdominal surgery, a patient needs pain relief that will allow effective coughing and mobilisation while limiting opioid adverse effects. Which addition to the analgesic plan may help achieve this?
17.
A patient continues to lose a substantial volume of fluid through a nasogastric tube after surgery. How should this loss be considered in the fluid plan?
18.
A patient receiving intravenous fluids develops increasing peripheral oedema and breathlessness. Which fluid-related problem is most likely?
19.
A patient using opioid patient-controlled analgesia becomes difficult to rouse. Their respiratory rate is 7/min and oxygen saturation is falling. What is the immediate priority?
20.
Which approach to pain relief is consistent with an enhanced recovery programme?
21.
A postoperative patient becomes mildly confused while receiving maintenance intravenous fluids. Serum sodium has fallen from 139 to 126 mmol/L. Which aspect of the fluid prescription should be reviewed first?
22.
Following abdominal surgery, a patient needs nutritional support but cannot use the gastrointestinal tract. Which method may be required?
23.
A patient breathes shallowly after abdominal surgery because movement is painful. Which system requires particular attention?
24.
A patient receiving nutrition through a central venous catheter develops fever and chills during an infusion. Which complication should be considered?
25.
Several days after surgery, a patient’s wound becomes increasingly red, warm and tender, with purulent discharge. Which complication is most likely?
26.
A patient with persistent swallowing difficulty needs enteral feeding for several weeks. The stomach functions normally. Which access route is more suitable for longer-term support?
27.
An elective surgical team introduces coordinated preoperative preparation, appropriate perioperative fluid management and planned postoperative recovery measures. Which outcome is a recognised aim of this approach?
28.
Two hours after abdominal surgery, a patient becomes pale and hypotensive. The pulse is 125/min, and fresh blood is rapidly filling the surgical drain. Which complication is most likely?
29.
A patient has abdominal distension, nausea and failure to pass flatus after abdominal surgery. Bowel sounds are markedly reduced. Which postoperative problem best explains the findings?
30.
A patient reports rapidly worsening abdominal pain despite prescribed analgesia. They are tachycardic, and the abdomen is newly rigid. What is the most appropriate response?
31.
A patient develops acute kidney injury after a prolonged operation. Urine output is low and serum potassium is 5.9 mmol/L. Which prescription requires immediate review?
32.
A patient with poorly controlled pain after abdominal surgery avoids taking deep breaths and coughing. Which consequence becomes more likely?
33.
An enhanced recovery plan encourages a stable patient to get out of bed soon after surgery. What is the main purpose of this measure?
34.
After uncomplicated bowel surgery, a stable patient is awake, has no vomiting and can swallow safely. Which nutritional plan best supports recovery?
35.
A patient scheduled for major elective surgery has marked recent weight loss and poor food intake. Which preoperative action best addresses this risk?
36.
Following bowel surgery, a patient has a high-output ileostomy, dizziness on standing and falling serum sodium. What should guide replacement of the ongoing losses?
37.
Shortly after surgery, a patient has a rapid pulse, low blood pressure and cool extremities. Which problem should be assessed promptly?
38.
A patient develops diarrhoea after enteral feeding is started. They are otherwise stable, and the tube remains correctly positioned. What is the best initial approach?
39.
A patient recovering from bowel surgery has received intravenous fluids for two days. The team needs to decide whether the current prescription remains appropriate. Which combination gives the best overall assessment?
40.
A postoperative patient has passed very little urine over the last four hours. What is the most appropriate initial approach?
