NCLEX Perioperative & PACU questions
The PrepScore bank has 108 Perioperative & PACU questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Recognize cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Pre-op teaching + NPO + consent verification, anesthesia types + medications, malignant hyperthermia recognition + dantrolene, PACU airway emergencies, post-op fever 5W's, ileus + DVT prevention, surgical site infection, hand-off communication SBAR, peri-op multi-patient priority.
Three worked questions
Q1. A post-op pt is shivering and has a temperature of 35.4°C. The PRIORITY intervention is:
- A. Give an antiemetic
- B. Apply warm blankets + monitor temp + ensure oxygenation
- C. Encourage ambulation
- D. Reduce IV fluids
Show answer and rationale
Answer: Apply warm blankets + monitor temp + ensure oxygenation
Post-op hypothermia: rewarm + monitor (shivering increases O2 demand → ischemia risk).
Q2. Which findings warrant immediate provider notification in PACU? Select all that apply.
- A. SpO2 95% on 2L NC
- B. HR 130 + BP 84/52
- C. RR 8 + SpO2 88%
- D. Bright red saturating dressing
- E. Pain 4/10
- F. Aldrete score 5
Show answer and rationale
Answer: HR 130 + BP 84/52RR 8 + SpO2 88%Bright red saturating dressingAldrete score 5
PACU red flags: hemodynamic instability, hypoventilation, hemorrhage, low Aldrete.
Q3. A post-op client's dressing has a quarter-sized blood stain that has not enlarged in 1 hour. What is the BEST action?
- A. Notify provider immediately
- B. Reinforce the dressing + mark/timestamp + reassess in 15 min
- C. Remove the original dressing
- D. Apply firm pressure for 30 min
Show answer and rationale
Answer: Reinforce the dressing + mark/timestamp + reassess in 15 min
Post-op dressing with quarter-sized blood + not enlarging in 1h: reinforce dressing (don't remove — disrupts clot + protective barrier), MARK + TIMESTAMP edge of stain (track expansion over time), reassess in 15 min. Notifying provider immediately for stable non-expanding stain is over-escalation; removing original dressing disrupts hemostasis; 30-min firm pressure isn't indicated for non-expanding.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Pre-op verification + surgeon site marking with patient verifying + time-out IMMEDIATELY before incision. If consent doesn't match patient or laterality → HALT until corrected. NPO per anesthesia guidelines (clear liquids 2 hr, light 6 hr, full 8 hr). Hold metformin (lactic acidosis), verify ACE/anticoagulant/insulin/herbals per protocol. Educate post-op (IS, splinted cough, mobility).
Triggers: volatile anesthetics (sevoflurane, iso, des) + SUCCINYLCHOLINE; genetic ryanodine receptor mutation. EARLY signs: rising EtCO2 (first) + masseter rigidity + tachycardia + tachypnea + acidosis. Fever is LATE. Treatment: STOP triggers + switch to TIVA + DANTROLENE 2.5 mg/kg IV (up to 10 mg/kg) + 100% O2 + ACTIVE COOLING + treat hyperK + call MH hotline. Future = TIVA + non-depolarizing NMBA + alert.
Upper airway obstruction in PACU differential: tongue (most common — jaw thrust + airway adjunct), laryngospasm (stridor — BVM positive pressure + jaw thrust ± succinylcholine + reintubation), aspiration (lateral + suction + O2), edema. NC alone can't overcome obstruction. Negative-pressure pulmonary edema can develop after relieved obstruction → O2 + diuretic + supportive vent.
Wind (POD 1-2): atelectasis/pneumonia → IS, splinted cough, mobility. Water (POD 3-5): UTI from Foley → UA + culture + remove Foley + targeted antibiotics. Walking (POD 5-6): DVT/PE → duplex US + CTA + anticoagulation. Wound (POD 5-7+): SSI → inspect + culture + antibiotics + I+D if abscess; surgeon for dehiscence. Wonder drugs (any day): drug fever or C. diff or deep abscess. AVOID empirical broad-spectrum shotgun.
Enhanced recovery: early mobility (within 24 hr), multimodal pain (acetaminophen + NSAID if safe + nerve blocks + minimal opioid), gum chewing, early enteral feeding, DVT prophylaxis (SCDs + enoxaparin/heparin per protocol within 24 hr unless contraindicated), incentive spirometry, address nausea + pain so patient can mobilize. Bed rest worsens DVT + ileus + atelectasis + delirium.
GA: unconsciousness + airway protection; reversal = sugammadex (rocuronium/vecuronium) or neostigmine + glycopyrrolate; naloxone for opioid; flumazenil selectively for benzo (seizure risk in chronic users). Spinal: rapid dense block, hypotension (sympathectomy) + brady (high block) → fluids + phenylephrine/ephedrine + atropine. Epidural: titratable, watch hematoma + dural puncture + total spinal. MAC: airway monitoring + capnography. LAST = intralipid 20%.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Perioperative & PACU questions does the bank have?
108 multiple-choice items, plus 10 unfolding cases in the Perioperative & PACU pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Recognize cues, though every step appears.
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