💓 Savvy NurseOpen the app

🏥 20 questions · answers and rationales · free

NCLEX perioperative practice questions

20 free NCLEX-style perioperative questions: the pre-op checklist, post-op complications day by day, procedure prep and aftercare, compartment syndrome and fat embolism, with rationales.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A circulating nurse is applying the dispersive (return) electrode for monopolar electrosurgery to a thin older adult before an open ventral hernia repair. Which site is most appropriate?

  1. On clean, dry skin over the deltoid muscle of the upper arm
  2. On the flank beside the incision, over a well-healed surgical scar
  3. On clean, dry, hair-free skin over the thigh muscle
  4. On clean, dry skin over the calf, well away from the prep area
Show the answer and rationale

Answer: C

The dispersive electrode spreads the current over a large area so it can leave the body without heating the skin, so it is placed on clean, dry, hair-free skin over a large, well-perfused muscle such as the thigh, close to the operative site and away from metal implants. The upper arm is an accepted site, but in a thin older adult the deltoid has less muscle than the thigh and lies farther from the abdomen. A calf pad far from the incision lengthens the current's path, and scar tissue, like bony prominences, has poor blood flow and uneven contact that concentrate the current.

📚 Learn it: The Pre-op Checklist: NPO, Consent, Jewelry, Void

Question 2 of 20

A nurse is caring for a client 12 hours after a living-donor kidney transplant. Which finding requires immediate follow-up?

  1. Urine output that fell from 300 to 20 mL/hr
  2. A serum creatinine that fell from 2.8 to 1.9 mg/dL since the surgery ended
  3. Incisional pain rated 3 of 10 that eases to 1 of 10 with the PCA pump
  4. Pink-tinged urine draining freely, with 150 mL collected in the past hour
Show the answer and rationale

Answer: A

A living-donor kidney usually produces large urine volumes right away, so a fall from 300 to 20 mL/hr can mean a blocked catheter, hypovolemia, a clot in the graft vessels, or early rejection; the nurse checks catheter patency and notifies the surgeon at once, because graft thrombosis can destroy the kidney within hours. The runner-up is the pink-tinged urine, because discolored urine can suggest bleeding or rejection, but pink urine draining freely in the first days is expected after transplant surgery. A creatinine falling from 2.8 to 1.9 mg/dL shows the graft is clearing waste. Incisional pain rated 3 of 10 that eases to 1 of 10 with the PCA is controlled and expected.

📚 Learn it: Post-op Days 1 Through 10: What Goes Wrong When

Question 3 of 20

A client with cirrhosis has 5 liters of ascitic fluid removed by paracentesis. Thirty minutes later, which finding requires the nurse's immediate action?

  1. BP 88/52 mm Hg and pulse 118, from 126/74 and 84 before
  2. Abdominal girth that is 4 inches (10 cm) smaller than before
  3. Clear, pale yellow fluid seeping onto the puncture site dressing
  4. Serum albumin of 2.6 g/dL on this morning's results
Show the answer and rationale

Answer: A

Removing a large volume of ascitic fluid lets fluid shift out of the vascular space, and a falling blood pressure with a rising heart rate signals hypovolemia that must be reported at once; albumin or fluid replacement is often prescribed with large-volume paracentesis for this reason. Fluid seeping from the puncture site does need a dressing change and a report, but a local leak does not threaten circulation the way hypotension does, and its clear color is reassuring, since cloudy fluid would suggest peritonitis. A smaller abdominal girth is the expected result of the procedure, and a low albumin is a long-standing finding in cirrhosis rather than a new change.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 4 of 20

A client in balanced skeletal traction for a fractured femur needs to have a bowel movement. Which action should the nurse take?

  1. Slide a fracture pan under the buttocks while the client lifts with the trapeze
  2. Raise the head of the bed fully so the client sits upright on the pan
  3. Have a second nurse lift the traction weights while the pan is placed
  4. Place a regular bedpan under the buttocks while the client lifts with the trapeze
Show the answer and rationale

Answer: A

A fracture pan is shallow, with a flat front end that slides under the buttocks with little lifting, so it is used for clients in traction or with hip and pelvic injuries; the client can help by lifting the hips slightly with the overhead trapeze while the line of pull stays intact. A regular bedpan with the trapeze sounds close, but it is much taller, so the client must lift higher and the pelvis tilts out of line with the traction. Sitting bolt upright pulls the body out of alignment. Lifting the weights releases the traction, and weights are never removed or lifted to make care easier unless a prescription allows it.

📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae

Question 5 of 20

A 64-year-old client with a mechanical mitral valve takes warfarin, and the INR has been stable at 3.0. The client is scheduled for an elective open colectomy in 8 days. Which plan for the anticoagulant should the nurse anticipate?

  1. Stop warfarin 5 days before surgery and give enoxaparin injections until the day before
  2. Keep taking warfarin through the surgery and give oral vitamin K on that morning
  3. Switch from warfarin to apixaban for the week before surgery and stop it 1 day prior
  4. Stop warfarin 5 days before surgery and give no other anticoagulant until after surgery
Show the answer and rationale

Answer: A

A mechanical mitral valve carries a high risk of valve thrombosis and stroke when warfarin is interrupted, so warfarin is stopped about 5 days before major surgery and a low-molecular-weight heparin such as enoxaparin bridges the gap, with the last dose the day before the operation. Stopping warfarin with no bridge is the runner-up because it is the usual plan for lower-risk clients, such as many with atrial fibrillation, but it leaves this valve unprotected. Continuing warfarin leaves the client fully anticoagulated for surgery, and a morning dose of vitamin K would not correct the INR in time. Apixaban and other direct oral anticoagulants are not used with mechanical heart valves.

📚 Learn it: The Pre-op Checklist: NPO, Consent, Jewelry, Void

Question 6 of 20 · Select all that apply

During a preadmission interview 10 days before an elective total hip replacement under general anesthesia, a client lists the medications and supplements taken at home. Which statements require follow-up with the surgeon or anesthesia provider? Select all that apply.

  1. 'I take metoprolol every morning for my blood pressure.'
  2. 'I take a calcium and vitamin D tablet with breakfast.'
  3. 'I take phenelzine every day for my depression.'
  4. 'I take acetaminophen a few times a week for knee pain.'
  5. 'I take garlic and ginseng capsules for my heart.'
  6. 'I take valerian root every night to help me sleep.'
Show the answer and rationale

Answer: C, E, F

Phenelzine is an MAOI, and the anesthesia team must plan around it, because meperidine and some drugs used to raise blood pressure can trigger serotonin syndrome or a hypertensive crisis. Valerian deepens the sedative effect of anesthetics, and garlic and ginseng impair platelet function and raise the risk of bleeding, so herbal supplements are reported and usually stopped about 2 weeks before surgery as the surgeon directs. Metoprolol is the tempting wrong choice because it lowers blood pressure, but beta blockers are continued through surgery, and acetaminophen and calcium with vitamin D pose no special surgical risk.

📚 Learn it: The Pre-op Checklist: NPO, Consent, Jewelry, Void

Question 7 of 20

Two hours after a total hip arthroplasty, a client is restless and pale. Heart rate is 124 beats/min, up from 82, and BP is 96/60 mm Hg, down from 134/78. The surgical drain has collected 250 mL of bright red blood in the past hour. A hemoglobin drawn 15 minutes ago is 12.9 g/dL, unchanged from before surgery. Which action should the nurse take?

  1. Notify the surgeon now of the drain output and vital sign changes
  2. Give the prescribed IV opioid, then recheck the heart rate in 30 minutes
  3. Request a repeat hemoglobin now and call the surgeon if it has dropped
  4. Reinforce the hip dressing and recheck the vital signs in 15 minutes
Show the answer and rationale

Answer: A

Early in acute hemorrhage the client loses whole blood, plasma and red cells together, so the hemoglobin can stay near baseline for hours until fluid shifts in or IV fluids dilute the blood. The climbing heart rate, falling blood pressure, restlessness, pallor and 250 mL of bright red drainage in an hour are the real evidence of bleeding, so the surgeon is notified now. A repeat hemoglobin is the runner-up because it feels like better data, but a second draw minutes later lags just as the first did, and waiting on it delays the call. Pain can raise the heart rate, but it does not explain hypotension and heavy drainage, and an opioid can drop the blood pressure further. Reinforcing the dressing and rechecking in 15 minutes treats the drainage as a local problem while the client moves toward shock.

📚 Learn it: Post-op Days 1 Through 10: What Goes Wrong When

Question 8 of 20

A nurse is completing the checklist for a client scheduled for a percutaneous liver biopsy this morning. Which finding should the nurse report to the provider before the procedure?

  1. Hemoglobin 14.2 g/dL
  2. INR 2.1
  3. Platelets 138,000/mm³
  4. ALT 96 units/L
Show the answer and rationale

Answer: B

The liver is highly vascular, and a percutaneous biopsy is generally postponed until the INR is below about 1.5, so an INR of 2.1 places the client at high risk of hemorrhage and must be reported for correction or a change in approach. A platelet count of 138,000/mm³ is the closest distractor because platelets also affect bleeding, but it is only slightly below normal and well above the level that would delay a biopsy. An elevated ALT reflects the liver disease the biopsy is meant to investigate, and a hemoglobin of 14.2 g/dL is normal. After the biopsy, the client lies on the right side to compress the site and is watched for tachycardia, hypotension, and severe pain that would signal bleeding.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 9 of 20

A client with a fracture of the shaft of the right humerus is wearing a coaptation splint. During a neurovascular check, which finding should the nurse report immediately?

  1. Bruising that has spread from the upper arm down toward the elbow since yesterday
  2. Capillary refill of 2 seconds, with warm, pink fingers on the right hand
  3. Swelling of the upper arm that stays soft, with fingers warm and moving freely
  4. Inability to extend the right wrist and fingers
Show the answer and rationale

Answer: D

The radial nerve winds around the shaft of the humerus, so this fracture or its splint can injure it; inability to extend the wrist and fingers, wrist drop, signals radial nerve damage and must be reported at once for evaluation. The runner-up is the spreading bruising, because expanding bruising can suggest ongoing bleeding, but blood from a fracture commonly tracks downward with gravity toward the elbow. Capillary refill of 2 seconds with warm, pink fingers shows intact perfusion. Soft upper-arm swelling with warm fingers that move freely is expected early swelling; tense swelling with severe pain would raise concern for compartment syndrome.

📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae

Question 10 of 20

During the preoperative interview before an open colon resection, a client says, 'I have a defibrillator in my chest that shocked me once last year.' Which action should the nurse take?

  1. Record the device model from the client's ID card in the chart
  2. Notify the surgical and anesthesia teams about the device
  3. Arrange for cardiology to check the device after the surgery
  4. Tape a magnet over the device before the client leaves for surgery
Show the answer and rationale

Answer: B

Electrocautery creates electrical interference that an implanted cardioverter-defibrillator can mistake for ventricular fibrillation, triggering an inappropriate shock, or that can inhibit pacing, and abdominal surgery still carries this risk, so the surgical and anesthesia teams need to know in advance to have the device checked and its shock function suspended under monitoring, with external defibrillator pads ready, and then restored after surgery. A magnet sounds like the fix, but suspending shocks leaves the client unprotected, so it is done by the anesthesia or device team during continuous monitoring, not taped on before transfer. Recording the model alerts no one, and a check after surgery is only part of the plan.

📚 Learn it: The Pre-op Checklist: NPO, Consent, Jewelry, Void

Practice 10 more Perioperative care questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A nurse on a surgical unit reviews four clients. Which client is at greatest risk for wound dehiscence today?

  1. Day 7 after a midline laparotomy, on long-term prednisone
  2. Day 1 after an open colectomy, BMI 34, and coughing often
  3. Day 3 after a laparoscopic cholecystectomy, BMI 40
  4. Day 2 after a total knee replacement, with type 2 diabetes
Show the answer and rationale

Answer: A

Dehiscence most often occurs about 5 to 10 days after surgery, before the wound has gained much strength, and long-term corticosteroids slow collagen formation, so the client 7 days after a midline laparotomy is at greatest risk today and needs splinting, close incision checks, and good protein intake. The client 1 day after a colectomy who is obese and coughing is the runner-up because those are real risk factors, but separation this early is unusual and the risk peaks later in the week. Laparoscopic incisions are small and rarely separate, and a knee incision 2 days after surgery is both early and not under the strain that coughing puts on an abdominal wound.

📚 Learn it: Post-op Days 1 Through 10: What Goes Wrong When

Question 12 of 20

A client who had an outpatient lumbar puncture 2 days ago as part of an evaluation for multiple sclerosis calls the clinic. Which report requires the nurse to direct the client to the emergency department now?

  1. Soreness and a small bruise, about 1 inch across, where the needle went in
  2. Tingling in both feet that was present before the procedure and is unchanged
  3. A severe headache rated 9 of 10 whenever sitting up that eases when lying flat
  4. A fever of 102.2°F (39°C) with a stiff neck and new confusion
Show the answer and rationale

Answer: D

Fever, a stiff neck, and confusion after a lumbar puncture suggest meningitis, a rare but dangerous complication of the procedure that needs emergency evaluation, cultures, and antibiotics. A severe headache that worsens upright and eases lying flat is the runner-up because it must be reported, but it is the classic post-dural puncture headache, managed first with rest, fluids, caffeine, and analgesics, with an epidural blood patch if it persists, and it does not need the emergency department today. Mild soreness and bruising at the site are expected, and tingling that began before the procedure is part of the client's baseline.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 13 of 20

A client with a long-leg cast for a tibial fracture asks how to keep the thigh muscles from getting weak while the cast is on. Which exercise should the nurse teach?

  1. Tighten the buttock muscles to support the thigh, hold for a count of 5 to 10, then relax
  2. Tighten the thigh muscles, hold for a count of 5 to 10, then relax
  3. Work the thigh by gently bending and straightening the knee often
  4. Press the foot up and down repeatedly to pump blood through the thigh muscles
Show the answer and rationale

Answer: B

Quadriceps setting tightens the thigh muscles without moving the joint, so it can be done inside a cast to slow atrophy and maintain strength, holding for a count of 5 to 10 and then relaxing. Tightening the buttock muscles to support the thigh is the runner-up because it is also an isometric, cast-safe exercise with the same hold, but it strengthens the gluteal muscles rather than the thigh the client asked about. Pressing the foot up and down repeatedly cannot be done with the ankle enclosed in a long-leg cast and would work the calf rather than the thigh, and bending and straightening the knee often is likewise prevented by the cast.

📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae

Question 14 of 20 · Select all that apply

A nurse is caring for a client with cirrhosis and tense ascites who is scheduled for a large-volume paracentesis. Which actions should the nurse take? Select all that apply.

  1. Monitor the BP and heart rate after the fluid is removed and anticipate IV albumin as prescribed
  2. Keep the client flat in bed for several hours afterward to prevent a headache
  3. Help the client into a sitting or high Fowler's position for the procedure
  4. Have the client empty the bladder just before the procedure
  5. Clamp the drainage after 1 liter to prevent re-expansion pulmonary edema
  6. Measure the weight and abdominal girth before and after the procedure
Show the answer and rationale

Answer: A, C, D, F

Emptying the bladder keeps it out of the needle's path, weight and girth before and after document how much fluid was removed, and an upright position lets the fluid collect in the lower abdomen at the puncture site. Removing several liters lets fluid shift out of the vessels, so blood pressure and heart rate are watched for hypotension, and albumin is often given to support the circulation. Stopping at 1 liter is the tempting wrong choice, but a limit of about 1 to 1.5 liters belongs to thoracentesis, where re-expansion pulmonary edema is the danger, and a large-volume paracentesis removes 5 liters or more. Lying flat to prevent a headache belongs to a lumbar puncture.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 15 of 20

A nurse assesses the abdominal incision of a client on postoperative day 8 after an open colon resection. Which finding suggests the client is at risk for wound dehiscence?

  1. Yellow-green bruising near the incision
  2. No healing ridge palpable beneath the incision
  3. Numbness of the skin just beside the incision
  4. Mild itching and tightness along the staple line
Show the answer and rationale

Answer: B

A healing ridge, a firm band of new collagen felt under the incision, normally forms between about days 5 and 9, so its absence on day 8 signals weak healing and a risk of dehiscence; the nurse reports it and reinforces splinting and avoiding strain. Yellow-green bruising sounds worrying, but that color marks an older bruise that is resolving, not fresh bleeding under the wound. Numbness beside the incision comes from small skin nerves cut during surgery, and mild itching and tightness are part of normal healing. A sudden gush of serosanguineous drainage or a feeling that something gave way would mean dehiscence may already be occurring.

📚 Learn it: Post-op Days 1 Through 10: What Goes Wrong When

Question 16 of 20

A nurse is monitoring a client 1 hour after a bronchoscopy with a transbronchial biopsy. Which finding requires immediate follow-up?

  1. Temperature of 100.8°F (38.2°C) with a heart rate of 108 beats/min
  2. Sputum streaked with blood and a few tiny clots after coughing
  3. A high-pitched, crowing sound on inspiration
  4. A hoarse voice with mild wheezing that clears after coughing
Show the answer and rationale

Answer: C

A high-pitched, crowing sound on inspiration is stridor, a sign of laryngospasm or laryngeal edema that can close the airway, so the nurse calls for help, stays with the client, and prepares for emergency airway management. The runner-up is the blood-streaked sputum with tiny clots: bleeding is a feared biopsy complication, but small streaks and tiny clots are expected for a few hours, while frank or increasing bleeding is not. Wheezing that clears with coughing and hoarseness follow passage of the scope and secretions, and a temperature of 100.8°F (38.2°C) with a modest rate rise is an early inflammatory response to monitor rather than an airway emergency.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 17 of 20

A nurse enters the room of a client who is in Buck's traction for a hip fracture while awaiting surgery. Which finding requires the nurse to take corrective action?

  1. The weights are left on while the client gets a bed bath
  2. The client reports a steady pulling sensation in the affected leg
  3. The weights are resting on the floor at the foot of the bed
  4. The foot of the bed is raised slightly higher than the head of the bed
Show the answer and rationale

Answer: C

Traction works only when the weights hang freely, so weights resting on the floor must be made to hang free again without removing them, and the cause, usually the client sliding toward the foot of the bed, is corrected. Leaving the weights on during a bed bath is the runner-up because it looks careless, but it is correct: weights are not removed or lifted for care or comfort without a prescription. A steady pull in the leg sounds like a complaint, but it is how working traction feels, and raising the foot of the bed slightly adds countertraction from the client's own body weight.

📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae

Question 18 of 20

On the third day after an open colectomy, a client has abdominal distention, hypoactive bowel sounds, and no flatus. The nasogastric tube to low intermittent suction has drained 1,400 mL in the past 24 hours. Which laboratory result should the nurse report as most likely contributing to the ileus?

  1. Hemoglobin 10.6 g/dL
  2. Sodium 134 mEq/L
  3. Potassium 3.0 mEq/L
  4. Glucose 168 mg/dL
Show the answer and rationale

Answer: C

Potassium is needed for smooth muscle contraction, and gastric suction removes potassium along with acid, so a level of 3.0 mEq/L (normal 3.5 to 5.0) slows peristalsis and prolongs an ileus; the nurse reports it and anticipates IV replacement. A sodium of 134 mEq/L is the runner-up because nasogastric losses can also lower sodium, but this mild drop does not paralyze the bowel the way a low potassium does. A glucose of 168 mg/dL is a common stress response after surgery, and a hemoglobin of 10.6 g/dL is an expected drop after an open operation with blood loss and IV fluids.

📚 Learn it: Post-op Days 1 Through 10: What Goes Wrong When

Question 19 of 20

Iodinated contrast is injected through a client's IV during a CT scan of the abdomen. Which statement by the client requires the nurse's immediate action?

  1. 'My throat feels tight, and my voice sounds strange.'
  2. 'I feel intensely warm all over, starting in my chest and spreading down.'
  3. 'I have a strong metallic taste, and my mouth is watering a lot.'
  4. 'It really feels like I'm wetting myself, even though I just voided.'
Show the answer and rationale

Answer: A

Throat tightness with a change in the voice suggests laryngeal edema, a severe allergic-like reaction to contrast, so the nurse stops the injection, calls for help, and prepares intramuscular epinephrine while watching the airway and blood pressure. The runner-up is the intense warmth spreading down from the chest: it can feel like the flushing of a reaction, but warmth without airway, skin, or blood pressure changes is a common, short-lived physiologic effect of iodinated contrast. A strong metallic taste with extra saliva and the sensation of wetting oneself despite having just voided are likewise well-known transient contrast effects that clients are warned about beforehand.

📚 Learn it: Procedure Prep and Aftercare: The Questions You Will Get

Question 20 of 20

A client had a left forearm arteriovenous fistula created for hemodialysis 1 week ago. Which finding should the nurse report to the provider promptly?

  1. A continuous vibration felt over the fistula, strongest with the arm lowered
  2. A low-pitched whooshing sound heard over the fistula with each heartbeat
  3. Mild swelling of the forearm near the incision that eases when the arm is elevated
  4. Cool, pale, numb fingers on the left hand
Show the answer and rationale

Answer: D

Cool, pale, numb fingers signal access steal syndrome: the fistula diverts so much arterial blood into the vein that the hand beyond it becomes ischemic, and prompt evaluation is needed to protect the hand. The runner-up is the forearm swelling, because swelling can suggest infection or clotting, but mild swelling near a 1-week-old incision is expected, and easing with elevation is reassuring. A continuous vibration, the thrill, and a low-pitched whooshing sound, the bruit, both show blood flowing through the fistula and are findings the nurse wants; their absence would be reported instead.

📚 Learn it: Compartment Syndrome and Fat Embolism: Pain and Petechiae

Practice 10 more Perioperative care questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

📚 Learn it first

📝 More NCLEX practice questions