NLE Perioperative & Pain Nursing — Postoperative Care and Surgical Wound ManagementExam Answer Templates

Marks

1

Topic

PACU Immediate Postoperative Care

Difficulty

easy

Template Id

T1

Examiner Tip

Examiners expect you to demonstrate knowledge of ABC priority. 'Airway first' must be explicit. Simply writing 'monitor the patient' earns no marks.

Model Answer

The priority nursing action is to maintain a patent airway by positioning the patient in a side-lying position (lateral) to prevent airway obstruction and aspiration until the gag reflex returns.

Question Type

very_short_answer

Answer Structure

• State the priority action (airway maintenance) with the correct positioning [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'monitor vital signs' as the priority — vital signs are important but airway comes first (ABCs)
• Omitting the rationale or positioning detail — makes the answer incomplete for full credit
• Stating 'supine position' — this is INCORRECT and potentially unsafe for the sedated patient

Key Phrases To Include

• patent airway
• side-lying or lateral position
• gag reflex
• aspiration prevention
• PACU priority

Marks

1

Topic

Wound Dehiscence and Evisceration

Difficulty

easy

Template Id

T2

Examiner Tip

The word 'viscera' or 'internal organs' must appear in the definition. Examiners specifically check for the distinction between dehiscence (edges apart) and evisceration (organs out).

Model Answer

Wound evisceration is the protrusion or herniation of internal abdominal organs (viscera) through a dehisced or separated surgical incision wound.

Question Type

very_short_answer

Answer Structure

• State what evisceration IS (protrusion of viscera through wound) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing evisceration with dehiscence — dehiscence is separation of wound edges without organ protrusion; evisceration includes organ protrusion
• Writing only 'wound opening' without mentioning organs protruding — too vague for full credit

Key Phrases To Include

• protrusion
• internal organs / viscera
• surgical wound / incision
• dehisced

Marks

1

Topic

Postoperative Respiratory Complications

Difficulty

easy

Template Id

T3

Examiner Tip

Both parts — the name AND the time — must be present for full credit on a 1-mark question that asks 'what and when.'

Model Answer

Atelectasis — collapse of alveoli due to shallow breathing and retained secretions — is the most common postoperative pulmonary complication. It typically occurs within the first 24 to 48 hours after surgery.

Question Type

very_short_answer

Answer Structure

• Name the complication (atelectasis) with a brief description [0.5 mark]
• State the time frame (24–48 hours) [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'pneumonia' as the most common — pneumonia is a secondary complication that follows untreated atelectasis
• Omitting the time frame — the question specifically asks 'when'

Key Phrases To Include

• atelectasis
• most common
• 24 to 48 hours
• alveolar collapse
• shallow breathing

Marks

2

Topic

Postoperative Respiratory Complications

Difficulty

easy

Template Id

T4

Examiner Tip

Examiners award marks per distinct intervention. The classic prevention bundle — deep breathing, incentive spirometry, coughing, early ambulation, repositioning, and hydration — is your answer pool. Know all six.

Model Answer

1. Encourage the patient to perform deep breathing exercises and use incentive spirometry every 1–2 hours to re-expand collapsed alveoli and mobilize secretions. 2. Promote early ambulation as soon as it is safe and ordered, because movement increases respiratory effort and improves lung expansion.

Question Type

short_answer

Answer Structure

• Intervention 1: Deep breathing / incentive spirometry with rationale [1 mark]
• Intervention 2: Early ambulation with rationale [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing two very similar interventions (e.g., 'deep breathing' and 'deep breathing exercises') — treat them as one intervention and earn only 1 mark
• Omitting interventions and writing only 'monitor breathing' — monitoring is assessment, not an intervention to PREVENT atelectasis
• Forgetting to include any rationale when the question or marking guide expects justification

Key Phrases To Include

• deep breathing exercises
• incentive spirometry
• early ambulation
• coughing
• repositioning
• hydration
• alveolar expansion

Marks

2

Topic

Postoperative Fever and Complications

Difficulty

medium

Template Id

T5

Examiner Tip

For this type of mnemonic question, a table or bulleted list with W + Day + Cause earns more marks than a narrative paragraph — it shows clarity and organization.

Model Answer

The '5 Ws' mnemonic helps nurses identify the probable CAUSE of postoperative fever based on the day it appears: • Wind (Day 1): Atelectasis — shallow breathing causes low-grade fever early. • Water (Days 2–3): Urinary tract infection. • Walking/Veins (Days 3–5): Deep vein thrombosis. • Wound (Days 4–6): Surgical site infection. • Wonder drugs (Any time): Drug reaction or IV-line infection. This guides systematic assessment and early intervention by matching the fever's timing to its most likely source.

Question Type

short_answer

Answer Structure

• State that the 5 Ws link fever timing to probable cause [1 mark]
• Correctly identify at least 3 of the 5 Ws with their corresponding timeline [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing the Ws without their time frames — the time-to-cause association is the clinical value of the mnemonic
• Confusing the order (e.g., placing wound infection on Day 1) — incorrect timeline loses the mark for that W

Key Phrases To Include

• Wind
• Water
• Walking/Veins
• Wound
• Wonder drugs
• atelectasis
• postoperative day
• fever timeline

Marks

3

Topic

Wound Dehiscence and Evisceration

Difficulty

hard

Template Id

T6

Examiner Tip

For emergency management questions, ALWAYS write your answers in numbered, sequential steps. Examiners expect to see prioritization — the most critical actions first. The phrase 'do NOT push organs back' is a safety marker that distinguishes safe from unsafe practice.

Model Answer

Wound evisceration is a surgical emergency requiring immediate, prioritized action: 1. STAY with the patient, press the call bell, and immediately notify the surgeon — the patient will require emergency return to the operating room. 2. Cover the protruding organs with sterile gauze dressings moistened with sterile normal saline to keep the viscera moist, protect them from drying, and reduce the risk of infection. Do NOT attempt to push the organs back into the abdomen. 3. Position the patient in LOW FOWLER'S position with the knees gently FLEXED to decrease tension on the abdominal wound and reduce further protrusion. 4. Keep the patient calm and NPO (nothing by mouth) in preparation for emergency surgery, and monitor vital signs continuously for signs of hypovolemic shock.

Question Type

short_answer

Answer Structure

• Step 1: Stay with patient, call for help, notify surgeon [1 mark]
• Step 2: Cover eviscerated organs with sterile saline-moistened gauze; do NOT push organs back [1 mark]
• Step 3: Correct positioning — low Fowler's with knees flexed [0.5 mark]
• Step 4: Keep NPO and monitor for shock [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'push the organs back in' — this is WRONG and unsafe; it will cost marks and demonstrates unsafe practice
• Omitting 'moistened with sterile normal saline' — a dry dressing on exposed viscera causes tissue damage; this detail is expected
• Forgetting to notify the surgeon — this is non-negotiable in an emergency
• Writing 'supine flat position' instead of low Fowler's with knees flexed

Key Phrases To Include

• surgical emergency
• notify surgeon immediately
• sterile saline-moistened dressing/gauze
• do NOT push organs back
• low Fowler's
• knees flexed/bent
• NPO
• monitor for shock
• aseptic technique

Marks

3

Topic

Postoperative DVT Prevention

Difficulty

medium

Template Id

T7

Examiner Tip

The 'do not massage' warning, even if not directly asked, earns you extra credit and shows the examiner you understand patient safety implications. Add it as a note at the end.

Model Answer

To prevent postoperative deep vein thrombosis (DVT), the nurse implements the following: 1. Early Ambulation: Encourage and assist the patient to walk as soon as it is safe and medically ordered — movement promotes venous return and prevents blood pooling (venous stasis) in the lower extremities. 2. Leg Exercises and Sequential Compression Devices (SCDs): Perform ankle pumping, quadriceps-setting, and calf flexion exercises while the patient is in bed; apply SCDs as ordered to provide intermittent pneumatic compression and enhance venous circulation. 3. Prophylactic Anticoagulation: Administer low-molecular-weight heparin (e.g., enoxaparin) or other anticoagulants as ordered to reduce hypercoagulability — one of Virchow's triad of DVT risk factors. Monitor for signs of bleeding as a side effect. IMPORTANT: If DVT is SUSPECTED (calf pain, swelling, warmth), do NOT massage the leg — this can dislodge the thrombus and cause a pulmonary embolism.

Question Type

short_answer

Answer Structure

• Intervention 1: Early ambulation with rationale [1 mark]
• Intervention 2: Leg exercises and/or SCDs with rationale [1 mark]
• Intervention 3: Prophylactic anticoagulation with drug example [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'massage the calf' as an intervention — this is CONTRAINDICATED with DVT; it is a critical error
• Listing three interventions that are essentially the same (e.g., 'walk early,' 'ambulate,' 'get up from bed') — treated as one point
• Not mentioning anticoagulants — prophylactic pharmacological prevention is a key pillar of DVT prevention

Key Phrases To Include

• early ambulation
• venous stasis
• leg exercises
• sequential compression devices
• SCDs
• anticoagulants
• enoxaparin
• do not massage
• venous return
• Virchow's triad

Marks

2

Topic

Postoperative Gastrointestinal Complications

Difficulty

easy

Template Id

T8

Examiner Tip

Always lead with 'absent bowel sounds' for paralytic ileus — it is the gold-standard clinical finding and the one examiners look for first.

Model Answer

Paralytic ileus is a temporary cessation of intestinal peristalsis after surgery. Its signs and symptoms include: • Absent or markedly decreased bowel sounds on auscultation • Abdominal distention and bloating • Failure to pass flatus (gas) or stool • Nausea and vomiting • Abdominal discomfort or cramping These signs indicate that peristalsis has not yet returned after surgery, anesthesia, opioid use, or bowel manipulation.

Question Type

short_answer

Answer Structure

• State 2–3 classic symptoms (absent bowel sounds, distention, no flatus) [1 mark]
• State 1–2 additional symptoms (nausea/vomiting, cramping) with brief context [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'nausea and vomiting' without the hallmark signs — these symptoms are non-specific; absent bowel sounds and distention are the defining features
• Not mentioning absent bowel sounds — this is the cardinal sign and its omission suggests poor clinical knowledge

Key Phrases To Include

• absent bowel sounds
• abdominal distention
• no passage of flatus
• no stool
• nausea and vomiting
• peristalsis
• auscultation

Marks

3

Topic

Postoperative Gastrointestinal Complications

Difficulty

medium

Template Id

T9

Examiner Tip

Show the examiner that you know the functional indicator — passage of flatus — signals readiness to advance the diet. This demonstrates clinical judgment beyond memorization.

Model Answer

Management of postoperative paralytic ileus aims to rest the bowel while supporting the patient and stimulating the return of peristalsis: 1. NPO (Nothing by Mouth): Keep the patient NPO to prevent vomiting, aspiration, and further bowel distention while the gut is non-functional. 2. Nasogastric (NG) Tube Decompression: Insert and maintain an NG tube as ordered to aspirate accumulated secretions and gas and relieve abdominal distention. 3. Early Ambulation: Encourage the patient to ambulate as soon as medically permitted — walking stimulates the return of peristalsis by activating gastrointestinal motility via neurological reflex. 4. Monitor for Return of Function: Auscultate bowel sounds every 4–8 hours, monitor for passage of flatus (first sign of returning peristalsis), and document accurately. Once bowel sounds return and the patient passes flatus, gradually advance the diet from clear liquids → full liquids → soft diet → regular diet as ordered. 5. IV Fluid and Electrolyte Management: Maintain IV access and monitor fluid and electrolyte balance, especially potassium (hypokalemia can worsen ileus).

Question Type

short_answer

Answer Structure

• NPO and rationale [1 mark]
• NG tube decompression and/or early ambulation [1 mark]
• Monitoring for return of peristalsis and diet advancement [1 mark]

Scoring Breakdown

Common Mark Deductions

• Recommending oral feeding without confirming return of bowel sounds — advancing diet too early is a clinical error
• Forgetting early ambulation — this is the most important non-pharmacological intervention and its omission is commonly penalized
• Not mentioning diet advancement steps — the progression (clear → full → soft → regular) is expected clinical knowledge

Key Phrases To Include

• NPO
• nasogastric tube
• NG decompression
• early ambulation
• bowel sounds
• passage of flatus
• peristalsis
• diet advancement
• clear liquids
• IV fluids
• electrolyte balance

Marks

3

Topic

Wound Healing Mechanisms

Difficulty

medium

Template Id

T10

Examiner Tip

Organize your answer as a clear three-column or three-paragraph structure with labels: 1) Primary, 2) Secondary, 3) Tertiary. Examiners scan for labels first, then content.

Model Answer

Wounds heal by three mechanisms depending on the nature of the wound and the surgical decision: 1. Primary Intention (Primary Closure): Clean wound edges are approximated (brought together) and closed with sutures, staples, or adhesive strips. Example: a clean surgical incision. Healing is rapid with minimal scarring and low infection risk. 2. Secondary Intention: The wound is left open and heals by granulation tissue formation from the wound base upward and inward. Example: a large, infected, or contaminated wound. Healing is slow, produces more scar tissue, and requires regular wound packing and dressing changes. 3. Tertiary Intention (Delayed Primary Closure): The wound is left open initially to allow drainage and control of infection, then surgically closed later (usually after 4–5 days). Example: a contaminated abdominal wound that is cleaned and then sutured after infection risk decreases.

Question Type

short_answer

Answer Structure

• Primary intention: definition + example + features [1 mark]
• Secondary intention: definition + example + features [1 mark]
• Tertiary intention: definition + example + features [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing secondary and tertiary intention — tertiary is specifically left open THEN closed; secondary is NEVER primarily closed
• Omitting examples — clinical examples demonstrate understanding and often earn the differentiating mark
• Not mentioning granulation tissue for secondary intention — this is the hallmark mechanism

Key Phrases To Include

• approximated
• sutures/staples
• granulation tissue
• wound left open
• delayed closure
• scarring
• contaminated wound
• primary closure
• secondary intention
• tertiary intention

Marks

2

Topic

Surgical Drains

Difficulty

medium

Template Id

T11

Examiner Tip

The one phrase that separates a good answer from a perfect answer for JP drain questions is: 'Compress the bulb before closing the port to restore negative suction pressure.' Memorize this phrase.

Model Answer

The Jackson-Pratt (JP) drain is a closed suction drainage system used to remove blood, serous fluid, and exudate from the surgical site. Nursing care includes: 1. Emptying and Recompressing: Empty the JP bulb every shift or when half-full using aseptic technique; measure, record, and describe the drainage (color, consistency, odor, amount). After emptying, COMPRESS the bulb before closing the port to restore the negative suction pressure needed for drainage. 2. Monitoring Output: Note the expected progression — drainage transitions from sanguineous (bright red/bloody) on Day 1 to serosanguineous (pink/old blood) by Days 2–3 to serous (clear yellow) as healing progresses. Report any sudden increase, return to bright red bleeding, or purulent/foul-smelling output immediately. 3. Site Care and Securing the Drain: Assess the drain insertion site for redness, swelling, or leakage; clean with aseptic technique as ordered; secure the drain to the patient's gown or skin to prevent accidental dislodgement or tension on the site.

Question Type

short_answer

Answer Structure

• Empty, measure, and recompress the bulb — with aseptic technique [1 mark]
• Monitor and document drainage characteristics AND assess/secure the insertion site [1 mark]

Scoring Breakdown

Common Mark Deductions

• Forgetting to mention RE-COMPRESSING the bulb after emptying — this is the defining action for JP drain care and its omission signals incomplete knowledge
• Not describing the expected color progression — shows failure to understand drain monitoring
• Omitting aseptic technique — always mandatory for any wound or drain care

Key Phrases To Include

• compress the bulb
• negative suction
• aseptic technique
• sanguineous to serosanguineous to serous
• measure and record
• secure the drain
• prevent accidental removal
• drain insertion site

Marks

5

Topic

Wound Dehiscence and Evisceration Emergency

Difficulty

hard

Template Id

T12

Examiner Tip

For 5-mark case study questions in perioperative nursing, structure your answer using the nursing process headings: Assessment (identify the problem), Nursing Diagnosis (NANDA), and Implementation (numbered, prioritized interventions). End with a patient outcome statement. This format alone earns 1 additional organizational mark. Under RA 9173, Article IV, independent nursing functions include emergency first-aid measures — covering the wound correctly demonstrates lawful nursing action.

Model Answer

NURSING MANAGEMENT OF WOUND EVISCERATION Clinical Situation: The patient is presenting with wound EVISCERATION — protrusion of internal abdominal organs through the separated surgical incision — which is a SURGICAL EMERGENCY. This typically occurs around postoperative days 5–7 and may be precipitated by increased abdominal pressure (coughing, vomiting, straining), obesity, malnutrition, or wound infection. NURSING DIAGNOSIS (NANDA): Primary: Risk for Infection related to exposure of visceral tissue through open wound Secondary: Acute Pain related to wound separation and tissue tension Tertiary: Anxiety related to surgical emergency and unexpected complication IMMEDIATE NURSING INTERVENTIONS (Priority Order): 1. STAY WITH THE PATIENT AND CALL FOR HELP (Priority 1 — Patient Safety) • Do not leave the patient alone. Activate the call system and immediately notify the physician/surgeon of the evisceration. • The patient will require emergency return to the operating room for wound closure. 2. COVER THE EVISCERATED ORGANS (Priority 2 — Prevent Infection and Tissue Damage) • Cover the exposed viscera with sterile gauze dressings MOISTENED with sterile normal saline (0.9% NaCl). • The moist dressing prevents the exposed organs from drying out, reduces contamination, and protects the delicate tissue until surgery. • CRITICAL: Do NOT attempt to push or replace the organs back into the abdominal cavity — this can cause contamination, ischemia, and further injury. 3. POSITION THE PATIENT (Priority 3 — Reduce Abdominal Tension) • Place the patient in LOW FOWLER'S POSITION (15–30 degrees head elevation) with the KNEES SLIGHTLY FLEXED. • This position decreases tension on the abdominal muscles and the wound, reducing further protrusion of organs. 4. SUPPORTIVE AND PREPARATORY ACTIONS (Priority 4) • Keep the patient CALM and NPO (nothing by mouth) in preparation for emergency surgery. • Monitor vital signs frequently for signs of HYPOVOLEMIC SHOCK (hypotension, tachycardia, cool clammy skin, restlessness). • Establish or maintain IV access for fluid resuscitation and medication administration. • Provide emotional support and explain what is being done — anxiety and panic increase abdominal tension through Valsalva maneuver. • Document all findings, actions taken, and notifications made with accurate timestamps. EXPECTED PATIENT OUTCOME: The patient will be stabilized without progression of organ protrusion, visceral tissue will remain moist and protected until surgical repair, vital signs will remain within normal parameters, and the patient will be transferred safely to the OR for emergency re-closure of the wound.

Question Type

long_answer

Answer Structure

• Identify the emergency: name evisceration, state it is a surgical emergency, mention typical timing (Days 5-7) [1 mark]
• Priority 1: Stay with patient and immediately notify surgeon [1 mark]
• Priority 2: Cover with sterile saline-moistened gauze AND state do NOT push organs back [1 mark]
• Priority 3: Correct positioning — low Fowler's with knees flexed and rationale [1 mark]
• Priority 4: NPO, vital signs monitoring for shock, IV access, emotional support, documentation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'push the organs back in' — CRITICAL ERROR; this is unsafe practice and will result in automatic loss of at least 1–2 marks
• Using a dry dressing instead of a saline-moistened one — demonstrates incorrect clinical knowledge
• Not stating 'low Fowler's with knees flexed' — simply writing 'comfortable position' earns no marks
• Omitting the surgeon notification — this is legally and clinically mandatory in an emergency under RA 9173 Scope of Nursing Practice
• Not addressing NPO status — critical because the patient will need general anesthesia for re-closure
• Missing the NANDA nursing diagnosis — for 5-mark questions, examiners typically expect the nursing process framework

Key Phrases To Include

• surgical emergency
• evisceration
• Day 5–7
• notify surgeon immediately
• sterile saline-moistened gauze
• do NOT push organs back
• low Fowler's
• knees flexed
• NPO
• hypovolemic shock
• vital signs monitoring
• aseptic technique
• IV access
• return to OR

Marks

3

Topic

PACU Transfer Criteria

Difficulty

medium

Template Id

T13

Examiner Tip

Mentioning the 'Aldrete Scoring System' by name at the start of your answer immediately signals to the examiner that you have strong theoretical knowledge of PACU protocols, earning you credibility even before they read the criteria.

Model Answer

Before transferring a patient from the PACU, the nurse must ensure that the following criteria are met — often assessed using the Aldrete Scoring System: 1. Stable Vital Signs: Blood pressure, pulse, and respiratory rate are within acceptable limits and have been stable for at least 15–30 minutes. 2. Patent Airway and Adequate Oxygenation: The patient maintains a clear airway independently; SpO2 is ≥ 95% on room air or within ordered oxygen parameters; respirations are unlabored. 3. Adequate Level of Consciousness: The patient is responsive, oriented to person and place, and able to follow simple commands — demonstrating that anesthetic effects have sufficiently reversed. 4. Controlled Pain and Nausea: Pain is at an acceptable level (e.g., ≤ 3–4/10 on pain scale); nausea and vomiting are controlled with antiemetics. 5. No Active Bleeding: The surgical dressing and drains show no evidence of active hemorrhage; the surgical site is stable. 6. Adequate Urine Output: Urine output is at least 30 mL/hour, indicating adequate renal perfusion and hydration.

Question Type

short_answer

Answer Structure

• Criteria 1–2: Stable vital signs AND patent airway/oxygenation [1 mark]
• Criteria 3–4: Adequate consciousness AND controlled pain/nausea [1 mark]
• Criteria 5–6: No active bleeding AND adequate urine output [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing only 2 criteria for a 3-mark question — you must demonstrate comprehensive knowledge of all major criteria
• Stating 'patient is awake' without specifying orientation or ability to follow commands — too vague
• Not mentioning urine output — this physiological indicator is commonly omitted but expected

Key Phrases To Include

• Aldrete score
• stable vital signs
• patent airway
• SpO2
• level of consciousness
• controlled pain
• controlled nausea
• no active bleeding
• urine output 30 mL/hour
• PACU discharge criteria

Marks

5

Topic

Discharge Teaching

Difficulty

hard

Template Id

T14

Examiner Tip

For discharge teaching questions at the 5-mark level, examiners use a marking guide with 5 distinct domains. Structure your answer with NUMBERED or BOLDED headings for each domain — this ensures the examiner sees all five areas clearly. Reference the nurse's responsibility for health education under RA 9173 (Section 28, Scope of Nursing Practice) to demonstrate legal awareness.

Model Answer

DISCHARGE TEACHING PLAN — POSTOPERATIVE OUTPATIENT SURGICAL PATIENT Discharge teaching is an essential nursing responsibility under RA 9173 (Philippine Nursing Act) and must be clear, comprehensive, and documented. Provide both verbal and WRITTEN instructions to ensure the patient can manage care at home safely. 1. WOUND AND DRESSING CARE • Teach the patient how to perform dressing changes using aseptic technique — clean hands, use clean gloves, apply sterile gauze as instructed. • Inspect the wound daily for signs of INFECTION: increasing redness, warmth, swelling (edema), purulent (yellow/green/foul-smelling) drainage, increased pain at the site, or wound edges that are separating. • Keep the incision dry as directed; avoid submerging in water (no bath tubs or pools) until cleared by the surgeon. 2. WARNING SIGNS TO REPORT IMMEDIATELY Instruct the patient to call the surgeon or go to the nearest emergency room if any of the following occur: • Fever above 38°C (100.4°F) • Wound separation, dehiscence, or protruding tissue • Bright red bleeding that soaks the dressing • Calf pain, swelling, or redness (possible DVT) • Sudden shortness of breath or chest pain (possible pulmonary embolism — a medical emergency) • Inability to urinate for more than 6–8 hours 3. ACTIVITY AND LIFTING RESTRICTIONS • Follow the surgeon's specific activity restrictions — generally, avoid heavy lifting (more than 2–5 kg), strenuous activity, and driving while on opioid medications or as instructed. • Gradually increase activity; short walks promote healing, improve circulation, and prevent DVT. • Avoid activities that increase intra-abdominal pressure (straining, constipation) — use stool softeners if prescribed. 4. MEDICATIONS • Take all prescribed medications as directed, including pain medications, antibiotics (complete the full course), and anticoagulants. • Explain how to use analgesics safely — take before pain becomes severe (around-the-clock for the first 24–48 hours, then as needed); avoid driving when taking opioids. 5. DIET AND NUTRITION • Eat a high-protein, vitamin C-rich, and zinc-containing diet to support wound healing (e.g., fish, eggs, leafy vegetables, citrus fruits, nuts). • Maintain adequate hydration; avoid alcohol. • For abdominal procedures: follow diet advancement instructions; begin with clear liquids and advance as tolerated. 6. FOLLOW-UP APPOINTMENTS • Keep all scheduled follow-up visits for wound inspection and suture/staple removal as ordered (typically 7–10 days postoperatively). • Do not remove sutures or staples at home without physician instruction. 7. SUPPORT AT HOME (especially for same-day surgery patients) • Ensure a responsible adult accompanies the patient home and can assist for the first 24 hours. • The patient should NOT drive, make legal decisions, or operate heavy machinery on the day of surgery due to residual anesthetic effects. EXPECTED OUTCOME: The patient will verbalize understanding of wound care, warning signs, activity restrictions, medications, diet, and follow-up, as evidenced by accurate teach-back demonstration before discharge.

Question Type

long_answer

Answer Structure

• Wound care instructions — how to change dressing, signs of infection [1 mark]
• Warning signs to report immediately — fever, bleeding, DVT symptoms, PE, wound separation [1 mark]
• Activity and lifting restrictions with rationale [1 mark]
• Medication instructions — completion of antibiotics, safe analgesic use [1 mark]
• Diet/nutrition for healing, follow-up schedule, and responsible adult companion [1 mark]

Scoring Breakdown

Common Mark Deductions

• Providing only 2–3 discharge topics for a 5-mark question — must cover all major domains (wound, activity, meds, diet, follow-up, warning signs)
• Not including DVT/PE warning signs — these are critical safety alerts that are highly tested
• Missing the instruction to 'complete the full antibiotic course' — incomplete course leads to antibiotic resistance, a patient safety issue
• No mention of teach-back or written instructions — good discharge teaching is two-way and documented
• Omitting nutritional support for wound healing (protein, vitamin C, zinc) — frequently tested in NLE

Key Phrases To Include

• aseptic technique
• signs of infection
• warning signs
• fever above 38°C
• wound separation
• DVT symptoms
• calf pain
• shortness of breath
• activity restrictions
• no heavy lifting
• complete antibiotic course
• protein and vitamin C
• follow-up appointment
• teach-back
• written instructions
• responsible adult
• RA 9173 discharge teaching

Marks

2

Topic

Wound Healing Phases

Difficulty

easy

Template Id

T15

Examiner Tip

The memory aid is H-I-P-M (Hemostasis, Inflammation, Proliferation, Maturation). The sequence is what earns the marks — not just knowing the names.

Model Answer

The four phases of wound healing in sequence are: 1. Hemostasis Phase — blood clotting stops bleeding immediately after injury. 2. Inflammatory Phase (Days 1–4) — redness, warmth, swelling, and pain; white blood cells clean the wound of debris and bacteria. 3. Proliferative Phase — granulation tissue forms, new blood vessels grow (angiogenesis), and the wound edges contract and epithelialize. 4. Maturation/Remodeling Phase — collagen reorganizes; scar tissue strengthens over weeks to months.

Question Type

very_short_answer

Answer Structure

• Phases 1–2 named in correct order (Hemostasis, Inflammatory) [1 mark]
• Phases 3–4 named in correct order (Proliferative, Maturation/Remodeling) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing the phases out of order — sequence is specifically what this question tests
• Missing 'hemostasis' as the first phase — many students start with inflammation, which earns no mark for Phase 1
• Writing 'resolution' instead of 'maturation/remodeling' — use the correct anatomical/physiological term

Key Phrases To Include

• hemostasis
• inflammatory phase
• proliferative phase
• maturation
• remodeling
• granulation tissue
• collagen
• Days 1-4