NLE Perioperative & Pain Nursing Reviewer 2026

Answer: C. Emergent

Step 1: Recall the classification of surgery by urgency. Step 2: Emergent surgery is performed immediately because the patient's life is at risk — there is no time to wait. Step 3: A ruptured aortic aneurysm causes massive internal bleeding and is immediately life-threatening, so it is classified as emergent. Step 4: Urgent surgery (e.g., acute appendicitis) is needed within 24–48 hours, but it is not as immediately critical as emergent. Step 5: Elective and optional surgeries are planned ahead of time and are not life-threatening if delayed.

Answer: B. Notify the surgeon because obtaining informed consent is the surgeon's responsibility

Step 1: Understand the nurse's role in informed consent. Step 2: The responsibility of explaining the procedure, its risks, benefits, and alternatives belongs to the surgeon (the physician performing the procedure), not the nurse. Step 3: The nurse's role is to witness the patient's signature and verify that the patient understands and is signing voluntarily. Step 4: If the patient has questions or shows a lack of understanding, the nurse must notify the surgeon — not independently explain the procedure. Step 5: Having the patient sign first would be inappropriate because the patient's questions must be answered before signing. This is also an ethical and legal protection of the patient's autonomy.

Answer: B. To reduce the risk of aspiration of gastric contents during anesthesia

Step 1: Recall what happens to protective reflexes under general anesthesia. Step 2: General anesthesia suppresses the gag and cough reflexes, which normally protect the airway. Step 3: If the stomach contains food or liquid, these contents can be regurgitated and aspirated into the lungs — a life-threatening complication called aspiration pneumonitis (Mendelson's syndrome). Step 4: NPO status ensures the stomach is as empty as possible to reduce this risk. Step 5: While NPO may secondarily reduce nausea and vomiting, the primary and critical reason is aspiration prevention.

Answer: C. Malignant hyperthermia

Step 1: Recognize the classic triad of early malignant hyperthermia (MH) signs. Step 2: MH is a rare but life-threatening inherited reaction to certain anesthetic agents such as succinylcholine and volatile agents like halothane. Step 3: The early signs are unexplained tachycardia, rising end-tidal CO2 (indicating increased metabolism), and muscle rigidity — the masseter muscle is often the first affected. Step 4: A very high, rapidly rising temperature is actually a late sign of MH. Step 5: Treatment must be immediate — administer dantrolene, apply cooling measures, and provide supportive care. A family history of MH is a critical screening question in the preoperative assessment.

Answer: B. To allow proper assessment of nail beds for oxygenation and circulation

Step 1: Think about what the nurse needs to assess intraoperatively. Step 2: Nail beds are assessed to monitor oxygenation (cyanosis appears as a blue discoloration) and circulation (capillary refill). Step 3: Nail polish — especially dark colors — can obscure these visual assessments, preventing the nurse from detecting early signs of hypoxia or poor perfusion. Step 4: While it is true that dark nail polish can interfere with pulse oximetry readings on some older devices, the primary nursing reason stated in perioperative practice is to allow visual assessment of nail beds. Step 5: This is a standard preoperative preparation step included in the preoperative checklist.

Answer: B. Surgical time-out

Step 1: Identify the WHO Surgical Safety Checklist steps. Step 2: The surgical time-out is a mandatory pause performed by the entire surgical team just before the incision is made. Step 3: During the time-out, the team verbally confirms: (a) correct patient identity, (b) correct surgical procedure, and (c) correct surgical site. Step 4: This practice directly prevents wrong-patient, wrong-procedure, and wrong-site surgeries — which are considered 'never events' in patient safety. Step 5: The surgical count (sponge, instrument, needle) is a separate safety practice done to prevent retained foreign objects, not to verify patient identity.

Answer: C. Post-dural puncture headache

Step 1: Recall the complications of spinal anesthesia. Step 2: Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, which contains cerebrospinal fluid (CSF). Step 3: The needle punctures the dura mater, and CSF can leak through the puncture site. Step 4: Loss of CSF lowers intracranial pressure, causing the classic post-dural puncture headache — positional in nature (worse when upright, relieved when lying flat). Step 5: Management includes keeping the patient flat to reduce CSF leakage, encouraging increased fluid intake to promote CSF production, and possibly an epidural blood patch for severe cases.

Answer: C. Scrub nurse

Step 1: Distinguish the two main intraoperative nursing roles. Step 2: The scrub nurse (also called scrub technician or instrument nurse) is scrubbed in — meaning they wear sterile gown and gloves and work within the sterile field. Step 3: The scrub nurse's responsibilities include: preparing sterile instruments and supplies, maintaining the sterile field, and passing instruments to the surgeon during the procedure. Step 4: The circulating nurse, in contrast, works outside the sterile field — managing the room, documenting, coordinating supplies, performing counts, and advocating for the patient. Step 5: In Philippine nursing practice under RA 9173, both roles are within the scope of professional nursing practice.

Answer: B. It impairs wound healing and increases the risk of infection

Step 1: Recall the effects of poorly controlled diabetes on surgical outcomes. Step 2: Hyperglycemia impairs the function of white blood cells (neutrophils and macrophages), reducing the body's ability to fight infection. Step 3: Poor glucose control also impairs fibroblast function and collagen synthesis, which are essential for wound healing. Step 4: As a result, diabetic patients have a higher risk of surgical site infection, poor wound healing, and wound dehiscence. Step 5: Preoperatively, blood glucose must be well-controlled. On the day of surgery, oral hypoglycemics (especially metformin) are usually held and insulin is adjusted per protocol to maintain safe glucose levels.

Answer: B. Pad bony prominences and pressure points to prevent pressure injury and nerve damage

Step 1: Recall why intraoperative positioning is a safety priority. Step 2: Under general anesthesia, patients lose the ability to feel pain and cannot reposition themselves — they are completely dependent on the surgical team for protection. Step 3: Bony prominences such as the heels, sacrum, elbows, and occiput are at high risk for pressure injuries and nerve compression during prolonged surgery. Step 4: The circulating nurse must ensure all pressure points are padded with appropriate materials, correct body alignment is maintained, and joints are not overextended. Step 5: Safety straps are necessary to prevent falls, Trendelenburg is only used when specifically indicated, and speed of positioning should never compromise patient safety.

Answer: B. Position the patient side-lying to maintain a patent airway and prevent aspiration

Step 1 – Identify the priority framework: In the PACU, nursing priorities follow the ABCs — Airway first, then Breathing, then Circulation. Step 2 – Recognize the risk: A drowsy, not-yet-fully-awake patient has a decreased gag reflex. The tongue can fall back and obstruct the airway, and the patient cannot protect themselves from aspiration. Step 3 – Choose the correct action: Positioning the patient side-lying (lateral position) or turning the head to the side keeps the airway open and allows secretions or vomitus to drain out rather than be aspirated. Step 4 – Eliminate distractors: Urine output, wound checks, and pain medication are all important, but they are secondary to ensuring the patient has a patent, protected airway. Without a clear airway, all other interventions are meaningless.

Answer: C. Atelectasis

Step 1 – Recall the '5 Ws' postoperative fever timeline: Wind (atelectasis) – first 24 hours; Water (UTI) – days 2–3; Walking/veins (DVT) – days 3–5; Wound infection – days 4–6; Wonder drugs/IV line – any time. Step 2 – Apply the timeline: The fever occurred on postoperative day 1, which corresponds to 'Wind' — atelectasis. Step 3 – Understand why: After surgery and anesthesia, patients breathe shallowly, causing alveoli to collapse (atelectasis), which triggers an inflammatory response and low-grade fever. Step 4 – Eliminate distractors: Surgical site infection (Wound) appears days 4–6; DVT (Walking) appears days 3–5; UTI (Water) appears days 2–3. All of these are too early to manifest on day 1.