++
++
++
++
A 65-year-old woman undergoes a thyroid lobectomy for a follicular neoplasm. She has a history of coronary artery disease, hypertension, insulin-dependent diabetes, and stroke. The procedure lasted 2 hours during which the patient required occasional Neo-Synephrine for brief interoperative hypotension. Two hours after the procedure, the nurse calls from the PACU to report that the patient is agitated and hypertensive. Which of the following is unlikely to be the cause for her agitation?
++
++
++
++
++
++
++
C. “Unmasking” of cognitive dysfunction
++
++
++
++
+
++
++
++
++
A 43-year-old man with a distant history of intravenous drug use is now status post a right inguinal hernia repair and is complaining of severe groin pain on the side of the operation. All of the following are appropriate maneuvers except
++
++
++
A. Evaluate the patient for necrotizing fasciitis
++
++
B. Reassure the patient that his use of preoperative suboxone that morning may have blocked his postoperative response to narcotics
++
++
C. Allow the nurse to administer a postoperative parenteral nonopioid analgesic
++
++
D. Discharge the patient with a prescription for pain medication and a plan for follow-up in 2 weeks
++
++
E. Perform a nerve block with local anesthetics
+
++
D. Discharge the patient with a prescription for pain medication and a plan for follow-up in 2 weeks
++
++
++
A 56-year-old woman is being prepared for an elective ventral hernia repair in the preoperative care unit. She is overweight, with a history of non–insulin-dependent diabetes, hypertension, and smoking. Her fingerstick glucose is 326, and you note that her most recent HgA1C is 8.4%. She wants to proceed with the operation and has traveled a long distance to see you and has taken the day off from work. The most appropriate choice of management is
++
++
++
A. Proceed with the operation and plan for an intraoperative insulin drip
++
++
B. Repeat the fingerstick after insulin administration and proceed with the operation if the glucose is improved with the plan for consultation of the diabetes team postoperatively for management
++
++
C. Cancel the operation with the plan for improved preoperative preparation
++
++
D. Admit the patient for preoperative glucose management and reschedule the operation for several days from now
+
++
C. Cancel the operation with the plan for improved preoperative preparation
++
++
++
Which of the following are routine components of the first 24-hour postoperative check in patients who have undergone colon resection?
++
++
++
A. Vital signs including heart rate, blood pressure, oxygen saturation
++
++
B. Wound evaluation including assessment of drain output and content
++
++
C. Assessment of the adequacy of pain management
++
++
D. Plan for removal of the nasogastric tube, Foley catheter, and advancement of diet
++
++
E. All of the above except for D
+
++
E. All of the above except for D
++
++
++
A 72-year-old man underwent resection of hepatic segments 5/6 for a hepatoma in the setting of hepatocellular carcinoma 2 days ago and was recently discharged to the floor. Perioperatively, he required a large volume of fluid resuscitation. He now has bloody output from his two Jackson-Pratt drains that are seated in the liver bed, his hematocrit has fallen 7 points to 23 and his INR is 2.7, and he is febrile to 102.8°F and confused. Which of the following is the most appropriate order and choice of management?
++
++
++
A. Evaluation of the patient, transfer to higher level of care, transfusion with 2 units of unmatched packed RBCs, return to the operating room for surgical control of bleeding
++
++
B. Evaluation of the patient, transfusion with two packs of FFP and 2 units of matched packed RBCs, computed tomography with angiography for possible embolization
++
++
C. Evaluation of the patient, intubation for protection of airway, transfer to higher level of care, transfusion with cryoprecipitate, antibiotic administration, return to the operating room for surgical control of bleeding.
++
++
D. Evaluation of the patient, intubation forprotection of airway, transfer to a higher level of care, transfusion with 2 units of FFP and 2 units of matched packed RBCs, antibiotic administration, and computed tomography of the abdomen.
+
++
D. Evaluation of the patient, intubation for protection of airway, transfer to a higher level of care, transfusion with 2 units of FFP and 2 units of matched packed RBCs, antibiotic administration, and computed tomography of the abdomen