NCLEX Perioperative Care: Pre-op, Post-op & Complications

bolt The 60-second version

check_circlePre-op: verify consent, allergies, NPO status per anesthesia orders, labs, and medication instructions (anticoagulants, insulin); remove jewelry and dentures per policy; have the client void.
check_circleTeach before surgery: deep breathing, coughing (splint the incision), incentive spirometry, leg exercises, early ambulation.
check_circlePost-op priorities: airway and breathing first, then circulation (bleeding, vital signs), then pain, nausea, and urine output (at least about 0.5 mL/kg/h).
check_circleCommon timing: atelectasis in the first 1–2 days; pneumonia and urinary infection around days 3–5; wound infection around days 5–7; DVT any time, often in the first 2 weeks.
check_circleMalignant hyperthermia: muscle rigidity, rising end-tidal CO₂, tachycardia, then high fever during or after anesthesia; stop triggering agents and give dantrolene.
check_circleEvisceration: cover the organs with sterile saline-moistened dressings, position with knees bent, keep NPO, and notify the surgeon immediately; never push organs back.

target What you'll be able to do · aligned to NCLEX-RN Test Plan · Reduction of Risk Potential

RISK REDComplete preoperative verification and teaching.
RISK REDPrioritize postoperative assessments and recognize warning signs.
PHYS ADAPTAnticipate the typical timing of postoperative complications.
PHYS ADAPTRespond to malignant hyperthermia, dehiscence, and evisceration.

Preoperative care

Most pre-op items test the checklist and safety verification.

Pre-op checklist. A surgical time-out confirms the client, procedure, and site before incision.

Pre-op teaching	Purpose
Deep breathing and incentive spirometry	Prevent atelectasis and pneumonia
Splinted coughing	Clear secretions with less pain
Leg exercises, early ambulation, compression devices	Prevent DVT
Pain scale and options	Effective pain control supports breathing and mobility

Report abnormal pre-op findings (such as fever, high potassium, or low hemoglobin) to the surgeon before the procedure.

Postoperative priorities

Assess in order of threat to life.

Post-op assessment. Check under the client for blood that pools beneath dressings.

Complication timing. These are typical patterns; any complication can occur earlier or later.

Surgical emergencies

Two emergencies are classic NCLEX items.

Emergency	Findings	Nursing action
Malignant hyperthermia	Rising end-tidal CO₂, masseter or generalized rigidity, tachycardia, then fever; triggered by volatile anesthetics or succinylcholine	Stop the trigger, call for help, dantrolene as ordered, cooling, treat hyperkalemia; family history matters
Wound dehiscence	Wound edges separate; "something gave way"	Low Fowler with knees flexed; cover with sterile saline-moistened dressing; notify
Evisceration	Organs protrude through the wound	Same as above, plus NPO and prepare for surgery; never reinsert organs
Hemorrhage	Tachycardia, hypotension, saturated dressing, restlessness	Pressure if accessible, notify, fluids and labs as ordered

Risk factors for dehiscence include obesity, diabetes, malnutrition, steroids, and coughing or straining.

Recovery: bowel, bladder, and mobility

Getting the client moving prevents most later complications.

Paralytic ileus: distension, absent bowel sounds, no flatus; keep NPO, nasogastric decompression as ordered, encourage ambulation.
Urinary retention: no void within about 6–8 hours, bladder distension; bladder scan and catheterize per order.
First ambulation: dangle first, then stand with assistance, watching for orthostatic hypotension.
Pain: control pain so the client can breathe deeply and walk, while monitoring sedation with opioids.

NGN-style case

Order of actions for an emergency.

functions Clinical judgment case — after a cough

On day 6 after abdominal surgery, an obese client with diabetes coughs hard and says, "I felt something pop." Loops of bowel are visible through the incision. What should the nurse do first?

Recognize cues: visible bowel through the wound.
Analyze: evisceration, a surgical emergency.
Stay with the client, call for help, and cover the bowel with sterile saline-moistened dressings.
Place in low Fowler with knees flexed, keep NPO, monitor vital signs, and prepare for surgery.

Answer. Cover the organs with sterile saline-moistened dressings and call for help; position with knees flexed and keep NPO.

Next in the roadmap

Diagnostic Procedures

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quiz Test yourself

Quick check — 3 questions

1. Which postoperative finding should the nurse report immediately?

2. Which drug treats malignant hyperthermia?

3. Which pre-op teaching best prevents atelectasis?

Frequently asked questions

What should the nurse do for wound evisceration?expand_more

Cover the organs with sterile saline-moistened dressings, position with knees flexed, keep the client NPO, and notify the surgeon immediately. Never push organs back in.

What is the earliest sign of malignant hyperthermia?expand_more

A rise in end-tidal carbon dioxide, often with muscle rigidity and tachycardia; fever usually comes later.

When does atelectasis usually occur after surgery?expand_more

Commonly in the first 1–2 days; deep breathing, incentive spirometry, and early ambulation help prevent it.

What urine output is acceptable after surgery?expand_more

At least about 0.5 mL/kg/h (often taught as 30 mL/h for adults).