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NCLEX-RN Postoperative complications practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Postoperative complications sits inside the Reduction of Risk Potential category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Postoperative complications sample questions

Question 1

A 48-year-old client undergoes an open colectomy for colon cancer. On postoperative day 3, the nurse assesses the client and finds a temperature of 38.9°C, heart rate 100 beats/min, blood pressure 100/60 mm Hg, and the surgical wound has purulent drainage with a foul odor. Which finding indicates the most likely complication?

  1. A Serum lactate level of 0.8 mmol/L and normal coagulation studies.
  2. B Abdominal girth increased by 2 cm from the previous day.
  3. C Increased white blood cell count of 14,000/mm³ with left shift.
  4. D Bowel sounds are hypoactive in all four quadrants.
Show the answer and explanation

Correct answer: C

Fever, tachycardia and purulent, foul-smelling drainage point to a surgical site infection. An elevated white blood cell count with a left shift (more immature neutrophils) confirms an active bacterial infection.

Why the other options are wrong:
A: A lactate of 0.8 mmol/L and normal coagulation studies are normal and do not support a complication.
B: A 2-cm increase in girth suggests mild distention and is less specific than a high WBC count with a left shift.
D: Hypoactive bowel sounds are common after colectomy while bowel function returns.

Question 2

A 52-year-old client is 6 hours post-operative from a right hemicolectomy. The nurse assesses the nasogastric (NG) tube and notes 350 mL of dark green output over the last 4 hours. The client reports mild abdominal distention and nausea. What is the nurse's best interpretation of these findings?

  1. A The dark green color indicates bile reflux and the tube should be irrigated with normal saline.
  2. B The high output and distention suggest the NG tube may be occluded and needs repositioning.
  3. C The NG tube is functioning properly and the output is an expected finding after abdominal surgery.
  4. D The client is developing a postoperative ileus and the NG tube should be placed to low intermittent suction.
Show the answer and explanation

Correct answer: C

Greenish drainage of gastric secretions mixed with bile is expected from an NG tube after abdominal surgery, and about 350 mL over 4 hours (roughly 90 mL/hr) shows the tube is draining well. Mild distention and nausea are common this early and should simply be monitored.

Why the other options are wrong:
A: Green drainage is expected gastric and bile fluid, and irrigation is unnecessary when the tube is draining freely.
B: An occluded tube would drain very little; steady output of 350 mL shows the tube is patent.
D: Slowed bowel activity is expected 6 hours after surgery, and the drainage shows the tube is already decompressing the stomach.

Question 3

A 72-year-old client who underwent an open reduction and internal fixation of a hip fracture 6 hours ago has a heart rate of 112/min, blood pressure 88/54 mm Hg, and urine output of 15 mL over the past 2 hours. The surgical dressing is dry and intact, and the client reports pain at the surgical site rated 5 on a 0-10 scale. Which finding requires the nurse to notify the surgical team immediately?

  1. A The client's temperature is 99.2°F (37.3°C), which is 0.6°F higher than the preoperative value.
  2. B The client's oxygen saturation is 94% on room air, which is 2% lower than the preoperative value.
  3. C The client's white blood cell count is 14,500/mcL, which is slightly elevated from the preoperative value.
  4. D The client's hemoglobin level is 9.2 g/dL, which is 2 g/dL lower than the preoperative value.
Show the answer and explanation

Correct answer: D

A 2-g/dL drop in hemoglobin together with tachycardia, hypotension and oliguria points to postoperative hemorrhage, which can be concealed even when the dressing is dry. The surgical team must be notified immediately.

Why the other options are wrong:
A: A slight temperature rise is common after surgery and does not explain the instability.
B: A saturation of 94% is acceptable and does not account for the signs of hypovolemia.
C: A mild rise in white blood cells can reflect surgical stress and does not explain the hemodynamic changes.

Question 4

A 72-year-old female returns from an open cholecystectomy 6 hours ago. Her vital signs are: blood pressure 98/56 mm Hg, heart rate 112 bpm, respiratory rate 24 breaths/min, oxygen saturation 94% on 2 L nasal cannula. The nurse notes 200 mL of serosanguinous drainage in the Jackson-Pratt drain over the past hour and the dressing over the incision has a 10 cm area of bright red spotting. Which action is the nurse's priority?

  1. A Administer the prescribed ondansetron for postoperative nausea
  2. B Apply direct pressure to the incision site and increase the IV fluid rate
  3. C Reposition the client to the left lateral side-lying position
  4. D Document the findings and recheck the drain output in 30 minutes
Show the answer and explanation

Correct answer: B

Hypotension, tachycardia, 200 mL of bloody drainage in one hour, and fresh bleeding on the dressing indicate postoperative hemorrhage. The nurse should apply direct pressure to control external bleeding and support circulating volume, while notifying the surgeon immediately.

Why the other options are wrong:
A: Ondansetron treats nausea, which is not the problem; the client shows signs of hemorrhage.
C: Repositioning does nothing to control the bleeding or restore circulating volume.
D: Waiting 30 minutes allows hemorrhage to progress toward shock; immediate action is needed.

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