Perioperative Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Pre-operative Assessment and Consent, Fasting, the Surgical Safety Checklist, Positioning, Counts, Anaesthesia Recovery, Post-operative Complications and Discharge Teaching

Perioperative care is tested throughout the medical-surgical and patient safety domains of the registered nurse paper, typically 10 to 15 questions, and it is the area where Gulf hospitals hire most aggressively: operating theatre, recovery and surgical ward nurses are perennially short. The exam tests the textbook sequence from pre-admission to discharge. Theatre technicians sit a separate paper (OT technician questions).

Pre-operative phase

Question 1

A patient scheduled for a cholecystectomy says, "I am not sure what the doctor is going to do, but I signed the form." The nurse should:

1. Proceed because the form is signed
2. Recognise that informed consent requires understanding, notify the surgeon so the procedure, risks, benefits and alternatives can be explained again before the patient goes to theatre, and document; the nurse witnesses the signature but the surgeon is responsible for obtaining consent
3. Explain the surgical technique in detail and re-sign the form
4. Cancel the surgery

Answer: B. Consent must be voluntary, informed and given by a competent adult; interpreters are used for non-Arabic and non-English speakers, and a family member should not interpret for consent where a professional interpreter is available.

Question 2

Which pre-operative fasting instruction for an elective adult procedure under general anaesthesia is correct?

1. Nothing by mouth from midnight regardless of the time of surgery
2. No solid food for 6 hours (8 hours for fatty meals), clear fluids allowed until 2 hours before anaesthesia, breast milk 4 hours and formula 6 hours for infants, with prescribed oral medications taken with a sip of water unless instructed otherwise
3. Clear fluids until the moment of induction
4. A light meal 2 hours before

Answer: B. Prolonged fasting causes dehydration, hypoglycaemia and discomfort without reducing aspiration risk; the 2-4-6 rule is standard across Gulf hospitals.

Question 3

A patient with type 2 diabetes on metformin and a patient on warfarin are both listed for elective surgery tomorrow. Which medication management is expected?

1. Continue both unchanged
2. Metformin is usually withheld on the morning of surgery (and around contrast), with glucose monitored and an insulin sliding scale if needed; warfarin is stopped about five days before with an INR check, bridged with low-molecular-weight heparin in high-risk patients per the prescriber's plan
3. Double the metformin to prevent stress hyperglycaemia
4. Give warfarin the morning of surgery

Answer: B. Antiplatelets, anticoagulants, ACE inhibitors (often held on the day), herbal supplements and insulin all need individual pre-operative instructions; the nurse confirms each with the anaesthetist's plan.

Question 4

Which pre-operative finding must the nurse report before the patient leaves the ward?

1. Mild anxiety
2. A temperature of 38.4 °C, a potassium of 2.9 mmol/L, a new cough with crackles, or a patient who has eaten within the fasting window
3. Blood pressure 132/84
4. Loose jewellery removed already

Answer: B. Any new infection, electrolyte abnormality or broken fasting may lead to postponement; the pre-operative checklist (identity band, consent, allergies, fasting, prostheses and dentures, nail polish and jewellery removed, voided, prophylactic antibiotics timing) is completed and signed.

Intra-operative phase

Question 5

The three pauses of the WHO Surgical Safety Checklist are:

1. Admission, discharge and follow-up
2. Sign-in before induction of anaesthesia (identity, site, consent, allergies, airway risk, blood loss risk), time-out before skin incision (team introductions, confirmation of patient, procedure and site, antibiotic prophylaxis within 60 minutes, imaging, anticipated critical events) and sign-out before the patient leaves theatre (procedure recorded, counts complete, specimen labelled, equipment problems, recovery concerns)
3. Scrub, gown and glove
4. Count, incision and closure

Answer: B. The checklist reduces mortality and complications and is mandatory in Gulf hospitals accredited by Joint Commission International; any team member can stop the list.

Question 6

Surgical site marking for a left total knee replacement should be done by:

1. The ward nurse with a ballpoint pen after the patient is sedated
2. The surgeon or a delegated privileged practitioner, with the awake patient's involvement, using an indelible marker at or near the incision site so that it remains visible after skin preparation and draping, before the patient enters the operating room
3. Any staff member once the patient is anaesthetised
4. Marking is not needed if the consent form is correct

Answer: B. Wrong-site surgery is a never event; laterality, multiple structures (fingers, toes, levels of the spine) and multiple lesions all require marking.

Question 7

A patient is positioned in lithotomy for a four-hour gynaecological procedure. Which nerve injury is the nurse most concerned about preventing?

1. Facial nerve
2. Common peroneal nerve compression at the fibular head against the stirrups (causing foot drop), and femoral and sciatic stretch from excessive hip flexion; legs are raised and lowered slowly and simultaneously and padding is checked, with compartment syndrome a risk in prolonged cases
3. Radial nerve
4. Phrenic nerve

Answer: B. Supine positioning risks ulnar nerve injury (arms pronated or excessively abducted over 90 degrees) and brachial plexus stretch; prone positioning risks eye injury and pressure on the breasts and genitalia.

Question 8

At the sign-out count before closure of the peritoneum, the scrub nurse finds one swab fewer than the initial count. The correct action is:

1. Record the discrepancy and allow closure
2. Inform the surgeon immediately, stop closure while the team searches the wound, drapes, floor and bins, recount, and if the swab is not found obtain an intra-operative radiograph before the patient leaves theatre, documenting everything and completing an incident report
3. Assume it was miscounted initially
4. Tell the surgeon after the patient wakes up

Answer: B. Counts are performed at the start, before closure of a cavity, at the start of skin closure and whenever staff change; retained items are never events, and radiopaque swabs are used for that reason.

Question 9

During a general anaesthetic with suxamethonium and sevoflurane, the patient develops masseter rigidity, a rapidly rising end-tidal carbon dioxide, tachycardia and a temperature climbing to 39.8 °C. The team recognises and treats:

1. Sepsis; antibiotics
2. Malignant hyperthermia; stop the triggering agents, hyperventilate with 100% oxygen, give dantrolene intravenously (2.5 mg/kg repeated), active cooling, treat hyperkalaemia and acidosis, monitor for rhabdomyolysis and arrhythmias, and transfer to ICU; the family is counselled about this inherited condition
3. Anaphylaxis; adrenaline
4. Thyroid storm; beta blockers

Answer: B. Every operating department keeps a malignant hyperthermia kit with dantrolene; the nurse knows where it is and how to reconstitute it.

Question 10

Which patient is at highest risk of inadvertent perioperative hypothermia and what prevents it?

1. A young fit man having a 20-minute procedure
2. An elderly patient having a long open abdominal procedure with large fluid volumes; prevention includes pre-warming, forced-air warming blankets, warmed intravenous and irrigation fluids, a theatre temperature of at least 21 °C, and core temperature monitoring with a target above 36 °C
3. A patient under regional anaesthesia for a hand procedure
4. Hypothermia is not a surgical concern

Answer: B. Hypothermia increases surgical site infection, bleeding, cardiac events and recovery time; it is a tested quality indicator.

Post-anaesthesia care unit

Question 11

A patient arrives in the recovery room after general anaesthesia, drowsy with snoring respirations and saturations of 90%. The nurse's first action is:

1. Document and continue routine observations
2. Assess and open the airway (head tilt, chin lift or jaw thrust, suction if secretions), apply oxygen, position in the lateral recovery position if not contraindicated, and call the anaesthetist if the obstruction does not resolve or saturations do not improve
3. Give naloxone immediately
4. Sit the patient upright and leave

Answer: B. Airway obstruction from a relaxed tongue is the commonest early recovery problem; laryngospasm presents with stridor or silence and needs immediate anaesthetic help.

Question 12

Which criteria must be met before a patient is discharged from recovery to the ward using the Aldrete score?

1. The patient asks to leave
2. Stable respiration and saturations near baseline on minimal or no oxygen, blood pressure within about 20% of pre-operative values, consciousness (awake or easily rousable), movement of limbs, controlled pain and nausea, no active bleeding, and a score of 9 or 10 out of 10, with handover using a structured tool
3. A score of 5
4. Thirty minutes have passed

Answer: B. Day-case discharge home adds criteria: tolerating fluids, voiding where relevant, ambulating, a responsible adult escort and written instructions.

Question 13

A patient recovering from spinal anaesthesia has a blood pressure of 85/50 mmHg and a heart rate of 55. The most likely cause and action are:

1. Haemorrhage; massive transfusion
2. Sympathetic blockade from the spinal with vasodilatation; lie the patient flat with legs elevated, administer intravenous fluids and vasopressors (ephedrine or phenylephrine) as prescribed, monitor the level of the block and sensation, and assess for urinary retention before discharge from recovery
3. Normal; no action
4. Anaphylaxis; adrenaline

Answer: B. Post-dural puncture headache (worse upright, better lying) is a later complication managed with fluids, analgesia, caffeine and, if severe, an epidural blood patch.

Post-operative complications

Question 14

Which post-operative complication is most likely in the first 24 to 48 hours and which measures prevent it?

1. Wound dehiscence; abdominal binder
2. Atelectasis and hypoxaemia; prevention includes deep breathing and coughing exercises, incentive spirometry, early mobilisation, adequate analgesia to allow deep breathing, head of bed elevation and splinting the incision when coughing
3. Deep vein thrombosis only after a week
4. Urinary infection on day 10

Answer: B. A low-grade fever in the first 48 hours is usually atelectasis; fever at days 3 to 5 suggests urinary or respiratory infection, days 5 to 7 wound infection or anastomotic leak, and after day 7 deep vein thrombosis or abscess.

Question 15

Six hours after a thyroidectomy, a patient complains of a tight feeling in the neck; the dressing is dry but the neck is swelling and the voice is becoming hoarse. The nurse should:

1. Reassure and recheck in an hour
2. Recognise a possible haematoma compressing the airway, call for immediate help, sit the patient up, give oxygen, prepare the clip or suture removal kit kept at the bedside to release the wound if the airway is threatened, and prepare for return to theatre
3. Give an antihistamine
4. Loosen the dressing only

Answer: B. Blood tracks under the strap muscles rather than into the dressing; airway obstruction from a neck haematoma is a surgical emergency.

Question 16

On day 6 after a laparotomy, an obese diabetic patient coughs and feels a "pop," and the nurse finds pink serous drainage and a loop of bowel visible through the wound. The nurse should:

1. Push the bowel back and apply a dry dressing
2. Stay with the patient, place them in low Fowler's position with knees slightly bent to reduce tension, cover the wound with sterile saline-soaked gauze, keep the patient nil by mouth, monitor vital signs for shock, and notify the surgeon urgently for return to theatre
3. Give oral fluids and reassure
4. Apply an abdominal binder tightly

Answer: B. Evisceration follows dehiscence; risk factors are obesity, diabetes, malnutrition, infection, coughing and straining, and steroids.

Question 17

Two days after abdominal surgery, a patient has abdominal distension, absent bowel sounds, nausea and has not passed flatus. The nurse's management of paralytic ileus includes:

1. Encourage a large meal to stimulate the bowel
2. Keep nil by mouth or restrict oral intake as directed, nasogastric decompression if vomiting, intravenous fluids and electrolyte correction (especially potassium), early mobilisation, reviewing opioid doses, chewing gum as a simple adjunct, and reporting severe pain or signs of obstruction
3. Give an antidiarrhoeal
4. Give a stimulant laxative immediately

Answer: B. Return of bowel sounds and passage of flatus mark recovery; mechanical obstruction presents with high-pitched or absent sounds, colicky pain and vomiting and needs surgical review.

Question 18

Eight hours after surgery under spinal anaesthesia, a patient has a palpable suprapubic mass, discomfort and has not voided. A bladder scan shows 650 mL. The nurse should:

1. Wait another eight hours
2. Recognise post-operative urinary retention, try non-invasive measures briefly (privacy, position, running water, warm compress, analgesia), then perform intermittent catheterisation as prescribed or per protocol, because retention beyond 400 to 500 mL risks bladder injury and infection
3. Give a diuretic
4. Restrict fluids

Answer: B. Anticholinergics, opioids, spinal anaesthesia and pelvic surgery are risk factors; an indwelling catheter is removed as early as possible.

Discharge and VTE prevention

Question 19

Which patient most needs pharmacological venous thromboembolism prophylaxis after surgery, and what does the nurse teach?

1. A 20-year-old having a 15-minute day-case procedure
2. A 65-year-old having a hip replacement or major abdominal cancer surgery; low-molecular-weight heparin or an oral anticoagulant as prescribed for the recommended duration (often 28 to 35 days after hip surgery), graduated compression stockings or intermittent pneumatic compression, early mobilisation and hydration, and teaching to report calf pain, swelling, chest pain or breathlessness
3. A patient with a bleeding disorder
4. Prophylaxis is never needed after surgery

Answer: B. Every surgical patient has a documented VTE risk assessment on admission; stockings are measured and contraindicated in peripheral arterial disease.

Question 20

Discharge teaching after a laparoscopic cholecystectomy should include which instruction?

1. Remain on bed rest for two weeks
2. Expect shoulder-tip pain from residual carbon dioxide for a day or two, keep wounds clean and dry and watch for redness, discharge or fever, resume a light diet and gradually normal activity, avoid heavy lifting for about two weeks, take analgesia as prescribed, and seek help for persistent vomiting, jaundice, severe abdominal pain or fever, with the follow-up appointment and emergency contact numbers in writing
3. Remove the dressings immediately and bathe
4. No follow-up is needed

Answer: B. Written instructions in the patient's language, confirmed with teach-back, are the standard; Gulf hospitals audit readmissions within 30 days.

How to practise

• Learn the sequences: pre-operative checklist, the three checklist pauses, counts, recovery discharge criteria.
• Know the complications by time: airway and bleeding first, atelectasis in 48 hours, infection at days 3 to 7, dehiscence at days 5 to 10, VTE thereafter.
• Memorise the emergencies: malignant hyperthermia, neck haematoma, evisceration, laryngospasm.

Surgical nursing chapters with explanations are in the Registered Nurse bank; related sets are the medical-surgical questions, infection control questions and fundamentals questions. Theatre and recovery roles in the Gulf are described in the OT and dialysis technician guide.

Frequently asked questions

How many perioperative questions are in the Prometric nursing exam?

About 10 to 15 of 150, spread across the medical-surgical and patient safety domains.

Which perioperative topics come up most?

Informed consent, fasting rules, the WHO Surgical Safety Checklist and counts, recovery room airway priorities, and post-operative complications by timing.

Are theatre nurses tested on anaesthesia?

At the level of recognising complications: airway obstruction, malignant hyperthermia, spinal hypotension and post-dural puncture headache.

Do ward nurses need to know the Surgical Safety Checklist?

Yes. Its components and purpose are tested on the general registered nurse paper.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.