ABA Clinical Practice & Patient Safety 3 â Questions and Answers
Question 1: A patient with OSA is extubated after laparoscopic cholecystectomy. Which postoperative monitoring approach is MOST appropriate?
- Discharge to an unmonitored ward bed with standard nursing checks
- Continuous pulse oximetry monitoring in a monitored setting (Correct answer)
- Admission to the ICU for all OSA patients regardless of severity
- Capnography monitoring only if the patient received neuraxial opioids
Correct answer: Continuous pulse oximetry monitoring in a monitored setting
OSA patients are at high risk for postoperative respiratory depression and require continuous oximetry in a monitored setting to detect desaturation events promptly.
Question 2: During a closed-loop communication in the OR, the circulating nurse announces 'blood pressure is 70/40.' The anesthesiologist responds 'I heard youâadministering ephedrine 10 mg.' This exchange exemplifies which patient safety principle?
- Crew resource managementâauthority gradient reduction
- Read-back or closed-loop communication to confirm receipt of critical information (Correct answer)
- Situation awareness and anticipation of adverse events
- SBAR structured communication format
Correct answer: Read-back or closed-loop communication to confirm receipt of critical information
Closed-loop communication requires the receiver to acknowledge and repeat back critical information, confirming that the message was correctly understood.
Question 3: A patient develops bronchospasm, urticaria, and hypotension 5 minutes after latex gloves are placed intraoperatively. Which vasopressor and dose is FIRST-LINE?
- Ephedrine 25 mg IV bolus
- Epinephrine 0.01â0.1 mg IV bolus (Correct answer)
- Vasopressin 0.03 units/min infusion
- Norepinephrine 0.1 mcg/kg/min infusion
Correct answer: Epinephrine 0.01â0.1 mg IV bolus
Epinephrine is the first-line drug for anaphylaxis due to its combined alpha-adrenergic vasoconstriction, beta-adrenergic bronchodilation, and mast-cell stabilization effects.
Question 4: Which factor MOST significantly increases the risk of postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia?
- Use of a laryngeal mask airway instead of endotracheal tube
- High tidal volumes (>10 mL/kg IBW) without PEEP (Correct answer)
- Use of volatile anesthetics instead of propofol-based TIVA
- Placement of a thoracic epidural for postoperative analgesia
Correct answer: High tidal volumes (>10 mL/kg IBW) without PEEP
Volutrauma from large tidal volumes without PEEP promotes atelectasis, ventilator-induced lung injury, and subsequent pulmonary complications.
Question 5: A 'near-miss' event is MOST accurately defined as:
- An adverse event that caused permanent patient harm
- An error that reached the patient but caused no detectable harm
- An unplanned event that was caught before reaching the patient (Correct answer)
- A sentinel event requiring mandatory root-cause analysis
Correct answer: An unplanned event that was caught before reaching the patient
A near-miss (also called a close call) is an unsafe act or condition that was identified and intercepted before it could reach the patient.
Question 6: A patient with a pacemaker (VVI mode) undergoes electrocautery. Which intraoperative measure BEST reduces the risk of pacemaker inhibition?
- Convert the pacemaker to asynchronous (DOO or VOO) mode preoperatively (Correct answer)
- Use monopolar electrocautery in continuous rather than blend mode
- Increase the pacemaker lower rate limit to 80 bpm intraoperatively
- Avoid any muscle relaxants to prevent EMG interference
Correct answer: Convert the pacemaker to asynchronous (DOO or VOO) mode preoperatively
Converting a demand pacemaker to asynchronous mode eliminates sensitivity to electromagnetic interference from electrocautery, ensuring continuous pacing.
Question 7: Which of the following BEST describes the purpose of a formal anesthesia handoff (sign-out) to the PACU nurse?
- Documenting the anesthesia record for billing purposes
- Transferring accurate clinical information to ensure continuity of patient care (Correct answer)
- Obtaining the PACU nurse's signature for medicolegal protection
- Reviewing surgical technique with the PACU nursing staff
Correct answer: Transferring accurate clinical information to ensure continuity of patient care
A structured handoff transfers critical clinical informationâairway, medications, hemodynamics, and concernsâto ensure safe continuity of care in the PACU.
ABA Clinical Practice & Patient Safety 3
A patient with OSA is extubated after laparoscopic cholecystectomy.
Which postoperative monitoring approach is MOST appropriate?