CAA Perioperative Care & Patient Monitoring 2 — Questions and Answers
Question 1: Which combination of intraoperative findings is most characteristic of early malignant hyperthermia?
- Decreasing blood pressure and bradycardia
- Rising ETCO2 and increasing core temperature (Correct answer)
- Decreasing SpO2 and hypotension
- Bradycardia and decreasing ETCO2
Correct answer: Rising ETCO2 and increasing core temperature
Malignant hyperthermia causes hypermetabolism leading to a rapid rise in ETCO2 (from excess CO2 production) and increasing core temperature, often before other signs appear.
Question 2: A train-of-four (TOF) ratio of 0.9 or greater at the adductor pollicis muscle indicates:
- Deep neuromuscular blockade requiring re-dosing
- Complete paralysis with no twitch response
- Adequate recovery of neuromuscular function for extubation (Correct answer)
- Insufficient reversal requiring additional neostigmine
Correct answer: Adequate recovery of neuromuscular function for extubation
A TOF ratio ≥0.9 at the adductor pollicis is the accepted threshold indicating adequate neuromuscular recovery and is considered safe for extubation.
Question 3: The modified Aldrete scoring system is used in the PACU to assess:
- Depth of residual anesthesia in the OR
- Patient readiness for discharge from the PACU (Correct answer)
- Preoperative surgical risk classification
- Degree of intraoperative neuromuscular blockade
Correct answer: Patient readiness for discharge from the PACU
The modified Aldrete score evaluates activity, respiration, circulation, consciousness, and oxygen saturation to determine when a patient is safe to leave the PACU.
Question 4: Which monitoring modality provides continuous beat-to-beat arterial blood pressure measurement and allows for repeated arterial blood gas sampling?
- Automated noninvasive blood pressure cuff
- Pulse oximetry waveform
- Radial arterial line (intra-arterial catheter) (Correct answer)
- Central venous catheter
Correct answer: Radial arterial line (intra-arterial catheter)
An intra-arterial catheter (arterial line) provides continuous beat-to-beat blood pressure monitoring and convenient access for serial arterial blood gas analysis.
Question 5: Which immediate postoperative complication is most frequently encountered in the PACU?
- Acute myocardial infarction
- Postoperative nausea and vomiting (PONV) (Correct answer)
- Deep vein thrombosis
- Pulmonary embolism
Correct answer: Postoperative nausea and vomiting (PONV)
PONV is the most common postoperative complication, occurring in up to 30% of all surgical patients and up to 80% in high-risk patients, significantly impacting recovery.
Question 6: The Apfel score is a clinical tool used to predict the risk of:
- Intraoperative awareness under anesthesia
- Difficult endotracheal intubation
- Postoperative nausea and vomiting (PONV)
- Postoperative pulmonary complications (Correct answer)
Correct answer: Postoperative pulmonary complications
The Apfel score assigns one point each for female sex, non-smoking status, history of PONV or motion sickness, and postoperative opioid use to stratify PONV risk.
Question 7: Unintentional intraoperative hypothermia (core temperature <36°C) is associated with which perioperative complication?
- Increased cardiac output and vasodilation
- Impaired drug metabolism and increased coagulopathy (Correct answer)
- Accelerated recovery from neuromuscular blockade
- Decreased anesthetic requirements
Correct answer: Impaired drug metabolism and increased coagulopathy
Hypothermia slows hepatic and plasma enzyme activity, prolonging drug effects, and impairs platelet function and coagulation cascade enzymes, increasing bleeding risk.
CAA Perioperative Care & Patient Monitoring 2
Which combination of intraoperative findings is most characteristic of early malignant hyperthermia?