CAPA Patient Safety & Monitoring 2 — Questions and Answers
Question 1: A patient in the PACU develops sudden onset stridor after extubation. Which intervention should the nurse perform FIRST?
- Administer IV succinylcholine
- Apply jaw thrust and supplemental oxygen (Correct answer)
- Reintubate immediately
- Administer IV neostigmine
Correct answer: Apply jaw thrust and supplemental oxygen
Initial management of post-extubation stridor includes positioning, jaw thrust, and supplemental oxygen before escalating to pharmacologic or airway interventions.
Question 2: Which capnography waveform pattern indicates bronchospasm in a PACU patient?
- Flat line with no waveform
- Shark-fin or oblique upstroke pattern (Correct answer)
- Normal plateau with decreased amplitude
- Rapid oscillations on the plateau
Correct answer: Shark-fin or oblique upstroke pattern
A 'shark-fin' or slanted upstroke on the capnography waveform indicates obstructive airway disease such as bronchospasm due to uneven CO2 emptying.
Question 3: A patient's SpO2 reads 99% but the waveform is dampened and the patient appears cyanotic. What is the most appropriate action?
- Document as normal and continue monitoring
- Correlate with arterial blood gas and assess perfusion (Correct answer)
- Increase FiO2 immediately
- Reposition the probe to the earlobe
Correct answer: Correlate with arterial blood gas and assess perfusion
A poor pulse oximetry waveform suggests unreliable readings; clinical assessment and ABG correlation are required when SpO2 conflicts with clinical appearance.
Question 4: Which condition is MOST likely responsible for a PACU patient with a respiratory rate of 6 breaths per minute and miosis?
- Malignant hyperthermia
- Opioid-induced respiratory depression (Correct answer)
- Pneumothorax
- Anaphylaxis
Correct answer: Opioid-induced respiratory depression
Slow respiratory rate combined with miosis (pinpoint pupils) is the classic presentation of opioid-induced respiratory depression.
Question 5: An ambulatory surgery patient is being monitored for PONV. Which Apfel score component is MOST strongly modifiable by nursing intervention?
- Female sex
- Non-smoking status
- History of PONV or motion sickness
- Postoperative opioid use (Correct answer)
Correct answer: Postoperative opioid use
Postoperative opioid use is the one Apfel risk factor most amenable to nursing intervention through multimodal analgesia and opioid-sparing techniques.
Question 6: During monitoring in Phase I PACU, a patient's ECG shows peaked T-waves and a widened QRS. Which electrolyte disturbance should be suspected?
- Hyponatremia
- Hypocalcemia
- Hyperkalemia (Correct answer)
- Hypomagnesemia
Correct answer: Hyperkalemia
Hyperkalemia classically produces peaked T-waves, widened QRS, and eventually sine-wave pattern, representing a life-threatening cardiac emergency.
Question 7: Which patient action most reliably indicates adequate return of neuromuscular function after non-depolarizing blockade?
- Ability to open eyes on command
- Sustained head lift for 5 seconds (Correct answer)
- SpO2 greater than 95% on room air
- Tidal volume greater than 300 mL
Correct answer: Sustained head lift for 5 seconds
A sustained 5-second head lift requires diaphragmatic and accessory muscle strength and is the classic clinical test for adequate neuromuscular recovery.
CAPA Patient Safety & Monitoring 2
A patient in the PACU develops sudden onset stridor after extubation.
Which intervention should the nurse perform FIRST?