CAPA Patient Safety & Monitoring 3 — Questions and Answers
Question 1: A PACU nurse notes that a patient's arterial line waveform shows pulsus paradoxus. Which condition is MOST concerning?
- Hypovolemic shock
- Cardiac tamponade (Correct answer)
- Pulmonary embolism
- Tension pneumothorax
Correct answer: Cardiac tamponade
Pulsus paradoxus — an exaggerated drop in systolic BP during inspiration — is a hallmark of cardiac tamponade caused by pericardial compression of the heart.
Question 2: A patient undergoing ambulatory knee arthroscopy reports sudden pleuritic chest pain and tachycardia at 30 minutes post-op. Which diagnosis should the nurse consider FIRST?
- Myocardial infarction
- Pulmonary embolism (Correct answer)
- Pleural effusion
- Pneumonia
Correct answer: Pulmonary embolism
Acute onset pleuritic chest pain with tachycardia in the postoperative period is a classic presentation of pulmonary embolism and requires urgent evaluation.
Question 3: Which urine output value per hour should prompt the PACU nurse to notify the physician for a 70 kg adult patient?
- 40 mL/hr
- 50 mL/hr
- 20 mL/hr (Correct answer)
- 30 mL/hr
Correct answer: 20 mL/hr
Adequate urine output is 0.5 mL/kg/hr; for a 70 kg patient this is 35 mL/hr, so 20 mL/hr indicates oliguria warranting physician notification.
Question 4: A patient in Phase II recovery begins shivering uncontrollably. Which intervention is MOST effective for perianesthesia shivering?
- Administer IV meperidine 12.5–25 mg (Correct answer)
- Apply warm blankets only
- Administer oral acetaminophen
- Increase IV fluid rate
Correct answer: Administer IV meperidine 12.5–25 mg
Low-dose IV meperidine is the most effective pharmacologic treatment for post-anesthesia shivering by acting on kappa-opioid receptors and thermoregulatory centers.
Question 5: When using a Bispectral Index (BIS) monitor in the PACU, which BIS value range indicates an adequately sedated but arousable patient?
- 0–40
- 40–60
- 60–80 (Correct answer)
- 80–100
Correct answer: 60–80
A BIS value of 60–80 corresponds to moderate sedation — the patient is responsive to stimulation but has depressed consciousness.
Question 6: Which assessment finding is the EARLIEST indicator of hypovolemia in a PACU patient?
- Decreased blood pressure
- Oliguria
- Tachycardia (Correct answer)
- Altered mental status
Correct answer: Tachycardia
Tachycardia is typically the earliest compensatory response to hypovolemia, occurring before hypotension as the body attempts to maintain cardiac output.
Question 7: A patient is transferred to Phase I PACU after general anesthesia. The nurse notices absence of breath sounds on the left side and tracheal deviation to the right. What should the nurse do IMMEDIATELY?
- Obtain a stat chest X-ray
- Administer albuterol nebulizer
- Notify physician and prepare for needle decompression (Correct answer)
- Reposition patient to left lateral decubitus
Correct answer: Notify physician and prepare for needle decompression
Absent breath sounds with tracheal deviation away from the affected side indicates tension pneumothorax, a life-threatening emergency requiring immediate needle decompression.
CAPA Patient Safety & Monitoring 3
A PACU nurse notes that a patient's arterial line waveform shows pulsus paradoxus.
Which condition is MOST concerning?