CAPA Patient Safety & Monitoring 4 — Questions and Answers
Question 1: A patient with a history of obstructive sleep apnea (OSA) is recovering from outpatient surgery. Which monitoring parameter is MOST critical in the immediate postoperative period?
- Blood pressure trend
- Continuous SpO2 with waveform (Correct answer)
- Urine output
- Temperature
Correct answer: Continuous SpO2 with waveform
OSA patients are at high risk for airway obstruction and oxygen desaturation; continuous pulse oximetry with waveform display is essential for early detection.
Question 2: Which PACU alarm condition should prompt the nurse to assess for laryngospasm?
- Sudden SpO2 drop with high-pitched inspiratory stridor and sternal retraction (Correct answer)
- Gradual SpO2 decline with snoring respirations
- SpO2 drop with wheezing on auscultation
- SpO2 drop accompanied by diaphoresis and hypertension
Correct answer: Sudden SpO2 drop with high-pitched inspiratory stridor and sternal retraction
Laryngospasm presents with sudden SpO2 drop, high-pitched crowing stridor or complete silence, and sternal retraction due to forceful inspiratory effort against a closed glottis.
Question 3: A post-surgical patient in the PACU is exhibiting signs of malignant hyperthermia (MH). Which laboratory result would be MOST consistent with an MH crisis?
- Respiratory alkalosis with hypokalemia
- Metabolic acidosis with elevated creatine kinase (Correct answer)
- Metabolic alkalosis with hypocalcemia
- Respiratory acidosis with elevated sodium
Correct answer: Metabolic acidosis with elevated creatine kinase
MH produces intense hypermetabolism causing metabolic (and respiratory) acidosis, and massive muscle destruction elevates creatine kinase (CK) markedly.
Question 4: When administering dantrolene for malignant hyperthermia, what is the correct initial IV dose?
- 1 mg/kg, repeated every 5 minutes up to 10 mg/kg
- 2.5 mg/kg, repeated every 5 minutes up to 10 mg/kg (Correct answer)
- 5 mg/kg as a single bolus
- 0.5 mg/kg, repeated every 10 minutes up to 5 mg/kg
Correct answer: 2.5 mg/kg, repeated every 5 minutes up to 10 mg/kg
The MHAUS protocol recommends dantrolene 2.5 mg/kg IV bolus, repeated every 5 minutes until symptoms resolve, up to a total of 10 mg/kg or more.
Question 5: A patient receiving a regional nerve block is in Phase II recovery when they report metallic taste and circumoral numbness. The nurse should FIRST:
- Administer IV diphenhydramine
- Assess for signs of local anesthetic systemic toxicity (LAST) and call for help (Correct answer)
- Apply supplemental oxygen and reassure the patient
- Check blood pressure and administer ephedrine if hypotensive
Correct answer: Assess for signs of local anesthetic systemic toxicity (LAST) and call for help
Metallic taste and circumoral numbness are early CNS signs of LAST; immediate recognition, calling for help, and preparation for treatment (lipid emulsion) are the priority.
Question 6: Which intervention is the FIRST-LINE treatment for local anesthetic systemic toxicity (LAST) with cardiovascular collapse?
- Epinephrine 1 mg IV bolus
- 20% lipid emulsion IV bolus at 1.5 mL/kg (Correct answer)
- Amiodarone 300 mg IV
- Sodium bicarbonate 1 mEq/kg IV
Correct answer: 20% lipid emulsion IV bolus at 1.5 mL/kg
20% lipid emulsion (Intralipid) at 1.5 mL/kg IV bolus is the definitive first-line treatment for LAST with cardiovascular collapse per ASRA guidelines.
Question 7: Which Aldrete score component specifically addresses the patient's ability to maintain their own airway in the PACU?
- Activity
- Respiration (Correct answer)
- Circulation
- Consciousness
Correct answer: Respiration
The Respiration component of the Aldrete score evaluates ability to breathe deeply and cough effectively, which reflects maintenance of airway patency.
CAPA Patient Safety & Monitoring 4
A patient with a history of obstructive sleep apnea (OSA) is recovering from outpatient surgery.
Which monitoring parameter is MOST critical in the immediate postoperative period?