CAPA Pediatric Perianesthesia Nursing 2 — Questions and Answers
Question 1: A 4-year-old post-tonsillectomy patient is restless and crying in the PACU. Which assessment finding would most indicate emergence delirium rather than pain?
- Inconsolable despite opioid administration (Correct answer)
- Heart rate 110 bpm
- SpO2 94% on room air
- Temperature 37.8°C
Correct answer: Inconsolable despite opioid administration
Emergence delirium is characterized by inconsolable agitation that does not respond to comfort measures or analgesics, unlike pain-related crying.
Question 2: When calculating IV fluid maintenance for a 20 kg pediatric patient using the Holliday-Segar method, what is the correct hourly rate?
- 60 mL/hr (Correct answer)
- 55 mL/hr
- 40 mL/hr
- 80 mL/hr
Correct answer: 60 mL/hr
Holliday-Segar: 4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for next 10 kg = 40 + 20 = 60 mL/hr for a 20 kg child.
Question 3: A 6-year-old child arrives in the PACU after adenoidectomy with a FLACC score of 7. Which analgesic approach is most appropriate as a first step?
- IV opioid titration (Correct answer)
- Oral acetaminophen
- Distraction and repositioning alone
- Ketorolac IM injection
Correct answer: IV opioid titration
A FLACC score of 7 indicates moderate-to-severe pain requiring IV opioid titration for prompt and effective relief.
Question 4: Which sign is the earliest indicator of respiratory compromise in a 3-year-old child recovering from general anesthesia?
- Increased respiratory rate (Correct answer)
- Cyanosis
- Decreased SpO2 below 90%
- Bradycardia
Correct answer: Increased respiratory rate
Tachypnea is the earliest compensatory response to hypoxia in children; cyanosis and desaturation are late signs.
Question 5: A parent asks to stay with their child during IV placement before surgery. What is the recommended nursing response?
- Allow parental presence as it reduces child anxiety (Correct answer)
- Decline as it increases procedure time
- Allow only if the child is under 2 years old
- Decline due to infection control concerns
Correct answer: Allow parental presence as it reduces child anxiety
Evidence supports parental presence during preoperative procedures as it significantly reduces pediatric anxiety and improves cooperation.
Question 6: Which factor most increases a child's risk for post-operative nausea and vomiting (PONV) after ambulatory surgery?
- Age over 3 years with history of motion sickness (Correct answer)
- Female sex under age 5
- Duration of anesthesia under 30 minutes
- Use of total IV anesthesia (TIVA)
Correct answer: Age over 3 years with history of motion sickness
Children over 3 years with a personal or family history of motion sickness or prior PONV are at highest risk for postoperative nausea and vomiting.
Question 7: A 9-year-old weighing 30 kg requires morphine for post-op pain. What is the appropriate IV dose range?
- 0.05–0.1 mg/kg (1.5–3 mg) (Correct answer)
- 0.01–0.02 mg/kg (0.3–0.6 mg)
- 0.2–0.4 mg/kg (6–12 mg)
- 1–2 mg flat dose regardless of weight
Correct answer: 0.05–0.1 mg/kg (1.5–3 mg)
The standard pediatric IV morphine dose is 0.05–0.1 mg/kg, giving 1.5–3 mg for a 30 kg child, titrated to effect.
CAPA Pediatric Perianesthesia Nursing 2
A 4-year-old post-tonsillectomy patient is restless and crying in the PACU.
Which assessment finding would most indicate emergence delirium rather than pain?