CAPA Pediatric Perianesthesia Nursing 3 — Questions and Answers
Question 1: A 5-year-old is brought to the PACU post-myringotomy with signs of upper airway obstruction: snoring, sternal retractions, and SpO2 88%. What is the priority intervention?
- Jaw thrust and airway repositioning (Correct answer)
- Immediate reintubation
- Administer racemic epinephrine
- Apply supplemental O2 via non-rebreather mask
Correct answer: Jaw thrust and airway repositioning
Jaw thrust with airway repositioning is the first-line maneuver to open a partially obstructed pediatric airway before escalating interventions.
Question 2: Which developmental stage consideration is most important when preparing a 7-year-old for ambulatory surgery?
- Providing honest, simple explanations of what they will see and feel (Correct answer)
- Avoiding all pre-op discussion to minimize fear
- Using only medical terminology to build confidence
- Delegating all education to parents only
Correct answer: Providing honest, simple explanations of what they will see and feel
School-age children benefit from honest, age-appropriate explanations of procedures as they are in a concrete operational stage and understand cause and effect.
Question 3: Post-tonsillectomy hemorrhage most commonly occurs within which time frame in the ambulatory setting?
- 5–10 days postoperatively (Correct answer)
- First 2 hours in PACU
- 24–48 hours postoperatively
- More than 2 weeks postoperatively
Correct answer: 5–10 days postoperatively
Secondary post-tonsillectomy hemorrhage peaks between days 5–10 when the fibrin eschar separates, and patients may present to ambulatory centers during this period.
Question 4: Which IV access site is preferred for infants under 6 months in the perianesthesia setting when hand and arm veins are inaccessible?
- Scalp vein (Correct answer)
- Femoral vein
- Internal jugular vein
- Umbilical vein
Correct answer: Scalp vein
Scalp veins are a viable and commonly used alternative IV site in infants under 6 months when peripheral extremity veins are inaccessible.
Question 5: A 10-year-old with a known history of malignant hyperthermia (MH) susceptibility undergoes ambulatory surgery. Which anesthetic approach is required?
- Total IV anesthesia (TIVA) with non-triggering agents only (Correct answer)
- Sevoflurane inhalation induction for smoother emergence
- Succinylcholine for rapid sequence intubation
- Desflurane maintenance as it is newer and safer
Correct answer: Total IV anesthesia (TIVA) with non-triggering agents only
MH-susceptible patients must receive only non-triggering agents (TIVA with propofol/opioids/non-depolarizing NMBAs); all volatile agents and succinylcholine are contraindicated.
Question 6: Which of the following best describes the Pediatric Anesthesia Emergence Delirium (PAED) scale?
- A 5-item observational tool scored 0–20 assessing eye contact, purposefulness, and awareness of surroundings (Correct answer)
- A pain scale using facial expressions for children 3–7 years
- A sedation scale based on response to verbal commands
- A behavioral checklist completed by parents post-discharge
Correct answer: A 5-item observational tool scored 0–20 assessing eye contact, purposefulness, and awareness of surroundings
The PAED scale scores five behaviors (eye contact, purposeful actions, awareness, restlessness, inconsolability) from 0–4 each, with scores ≥10 indicating delirium.
Question 7: A 2-year-old child in the PACU develops stridor and a barking cough 30 minutes after extubation. What is the most likely diagnosis?
- Post-extubation croup (subglottic edema) (Correct answer)
- Laryngospasm
- Bronchospasm
- Aspiration pneumonitis
Correct answer: Post-extubation croup (subglottic edema)
Barking cough with inspiratory stridor developing 30–60 minutes post-extubation in a toddler is classic post-extubation croup due to subglottic mucosal edema.
CAPA Pediatric Perianesthesia Nursing 3
A 5-year-old is brought to the PACU post-myringotomy with signs of upper airway obstruction: snoring, sternal retractions, and SpO2 88%.
What is the priority intervention?