CAPA Pediatric Perianesthesia Nursing 4 — Questions and Answers
Question 1: A 4-year-old weighing 16 kg is to receive ketamine for procedural sedation. What is the appropriate IV sedation dose?
- 1–2 mg/kg (16–32 mg) (Correct answer)
- 0.1–0.2 mg/kg (1.6–3.2 mg)
- 5 mg/kg (80 mg)
- 0.5 mg/kg only for induction
Correct answer: 1–2 mg/kg (16–32 mg)
IV ketamine for procedural sedation in children is dosed at 1–2 mg/kg; the dissociative state provides analgesia and sedation while maintaining airway reflexes.
Question 2: Which discharge criterion specifically addresses readiness for home after ambulatory anesthesia in a pediatric patient?
- Modified Aldrete score ≥9 or PADSS ≥18 with stable vital signs (Correct answer)
- Return to baseline mental status and ability to ambulate independently
- Ability to tolerate a full meal without nausea
- Complete resolution of any sedation with no drowsiness
Correct answer: Modified Aldrete score ≥9 or PADSS ≥18 with stable vital signs
Most ambulatory centers use a Modified Aldrete score ≥9 or PADSS ≥18 as objective discharge criteria, combined with clinical assessment of the child.
Question 3: A 3-year-old in the PACU develops total laryngospasm. After calling for help, what is the immediate nursing priority?
- Apply firm jaw thrust and positive pressure ventilation with 100% O2 (Correct answer)
- Administer IV succinylcholine immediately
- Place the child in lateral decubitus position
- Administer nebulized racemic epinephrine
Correct answer: Apply firm jaw thrust and positive pressure ventilation with 100% O2
Immediate management of laryngospasm begins with jaw thrust and gentle positive pressure ventilation with 100% O2 to break the spasm before escalating to succinylcholine.
Question 4: Which preoperative fasting guideline (NPO) applies to a healthy 5-year-old scheduled for elective ambulatory surgery?
- Clear liquids up to 2 hours, breast milk up to 4 hours, solids up to 6 hours before surgery (Correct answer)
- Nothing by mouth for 8 hours for all substances
- Clear liquids up to 4 hours, solids up to 8 hours before surgery
- Formula and solid food may be given up to 4 hours before surgery
Correct answer: Clear liquids up to 2 hours, breast milk up to 4 hours, solids up to 6 hours before surgery
ASA fasting guidelines: clear liquids 2h, breast milk 4h, formula/non-human milk/solids 6h, and fatty meals 8h before elective anesthesia.
Question 5: A toddler's caregiver reports the child has a loose tooth. What is the priority perianesthesia concern?
- Risk of aspiration of a dislodged tooth during intubation or emergence (Correct answer)
- Increased bleeding risk during IV placement
- Dental injury liability requiring documentation only
- Delay surgery until tooth is extracted
Correct answer: Risk of aspiration of a dislodged tooth during intubation or emergence
A loose tooth creates a significant aspiration risk during airway management; the anesthesia team must be notified immediately for risk-benefit assessment and airway planning.
Question 6: Which behavioral sign in the PACU most reliably indicates adequate pain control in a non-verbal 18-month-old?
- Calm facial expression, relaxed body posture, and ability to be comforted (Correct answer)
- Heart rate below 100 bpm
- Absence of crying for more than 5 minutes
- SpO2 maintained above 95%
Correct answer: Calm facial expression, relaxed body posture, and ability to be comforted
In non-verbal toddlers, behavioral indicators such as calm expression, relaxed posture, and consolability are the most reliable signs of adequate pain management.
Question 7: A 6-year-old with a history of severe needle phobia is scheduled for ambulatory surgery. Which premedication is most commonly used to reduce preoperative anxiety in pediatric patients?
- Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction (Correct answer)
- IV lorazepam given on arrival to pre-op
- IM ketamine 4 mg/kg in the preoperative holding area
- Oral diazepam the night before surgery
Correct answer: Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction
Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction is the most widely used and effective pediatric anxiolytic premedication.
CAPA Pediatric Perianesthesia Nursing 4
A 4-year-old weighing 16 kg is to receive ketamine for procedural sedation.
What is the appropriate IV sedation dose?