CAPA Respiratory Assessment & Management 2 — Questions and Answers
Question 1: A patient in the PACU after laparoscopic cholecystectomy has an SpO2 of 91% on 2L nasal cannula. The FIRST nursing intervention should be:
- Increase oxygen flow to 4L via nasal cannula
- Stimulate the patient and encourage deep breathing (Correct answer)
- Apply a non-rebreather mask at 15L/min
- Notify the anesthesia provider immediately
Correct answer: Stimulate the patient and encourage deep breathing
Stimulating the patient and encouraging deep breathing addresses the most common cause of hypoxemia in PACU — residual anesthetic-induced hypoventilation.
Question 2: Which clinical finding BEST indicates upper airway obstruction in a post-anesthesia patient?
- Stridor with paradoxical chest-abdominal movement (Correct answer)
- Shallow breathing with bilateral crackles
- Decreased SpO2 with expiratory wheezing
- Tachypnea with accessory muscle use only
Correct answer: Stridor with paradoxical chest-abdominal movement
Stridor combined with paradoxical (seesaw) chest-abdominal movement is the hallmark of upper airway obstruction, where the diaphragm descends but the airway blockage prevents chest rise.
Question 3: A patient who received a cervical nerve block for shoulder surgery develops dyspnea 30 minutes postoperatively. The MOST likely complication is:
- Pulmonary embolism
- Ipsilateral phrenic nerve palsy causing hemidiaphragm paresis (Correct answer)
- Bilateral vocal cord paralysis
- Opioid-induced respiratory depression
Correct answer: Ipsilateral phrenic nerve palsy causing hemidiaphragm paresis
Interscalene brachial plexus blocks reliably cause ipsilateral phrenic nerve palsy, resulting in hemidiaphragm paresis and reduced respiratory capacity.
Question 4: When assessing breath sounds in a PACU patient, the nurse auscultates absent sounds over the left lung base with dullness to percussion. This finding is MOST consistent with:
- Pneumothorax
- Atelectasis of a small segment
- Pleural effusion or hemothorax (Correct answer)
- Pulmonary embolism
Correct answer: Pleural effusion or hemothorax
Absent breath sounds with dullness to percussion indicate fluid in the pleural space, consistent with pleural effusion or hemothorax, not pneumothorax (which causes hyperresonance).
Question 5: A 58-year-old patient with a 40-pack-year smoking history is post-op day 0 after abdominal surgery. Which incentive spirometry instruction is MOST appropriate?
- Breathe in as fast as possible to move the ball quickly
- Take a slow, sustained maximal inhalation and hold for 5-10 seconds (Correct answer)
- Perform 2 repetitions every hour
- Use the device only when feeling short of breath
Correct answer: Take a slow, sustained maximal inhalation and hold for 5-10 seconds
A slow, sustained maximal inhalation held for 5-10 seconds maximally expands alveoli and prevents atelectasis, which is the therapeutic goal of incentive spirometry.
Question 6: The nurse notes a PACU patient's ETCO2 waveform has a gradually rising baseline that never returns to zero. This capnography pattern indicates:
- Complete airway obstruction
- Rebreathing of exhaled CO2 (Correct answer)
- Hyperventilation
- Pulmonary embolism
Correct answer: Rebreathing of exhaled CO2
A rising ETCO2 baseline that does not return to zero indicates CO2 rebreathing, often caused by an exhausted CO2 absorber or an incompetent expiratory valve.
Question 7: Which patient is at HIGHEST risk for postoperative pulmonary complications in the ambulatory setting?
- 35-year-old with BMI 22 undergoing knee arthroscopy under spinal anesthesia
- 68-year-old with COPD undergoing inguinal hernia repair under general anesthesia (Correct answer)
- 45-year-old non-smoker undergoing laparoscopic tubal ligation
- 55-year-old with well-controlled hypertension undergoing colonoscopy
Correct answer: 68-year-old with COPD undergoing inguinal hernia repair under general anesthesia
Older age, pre-existing COPD, and general anesthesia are all independent risk factors for postoperative pulmonary complications, making this patient highest risk.
CAPA Respiratory Assessment & Management 2
A patient in the PACU after laparoscopic cholecystectomy has an SpO2 of 91% on 2L nasal cannula.
The FIRST nursing intervention should be: