CAPA Respiratory Assessment & Management 3 — Questions and Answers
Question 1: A post-anesthesia patient is receiving oxygen via face mask at 8L/min with an SpO2 of 95%. The nurse notes the reservoir bag on the partial rebreather mask deflates completely with each breath. The CORRECT action is:
- Switch to a non-rebreather mask and increase flow (Correct answer)
- Decrease oxygen flow to 4L/min
- Document the finding as normal mask function
- Place the patient on high-flow nasal cannula instead
Correct answer: Switch to a non-rebreather mask and increase flow
Complete deflation of the reservoir bag indicates flow is insufficient to meet the patient's inspiratory demand; switching to a non-rebreather mask with higher flow maintains FiO2 delivery.
Question 2: A patient emerges from general anesthesia biting the oropharyngeal airway and is extremely agitated. The nurse's PRIORITY action is:
- Administer IV midazolam immediately
- Remove the oral airway only after confirming adequate protective reflexes (Correct answer)
- Restrain the patient to prevent self-extubation
- Apply a jaw thrust and leave the airway in place
Correct answer: Remove the oral airway only after confirming adequate protective reflexes
An oral airway should be removed when the patient demonstrates adequate protective airway reflexes (e.g., purposeful attempts to remove it), because forceful biting indicates the patient is capable of maintaining their airway.
Question 3: Which arterial blood gas result is MOST consistent with acute respiratory acidosis from hypoventilation?
- pH 7.52, PaCO2 28, HCO3 22
- pH 7.28, PaCO2 58, HCO3 24 (Correct answer)
- pH 7.35, PaCO2 60, HCO3 32
- pH 7.48, PaCO2 40, HCO3 29
Correct answer: pH 7.28, PaCO2 58, HCO3 24
pH 7.28 with elevated PaCO2 of 58 and normal bicarbonate indicates acute uncompensated respiratory acidosis due to CO2 retention from hypoventilation.
Question 4: A patient returns from TURP under spinal anesthesia and develops sudden dyspnea with decreased breath sounds on the right and tracheal deviation to the left. The nurse should IMMEDIATELY:
- Administer bronchodilator via nebulizer
- Prepare for emergency needle decompression of the right chest (Correct answer)
- Apply high-flow oxygen and elevate the head of bed 30 degrees
- Obtain a STAT chest X-ray before any intervention
Correct answer: Prepare for emergency needle decompression of the right chest
Tracheal deviation away from the affected side combined with absent breath sounds indicates tension pneumothorax, a life-threatening emergency requiring immediate needle decompression.
Question 5: When monitoring a patient's respiratory rate in the PACU, the nurse should count respirations for at least:
- 15 seconds and multiply by 4
- 30 seconds and multiply by 2
- A full 60 seconds without the patient's knowledge (Correct answer)
- 10 seconds and multiply by 6
Correct answer: A full 60 seconds without the patient's knowledge
Respirations should be counted for a full 60 seconds without the patient's knowledge, as awareness can alter breathing pattern and shorter intervals are less accurate for detecting bradypnea.
Question 6: A patient with known obstructive sleep apnea (OSA) is in Phase I recovery after knee replacement. Which monitoring parameter is MOST critical in addition to SpO2?
- End-tidal CO2 via capnography (Correct answer)
- Continuous ECG monitoring
- Hourly urine output
- Non-invasive blood pressure every 5 minutes
Correct answer: End-tidal CO2 via capnography
Capnography (ETCO2) detects hypoventilation and apneic episodes earlier than pulse oximetry alone, which is especially important in OSA patients prone to opioid-induced respiratory depression.
Question 7: A nurse prepares to perform a modified jaw thrust on an unconscious post-anesthesia patient. Which technique is CORRECT?
- Place thumbs on the chin and push the jaw forward while hyperextending the neck
- Position fingers behind the angle of the mandible and lift forward without moving the neck (Correct answer)
- Grip the lower teeth with fingers and pull the jaw anteriorly
- Apply bilateral pressure over the zygomatic arches while tilting the head back
Correct answer: Position fingers behind the angle of the mandible and lift forward without moving the neck
The jaw thrust is performed by positioning fingers behind the angle of the mandible and lifting anteriorly, which opens the airway while maintaining cervical spine alignment.
CAPA Respiratory Assessment & Management 3
A post-anesthesia patient is receiving oxygen via face mask at 8L/min with an SpO2 of 95%.
The nurse notes the reservoir bag on the partial rebreather mask deflates completely with each breath.
The CORRECT action is: