CAPA Respiratory Assessment & Management 4 — Questions and Answers
Question 1: A patient received IV morphine 4mg in PACU and now has a respiratory rate of 8 breaths/min with pinpoint pupils. The nurse administers naloxone 0.4mg IV. Which outcome requires repeat naloxone dosing?
- Respiratory rate increases to 14 breaths/min but patient remains sleepy
- Patient becomes agitated and requests pain medication
- Respiratory rate of 8 persists after 2-3 minutes (Correct answer)
- SpO2 increases from 88% to 94% on room air
Correct answer: Respiratory rate of 8 persists after 2-3 minutes
If respiratory depression persists after 2-3 minutes, repeat naloxone dosing (0.1-0.2mg increments) is indicated, as the initial dose was insufficient to reverse opioid effect.
Question 2: Which of the following is a contraindication to nasopharyngeal airway insertion in a PACU patient?
- Intact gag reflex
- Mild nasal congestion
- Suspected basilar skull fracture (Correct answer)
- Use of antiplatelet medication
Correct answer: Suspected basilar skull fracture
Suspected basilar skull fracture is an absolute contraindication to nasopharyngeal airway insertion, as the tube could enter the cranial vault through a cribriform plate fracture.
Question 3: A patient post-thyroidectomy develops inspiratory stridor, dysphagia, and neck swelling 2 hours after surgery. The PRIORITY intervention is:
- Administer racemic epinephrine via nebulizer
- Open the neck wound at the bedside to relieve hematoma pressure
- Apply ice packs to the neck and elevate the head of bed
- Prepare for reintubation or surgical airway (Correct answer)
Correct answer: Prepare for reintubation or surgical airway
Progressive neck hematoma after thyroidectomy can cause complete airway obstruction; securing the airway via reintubation or surgical airway is the immediate priority before the airway is lost.
Question 4: When applying a nasal cannula, the nurse should position the prongs so that:
- The prongs curve upward into the nares
- The prongs curve downward following the natural curvature of the nares (Correct answer)
- The prongs are inserted as deeply as possible for maximum oxygen delivery
- The prongs rest just at the entrance of the nares without insertion
Correct answer: The prongs curve downward following the natural curvature of the nares
Nasal cannula prongs should curve downward to follow the natural anatomy of the nares, optimizing flow toward the pharynx and improving patient comfort and oxygen delivery.
Question 5: A post-anesthesia patient has a PaO2 of 70 mmHg on 4L nasal cannula (estimated FiO2 ~0.36). What is the approximate P/F ratio, and what does it indicate?
- P/F = 194, indicating mild ARDS (Correct answer)
- P/F = 280, indicating normal oxygenation efficiency
- P/F = 175, indicating moderate respiratory failure
- P/F = 350, indicating adequate gas exchange
Correct answer: P/F = 194, indicating mild ARDS
P/F ratio = PaO2 ÷ FiO2 = 70 ÷ 0.36 ≈ 194, which falls in the mild ARDS range (200-300) and indicates impaired oxygenation requiring close monitoring.
Question 6: Which post-anesthetic respiratory complication is characterized by severe bronchospasm, hypoxia, and decreased lung compliance that occurs within hours of aspiration of gastric contents?
- Mendelson's syndrome (aspiration pneumonitis) (Correct answer)
- Pulmonary embolism
- Flash pulmonary edema
- Negative-pressure pulmonary edema
Correct answer: Mendelson's syndrome (aspiration pneumonitis)
Mendelson's syndrome is chemical pneumonitis from aspiration of acidic gastric contents, causing severe bronchospasm, hypoxia, and decreased lung compliance within 2 hours.
Question 7: A PACU nurse notes a patient's end-tidal CO2 waveform has a 'shark fin' appearance with a prolonged expiratory phase. This pattern is MOST associated with:
- Normal ventilation
- Bronchospasm or obstructive airway disease (Correct answer)
- Hyperventilation from pain
- Esophageal intubation
Correct answer: Bronchospasm or obstructive airway disease
A 'shark fin' or slanted ETCO2 waveform with prolonged expiratory upslope indicates obstruction to expiratory airflow, characteristic of bronchospasm or COPD exacerbation.
CAPA Respiratory Assessment & Management 4
A patient received IV morphine 4mg in PACU and now has a respiratory rate of 8 breaths/min with pinpoint pupils.
The nurse administers naloxone 0.4mg IV.
Which outcome requires repeat naloxone dosing?