CAPA Respiratory Assessment & Management 5 — Questions and Answers
Question 1: A patient who underwent 4-hour abdominal surgery under general anesthesia is being assessed using the Aldrete scoring system. A respiratory score of '1' is assigned when:
- The patient breathes deeply and coughs freely
- Dyspnea or limited breathing is present (Correct answer)
- The patient is apneic
- SpO2 is greater than 92% on room air
Correct answer: Dyspnea or limited breathing is present
An Aldrete respiratory score of 1 indicates dyspnea, shallow breathing, or limited respiratory effort; a score of 2 indicates normal breathing, and 0 indicates apnea.
Question 2: A patient with a history of reactive airway disease develops audible expiratory wheezing 20 minutes after extubation. After administering albuterol via MDI, the nurse should reassess within:
- 5 minutes
- 15-20 minutes (Correct answer)
- 30-45 minutes
- 60 minutes
Correct answer: 15-20 minutes
Albuterol's peak bronchodilatory effect occurs at 15-20 minutes after inhalation, making this the appropriate reassessment window to evaluate therapeutic response.
Question 3: Which maneuver is MOST effective for opening the airway in a patient suspected of having a cervical spine injury?
- Head-tilt chin-lift
- Modified jaw thrust without head extension (Correct answer)
- Neck flexion with chin tuck
- Lateral neck rotation to 45 degrees
Correct answer: Modified jaw thrust without head extension
The modified jaw thrust without head extension opens the airway while maintaining cervical spine neutrality, making it the preferred technique when spinal injury is suspected.
Question 4: A patient with COPD is being discharged from the ambulatory surgery unit on home oxygen at 2L/min. Teaching should emphasize that the PRIMARY goal of supplemental oxygen in COPD is:
- Achieving SpO2 greater than 98%
- Maintaining SpO2 between 88-92% to avoid blunting hypoxic drive (Correct answer)
- Eliminating dyspnea completely at rest
- Increasing PaCO2 to normal levels
Correct answer: Maintaining SpO2 between 88-92% to avoid blunting hypoxic drive
In COPD patients who may rely on hypoxic drive, oxygen is titrated to SpO2 88-92% to prevent hyperoxia-induced hypercapnia while maintaining adequate tissue oxygenation.
Question 5: Which finding during respiratory assessment of a PACU patient requires IMMEDIATE escalation to the anesthesia provider?
- SpO2 of 95% on 2L nasal cannula that improves to 98% with deep breathing
- Respiratory rate of 18 breaths/min with clear bilateral breath sounds
- Paradoxical inward chest movement with each respiratory effort (Correct answer)
- Mild throat discomfort after endotracheal intubation
Correct answer: Paradoxical inward chest movement with each respiratory effort
Paradoxical inward chest movement during inspiration indicates severe upper airway obstruction or respiratory muscle fatigue and represents impending respiratory failure requiring immediate intervention.
Question 6: A patient post-laparoscopic Nissen fundoplication has difficulty swallowing and a weak voice 2 hours after surgery. The nurse's PRIORITY assessment is for:
- Pain level using a numeric scale
- Recurrent laryngeal nerve injury and potential airway compromise (Correct answer)
- Oral intake tolerance beginning with clear liquids
- Nausea intensity before antiemetic administration
Correct answer: Recurrent laryngeal nerve injury and potential airway compromise
Dysphagia and hoarseness after fundoplication raise concern for recurrent laryngeal nerve injury, which can progress to bilateral vocal cord paralysis and complete airway obstruction.
Question 7: The nurse is preparing to suction a patient via nasotracheal route in the PACU. Which action is essential BEFORE suctioning?
- Pre-oxygenate the patient with 100% oxygen for at least 30 seconds (Correct answer)
- Administer 5mL normal saline into the airway to loosen secretions
- Set suction pressure to the highest available setting for efficiency
- Have the patient perform a Valsalva maneuver to close the glottis
Correct answer: Pre-oxygenate the patient with 100% oxygen for at least 30 seconds
Pre-oxygenation with 100% oxygen for at least 30 seconds before suctioning reduces the risk of hypoxemia caused by oxygen removal during the suctioning procedure.
CAPA Respiratory Assessment & Management 5
A patient who underwent 4-hour abdominal surgery under general anesthesia is being assessed using the Aldrete scoring system.
A respiratory score of '1' is assigned when: