CAPA Thermoregulation & Fluid Management 2 — Questions and Answers
Question 1: A patient in Phase I PACU has a core temperature of 35.1°C after a 90-minute laparoscopic procedure. Which intervention is MOST effective for rewarming?
- Warm blankets alone
- Forced-air warming device (Correct answer)
- Increased room temperature
- Warm IV fluids at 100 mL/hr
Correct answer: Forced-air warming device
Forced-air warming devices are the most effective non-invasive method for rewarming hypothermic postoperative patients.
Question 2: During fluid resuscitation in a 70 kg ambulatory surgery patient, which finding BEST indicates adequate volume replacement?
- Heart rate decreasing from 110 to 88 bpm (Correct answer)
- Urine output of 0.2 mL/kg/hr
- MAP of 55 mmHg
- Capillary refill of 4 seconds
Correct answer: Heart rate decreasing from 110 to 88 bpm
A decreasing heart rate toward normal range is a reliable clinical indicator of improving intravascular volume.
Question 3: Which patient is at HIGHEST risk for perioperative hypothermia in the ambulatory setting?
- A 35-year-old with BMI 32 undergoing knee arthroscopy
- An 80-year-old undergoing 3-hour shoulder repair (Correct answer)
- A 45-year-old diabetic having cataract surgery (20 minutes)
- A 25-year-old having a laparoscopic appendectomy
Correct answer: An 80-year-old undergoing 3-hour shoulder repair
Advanced age impairs thermoregulatory mechanisms and longer surgical duration increases heat loss, making elderly patients with lengthy procedures highest risk.
Question 4: A patient receiving 3 liters of 0.9% normal saline develops a serum chloride of 115 mEq/L. The nurse should anticipate which complication?
- Hypokalemic alkalosis
- Hyperchloremic metabolic acidosis (Correct answer)
- Hypochloremic metabolic alkalosis
- Respiratory alkalosis
Correct answer: Hyperchloremic metabolic acidosis
Large volumes of normal saline cause hyperchloremic metabolic acidosis due to the high chloride load relative to bicarbonate.
Question 5: Shivering in the PACU increases oxygen consumption by approximately how much?
- 10-20%
- 25-40%
- 100-400% (Correct answer)
- 50-60%
Correct answer: 100-400%
Postoperative shivering can increase oxygen consumption by 100-400%, significantly stressing cardiopulmonary reserves.
Question 6: A patient with congestive heart failure is scheduled for outpatient surgery. Which IV fluid strategy is MOST appropriate intraoperatively?
- Liberal crystalloid at 20 mL/kg/hr
- Colloid-based resuscitation targeting CVP >12
- Restrictive fluid strategy with goal-directed therapy (Correct answer)
- Dextrose 5% at maintenance rate
Correct answer: Restrictive fluid strategy with goal-directed therapy
Patients with CHF benefit from a restrictive, goal-directed fluid strategy to avoid volume overload and pulmonary edema.
Question 7: Which temperature monitoring site provides the MOST accurate core temperature reading in an ambulatory surgery patient?
- Axillary
- Oral
- Tympanic membrane (Correct answer)
- Rectal
Correct answer: Tympanic membrane
Tympanic membrane temperature reflects hypothalamic temperature via the carotid artery supply, providing accurate core temperature measurement.
CAPA Thermoregulation & Fluid Management 2
A patient in Phase I PACU has a core temperature of 35.1°C after a 90-minute laparoscopic procedure.
Which intervention is MOST effective for rewarming?