CAPA Thermoregulation & Fluid Management 3 — Questions and Answers
Question 1: A patient develops oliguria (20 mL/hr) in Phase II PACU after ambulatory surgery. What is the FIRST nursing action?
- Administer furosemide 20 mg IV
- Assess fluid intake, blood pressure, and pain level (Correct answer)
- Insert a Foley catheter
- Call the physician immediately for dialysis consult
Correct answer: Assess fluid intake, blood pressure, and pain level
Assessing the clinical picture — volume status, hemodynamics, and pain — helps differentiate pre-renal, renal, or obstructive causes before intervening.
Question 2: During passive rewarming of a mildly hypothermic PACU patient, the nurse should monitor closely for which cardiac complication?
- Supraventricular tachycardia
- Ventricular fibrillation
- Bradycardia with prolonged QT (Correct answer)
- Heart block
Correct answer: Bradycardia with prolonged QT
Hypothermia prolongs the QT interval and slows conduction, increasing risk of bradycardia and dysrhythmias during rewarming.
Question 3: Balanced crystalloid solutions (e.g., lactated Ringer's) are preferred over normal saline for large-volume resuscitation primarily because they:
- Have lower osmolality preventing cellular edema
- More closely match plasma electrolyte composition (Correct answer)
- Are less expensive and equally effective
- Contain glucose for energy support
Correct answer: More closely match plasma electrolyte composition
Balanced crystalloids match plasma electrolyte composition more closely, reducing the risk of hyperchloremic metabolic acidosis seen with large-volume NS.
Question 4: A patient with a core temperature of 36.0°C complains of feeling cold and requests more blankets in Phase I PACU. The BEST response is to:
- Explain their temperature is normal and deny the request
- Apply forced-air warming and recheck temperature in 15 minutes (Correct answer)
- Administer meperidine 12.5 mg IV for perceived cold discomfort
- Document the complaint and continue routine monitoring
Correct answer: Apply forced-air warming and recheck temperature in 15 minutes
Even with a borderline normal temperature, patient comfort warrants active warming measures, and reassessment confirms treatment effectiveness.
Question 5: Which colloid solution is CONTRAINDICATED in patients with known renal dysfunction undergoing ambulatory procedures?
- 5% Albumin
- Hetastarch (HES 6%) (Correct answer)
- Fresh frozen plasma
- Dextran 40
Correct answer: Hetastarch (HES 6%)
Hydroxyethyl starch (HES) is contraindicated in renal dysfunction due to its association with acute kidney injury and accumulation in renal tubules.
Question 6: In a pediatric patient undergoing ambulatory surgery, the minimum acceptable urine output is:
- 0.5 mL/kg/hr
- 1 mL/kg/hr (Correct answer)
- 2 mL/kg/hr
- 0.25 mL/kg/hr
Correct answer: 1 mL/kg/hr
Pediatric patients require a minimum urine output of 1 mL/kg/hr due to higher metabolic rate and proportionally greater fluid requirements.
Question 7: A patient returns from a 2-hour hysteroscopy with documented fluid deficit of 1,500 mL absorbed irrigation fluid. The nurse should MOST closely monitor for:
- Hypovolemic shock
- TURP syndrome with hyponatremia and cerebral edema (Correct answer)
- Hyperkalemia from cellular breakdown
- Metabolic alkalosis
Correct answer: TURP syndrome with hyponatremia and cerebral edema
Absorption of hypotonic irrigation fluid during hysteroscopy causes TURP-like syndrome with dilutional hyponatremia and risk of cerebral edema.
CAPA Thermoregulation & Fluid Management 3
A patient develops oliguria (20 mL/hr) in Phase II PACU after ambulatory surgery.
What is the FIRST nursing action?