CAPA Thermoregulation & Fluid Management 5 — Questions and Answers
Question 1: A patient in Phase II PACU reports dizziness and nausea after attempted ambulation. Orthostatic vital signs show BP drop of 25 mmHg systolic. The MOST appropriate intervention is:
- Discharge the patient with instructions to rest at home
- Administer ondansetron and attempt ambulation again in 10 minutes
- Return patient to supine, give a 250 mL IV fluid bolus, and reassess (Correct answer)
- Apply a compression device and call for wheelchair discharge
Correct answer: Return patient to supine, give a 250 mL IV fluid bolus, and reassess
Symptomatic orthostatic hypotension indicating volume depletion requires fluid bolus and reassessment before safe discharge can occur.
Question 2: Which warming method is CONTRAINDICATED in a patient with peripheral vascular disease undergoing ambulatory foot surgery?
- Forced-air warming blanket over upper body
- Warm IV fluids
- Direct heating pad applied to the surgical extremity (Correct answer)
- Increasing OR room temperature
Correct answer: Direct heating pad applied to the surgical extremity
Direct heat application to ischemic extremities in peripheral vascular disease can cause thermal injury due to impaired sensation and circulation.
Question 3: A patient's intraoperative urine output averages 15 mL/hr during a 2-hour ambulatory surgery despite adequate IV fluids. Which medication history is MOST likely responsible?
- Preoperative ibuprofen use (Correct answer)
- Morning metformin dose taken
- ACE inhibitor taken day of surgery
- Preoperative hydrocodone for pain
Correct answer: Preoperative ibuprofen use
NSAIDs inhibit prostaglandin-mediated renal afferent arteriolar dilation, reducing GFR and urine output, especially under anesthesia.
Question 4: In the ambulatory setting, which factor MOST strongly predicts the need for IV fluid resuscitation in PACU rather than oral hydration?
- Patient age over 65
- Procedure duration greater than 60 minutes with significant blood loss (Correct answer)
- BMI greater than 30
- Preoperative NPO status longer than 8 hours
Correct answer: Procedure duration greater than 60 minutes with significant blood loss
Significant intraoperative blood loss during longer procedures creates volume deficits that require IV replacement rather than oral hydration.
Question 5: The target core temperature for discharge from Phase I PACU per ASPAN standards is:
- Above 36.0°C (Correct answer)
- Above 36.5°C
- Between 36.0°C and 37.5°C
- Between 35.5°C and 38.0°C
Correct answer: Above 36.0°C
ASPAN guidelines require a minimum core temperature of 36.0°C before Phase I discharge to prevent complications of hypothermia.
Question 6: A patient receiving transfusion of 2 units packed red blood cells in PACU develops fever, chills, and flank pain 30 minutes into the transfusion. The FIRST nursing action is:
- Slow the transfusion rate and administer diphenhydramine
- Stop the transfusion immediately, keep IV open with NS, and notify provider (Correct answer)
- Administer acetaminophen and continue transfusion at slower rate
- Obtain blood cultures and continue transfusion
Correct answer: Stop the transfusion immediately, keep IV open with NS, and notify provider
Symptoms of acute hemolytic transfusion reaction require immediate transfusion cessation, IV access maintenance with NS, and immediate provider notification.
Question 7: Which postoperative fluid regimen BEST supports early discharge in an ambulatory surgery patient without nausea or vomiting?
- Mandatory 500 mL IV crystalloid before oral fluids are allowed
- Encouraging oral fluid intake as tolerated once alert with no PONV (Correct answer)
- NPO until surgeon approval 2 hours post-procedure
- Ice chips only until next morning follow-up
Correct answer: Encouraging oral fluid intake as tolerated once alert with no PONV
Current evidence supports early oral hydration as tolerated in alert patients without PONV, facilitating safe and timely discharge from ambulatory settings.
CAPA Thermoregulation & Fluid Management 5
A patient in Phase II PACU reports dizziness and nausea after attempted ambulation.
Orthostatic vital signs show BP drop of 25 mmHg systolic.
The MOST appropriate intervention is: