CMSRN Perioperative 3 — Questions and Answers
Question 1: A patient in the PACU is showing signs of laryngospasm after extubation. Which is the priority nursing intervention?
- Administer oxygen via nasal cannula
- Apply positive pressure ventilation with a bag-valve mask (Correct answer)
- Position the patient in high Fowler's
- Prepare for immediate reintubation
Correct answer: Apply positive pressure ventilation with a bag-valve mask
Positive pressure ventilation with a bag-valve mask is the first intervention to break laryngospasm and maintain oxygenation.
Question 2: Which of the following is the MOST reliable indicator of adequate reversal of neuromuscular blockade in the PACU?
- SpO2 greater than 95%
- Ability to sustain head lift for 5 seconds (Correct answer)
- Respiratory rate of 12 breaths/min
- Verbal response to commands
Correct answer: Ability to sustain head lift for 5 seconds
A 5-second head lift demonstrates adequate neuromuscular recovery and respiratory muscle strength needed for safe extubation.
Question 3: A patient returns from surgery with a Jackson-Pratt drain. The nurse notes the bulb is firm and not compressed. What action should be taken?
- Leave it as it is; a firm bulb is normal
- Empty the drain and recompress the bulb to restore suction (Correct answer)
- Remove the drain and apply a pressure dressing
- Irrigate the drain with normal saline
Correct answer: Empty the drain and recompress the bulb to restore suction
A Jackson-Pratt drain works by closed suction; the bulb must be emptied and recompressed to maintain negative pressure and effective drainage.
Question 4: In caring for a patient who underwent general anesthesia, the nurse assesses for which early sign of malignant hyperthermia?
- Bradycardia and hypotension
- Muscle rigidity and rapid rise in end-tidal CO2 (Correct answer)
- Hypothermia and respiratory alkalosis
- Miosis and decreased level of consciousness
Correct answer: Muscle rigidity and rapid rise in end-tidal CO2
Muscle rigidity and a rapid increase in end-tidal CO2 are early hallmarks of malignant hyperthermia due to uncontrolled skeletal muscle hypermetabolism.
Question 5: A patient is NPO for surgery and asks why they cannot drink clear liquids the morning of their procedure. The best nurse's response is:
- Clear liquids slow gastric emptying and may cause nausea
- Even clear liquids increase the risk of aspiration during anesthesia (Correct answer)
- It is hospital policy and cannot be changed
- Clear liquids interfere with anesthetic drug metabolism
Correct answer: Even clear liquids increase the risk of aspiration during anesthesia
Clear liquids in the stomach increase aspiration risk during anesthesia induction when protective airway reflexes are suppressed.
Question 6: When performing a preoperative skin prep, which action by the nurse is INCORRECT?
- Using chlorhexidine-alcohol solution for the prep
- Scrubbing from the incision site outward in a circular motion
- Shaving the surgical site with a razor the night before surgery (Correct answer)
- Allowing the prep solution to dry fully before draping
Correct answer: Shaving the surgical site with a razor the night before surgery
Razor shaving the night before surgery increases SSI risk due to skin microabrasions; hair removal should use clippers immediately before surgery if needed.
Question 7: A postoperative patient complains of severe pain unrelieved by opioids and the nurse notes a tense, swollen surgical extremity. The nurse's priority concern is:
- Opioid tolerance requiring dose escalation
- Development of acute compartment syndrome (Correct answer)
- Surgical site infection with abscess formation
- Deep vein thrombosis of the affected extremity
Correct answer: Development of acute compartment syndrome
Pain disproportionate to injury combined with a tense, swollen extremity are hallmark signs of acute compartment syndrome, a surgical emergency.
CMSRN Perioperative 3
A patient in the PACU is showing signs of laryngospasm after extubation.
Which is the priority nursing intervention?