CPAN CPAN Respiratory and Airway Management 2 — Questions and Answers
Question 1: A PACU patient has shallow respirations and a tidal volume of 3 mL/kg after general anesthesia. What is the likely cause?
- Fluid overload causing pulmonary edema
- Residual neuromuscular blockade causing inadequate respiratory effort (Correct answer)
- Metabolic alkalosis from excessive bicarbonate
- Acute bronchospasm
Correct answer: Residual neuromuscular blockade causing inadequate respiratory effort
Residual neuromuscular blockade from non-depolarizing muscle relaxants is a common cause of inadequate tidal volumes and respiratory weakness post-anesthesia.
Question 2: Which test best assesses for adequate reversal of neuromuscular blockade before extubation in the PACU?
- Checking SpO2 on room air for 5 minutes
- Train-of-four (TOF) ratio ≥0.9 with qualitative or quantitative neuromuscular monitoring (Correct answer)
- Asking the patient if they feel strong
- Checking end-tidal CO2 level
Correct answer: Train-of-four (TOF) ratio ≥0.9 with qualitative or quantitative neuromuscular monitoring
A train-of-four ratio of 0.9 or greater using neuromuscular monitoring confirms adequate reversal of neuromuscular blockade and safe muscle function.
Question 3: A patient develops acute bronchospasm in the PACU after extubation. What is the first-line pharmacological treatment?
- IV methylprednisolone
- Inhaled short-acting beta-2 agonist (e.g., albuterol) (Correct answer)
- IV aminophylline
- Subcutaneous epinephrine only
Correct answer: Inhaled short-acting beta-2 agonist (e.g., albuterol)
Inhaled short-acting beta-2 agonists such as albuterol are the first-line treatment for bronchospasm, providing rapid bronchodilation with minimal systemic effects.
Question 4: How does the PACU nurse differentiate between hypoxemia caused by hypoventilation versus ventilation-perfusion (V/Q) mismatch?
- Hypoventilation causes hypoxemia with normal CO2; V/Q mismatch causes hypoxemia with elevated CO2
- Hypoventilation improves with 100% oxygen alone; V/Q mismatch does not reliably correct with oxygen alone and is associated with elevated CO2 (Correct answer)
- Both conditions respond identically to supplemental oxygen
- V/Q mismatch causes hypercapnia; hypoventilation does not affect CO2
Correct answer: Hypoventilation improves with 100% oxygen alone; V/Q mismatch does not reliably correct with oxygen alone and is associated with elevated CO2
Hypoventilation causes hypoxemia with elevated CO2 that responds to increasing ventilation, while V/Q mismatch (e.g., atelectasis, PE) may not fully correct with oxygen alone.
Question 5: Which nursing intervention best prevents post-operative atelectasis in PACU patients?
- Restricting fluid intake to minimize pulmonary edema
- Encouraging incentive spirometry and deep breathing exercises every 1-2 hours (Correct answer)
- Keeping patients supine to minimize respiratory effort
- Administering prophylactic bronchodilators to all patients
Correct answer: Encouraging incentive spirometry and deep breathing exercises every 1-2 hours
Regular incentive spirometry and deep breathing promote alveolar recruitment and prevent atelectasis, which is common after general anesthesia due to reduced functional residual capacity.
Question 6: A PACU patient who underwent oral surgery develops progressive swelling of the tongue and uvula with increasing respiratory difficulty. What condition should the nurse suspect?
- Post-operative nausea and vomiting
- Angioedema or airway edema requiring urgent airway management (Correct answer)
- Normal post-operative swelling
- Opioid-induced sedation
Correct answer: Angioedema or airway edema requiring urgent airway management
Progressive tongue and uvular swelling with respiratory difficulty after oral or head/neck surgery suggests angioedema or surgical edema requiring immediate airway intervention.
CPAN CPAN Respiratory and Airway Management 2
A PACU patient has shallow respirations and a tidal volume of 3 mL/kg after general anesthesia.
What is the likely cause?