CPAN CPAN Respiratory and Airway Management 1 — Questions and Answers
Question 1: A post-anesthesia patient in the PACU has an SpO2 of 88% on room air. What is the nurse's first intervention?
- Obtain an arterial blood gas immediately
- Apply supplemental oxygen and stimulate the patient to breathe deeply (Correct answer)
- Call a code blue immediately
- Administer IV epinephrine
Correct answer: Apply supplemental oxygen and stimulate the patient to breathe deeply
The first response to low SpO2 is applying supplemental oxygen and stimulating the patient to take deep breaths, as residual anesthesia frequently causes hypoventilation.
Question 2: Which assessment finding most suggests upper airway obstruction in a PACU patient?
- Inspiratory stridor with paradoxical chest and abdominal movement (Correct answer)
- Regular respiratory rate of 14 breaths/minute with clear breath sounds
- Mild expiratory wheezing bilaterally
- Decreased SpO2 with productive cough
Correct answer: Inspiratory stridor with paradoxical chest and abdominal movement
Inspiratory stridor and paradoxical chest-abdominal movement (chest falls while abdomen rises on inspiration) are classic signs of upper airway obstruction.
Question 3: A patient emerges from general anesthesia with significant laryngospasm. What is the most appropriate initial intervention?
- Perform emergency tracheostomy
- Apply firm upward jaw thrust and administer 100% oxygen via positive pressure ventilation (Correct answer)
- Administer IV atropine immediately
- Place patient in Trendelenburg position and wait
Correct answer: Apply firm upward jaw thrust and administer 100% oxygen via positive pressure ventilation
Jaw thrust and 100% oxygen with positive-pressure ventilation are the initial treatment for laryngospasm, which is involuntary spasm of the vocal cords.
Question 4: Which factor most increases a PACU patient's risk for post-extubation respiratory complications?
- History of mild seasonal allergies
- Obstructive sleep apnea (OSA) (Correct answer)
- Recent viral upper respiratory infection resolved 4 weeks ago
- BMI of 24
Correct answer: Obstructive sleep apnea (OSA)
Obstructive sleep apnea significantly increases the risk of post-extubation airway collapse and respiratory depression, especially with residual opioids and sedatives.
Question 5: What is the recommended position for a PACU patient at risk for aspiration?
- Supine with bed flat
- Semi-prone or lateral decubitus position (Correct answer)
- Trendelenburg (head down)
- High Fowler's with neck hyperextended
Correct answer: Semi-prone or lateral decubitus position
Lateral decubitus or semi-prone positioning helps protect the airway from aspiration by allowing secretions and vomitus to drain away from the glottis.
Question 6: When should the PACU nurse most urgently prepare for reintubation?
- Patient reports mild nausea
- Patient develops progressive stridor unresponsive to jaw thrust and supplemental oxygen (Correct answer)
- Respiratory rate is 18 breaths/minute
- Patient requests to remove the nasal cannula
Correct answer: Patient develops progressive stridor unresponsive to jaw thrust and supplemental oxygen
Progressive stridor unresponsive to initial airway maneuvers signals impending complete airway obstruction and requires immediate preparation for reintubation.
CPAN CPAN Respiratory and Airway Management 1
A post-anesthesia patient in the PACU has an SpO2 of 88% on room air.
What is the nurse's first intervention?