CPAN Documentation and Record Keeping 5

Question 1

A PACU nurse is completing discharge documentation for a patient being discharged to home. Which criteria documented in the Modified Aldrete Score indicates readiness for discharge?

Accepted Answer

A score of 9 or greater out of 10

Answer

A Modified Aldrete Score of 9 or greater (out of 10) is the standard threshold documenting patient readiness for PACU discharge.

Question 2

When documenting a patient's neurovascular assessment of an extremity postoperatively, which five parameters are classically documented using the '5 P's'?

Accepted Answer

Pain, Pallor, Pulselessness, Paresthesia, Paralysis (or Poikilothermia)

Answer

The 5 P's of neurovascular assessment — Pain, Pallor, Pulselessness, Paresthesia, and Paralysis (or Poikilothermia) — are the standard parameters for compartment syndrome surveillance.

Question 3

A post-cardiac surgery patient's chest tube drains 250mL of bright red blood in 30 minutes. Which documentation action is MOST appropriate?

Accepted Answer

Document the output immediately with time, color, amount, consistency, and notification of the surgeon

Answer

Sudden, excessive, bright red chest tube output is a surgical emergency requiring immediate documentation and physician notification simultaneously.

Question 4

Which of the following is the MOST accurate statement about the nurse's legal responsibility regarding documentation of patient teaching in the PACU?

Accepted Answer

The nurse must document the content taught, teaching method used, patient's demonstrated understanding, and any barriers to learning

Answer

Complete discharge teaching documentation must include content, method, learner response, and barriers to demonstrate that safe discharge education was provided.

Question 5

A PACU nurse administers a blood transfusion. Which documentation is REQUIRED at the START of the transfusion, separate from later monitoring entries?

Accepted Answer

Pretransfusion vital signs, blood product verification (two-nurse check), blood type, unit number, and start time

Answer

Pre-transfusion documentation must capture the two-nurse verification process, product details, and baseline vital signs before the transfusion begins.

(CPAN) Certified Post Anesthesia Nurse Practice Test

(CPAN) Certified Post Anesthesia Nurse Practice Test

CPAN Documentation and Record Keeping 5