CPAN Emergency Response Procedures 2 — Questions and Answers
Question 1: A PACU patient develops sudden onset of stridor and progressive hoarseness 20 minutes post-extubation. What is the most likely cause?
- Laryngospasm
- Subglottic edema (Correct answer)
- Vocal cord paralysis
- Bronchospasm
Correct answer: Subglottic edema
Post-extubation subglottic edema (croup) presents with stridor and hoarseness and is caused by mucosal irritation from the endotracheal tube.
Question 2: During phase I PACU recovery, a patient's SpO2 drops to 84% despite 10 L/min O2 via non-rebreather mask. Which intervention has the highest priority?
- Increase O2 flow to 15 L/min
- Perform bag-mask ventilation (Correct answer)
- Obtain arterial blood gas
- Administer IV methylprednisolone
Correct answer: Perform bag-mask ventilation
Bag-mask ventilation directly addresses inadequate oxygenation and ventilation when supplemental O2 alone is insufficient.
Question 3: A patient in the PACU is exhibiting masseter muscle rigidity, rising end-tidal CO2, and a temperature of 39.8°C (103.6°F). Which drug should be administered immediately?
- Succinylcholine 1.5 mg/kg IV
- Dantrolene 2.5 mg/kg IV (Correct answer)
- Propofol 1 mg/kg IV
- Neostigmine 0.04 mg/kg IV
Correct answer: Dantrolene 2.5 mg/kg IV
Dantrolene sodium is the specific antidote for malignant hyperthermia and must be given immediately upon clinical recognition.
Question 4: A post-cardiac surgery patient in the PACU has a blood pressure of 60/40 mmHg, distended neck veins, and muffled heart sounds. What is the most likely emergency?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Pulmonary embolism
- Anaphylaxis
Correct answer: Cardiac tamponade
Beck's triad (hypotension, distended neck veins, muffled heart sounds) is the classic presentation of cardiac tamponade.
Question 5: When managing a PACU patient in pulseless ventricular tachycardia, what is the correct energy setting for the first biphasic defibrillation attempt?
- 50–100 J
- 120–200 J (Correct answer)
- 300 J
- 360 J
Correct answer: 120–200 J
Current AHA guidelines recommend 120–200 J for the first biphasic defibrillation shock for pulseless VT/VF.
Question 6: A PACU nurse notices a patient's surgical drain output has increased from 30 mL/hr to 200 mL/hr of bright red blood over 15 minutes. Which intervention is the priority?
- Clamp the drain tubing
- Increase IV fluid rate to 500 mL bolus
- Notify the surgeon immediately (Correct answer)
- Administer protamine sulfate
Correct answer: Notify the surgeon immediately
Sudden significant increase in bright red drainage indicates surgical hemorrhage requiring immediate surgeon notification for potential return to the OR.
Question 7: A patient exhibits agitation, diaphoresis, hypertension, and muscle twitching 2 hours after receiving meperidine and a serotonergic antidepressant. Which condition should the nurse suspect?
- Neuroleptic malignant syndrome
- Serotonin syndrome (Correct answer)
- Malignant hyperthermia
- Anticholinergic crisis
Correct answer: Serotonin syndrome
Serotonin syndrome results from excess serotonergic activity and is precipitated by combining opioids like meperidine with serotonergic drugs.
CPAN Emergency Response Procedures 2
A PACU patient develops sudden onset of stridor and progressive hoarseness 20 minutes post-extubation.
What is the most likely cause?