CPAN Emergency Response Procedures 3 — Questions and Answers
Question 1: A PACU patient develops wheezing, urticaria, and hypotension 5 minutes after receiving IV ketorolac. What is the first-line pharmacologic treatment?
- Diphenhydramine 50 mg IV
- Epinephrine 0.3 mg IM (Correct answer)
- Methylprednisolone 125 mg IV
- Albuterol via nebulizer
Correct answer: Epinephrine 0.3 mg IM
Epinephrine is the first-line treatment for anaphylaxis due to its combined alpha and beta adrenergic effects.
Question 2: During PACU assessment, the nurse finds a patient unresponsive with a GCS of 6, pinpoint pupils, and a respiratory rate of 6/min. Which reversal agent should be prepared?
- Flumazenil 0.2 mg IV
- Naloxone 0.4 mg IV (Correct answer)
- Neostigmine 2.5 mg IV
- Physostigmine 1 mg IV
Correct answer: Naloxone 0.4 mg IV
Pinpoint pupils, respiratory depression, and unresponsiveness constitute the opioid toxidrome, reversed by naloxone.
Question 3: A patient 30 minutes post-thoracotomy develops absent breath sounds on the left, tracheal deviation to the right, and SpO2 of 78%. The priority intervention is:
- Order a STAT chest X-ray
- Perform needle decompression of the left chest (Correct answer)
- Administer 100% O2 via non-rebreather
- Reposition to right lateral decubitus
Correct answer: Perform needle decompression of the left chest
Absent breath sounds with tracheal deviation indicates tension pneumothorax, which requires immediate needle decompression at the 2nd intercostal space, midclavicular line.
Question 4: The PACU nurse observes that a patient's urine output has been 10 mL/hr for the past 2 hours despite adequate fluid resuscitation. Which early intervention is most appropriate?
- Administer furosemide 40 mg IV push
- Insert a urinary catheter to verify accuracy
- Notify the physician and prepare for further assessment (Correct answer)
- Restrict all IV fluids immediately
Correct answer: Notify the physician and prepare for further assessment
Oliguria (< 0.5 mL/kg/hr) unresponsive to fluids suggests possible acute kidney injury or hemodynamic compromise requiring physician evaluation.
Question 5: A patient with a history of coronary artery disease develops new ST-segment elevation in leads II, III, and aVF on the PACU monitor. Which action should the nurse take first?
- Administer aspirin 325 mg PO
- Activate the cardiac catheterization lab team
- Obtain a 12-lead ECG and notify the physician (Correct answer)
- Administer sublingual nitroglycerin
Correct answer: Obtain a 12-lead ECG and notify the physician
A 12-lead ECG confirms the ST changes and physician notification initiates the STEMI response protocol.
Question 6: During the handoff from the OR, the anesthesiologist reports the patient received 300 mg of succinylcholine for a difficult intubation. Four hours later the patient remains apneic. The most likely explanation is:
- Opioid-induced respiratory depression
- Pseudocholinesterase deficiency (Correct answer)
- Residual non-depolarizing blockade
- Malignant hyperthermia
Correct answer: Pseudocholinesterase deficiency
Pseudocholinesterase (butyrylcholinesterase) deficiency impairs succinylcholine metabolism, resulting in prolonged neuromuscular blockade lasting hours.
Question 7: A PACU patient receiving a heparin infusion suddenly develops a focal neurological deficit with right-sided facial droop and arm weakness. The immediate nursing priority is:
- Stop the heparin infusion and administer protamine
- Perform a NIHSS stroke assessment and notify the physician STAT (Correct answer)
- Obtain a STAT head CT scan
- Administer tPA 0.9 mg/kg IV
Correct answer: Perform a NIHSS stroke assessment and notify the physician STAT
Rapid stroke assessment using a validated tool and immediate physician notification activates the stroke response team and informs treatment decisions.
CPAN Emergency Response Procedures 3
A PACU patient develops wheezing, urticaria, and hypotension 5 minutes after receiving IV ketorolac.
What is the first-line pharmacologic treatment?