CPAN Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A PACU patient who received general anesthesia with succinylcholine develops jaw rigidity, rapidly rising temperature, and muscle rigidity 30 minutes post-induction. Which lab value is the earliest indicator of the suspected complication?
- Elevated serum potassium
- Elevated creatine kinase (CK)
- Elevated serum lactate (Correct answer)
- Arterial blood gas showing metabolic acidosis
Correct answer: Elevated serum lactate
Elevated serum lactate from anaerobic metabolism is one of the earliest laboratory indicators of malignant hyperthermia, reflecting increased cellular oxygen consumption.
Question 2: When performing a post-anesthesia neurological assessment, which finding indicates the highest level of consciousness on the AVPU scale?
- Patient responds to painful stimuli
- Patient responds to verbal stimulation
- Patient is alert and oriented (Correct answer)
- Patient is unresponsive
Correct answer: Patient is alert and oriented
On the AVPU scale, 'A' (Alert) represents the highest level, indicating the patient is fully conscious without any external stimulation.
Question 3: A 68-year-old patient in the PACU becomes agitated and tries to remove the IV line 45 minutes after emergence from general anesthesia. Which assessment finding would most suggest emergence delirium rather than pain?
- Purposeful self-protective behavior with facial grimacing
- Non-purposeful thrashing with inconsolable crying unrelated to stimuli (Correct answer)
- Elevated heart rate and blood pressure responding to analgesic
- Moaning that intensifies with movement of the surgical site
Correct answer: Non-purposeful thrashing with inconsolable crying unrelated to stimuli
Non-purposeful, inconsolable behavior unrelated to external stimuli is characteristic of emergence delirium, distinguishing it from pain-related agitation.
Question 4: During PACU assessment, a patient's capnography shows a waveform with a gradually rising plateau and a prolonged expiratory phase. This pattern is most consistent with:
- Esophageal intubation
- Obstructive airway disease such as bronchospasm (Correct answer)
- Normal ventilation
- Hypoventilation from oversedation
Correct answer: Obstructive airway disease such as bronchospasm
A shark-fin or oblique capnography waveform with prolonged expiration indicates obstructive airway disease due to impaired exhalation.
Question 5: A post-anesthesia patient's Steward Recovery Score is being calculated. Which three parameters does this scoring system evaluate?
- Respiration, consciousness, and movement (Correct answer)
- Blood pressure, oxygen saturation, and pain
- Activity, breathing, and circulation
- Consciousness, color, and reflexes
Correct answer: Respiration, consciousness, and movement
The Steward Recovery Score, used primarily in pediatric patients, evaluates respiration, consciousness, and movement to determine readiness for discharge from Phase I PACU.
Question 6: A patient with a history of obstructive sleep apnea (OSA) is in the PACU after laparoscopic cholecystectomy. Which assessment finding warrants the highest concern?
- SpO2 of 94% on 2L/min nasal cannula while awake
- Loud snoring with SpO2 dropping to 86% during sleep (Correct answer)
- Pain score of 6/10 requiring opioid analgesic
- Heart rate of 88 bpm and blood pressure 145/90 mmHg
Correct answer: Loud snoring with SpO2 dropping to 86% during sleep
OSA patients are at highest risk for airway obstruction during sleep; SpO2 dropping to 86% during snoring indicates significant upper airway obstruction requiring intervention.
Question 7: When assessing a PACU patient for residual neuromuscular blockade, which clinical finding best confirms adequate reversal?
- Ability to open eyes on command
- Sustained head lift for 5 seconds (Correct answer)
- Regular spontaneous breathing at 12 breaths/min
- Train-of-four ratio of 0.7
Correct answer: Sustained head lift for 5 seconds
A sustained head lift for 5 seconds requires adequate muscle strength and is a reliable clinical indicator of sufficient reversal of neuromuscular blockade.
CPAN Patient Assessment and Evaluation 3
A PACU patient who received general anesthesia with succinylcholine develops jaw rigidity, rapidly rising temperature, and muscle rigidity 30 minutes post-induction.
Which lab value is the earliest indicator of the suspected complication?