CPAN Skills and Competencies 2 — Questions and Answers
Question 1: A PACU patient receiving supplemental oxygen via nasal cannula has an SpO2 of 91% and is difficult to arouse. What is the priority intervention?
- Increase oxygen flow rate to 6 L/min
- Administer naloxone 0.4 mg IV push
- Apply jaw-thrust maneuver and reassess airway patency (Correct answer)
- Place patient in Trendelenburg position
Correct answer: Apply jaw-thrust maneuver and reassess airway patency
Airway obstruction is the most common cause of hypoxia in the immediate post-anesthesia period and must be corrected before pharmacologic intervention.
Question 2: Which medication is the first-line reversal agent for residual neuromuscular blockade from rocuronium or vecuronium?
- Neostigmine with glycopyrrolate
- Sugammadex (Correct answer)
- Pyridostigmine
- Physostigmine
Correct answer: Sugammadex
Sugammadex selectively encapsulates and reverses aminosteroid neuromuscular blocking agents such as rocuronium and vecuronium.
Question 3: A post-thyroidectomy patient in the PACU develops stridor and increasing respiratory distress 2 hours after surgery. The nurse's priority action is to:
- Administer racemic epinephrine via nebulizer
- Notify the surgeon immediately and prepare for emergency airway management (Correct answer)
- Apply ice packs to the neck to reduce swelling
- Reposition the patient to high Fowler's and administer humidified oxygen
Correct answer: Notify the surgeon immediately and prepare for emergency airway management
Post-thyroidectomy stridor may indicate hematoma compressing the trachea, a surgical emergency requiring immediate provider notification and potential airway intervention.
Question 4: When assessing adequacy of neuromuscular reversal, the CPAN should confirm the patient can:
- Open eyes to verbal stimulation
- Sustain a head lift for 5 seconds (Correct answer)
- State their name and date of birth
- Grip the nurse's hand firmly with one hand
Correct answer: Sustain a head lift for 5 seconds
A sustained 5-second head lift indicates adequate respiratory muscle strength and reliable reversal of neuromuscular blockade.
Question 5: A patient in Phase I recovery has a blood pressure of 86/50 mmHg after spinal anesthesia for knee replacement. The most appropriate initial intervention is:
- Administer phenylephrine 100 mcg IV bolus
- Infuse a 500 mL normal saline bolus rapidly (Correct answer)
- Administer epinephrine 1 mg IV push
- Place the patient in reverse Trendelenburg position
Correct answer: Infuse a 500 mL normal saline bolus rapidly
Spinal-induced hypotension is commonly caused by vasodilation and reduced preload; a fluid bolus is the first-line treatment to restore hemodynamic stability.
Question 6: Which finding in a post-laparoscopic patient would alert the PACU nurse to possible pneumothorax?
- Bilateral crackles on auscultation
- Unilateral absent breath sounds with tracheal deviation (Correct answer)
- Distended neck veins without respiratory distress
- Bradycardia with hypertension
Correct answer: Unilateral absent breath sounds with tracheal deviation
Absent unilateral breath sounds with tracheal deviation toward the opposite side are hallmark signs of tension pneumothorax requiring emergent intervention.
Question 7: A PACU patient develops sudden onset shivering after general anesthesia. The CPAN understands this increases:
- Risk of aspiration
- Oxygen consumption by up to 400% (Correct answer)
- Likelihood of delayed emergence
- Serum potassium levels
Correct answer: Oxygen consumption by up to 400%
Post-anesthesia shivering dramatically increases metabolic oxygen demand, which can be dangerous in patients with cardiac or respiratory compromise.
CPAN Skills and Competencies 2
A PACU patient receiving supplemental oxygen via nasal cannula has an SpO2 of 91% and is difficult to arouse.
What is the priority intervention?