CPAN Skills and Competencies 3 — Questions and Answers
Question 1: A patient with a history of malignant hyperthermia is admitted to the PACU. The CPAN knows the most important monitoring parameter specific to this risk is:
- Serum sodium every 30 minutes
- End-tidal CO2 and temperature trending (Correct answer)
- Urine specific gravity
- Peripheral nerve stimulator readings
Correct answer: End-tidal CO2 and temperature trending
Rising end-tidal CO2 and temperature are early hallmarks of malignant hyperthermia crisis, requiring immediate recognition and dantrolene administration.
Question 2: Which assessment finding in a post-tonsillectomy pediatric patient should prompt the PACU nurse to immediately notify the surgeon?
- Mild sore throat rated 3/10
- Frequent swallowing and restlessness (Correct answer)
- Heart rate of 98 beats per minute
- Refusal to drink oral fluids
Correct answer: Frequent swallowing and restlessness
Frequent swallowing in a post-tonsillectomy patient is a key sign of hemorrhage as the child swallows blood pooling in the posterior pharynx.
Question 3: A PACU patient receiving patient-controlled analgesia (PCA) with morphine has a respiratory rate of 7 breaths/min and pinpoint pupils. The CPAN should first:
- Decrease the PCA basal rate
- Administer naloxone 0.4 mg IV and prepare to repeat dosing (Correct answer)
- Apply a non-rebreather mask at 15 L/min
- Stimulate the patient vigorously and reassess in 5 minutes
Correct answer: Administer naloxone 0.4 mg IV and prepare to repeat dosing
Signs of opioid toxicity with respiratory depression require immediate naloxone administration to reverse life-threatening respiratory compromise.
Question 4: When performing a Romberg test assessment in Phase II recovery, the nurse is evaluating:
- Return of motor function after spinal anesthesia
- Proprioception and balance for safe ambulation (Correct answer)
- Adequacy of analgesia for discharge
- Cognitive orientation post-general anesthesia
Correct answer: Proprioception and balance for safe ambulation
The Romberg test assesses proprioceptive balance, which must be intact before a patient is considered safe for independent ambulation after neuraxial anesthesia.
Question 5: A post-cardiac surgery patient in the PACU develops cardiac tamponade. Which hemodynamic pattern is most consistent with this diagnosis?
- Widened pulse pressure with elevated CVP
- Beck's triad: hypotension, muffled heart sounds, elevated JVD (Correct answer)
- Hypertension with bradycardia and irregular rhythm
- Low CVP with hypotension and tachycardia
Correct answer: Beck's triad: hypotension, muffled heart sounds, elevated JVD
Beck's triad — hypotension, muffled heart sounds, and elevated jugular venous distension — is the classic presentation of cardiac tamponade.
Question 6: The modified Aldrete scoring system used in PACU Phase I recovery evaluates which five parameters?
- Pain, sedation, nausea, bleeding, and temperature
- Activity, respiration, circulation, consciousness, and oxygen saturation (Correct answer)
- Orientation, motor function, vital signs, pain, and ambulation
- Level of consciousness, airway, breathing, circulation, and skin color
Correct answer: Activity, respiration, circulation, consciousness, and oxygen saturation
The modified Aldrete score assesses activity, respiration, circulation, consciousness, and oxygen saturation to determine readiness for Phase II or discharge.
Question 7: A CPAN is caring for a patient who had an open bowel resection. The patient reports severe pain rated 9/10 unrelieved by current IV opioids. An appropriate multimodal strategy to consider includes:
- Doubling the opioid dose every 15 minutes until pain resolves
- Administering IV ketorolac per protocol as an opioid-sparing adjunct (Correct answer)
- Applying ice packs to the abdomen over the surgical dressing
- Withholding additional analgesia until the surgeon is consulted
Correct answer: Administering IV ketorolac per protocol as an opioid-sparing adjunct
Ketorolac is an NSAID analgesic that provides opioid-sparing pain control through a different mechanism, supporting multimodal analgesia strategies.
CPAN Skills and Competencies 3
A patient with a history of malignant hyperthermia is admitted to the PACU.
The CPAN knows the most important monitoring parameter specific to this risk is: