CSFA Postoperative and Emergency Care 2 — Questions and Answers
Question 1: A patient in the PACU develops stridor and accessory muscle use 20 minutes after extubation. What is the most likely cause?
- Bronchospasm
- Laryngospasm (Correct answer)
- Pulmonary edema
- Pneumothorax
Correct answer: Laryngospasm
Laryngospasm presents with high-pitched stridor and increased work of breathing and is a common postextubation complication in the PACU.
Question 2: Which intervention is the FIRST priority when a patient develops malignant hyperthermia intraoperatively?
- Administer sodium bicarbonate
- Discontinue triggering agents and administer dantrolene (Correct answer)
- Apply ice packs to the groin and axillae
- Hyperventilate with 100% oxygen only
Correct answer: Discontinue triggering agents and administer dantrolene
Discontinuing triggering agents (volatile anesthetics, succinylcholine) and giving IV dantrolene are the immediate priorities in malignant hyperthermia management.
Question 3: Postoperative oliguria is defined as urine output less than:
- 0.1 mL/kg/hr
- 0.5 mL/kg/hr (Correct answer)
- 1.0 mL/kg/hr
- 1.5 mL/kg/hr
Correct answer: 0.5 mL/kg/hr
Oliguria is defined as urine output less than 0.5 mL/kg/hr and indicates potentially inadequate renal perfusion.
Question 4: A patient's SpO2 drops to 88% in the PACU. After applying supplemental oxygen, the reading improves to 95%. What is the most appropriate next action?
- Discharge the patient to the floor immediately
- Reassess the patient frequently and document the oxygen requirement (Correct answer)
- Reintubate the patient prophylactically
- Administer IV naloxone
Correct answer: Reassess the patient frequently and document the oxygen requirement
Response to supplemental oxygen is reassuring, but the patient must be closely monitored and the supplemental oxygen requirement documented before discharge.
Question 5: Which of the following is a cardinal sign of compartment syndrome in a postoperative extremity?
- Pain disproportionate to the injury that worsens with passive stretch (Correct answer)
- Blanching of the skin over the affected extremity
- Decreased skin temperature distal to the injury
- Presence of pitting edema proximal to the surgical site
Correct answer: Pain disproportionate to the injury that worsens with passive stretch
Pain out of proportion to the injury and pain on passive stretch are the earliest and most reliable signs of acute compartment syndrome.
Question 6: During PACU recovery, a patient begins experiencing anginal chest pain with ST-segment elevation on the monitor. After activating the emergency response, what is the FIRST drug the PACU nurse should administer per protocol?
- IV morphine
- Aspirin 325 mg orally if not contraindicated (Correct answer)
- IV heparin bolus
- Sublingual nitroglycerin
Correct answer: Aspirin 325 mg orally if not contraindicated
Aspirin is the first-line medication for suspected acute MI as it inhibits platelet aggregation and reduces mortality.
Question 7: A patient who received general anesthesia is shivering intensely in the PACU. Which intervention is MOST effective at reducing postoperative shivering?
- Applying warm blankets externally
- Administering meperidine 25 mg IV (Correct answer)
- Increasing IV fluid rate to warm the patient from within
- Turning the room temperature up
Correct answer: Administering meperidine 25 mg IV
Low-dose IV meperidine (pethidine) is the most effective pharmacologic treatment for postoperative shivering, acting on kappa and mu opioid receptors.
CSFA Postoperative and Emergency Care 2
A patient in the PACU develops stridor and accessory muscle use 20 minutes after extubation.
What is the most likely cause?