CSFA Postoperative Patient Management 2 — Questions and Answers
Question 1: A patient in the PACU develops a respiratory rate of 6 breaths/min and is difficult to arouse 30 minutes after receiving fentanyl intraoperatively. What is the most appropriate immediate intervention?
- Administer naloxone (Narcan) IV (Correct answer)
- Apply supplemental oxygen via nasal cannula
- Notify the surgeon and document findings
- Reposition the patient to a lateral decubitus position
Correct answer: Administer naloxone (Narcan) IV
Naloxone reverses opioid-induced respiratory depression and is the priority intervention for a patient with signs of opioid overdose.
Question 2: Which assessment finding in the immediate postoperative period is MOST indicative of laryngospasm?
- High-pitched crowing sound with paradoxical chest movement (Correct answer)
- Expiratory wheezing with prolonged exhalation
- Gurgling sound relieved by suctioning
- Slow shallow respirations with decreased SpO2
Correct answer: High-pitched crowing sound with paradoxical chest movement
Laryngospasm produces a high-pitched stridor or crowing noise accompanied by paradoxical chest and abdominal movement due to complete or partial glottic closure.
Question 3: A postoperative patient receiving morphine PCA complains of itching over the face and trunk without hives or hypotension. This reaction is MOST likely caused by:
- Opioid-induced histamine release from mast cells (Correct answer)
- Anaphylactic reaction requiring epinephrine
- Surgical skin preparation residue
- Latex allergy
Correct answer: Opioid-induced histamine release from mast cells
Morphine commonly causes non-allergic pruritus through direct mast cell histamine release, which is different from a true allergic reaction.
Question 4: During the immediate postoperative period, which parameter is the EARLIEST indicator of hemorrhagic shock?
- Increased heart rate (tachycardia) (Correct answer)
- Decreased blood pressure (hypotension)
- Decreased urine output
- Altered mental status
Correct answer: Increased heart rate (tachycardia)
Tachycardia is the earliest compensatory response to hemorrhage as the body attempts to maintain cardiac output before blood pressure falls.
Question 5: A patient 2 hours postoperative from an abdominal procedure has a urine output of 15 mL over the past hour. The FIRST nursing action should be to:
- Assess fluid intake, blood pressure, and catheter patency (Correct answer)
- Administer furosemide (Lasix) per standing order
- Increase IV fluid rate to maximum
- Notify the nephrologist
Correct answer: Assess fluid intake, blood pressure, and catheter patency
Oliguria (less than 30 mL/hr) requires a systematic assessment of volume status, hemodynamics, and mechanical causes before any pharmacologic intervention.
Question 6: Which of the following postoperative complications is characterized by absent bowel sounds, abdominal distension, and failure to pass flatus after abdominal surgery?
- Paralytic ileus (Correct answer)
- Mechanical bowel obstruction
- Anastomotic leak
- Peritonitis
Correct answer: Paralytic ileus
Paralytic ileus presents with absent bowel sounds and abdominal distension due to temporary cessation of peristalsis following abdominal surgery.
Question 7: A patient returning from a 4-hour laparoscopic procedure is shivering vigorously in the PACU with a core temperature of 35.2°C. The PRIORITY intervention is:
- Active external rewarming with forced-air warming blanket (Correct answer)
- Administer meperidine (Demerol) to suppress shivering
- Increase IV fluid infusion rate with warmed saline
- Apply passive insulation with warm cotton blankets only
Correct answer: Active external rewarming with forced-air warming blanket
Forced-air warming blankets provide the most effective active external rewarming and are the priority for treating postoperative hypothermia.
CSFA Postoperative Patient Management 2
A patient in the PACU develops a respiratory rate of 6 breaths/min and is difficult to arouse 30 minutes after receiving fentanyl intraoperatively.
What is the most appropriate immediate intervention?