PROPHECY GENERAL PACU RN A V3 EXAM 2026 | Questions
& Answers | Verified Answers | 70 Questions w/ Detailed Rationales
| Comprehensive Practice | Pass Guaranteed - A+ Graded
SECTION 1: INITIAL POST-ANESTHESIA ASSESSMENT AND AIRWAY
MANAGEMENT
(Questions 1-12)
Q1: A patient arrives in PACU following general anesthesia for laparoscopic
cholecystectomy. The nurse's initial assessment reveals: snoring respirations, SpO2
88% on room air, respiratory rate 8/min, and the patient is unarousable to verbal stimuli.
Using the ABCDE approach, what is the nurse's FIRST priority action?
A. Administer 2 mg morphine IV for postoperative pain
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Perform a jaw thrust maneuver and open the airway
D. Check the Aldrete Score to determine discharge readiness
Correct Answer: C
Rationale: The ABCDE approach prioritizes Airway first. This patient exhibits classic
signs of upper airway obstruction (snoring respirations from soft palate/uvula against
posterior pharyngeal wall) with hypoventilation (RR 8/min) and hypoxemia (SpO2 88%).
The unarousable state suggests residual anesthetic/sedative effects with loss of
pharyngeal muscle tone. FIRST priority: Open the airway with jaw thrust (pulls tongue
and soft tissues forward), chin lift, and oropharyngeal/nasopharyngeal airway insertion
,if needed. Option A is lethal—opioids worsen respiratory depression and obstruction.
Option B is insufficient—oxygen doesn't address the anatomical obstruction; the patient
needs airway patency first. Option D is inappropriate—Aldrete scoring is for Phase I
discharge assessment, not initial emergency airway management. After airway opening,
apply oxygen, assess breathing/circulation, and consider naloxone if opioid-related or
anesthetic reversal. ASPAN standards emphasize immediate airway assessment on
PACU admission.
Q2: [SATA] A PACU nurse is admitting a patient from the operating room. Which
assessments are required components of the initial comprehensive post-anesthesia
evaluation? Select all that apply.
A. Verification of patient identity using two identifiers
B. Assessment of level of consciousness using standardized scoring system
C. Evaluation of surgical site and dressing integrity
D. Review of intraoperative anesthetic record and events
E. Aldrete Score calculation for Phase II discharge readiness
F. Assessment of pain level using appropriate pain scale
Correct Answers: A, B, C, D, F [CORRECT]
Rationale: Initial PACU admission assessment (ASPAN Standard I) includes:
A—Two-identifier verification (name, DOB, medical record number) is mandatory for
patient safety; B—LOC assessment (Aldrete, RASS, or institutional tool) establishes
baseline and detects emergence issues; C—Surgical site assessment identifies
immediate bleeding, hematoma, or dressing problems; D—Handoff communication
,including anesthetic record review (medications given, fluids, blood loss, complications,
reversal agents) is critical for continuity; F—Pain assessment is required but may be
deferred if patient unresponsive (document "unable to assess"). Option E is
incorrect—Aldrete Score is used for Phase I discharge readiness (to Phase II or unit), not
initial admission assessment. Phase II discharge uses PADSS. The nurse must
complete all admission assessments within 15 minutes per ASPAN standards, with vital
signs every 15 minutes minimum in Phase I.
Q3: A patient who received general anesthesia 30 minutes ago suddenly becomes
agitated, thrashing in bed, attempting to pull at lines and tubes, and does not recognize
the nurse or their surroundings. The patient is screaming and inconsolable. Vital signs:
HR 110, BP 160/90, RR 24, SpO2 96%. What is the MOST likely diagnosis?
A. Acute myocardial infarction
B. Emergence delirium
C. Hypoglycemic reaction
D. Malignant hyperthermia
Correct Answer: B
Rationale: Emergence delirium (agitated emergence) is characterized by acute
confusion, disorientation, agitation, thrashing, hallucinations, and lack of awareness
occurring during emergence from general anesthesia. Common in: pediatric patients
(incidence 10-80%), adults with pre-existing cognitive issues, sevoflurane use, rapid
emergence, pain, and anxiety. Vital signs are elevated but not extreme (distinguishes
from MH). Option A would show chest pain, ECG changes, hemodynamic collapse—not
behavioral symptoms. Option C would show sweating, tremors, confusion, but typically
, not extreme agitation/thrashing; check glucose to rule out. Option D would show
hyperthermia >38.8°C, rigidity, hypercarbia, tachycardia >150, metabolic acidosis—this
patient lacks these. Management: ensure safety (protect from self-harm), reassure and
reorient, treat pain (delirium often coexists with or masks pain), consider
dexmedetomidine or low-dose propofol if severe. Avoid physical restraints if possible;
pharmacologic sedation may prolong PACU stay.
Q4: [Calculation] A patient weighs 75 kg and requires sugammadex 2 mg/kg for
moderate neuromuscular blockade reversal. The medication is supplied as 100 mg/mL.
How many mL should the nurse administer?
A. 0.75 mL
B. 1.0 mL
C. 1.5 mL
D. 2.5 mL
Correct Answer: C
Rationale: Step 1: Calculate total dose: 2 mg/kg × 75 kg = 150 mg. Step 2: Calculate
volume: 150 mg ÷ 100 mg/mL = 1.5 mL. Option A (0.75 mL) uses 1 mg/kg dose (deep
block reversal dose). Option B (1.0 mL) is 100 mg, insufficient for 75 kg patient. Option
D (2.5 mL) is 250 mg, overdose. Sugammadex is a modified gamma-cyclodextrin that
encapsulates rocuronium/vecuronium, providing rapid reversal without
anticholinesterase side effects. Dosing: 2 mg/kg for moderate block (TOF count ≥2), 4
mg/kg for deep block (1-2 post-tetanic counts), 16 mg/kg for immediate reversal (3
minutes). The nurse must verify: TOF monitoring, adequate spontaneous ventilation,
and absence of residual blockade before extubation or PACU discharge.
& Answers | Verified Answers | 70 Questions w/ Detailed Rationales
| Comprehensive Practice | Pass Guaranteed - A+ Graded
SECTION 1: INITIAL POST-ANESTHESIA ASSESSMENT AND AIRWAY
MANAGEMENT
(Questions 1-12)
Q1: A patient arrives in PACU following general anesthesia for laparoscopic
cholecystectomy. The nurse's initial assessment reveals: snoring respirations, SpO2
88% on room air, respiratory rate 8/min, and the patient is unarousable to verbal stimuli.
Using the ABCDE approach, what is the nurse's FIRST priority action?
A. Administer 2 mg morphine IV for postoperative pain
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Perform a jaw thrust maneuver and open the airway
D. Check the Aldrete Score to determine discharge readiness
Correct Answer: C
Rationale: The ABCDE approach prioritizes Airway first. This patient exhibits classic
signs of upper airway obstruction (snoring respirations from soft palate/uvula against
posterior pharyngeal wall) with hypoventilation (RR 8/min) and hypoxemia (SpO2 88%).
The unarousable state suggests residual anesthetic/sedative effects with loss of
pharyngeal muscle tone. FIRST priority: Open the airway with jaw thrust (pulls tongue
and soft tissues forward), chin lift, and oropharyngeal/nasopharyngeal airway insertion
,if needed. Option A is lethal—opioids worsen respiratory depression and obstruction.
Option B is insufficient—oxygen doesn't address the anatomical obstruction; the patient
needs airway patency first. Option D is inappropriate—Aldrete scoring is for Phase I
discharge assessment, not initial emergency airway management. After airway opening,
apply oxygen, assess breathing/circulation, and consider naloxone if opioid-related or
anesthetic reversal. ASPAN standards emphasize immediate airway assessment on
PACU admission.
Q2: [SATA] A PACU nurse is admitting a patient from the operating room. Which
assessments are required components of the initial comprehensive post-anesthesia
evaluation? Select all that apply.
A. Verification of patient identity using two identifiers
B. Assessment of level of consciousness using standardized scoring system
C. Evaluation of surgical site and dressing integrity
D. Review of intraoperative anesthetic record and events
E. Aldrete Score calculation for Phase II discharge readiness
F. Assessment of pain level using appropriate pain scale
Correct Answers: A, B, C, D, F [CORRECT]
Rationale: Initial PACU admission assessment (ASPAN Standard I) includes:
A—Two-identifier verification (name, DOB, medical record number) is mandatory for
patient safety; B—LOC assessment (Aldrete, RASS, or institutional tool) establishes
baseline and detects emergence issues; C—Surgical site assessment identifies
immediate bleeding, hematoma, or dressing problems; D—Handoff communication
,including anesthetic record review (medications given, fluids, blood loss, complications,
reversal agents) is critical for continuity; F—Pain assessment is required but may be
deferred if patient unresponsive (document "unable to assess"). Option E is
incorrect—Aldrete Score is used for Phase I discharge readiness (to Phase II or unit), not
initial admission assessment. Phase II discharge uses PADSS. The nurse must
complete all admission assessments within 15 minutes per ASPAN standards, with vital
signs every 15 minutes minimum in Phase I.
Q3: A patient who received general anesthesia 30 minutes ago suddenly becomes
agitated, thrashing in bed, attempting to pull at lines and tubes, and does not recognize
the nurse or their surroundings. The patient is screaming and inconsolable. Vital signs:
HR 110, BP 160/90, RR 24, SpO2 96%. What is the MOST likely diagnosis?
A. Acute myocardial infarction
B. Emergence delirium
C. Hypoglycemic reaction
D. Malignant hyperthermia
Correct Answer: B
Rationale: Emergence delirium (agitated emergence) is characterized by acute
confusion, disorientation, agitation, thrashing, hallucinations, and lack of awareness
occurring during emergence from general anesthesia. Common in: pediatric patients
(incidence 10-80%), adults with pre-existing cognitive issues, sevoflurane use, rapid
emergence, pain, and anxiety. Vital signs are elevated but not extreme (distinguishes
from MH). Option A would show chest pain, ECG changes, hemodynamic collapse—not
behavioral symptoms. Option C would show sweating, tremors, confusion, but typically
, not extreme agitation/thrashing; check glucose to rule out. Option D would show
hyperthermia >38.8°C, rigidity, hypercarbia, tachycardia >150, metabolic acidosis—this
patient lacks these. Management: ensure safety (protect from self-harm), reassure and
reorient, treat pain (delirium often coexists with or masks pain), consider
dexmedetomidine or low-dose propofol if severe. Avoid physical restraints if possible;
pharmacologic sedation may prolong PACU stay.
Q4: [Calculation] A patient weighs 75 kg and requires sugammadex 2 mg/kg for
moderate neuromuscular blockade reversal. The medication is supplied as 100 mg/mL.
How many mL should the nurse administer?
A. 0.75 mL
B. 1.0 mL
C. 1.5 mL
D. 2.5 mL
Correct Answer: C
Rationale: Step 1: Calculate total dose: 2 mg/kg × 75 kg = 150 mg. Step 2: Calculate
volume: 150 mg ÷ 100 mg/mL = 1.5 mL. Option A (0.75 mL) uses 1 mg/kg dose (deep
block reversal dose). Option B (1.0 mL) is 100 mg, insufficient for 75 kg patient. Option
D (2.5 mL) is 250 mg, overdose. Sugammadex is a modified gamma-cyclodextrin that
encapsulates rocuronium/vecuronium, providing rapid reversal without
anticholinesterase side effects. Dosing: 2 mg/kg for moderate block (TOF count ≥2), 4
mg/kg for deep block (1-2 post-tetanic counts), 16 mg/kg for immediate reversal (3
minutes). The nurse must verify: TOF monitoring, adequate spontaneous ventilation,
and absence of residual blockade before extubation or PACU discharge.
