PACU & CPAN CONTENT EXAM QUE
n n n n n
STIONS AND VERIFIED ANSWERS
n n n
An65-year-
oldnmalencomesninnforntesting,nschedulednfornanradical nprostatectomynin n3ndays.nHenhasna
n45pk/yrnof nsmoking.nHenalsonhasnsomenmedicinesnforn"heartnpalpitations" nTestsnneeded
nfornthisnptninclude:n-nANSWER nEKG,nhgb/hct,nbmp,ntype&screen
thenfollowingnstatementsnaboutnpain nmanagementnapply:n-nANSWER n-
npreoperative ndiscussionnaboutnpainnexpectations/managementncanndecrease nanxiety
discussion nshouldnstartnin nthenphysician'snoffice
thenpatientnhasnanrolenin nhis/hernmanagementnof npain nandncomfort
thenperianesthesiancomprehensivenhealth nhistorynincludesnall nof nthenfollowingnexcept:
-nANSWER nvital nsigns
thenperianestheisannurse'sngoal nof npreoperativenpreparation nfornthenpatientnis:n-
nANSWER n-ntondecrease nthenpotential nforncomplications
reducenanxietynin nthenpatient
impartnaccuratenandntimelyncommunication ntonthenhealthcarenteam
airwaynsoundsnassociatednwith nlaryngospasmnmaynincludenallnof nthenfollowingnexcept:
-nANSWER ndiminishednbreath nsounds
which nof nthenfollowingnarenincludedninnrespiratorynassessmentnofnthenpatientnin nthenim
mediatenpostoperativenperiodn-nANSWERn-nworknof nbreathing
CBC,nchemistries,nABGs
location nof nincision nsite
classicnsignsnandnsymptomsnassociatednwith npneumothoraxninclude:n-nANSWER
chestnpain,ntracheal nshift,ndyspnea
thendichroticnnotchnof nthenarterialnwaveformnisnassociatednwith nclosurenof nthe:n-
nANSWER naorticnvalve
thenmostncommon ncausenof nPEAnin nthenperianesthesiansettingnisnhypovolemian-
nANSWER ntrue
,risksnandncomplicationsnassociatednwith ncentral nvenousncannulation ninclude:n-
nANSWER npneumothorax
thenmostncommon ncausenof ndecreasednCVPnin nthenpacu nis:n-nANSWERnhypovolemia
opioidsncan ncausenpupillarynconstriction:n-nANSWERntrue
thenglasgow ncomanscalenisnthenmostnreliablenindicatornof nchangenin nLOC nandn
neurological nstatusn-nANSWERntrue
thennormal nvaluenfornICPnis:n-nANSWER n0n-n20
signsnof nincreasednicpnincludenthenfollowing:n-nANSWERn-
nrestlessness,nbradycardia,nincreasednsystolicnBP,nwideningnpulsenpressure
thenfollowingnpositionnisnappropriatenfornan ninfratentorial ncraniotomynpatient:n-
nANSWER nflatnin nbed
normal nurinenoutputnisnconsideredntonbe:n-nANSWERn0.5mLn-n1.0nmL/kg/hr
volumenoutputndoesnnotninclude:n-nANSWER ninterstitial nfluidnshifts
when ncalculatingnurinenoutputnwith ncontinuousnbladdernirrigation:n-
nANSWER nirrigantnisnsubtractednfromnthentotal noutput
onenearlynsign nof nleakingnfromnthenanastomosisnsitenfollowingnrobotic-
assistednprostatectomynis:n-
nANSWER nhigh nvolumenoutputnin nthenJP novernanshortnperiodnof ntime
fornthenadultnpatient,nannearlynsignnofnhypoventilationnwhichncannleadntonhypoxianandnc
ardiacnarrestnis:n-nANSWERnslow,nshallow nrespirations
thenprimaryndrugsnusedntonreversensedation nandnanalgesianin nmoderatensedation nare:
-nANSWER nnaloxenenandnflumazenil
patientsnreceivingnmedicationntonachievenmoderatensedation/analgesianmustnhave
venousnaccessnmaintainednuntil ndischargencriterianarenmet:n-nANSWER ntrue
thenhighestnprioritynof nassessmentnis:n-nANSWERnoxygenation
thenstagenof nanesthesianduringnwhichnthenpatientnisnatnmostnriskntonharmnthemselvesni
s:n-nANSWER nstagenII:ndelirium
recoverynandnemergencynarendependentnupon:n-nANSWER n-nduration nof nanesthesia
, usenof nadditional nmedications
physical nstatusnof nthenpatient
postoperativenshiveringnduentonintraoperativenvasodilation nisnanconsideration nwith:n-
nANSWER nhalothane
seizurenactivitynmaynbenenhancednbynthenadministration nof:n-nANSWERnenflurane
succinylcholinenis:n-nANSWERnmetabolizednbynplasmancholinesterase
factorsnthatnmayncontributentonanprolongednneuromuscularnblockadenare:n-nANSWER n-
hypothermia
acidosis
renal nornhepaticndisease
blockadenof nnervenfibersnbynlocalnanestheticnagentsnoccursnin nthenfollowingnorder:n-
nANSWER nfalse
in noutpatientnsurgery,nanpatientnhasnhadnanreversal nagentnin nPhasenInPACU.n20min
later,nthenpatientnisntransferredntonPhasenIInPACU.nSuddenly,nthenpatientnisnexhibiting
thenfollowingnsignsnandnsymptoms:ndrowsynandnunarousable,nrespirationsnaren8nand
shallow,nbloodnpressurenisn90/60,nandnthenheartnratenisn58.ntheninitial nnursing
managementnof nthisnpatientnisnthenfollowing:n-nANSWER nbag-valve-masknatn15L/min
thentotal nbodynwaternin nthennormal nadultnis:n-nANSWER n70%
thenperianesthesiannursenshouldndiscontinuenthenusenofnintravenousnopioidsnwhen nth
erenis/are:n-nANSWER nsignsnof nan nallergicnreaction
when ncaringnfornthenpatientnwhonhasnjustnhadnanlumbarnepidural ncatheternplaced,nall nof nt
henfollowingnarentruenexcept:n-
nANSWERncontinuousnadministration nof nthenmedication nisnappropriate nwith nandermatom
e level of T3
itnisnsafenandneffectiventonusenIVnPCAnadministration nin nchildren noldernthan n8nyearsnof
agenprovidednthey:n-nANSWER
factorsninfluencingnnauseanandnvomitingnareneithernperipheralnorncentral ninnorigin.n
which nof nthenfollowingnarenperipheralnfactors?n-nANSWERnmajornintra-
abdominal nsurgerynandnprematurenoralnintakenof nfluids
thenbestnposition nfornthenprevention nof naspiration nis:n-
nANSWER nheadndown nandnleftnlateral
malignantnhyperthermianmaynbentriggerednbynwhich nagentn-nANSWER nsuccinylcholine
, which nof nthenfollowingncan nmimicnMH?n-nANSWER n-nthyroidnstorm
cocainen/necstasynoverdose
sepsis
if nanpatientnundergoingnanmajornabdominalnsurgerynisnmorenlikelyntonbecomenhypothe
rmicnthan nanothernpatientnhavingnanventral nhernianrepairnandnboth nsurgeriesntakenapp
roximatelyntwonhours,nwhatnwouldnbenthenminimumnambientnroomntemperature?n-
nANSWER n68ndegnfarenheit
antruencorentemperaturencan nbenmeasurednbynall nof nthenmethodsnexcept:n-nANSWER
an ninfraredntympanicntemperature
you nhavenjustnadmittednanfrailn92nyearoldnfemalentonthenPACUnafternhernhipnfracturenr
epair.non nassessment,nyounnotenseveralnlargenflatnbruisednareasnonnhernhandsnandnar
ms.nyou:n-nANSWER n-ncontinuenyournassessmentnbynreviewingnthenchart
-ncontinuenyournassessmentnbynreceivingnreportnfromnthenanesthesiologist
bradycardianmaynbenlifenthreateningninntheninfant/small nchildnandnrequiresnimmediaten
attention:n-nANSWER ntrue
fornperianesthesianteachingntonbeneffectivenitnmust:n-nANSWER n-
nbentailored ntonthenpatient'snidentified nneeds
benpresentednin nanmannernin nwhich nthenpatientncan nunderstand
benmodifiedntonovercomensensorynandnlanguagenbarriers
usensimplenphrases,nrepetition,nandnreturn ndemonstration
documentation nof nallnteaching,nboth npreoperativenandnpostoperativenservesnasna:n-
nANSWER n-nreference nfornthenpatientntonreview
checklistnfornthennursentonrefernto
legal nandnchartnauditingnpurposes
dischargencriterianarenestablished:n-nANSWERn-
nin ncollaboration nwithnnursing,nthendepartmentnof nanesthesiology,nandnmedical nstaff
- usenspecificnassessmentnparameters
- mustnbenapprovednbynthendepartmentnof nanesthesiologynandnmedicalnstaff
when npreparingnthenphasenIInpatientnforndischarge,nthenperianesthesiannursenco
mpletesnthenfollowingnexcept:n-
nANSWER ndischargesnthenpatientn60min nafternadmission ntonphasenII
identifynthreenwaysntonlimitnexposurentonradiation n-nANSWERn-
ndecrease nthentimenof nexposure
-nincreasenthendistancenfromnthenradiation nsource
n n n n n
STIONS AND VERIFIED ANSWERS
n n n
An65-year-
oldnmalencomesninnforntesting,nschedulednfornanradical nprostatectomynin n3ndays.nHenhasna
n45pk/yrnof nsmoking.nHenalsonhasnsomenmedicinesnforn"heartnpalpitations" nTestsnneeded
nfornthisnptninclude:n-nANSWER nEKG,nhgb/hct,nbmp,ntype&screen
thenfollowingnstatementsnaboutnpain nmanagementnapply:n-nANSWER n-
npreoperative ndiscussionnaboutnpainnexpectations/managementncanndecrease nanxiety
discussion nshouldnstartnin nthenphysician'snoffice
thenpatientnhasnanrolenin nhis/hernmanagementnof npain nandncomfort
thenperianesthesiancomprehensivenhealth nhistorynincludesnall nof nthenfollowingnexcept:
-nANSWER nvital nsigns
thenperianestheisannurse'sngoal nof npreoperativenpreparation nfornthenpatientnis:n-
nANSWER n-ntondecrease nthenpotential nforncomplications
reducenanxietynin nthenpatient
impartnaccuratenandntimelyncommunication ntonthenhealthcarenteam
airwaynsoundsnassociatednwith nlaryngospasmnmaynincludenallnof nthenfollowingnexcept:
-nANSWER ndiminishednbreath nsounds
which nof nthenfollowingnarenincludedninnrespiratorynassessmentnofnthenpatientnin nthenim
mediatenpostoperativenperiodn-nANSWERn-nworknof nbreathing
CBC,nchemistries,nABGs
location nof nincision nsite
classicnsignsnandnsymptomsnassociatednwith npneumothoraxninclude:n-nANSWER
chestnpain,ntracheal nshift,ndyspnea
thendichroticnnotchnof nthenarterialnwaveformnisnassociatednwith nclosurenof nthe:n-
nANSWER naorticnvalve
thenmostncommon ncausenof nPEAnin nthenperianesthesiansettingnisnhypovolemian-
nANSWER ntrue
,risksnandncomplicationsnassociatednwith ncentral nvenousncannulation ninclude:n-
nANSWER npneumothorax
thenmostncommon ncausenof ndecreasednCVPnin nthenpacu nis:n-nANSWERnhypovolemia
opioidsncan ncausenpupillarynconstriction:n-nANSWERntrue
thenglasgow ncomanscalenisnthenmostnreliablenindicatornof nchangenin nLOC nandn
neurological nstatusn-nANSWERntrue
thennormal nvaluenfornICPnis:n-nANSWER n0n-n20
signsnof nincreasednicpnincludenthenfollowing:n-nANSWERn-
nrestlessness,nbradycardia,nincreasednsystolicnBP,nwideningnpulsenpressure
thenfollowingnpositionnisnappropriatenfornan ninfratentorial ncraniotomynpatient:n-
nANSWER nflatnin nbed
normal nurinenoutputnisnconsideredntonbe:n-nANSWERn0.5mLn-n1.0nmL/kg/hr
volumenoutputndoesnnotninclude:n-nANSWER ninterstitial nfluidnshifts
when ncalculatingnurinenoutputnwith ncontinuousnbladdernirrigation:n-
nANSWER nirrigantnisnsubtractednfromnthentotal noutput
onenearlynsign nof nleakingnfromnthenanastomosisnsitenfollowingnrobotic-
assistednprostatectomynis:n-
nANSWER nhigh nvolumenoutputnin nthenJP novernanshortnperiodnof ntime
fornthenadultnpatient,nannearlynsignnofnhypoventilationnwhichncannleadntonhypoxianandnc
ardiacnarrestnis:n-nANSWERnslow,nshallow nrespirations
thenprimaryndrugsnusedntonreversensedation nandnanalgesianin nmoderatensedation nare:
-nANSWER nnaloxenenandnflumazenil
patientsnreceivingnmedicationntonachievenmoderatensedation/analgesianmustnhave
venousnaccessnmaintainednuntil ndischargencriterianarenmet:n-nANSWER ntrue
thenhighestnprioritynof nassessmentnis:n-nANSWERnoxygenation
thenstagenof nanesthesianduringnwhichnthenpatientnisnatnmostnriskntonharmnthemselvesni
s:n-nANSWER nstagenII:ndelirium
recoverynandnemergencynarendependentnupon:n-nANSWER n-nduration nof nanesthesia
, usenof nadditional nmedications
physical nstatusnof nthenpatient
postoperativenshiveringnduentonintraoperativenvasodilation nisnanconsideration nwith:n-
nANSWER nhalothane
seizurenactivitynmaynbenenhancednbynthenadministration nof:n-nANSWERnenflurane
succinylcholinenis:n-nANSWERnmetabolizednbynplasmancholinesterase
factorsnthatnmayncontributentonanprolongednneuromuscularnblockadenare:n-nANSWER n-
hypothermia
acidosis
renal nornhepaticndisease
blockadenof nnervenfibersnbynlocalnanestheticnagentsnoccursnin nthenfollowingnorder:n-
nANSWER nfalse
in noutpatientnsurgery,nanpatientnhasnhadnanreversal nagentnin nPhasenInPACU.n20min
later,nthenpatientnisntransferredntonPhasenIInPACU.nSuddenly,nthenpatientnisnexhibiting
thenfollowingnsignsnandnsymptoms:ndrowsynandnunarousable,nrespirationsnaren8nand
shallow,nbloodnpressurenisn90/60,nandnthenheartnratenisn58.ntheninitial nnursing
managementnof nthisnpatientnisnthenfollowing:n-nANSWER nbag-valve-masknatn15L/min
thentotal nbodynwaternin nthennormal nadultnis:n-nANSWER n70%
thenperianesthesiannursenshouldndiscontinuenthenusenofnintravenousnopioidsnwhen nth
erenis/are:n-nANSWER nsignsnof nan nallergicnreaction
when ncaringnfornthenpatientnwhonhasnjustnhadnanlumbarnepidural ncatheternplaced,nall nof nt
henfollowingnarentruenexcept:n-
nANSWERncontinuousnadministration nof nthenmedication nisnappropriate nwith nandermatom
e level of T3
itnisnsafenandneffectiventonusenIVnPCAnadministration nin nchildren noldernthan n8nyearsnof
agenprovidednthey:n-nANSWER
factorsninfluencingnnauseanandnvomitingnareneithernperipheralnorncentral ninnorigin.n
which nof nthenfollowingnarenperipheralnfactors?n-nANSWERnmajornintra-
abdominal nsurgerynandnprematurenoralnintakenof nfluids
thenbestnposition nfornthenprevention nof naspiration nis:n-
nANSWER nheadndown nandnleftnlateral
malignantnhyperthermianmaynbentriggerednbynwhich nagentn-nANSWER nsuccinylcholine
, which nof nthenfollowingncan nmimicnMH?n-nANSWER n-nthyroidnstorm
cocainen/necstasynoverdose
sepsis
if nanpatientnundergoingnanmajornabdominalnsurgerynisnmorenlikelyntonbecomenhypothe
rmicnthan nanothernpatientnhavingnanventral nhernianrepairnandnboth nsurgeriesntakenapp
roximatelyntwonhours,nwhatnwouldnbenthenminimumnambientnroomntemperature?n-
nANSWER n68ndegnfarenheit
antruencorentemperaturencan nbenmeasurednbynall nof nthenmethodsnexcept:n-nANSWER
an ninfraredntympanicntemperature
you nhavenjustnadmittednanfrailn92nyearoldnfemalentonthenPACUnafternhernhipnfracturenr
epair.non nassessment,nyounnotenseveralnlargenflatnbruisednareasnonnhernhandsnandnar
ms.nyou:n-nANSWER n-ncontinuenyournassessmentnbynreviewingnthenchart
-ncontinuenyournassessmentnbynreceivingnreportnfromnthenanesthesiologist
bradycardianmaynbenlifenthreateningninntheninfant/small nchildnandnrequiresnimmediaten
attention:n-nANSWER ntrue
fornperianesthesianteachingntonbeneffectivenitnmust:n-nANSWER n-
nbentailored ntonthenpatient'snidentified nneeds
benpresentednin nanmannernin nwhich nthenpatientncan nunderstand
benmodifiedntonovercomensensorynandnlanguagenbarriers
usensimplenphrases,nrepetition,nandnreturn ndemonstration
documentation nof nallnteaching,nboth npreoperativenandnpostoperativenservesnasna:n-
nANSWER n-nreference nfornthenpatientntonreview
checklistnfornthennursentonrefernto
legal nandnchartnauditingnpurposes
dischargencriterianarenestablished:n-nANSWERn-
nin ncollaboration nwithnnursing,nthendepartmentnof nanesthesiology,nandnmedical nstaff
- usenspecificnassessmentnparameters
- mustnbenapprovednbynthendepartmentnof nanesthesiologynandnmedicalnstaff
when npreparingnthenphasenIInpatientnforndischarge,nthenperianesthesiannursenco
mpletesnthenfollowingnexcept:n-
nANSWER ndischargesnthenpatientn60min nafternadmission ntonphasenII
identifynthreenwaysntonlimitnexposurentonradiation n-nANSWERn-
ndecrease nthentimenof nexposure
-nincreasenthendistancenfromnthenradiation nsource
