Certified Postanesthesia Nurse CPAN Exams Forms 1-4, Answered_ .

Certified Postanesthesia Nurse CPAN Exams Forms 1-4, Answered_2022. A 60-year-old female is admitted to the PACU following a diagnostic dilation and curettage with general anesthesia. Chart review reveals normal preoper ...

Certified Postanesthesia Nurse CPAN Exams Forms 1-4, Answered_2022. A 60-year-old female is admitted to the PACU following a diagnostic dilation and curettage with general anesthesia. Chart review reveals normal preoperative EKG-hemoglobin-hematocrit- and electrolyte values. Past medical history is remarkable for rheumatic fever during childhood. Thirty minutes later the patient develops the following EKG pattern --- A-fib--- The perianesthesia nurse interprets the rhythm strip as indicating A. Occasional premature atrial contractions B. First-degree heart block C. Atrial flutter D. Atrial fibrillation - A. Occasional premature atrial contractions B. First-degree heart block C. Atrial flutter D. Atrial fibrillation A 60-year-old female is admitted to the PACU following a diagnostic dilation and curettage with general anesthesia. Chart review reveals normal preoperative EKG-hemoglobin-hematocrit- and electrolyte values. Past medical history is remarkable for rheumatic fever during childhood. Thirty minutes later the patient develops the following EKG pattern --- A-fib--- If the defibrillator is not set on the synchronized mode during a cardioversion- which life threatening arrhythmia could occur? A. Ventricular fibrillations B. Wenckebach's phenomenon C. Premature ventricular contractions D. Ventricular tachycardia - Ventricular fibrillations Wenckebach's phenomenon Premature ventricular contractions Ventricular tachycardia A 60-year-old female is admitted to the PACU following a diagnostic dilation and curettage with general anesthesia. Chart review reveals normal preoperative EKG-hemoglobin-hematocrit- and electrolyte values. Past medical history is remarkable for rheumatic fever during childhood. Thirty minutes later the patient develops the following EKG pattern --- A-fib--- The patient is transferred to a surgical nursing unit following successful cardioversion because the ICU and monitored units are full. The PACU nurse should emphasize assessment for A. Atrioventricular dissociation B. Thermal incident C. Sinus bradycardia D. Emboli - A. Atrioventricular dissociation B. Thermal incident C. Sinus bradycardia D. Emboli The perianesthesia nurse has given the patient instructions regarding taking medications on the day of surgery. Which statement indicates that the patient understands the pre-op teaching A. "I will only have small amounts of water with the medications I take on the morning of surgery" B. "Since I have atrial fibrillation, I need to take my warfarin on the morning of surgery" C. "I will take my vitamins and herbal supplements on the morning of surgery" D. "Since I am diabetic, I need to take my insulin and eat breakfast every day" - A. "I will only have small amounts of water with the medications I take on the morning of surgery" B. "Since I have atrial fibrillation, I need to take my warfarin on the morning of surgery" C. "I will take my vitamins and herbal supplements on the morning of surgery" D. "Since I am diabetic, I need to take my insulin and eat breakfast every day" A patient in Phase II is complaining of nausea and refusing any medication. Which essential oil may be inhaled to treat post-operative nausea and vomiting? A. Rose B. Sandalwood C. Lemongrass D. Peppermint - A. Rose B. Sandalwood C. Lemongrass D. Peppermint Which one of the following positions would be indicated for a left lower lobectomy? A. Flat bed rest B. Turned to operative side only C. Turned to nonoperative side only D. Semi-Fowler's position with turning to either side - A. Flat bed rest B. Turned to operative side only C. Turned to nonoperative side only D. Semi-Fowler's position with turning to either side A patient with an implantable cardioverter defibrillator (ICD) arrives in the PACU with a magnet over the generator. The perianesthesia nurse should: A. Remove the magnet so the ICD is activated B. Remove the magnet so the ICD is deactivated C. Educate the patient on the care of the magnet D. Adjust the placement of the magnet - A. Remove the magnet so the ICD is activated B. Remove the magnet so the ICD is deactivated C. Educate the patient on the care of the magnet D. Adjust the placement of the magnet A patient with a subarachnoid hemorrhage is lethargic but arousable. The patient is taken to surgery for an aneurysm clipping. ABG shows pH= 7.50 pCO2= 45 mm HG and HCO3-= 30 mEq/L. The perianesthesia nurse interprets this as: A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis - A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis While caring for a patient after lumbar posterior nerve root rhizotomy the perianesthesia nurse notes the patient has no movement or sensation to the lower extremities. The priority nursing action is to notify the: A. Anesthesiologist of muscle paralysis B. Operating room of the complications C. Surgeon of the absence of sensation D. Surgeon of lack of motor ability - A. Anesthesiologist of muscle paralysis B. Operating room of the complications C. Surgeon of the absence of sensation D. Surgeon of lack of motor ability While assisting an anesthesiologist performing a block for reflex sympathetic dystrophy the perianesthesia nurse observes that the affected arm becomes warm to the touch and flushed. The patient reports a sensation of heaviness in the arm. This indicates which of the following? A. Ineffective regional block B. Severe allergic reaction C. Successful therapeutic block D. Extravasation of the medication - A. Ineffective regional block B. Severe allergic reaction C. Successful therapeutic block D. Extravasation of the medication The perianesthesia nurse receives a patient post total parathyroidectomy. The patient is awake and oriented with a patent airway but complains of tingling around the mouth- slight hoarseness- and is mildly apprehensive. The perianesthesia nurse suspects: A. Vocal cord irritation B. Hypocalcemia C. Hypercalcemia D. Compromised airway - A. Vocal cord irritation B. Hypocalcemia C. Hypercalcemia D. Compromised airway The perianesthesia nurse receives a patient post total parathyroidectomy. The patient is awake and oriented with a patent airway but complains of tingling around the mouth- slight hoarseness- and is mildly apprehensive. The perianesthesia nurse's next action is to: A. Instruct the patient to remain silent to rest the vocal cords B. Have patient say "e" to check for nerve damage C. Call surgeon and anticipate an order for a calcium level D. Administer pain medication and look for signs of hemorrhage - A. Instruct the patient to remain silent to rest the vocal cords B. Have patient say "e" to check for nerve damage C. Call surgeon and anticipate an order for a calcium level D. Administer pain medication and look for signs of hemorrhage A 3-year-old patient arrives in the PACU following general anesthesia. The patient has a croupy cough- inspiratory stridor- and intercostal retractions are noted. Humidified oxygen is being administered at 8L/min via blow by. Initially the perianesthesia nurse anticipates: A. Administration of nebulized racemic epinephrine B. Assisting the patient's breathing with BMV C. Maintaining the patient's head in the sniff position D. Suctioning the patient's oropharynx - A. Administration of nebulized racemic epinephrine B. Assisting the patient's breathing with BMV C. Maintaining the patient's head in the sniff position D. Suctioning the patient's oropharynx A postoperative pediatric tympanoplasty patient is asked to wrinkle the forehead- pucker lips- smile- and squeeze eyelids together. The PACU nurse is assessing the function of cranial nerve: A. V B. VII C. IX D. XII - A. V B. VII C. IX D. XII Evaluation calls made to an ambulatory patient during the 24-hour period after discharge can provide effective post-operative follow-up. This nursing action is most important to : A. Transfer aftercare to a public health nurse B. Give the patient a chance to ask questions and identify problems in the care given C. Advertise the institution's ambulatory surgery program D. Facilitate readmission in the event of complications - A. Transfer aftercare to a public health nurse B. Give the patient a chance to ask questions and identify problems in the care given C. Advertise the institution's ambulatory surgery program D. Facilitate readmission in the event of complications Following stabilization of femur and pelvic fractures a patient becomes anxious and oxygen saturations decrease to 86%. The patient continues to become confused and agitated. Upon further assessment the perianesthesia nurse notes petechiae on the patient's trunk. The perianesthesia nurse suspects: A. Fat embolism B. Tension pneumothorax C. Compartment syndrome D. Neurogenic bladder- A. Fat embolism B. Tension pneumothorax C. Compartment syndrome D. Neurogenic bladder In a young healthy post-operative patient hypoventilation may be reversed by: A. Restriction of fluids B. Administration of oxygen C. Stimulation of the patient D. Administration of pain medication- A. Restriction of fluids B. Administration of oxygen C. Stimulation of the patient D. Administration of pain medication A patient with type I diabetes is admitted the day of surgery with a glucose of 400 mg/dL. The nurse is aware that the patient may be at risk for: A. Hyperglycemic hyperosmolar syndrome B. Anuria C. Diabetic ketoacidosis D. Diabetes insipidus- A. Hyperglycemic hyperosmolar syndrome B. Anuria C. Diabetic ketoacidosis D. Diabetes insipidus During the interview of a 55-year-old patient before elective surgery the patient reports using no routine prescription medications- just some natural herbs. The perianesthesia nurse is aware that- according to the ASA- teaching should include which of the following? A. Continue all herbal supplements that are taken in the evening B. Discontinue all herbal supplements 2 weeks prior to surgery C. Herbal supplements have no contraindications for surgery D. Continue all herbal supplements until 2 days prior to surgery- A. Continue all herbal supplements that are taken in the evening B. Discontinue all herbal supplements 2 weeks prior to surgery C. Herbal supplements have no contraindications for surgery D. Continue all herbal supplements until 2 days prior to surgery The occurrence of post-dural puncture headache is most frequently attributed to: A. A history of migraine headaches B. Poor positioning C. A slow loss of cerebrospinal fluid at puncture site D. Caffeine deprivation- A. A history of migraine headaches B. Poor positioning C. A slow loss of cerebrospinal fluid at puncture site D. Caffeine deprivation Asking the patient to position the tongue in midline following a carotid endarterectomy helps the perianesthesia nurse to assess the: A. Acoustic nerve B. Hypoglossal nerve C. Glossopharyngeal nerve D. Facial nerve- A. Acoustic nerve B. Hypoglossal nerve C. Glossopharyngeal nerve D. Facial nerve Which of the following symptoms in a postoperative tonsillectomy patient would be of particular concern to the perianesthesia nurse? A. Discomfort in the ear B. Hoarseness C. Frequent swallowing D. Throat discomfort- A. Discomfort in the ear B. Hoarseness C. Frequent swallowing D. Throat discomfort In postoperative patients with a history of end-stage renal disease the administration of IV glucose and regular insulin is used to correct the complication of: A. Hyponatremia B. Hypokalemia C. Hypernatremia D. Hyperkalemia- A. Hyponatremia B. Hypokalemia C. Hypernatremia D. Hyperkalemia The perianesthesia nurse caring for a 60 kg patient who is NPO should maintain IV fluid hourly maintenance rate at: A. 45 ml/kg/hr B. 55 ml/kg/hr C. 65 ml/kg/hr D. 100 ml/kg/hr- A. 45 ml/kg/hr B. 55 ml/kg/hr C. 65 ml/kg/hr D. 100 ml/kg/hr Which electrolyte abnormality will produce a widened QRS segment- peaked T waves- and impaired atrioventricular conduction? A. Hypokalemia B. Hyperkalemia C. Hypercalcemia D. Hypocalcemia- A. Hypokalemia B. Hyperkalemia C. Hypercalcemia D. Hypocalcemia After receiving cefazolin 1g- a patient experiences cardiac arrest. CPR is hampered by edema of the face- neck- and upper airway. The first drug prepared by the PACU nurse is: A. Epinephrine B. Ephedrine C. Dexamethasone D. Diphenhydramine- A. Epinephrine B. Ephedrine C. Dexamethasone D. Diphenhydramine The most common dysrhythmia in the pediatric patient in cardiac arrest is: A. Pulseless electrical activity B. Ventricular fibrillation C. Ventricular tachycardia D. Asystole- A. Pulseless electrical activity B. Ventricular fibrillation C. Ventricular tachycardia D. Asystole Following inhalational anesthesia a patient should be monitored for hypothermia. The PACU nurse is aware that the regulation of temperature is: A. Depressant effect on the hypothalamus B. Stimulating effect on the cerebral cortex C. Depressant effect on the cerebral cortex D. Stimulating effect on the hypothalamus- A. Depressant effect on the hypothalamus B. Stimulating effect on the cerebral cortex C. Depressant effect on the cerebral cortex D. Stimulating effect on the hypothalamus During spinal and epidural anesthesia- the patient's body temperature control mechanisms are: A. Not affected B. Impaired in a way that promotes temperature fluctuation C. Impaired in a way that promotes hyperthermia D. Impaired in a way that promotes hypothermia- A. Not affected B. Impaired in a way that promotes temperature fluctuation C. Impaired in a way that promotes hyperthermia D. Impaired in a way that promotes hypothermia The psychic disturbances attributed to ketamine anesthesia can be modified by the administration of: A. Diazepam B. Etomidate C. Butorphanol D. Nalbuphine- A. Diazepam B. Etomidate C. Butorphanol D. Nalbuphine The anesthetist indicates in the postoperative report that the patient was reversed with edrophonium and atropine. The reason for administering atropine is to: A. Decreases the likelihood of vomiting B. Promote acetylcholine release C. Enhance the onset of neuromuscular reversal D. Minimize muscarinic stimulation- A. Decreases the likelihood of vomiting B. Promote acetylcholine release C. Enhance the onset of neuromuscular reversal D. Minimize muscarinic stimulation The most common triggering agents of a malignant hyperthermia crisis are: A. Nitrous oxide and thiopental B. Halothane and succinylcholine C. Fentanyl and succinylcholine D. Isoflurane and thiopental- A. Nitrous oxide and thiopental B. Halothane and succinylcholine C. Fentanyl and succinylcholine D. Isoflurane and thiopental A surgical patient has been taking feverfew for migraine headache prevention. Medication reconciliation reveals the patient also take aspirin. The perianesthesia nurse informs the patient that the risks of using feverfew in combination with aspirin includes: A. An increased risk of bleeding B. An increased absorption of iron C. No effect on platelet aggregation D. Safe use during pregnancy- A. An increased risk of bleeding B. An increased absorption of iron C. No effect on platelet aggregation D. Safe use during pregnancy A 9-year-old child post appendectomy is dozing in the PACU after receiving morphine for patient- reported pain of 3 on a 0-to-10 scale. A short time later the nurse observes that the child is listless and sees the mother activating the patient-controlled analgesia (PCA). The nurse should first: A. Call the physician for a change of medication B. Tell the parent that this is an appropriate intervention C. Explain that only the patient is to operate the pump D. Discontinue the PCA- A. Call the physician for a change of medication B. Tell the parent that this is an appropriate intervention C. Explain that only the patient is to operate the pump D. Discontinue the PCA A patient arrives in the Phase I PACU with epidural infusion of fentanyl and bupivacaine. Vital signs are stable. The patient requests that the head of the bed be elevated. The perianesthesia nurse explains that the head elevation could result in: A. Hyperventilation B. Hypoventilation C. Hypertension D. Hypotension- A. Hyperventilation B. Hypoventilation C. Hypertension D. Hypotension It is important for a perianesthesia nurse to understand that a child's ability to classify and estimate pain normally develops around the age of: A. 4 or 5 years B. 7 or 8 years C. 10 or 11 years D. 13 or 14 years- A. 4 or 5 years B. 7 or 8 years C. 10 or 11 years D. 13 or 14 years The perianesthesia nurse assesses that a patient understands the impact of opioid use postoperatively when the patient verbalizes that opioids can cause: A. Diarrhea B. Nausea and vomiting C. Hypotension D. Insomnia- A. Diarrhea B. Nausea and vomiting C. Hypotension D. Insomnia During anesthesia handoff the provider reports using rapid sequence induction for intubation. The PACU nurse realizes the patient must have a history of: A. Gastroesophageal reflux B. Brain stem ataxia C. Anaphylaxis with sepsis D. Liver dysfunction- A. Gastroesophageal reflux B. Brain stem ataxia C. Anaphylaxis with sepsis D. Liver dysfunction The perianesthesia nurse demonstrates best practices in discharge teaching by: A. Assessing individual learning needs B. Giving all patients the same amount of information C. Completing written documentation in a timely manner D. Demonstrating psychomotor skills- A. Assessing individual learning needs B. Giving all patients the same amount of information C. Completing written documentation in a timely manner D. Demonstrating psychomotor skills According to ASPAN Perianesthesia Nursing Standards Practice recommendations and Interpretative Statements- the scope of care provided in post anesthesia Phase I includes: A. Preparation of patient and family for home care B. Preparation of patient for extended care C. Transition of the patient from an anesthetized state to Phase II or an inpatient setting D. Transition of the patient from the preoperative to the intraoperative phase- A. Preparation of patient and family for home care B. Preparation of patient for extended care C. Transition of the patient from an anesthetized state to Phase II or an inpatient setting D. Transition of the patient from the preoperative to the intraoperative phase A patient status post appendectomy is complaining of myalgia. The nurse reassures the patient this is a normal side effect of: A. Sevoflurane B. Fentanyl C. Midazolam D. Succinylcholine- A. Sevoflurane B. Fentanyl C. Midazolam D. Succinylcholine An Rh negative patient status post dilation and curettage for a missed abortion is instructed that before discharge she will receive: A. Vitamin B-12 B. Pitocin C. RhoGam D. Terbutaline- A. Vitamin B-12 B. Pitocin C. RhoGam D. Terbutaline In transcultural patient teaching- the perianesthesia nurse plans to: A. Learn how listening is communicated in the patient's culture B. Assume meaning is interpreted without distortion C. View the patient's culture through the nurse's life experience D. Avoid using gestures to help patient understand- A. Learn how listening is communicated in the patient's culture B. Assume meaning is interpreted without distortion C. View the patient's culture through the nurse's life experience D. Avoid using gestures to help patient understand A patient status post knee arthroscopy has a history of coronary artery disease and hypertension and did not take his metoprolol yesterday. The perianesthesia nurse is aware that the discharge instructions need to include the importance of taking this medication because the patient is at increased risk of: A. Hyperlipidemia B. Plaque rupture C. Hyperglycemia D. Myocardial ischemia- A. Hyperlipidemia B. Plaque rupture C. Hyperglycemia D. Myocardial ischemia Crutch training instruction after arthroscopic right knee surgery should include: A. Leading with the unaffected leg B. Applying dominant weight to axillary pads C. Taking large- steady steps D. Standing erect and looking downward when walking- A. Leading with the unaffected leg B. Applying dominant weight to axillary pads C. Taking large- steady steps D. Standing erect and looking downward when walking The patient displays understanding of the most effective way of preventing infection by hands that are not visibly soiled in stating that: A. Non-latex gloves must be used B. Hands must be washed with soap and water C. Fingernails must be free of nail polish D. An alcohol-based gel must be used- A. Non-latex gloves must be used B. Hands must be washed with soap and water C. Fingernails must be free of nail polish D. An alcohol-based gel must be used In evaluating the care of a patient with vancomycin-resistant enterococci (VRE) the PACU nurse will consider which of the following? A. VRE can live for weeks on surfaces such as bed rails B. The patient should be placed in a negative-pressure room C. Transmission-based droplet precautions should be utilized D. Gloves are a sufficient barrier device- A. VRE can live for weeks on surfaces such as bed rails B. The patient should be placed in a negative-pressure room C. Transmission-based droplet precautions should be utilized D. Gloves are a sufficient barrier device In the care of a conscious patient who has been admitted to the PACU following a thyroidectomy- the position of choice is: A. Supine with one pillow B. Lying on one side with the head hyperextended C. Sim's position D. Semi-Fowler's position- A. Supine with one pillow B. Lying on one side with the head hyperextended C. Sim's position D. Semi-Fowler's position Postoperative discharge teaching for a patient who received an interscalene block with Ropivacaine should include instructions for the patient to: A. Notify surgeon for sudden pain or tingling of the arm B. Perform full range of motion exercises every 2 hours C. Contact surgeon if patient's hand is still numb 3 hours after surgery D. Protect elbow to avoid damage to ulnar nerve until block resolves- A. Notify surgeon for sudden pain or tingling of the arm B. Perform full range of motion exercises every 2 hours C. Contact surgeon if patient's hand is still numb 3 hours after surgery D. Protect elbow to avoid damage to ulnar nerve until block resolves The presence of the family visitation in the PACU will: A. Increase patient satisfaction B. Extended PACU length of stay C. Increase the infection rate D. Decrease nursing interaction- A. Increase patient satisfaction B. Extended PACU length of stay C. Increase the infection rate D. Decrease nursing interaction A patient who underwent a craniotomy for tumor removal is admitted to the PACU awake and alert. 30 minutes later the patient's level of consciousness decreases heart rate decreases to less than 60 and hypertension occurs. The PACU nurse notifies the neurosurgeon and anticipates the need for: A. Phenytoin and mannitol B. Atropine and furosemide C. Analgesics and midazolam D. Nitroprusside and labetolol- A. Phenytoin and mannitol B. Atropine and furosemide C. Analgesics and midazolam D. Nitroprusside and labetolol While drawing-up Versed into a syringe to use during a bedside procedure the perianesthesia nurse must make certain the label identifies the: A. Patient's full name the drug name and the expiration date B. Patient's full name the hospital identifiers and expiration date C. Medication name the solution strength and the hospital identifier D. Medication name, the quantity, and the solution strength of the medication- A. Patient's full name the drug name and the expiration date B. Patient's full name the hospital identifiers and expiration date C. Medication name the solution strength and the hospital identifier D. Medication name, the quantity, and the solution strength of the medication When conducting a discharge phone call on a patient following a partial thyroidectomy which of the following complaints should prompt the nurse to recommend immediate medical follow-up? A. Tetany B. Nausea C. Headache D. tinnitus- A. Tetany B. Nausea C. Headache D. tinnitus According to the Safe Medical Device Act the perianesthesia nurse must report any serious event that involves: A. Oral medications B. Restraint application C. Computer programs D. Family interactions- A. Oral medications B. Restraint application C. Computer programs D. Family interactions A perianesthesia nurse in Phase I PACU may care for which of the following patients? A. One unconscious adult stable with artificial airway and one conscious adult stable free of complications B. One unconscious patient hemodynamically stable with a stable airway over the age of 8 and one conscious patient stable free of complications C. Two unconscious stable patients 5 and 8 years of age D. One patient on mechanical life support and one stable patient- A. One unconscious adult stable with artificial airway and one conscious adult stable free of complications B. One unconscious patient hemodynamically stable with a stable airway over the age of 8 and one conscious patient stable free of complications C. Two unconscious stable patients 5 and 8 years of age D. One patient on mechanical life support and one stable patient The ASPAN recommended staffing ratio for a patient in isolation upon arrival to PACU is: A. One RN to one patient B. Two RNs to one patient C. One RN to two patients D. One RN to three patients- A. One RN to one patient B. Two RNs to one patient C. One RN to two patients D. One RN to three patients According to the ASPAN 2017-2018 Perianesthesia Nursing Standards Practice Recommendations and Interpretive Statements the perianesthesia nurse administering moderate sedation to a patient makes sure that an emergency cart with a defibrillator is: A. Immediately available during the administrations B. Available on the next floor, near the elevator C. Unnecessary for a patient whose ASA score is 2 or less D. Unnecessary for moderate sedation- A. Immediately available during the administrations B. Available on the next floor, near the elevator C. Unnecessary for a patient whose ASA score is 2 or less D. Unnecessary for moderate sedation According to the American Society of Perianesthesia Nursing guidelines staffing of Phase I and Phase II PACUs is based on which of the following? A. A ratio of one registered nurse to two patients B. Vacation schedules and bed availability C. Patient acuity and physical facility D. The number of staff with ACLS and PALS- A. A ratio of one registered nurse to two patients B. Vacation schedules and bed availability C. Patient acuity and physical facility D. The number of staff with ACLS and PALS The most common allegation for medical malpractice claims occurring in the PACU is failure to: A. Obtain adequate orders B. Provide discharge teaching C. Monitor the patient's physiologic status D. Document appropriately- A. Obtain adequate orders B. Provide discharge teaching C. Monitor the patient's physiologic status D. Document appropriately A patient has been given ketamine as part of the anesthesia regimen. The perianesthesia nurse recognized that caring for this patient includes: A. Immediate implementation of stir-up regimen B. Avoiding early tactile and verbal stimulation C. Avoiding the use of benzodiazepines D. Obtaining orders for restraints PRN- A. Immediate implementation of stir-up regimen B. Avoiding early tactile and verbal stimulation C. Avoiding the use of benzodiazepines D. Obtaining orders for restraints PRN To prevent complications and promote healing for a patient following a right femoral popliteal bypass surgery the perianesthesia nurse instructs the patient on the importance of: A. Applying heel protectors bilaterally B. Elevating the right leg on two pillows C. Keeping the legs warm with heavy blankets D. Ambulating within the first 24 hours- A. Applying heel protectors bilaterally B. Elevating the right leg on two pillows C. Keeping the legs warm with heavy blankets D. Ambulating within the first 24 hours A patient is admitted to the PACU to receive an epidural blood patch for severe headache after receiving spinal anesthesia the previous day. The perianesthesia nurse explains to the patient that this is most frequently attributed to: A. Elevating the head of the bed too soon B. A previous post dural puncture headache C. Being NPO for a long period preoperatively D. A slow loss of cerebrospinal fluid at the puncture site- A. Elevating the head of the bed too soon B. A previous post dural puncture headache C. Being NPO for a long period preoperatively D. A slow loss of cerebrospinal fluid at the puncture site A patient who received general anesthesia with desflurane and succinylcholine remainsapneic and intubated in the Phase I PACU. The perianesthesia nurse suspects that this patient: A. Has pseudocholinesterase deficiency B. Has malignant hyperthermia C. Will require reversal with glycopyrrolate and neostigmine D. Is progressing normally and will be extubated soon- A. Has pseudocholinesterase deficiency B. Has malignant hyperthermia C. Will require reversal with glycopyrrolate and neostigmine D. Is progressing normally and will be extubated soon In order to ensure accuracy and meet legally required standards nursing notes should be written: A. Using formal legal and medical terms B. Objectively, with the current date and time C. At the end of the shift when the nurse will not be interrupted D. In outline form for easier comprehension- A. Using formal legal and medical terms B. Objectively, with the current date and time C. At the end of the shift when the nurse will not be interrupted D. In outline form for easier comprehension After a laparoscopic cholecystectomy the perianesthesia nurse is aware that it is normal for the patient to have: A. Urinary retention B. Shoulder pain C. Abdominal cramping D. Chest fullness- A. Urinary retention B. Shoulder pain C. Abdominal cramping D. Chest fullness Following a dilation and curettage for missed abortion the perianesthesia nurse instructs the patient to call the surgeon for: A. Saturation of more than one sanitary pad per hour B. Abdominal cramping C. Any serosanguinous drainage on pad D. Breast tenderness- A. Saturation of more than one sanitary pad per hour B. Abdominal cramping C. Any serosanguinous drainage on pad D. Breast tenderness A 65-year-old retired patient has been scheduled for a septoplasty. The patient states that after the preoperative visit blood draw the patient noticed a rash and edema where the tourniquet was applied. The patient may be at risk for: A. Latex allergy B. Herpes zoster C. Bleeding D. Ecchymosis- A. Latex allergy B. Herpes zoster C. Bleeding D. Ecchymosis A patient is admitted to the hospital for maxillofacial surgery to correct congenital deformities. When implementing the teaching plan the perianesthesia nurse should emphasize: A. How to clear secretions or remove vomitus while the patient is in intermaxillary fixation B. Expectations of temporary physical disfigurement C. An explanation of the surgical procedure anticipated, with details of the intermaxillary fixation D. Instruction on how to cough, deep-breathe, and move- A. How to clear secretions or remove vomitus while the patient is in intermaxillary fixation B. Expectations of temporary physical disfigurement C. An explanation of the surgical procedure anticipated, with details of the intermaxillary fixation D. Instruction on how to cough, deep-breathe, and move Preoperative teaching for patients undergoing tympanoplasty should include instructions to perform which of the following in the immediate postoperative period? A. Avoid slow motion of the head B. Blow nose forcefully to relieve ear pressure C. Sneeze with mouth open D. Irrigate ear canals frequently to remove drainage- A. Avoid slow motion of the head B. Blow nose forcefully to relieve ear pressure C. Sneeze with mouth open D. Irrigate ear canals frequently to remove drainage A patient has received a stellgate ganglion block. The perianesthesia nurse evaluates for a successful block by assessing for the presence of: A. Horner's syndrome B. Pallor C. Diaphoresis D. Vasoconstriction at the site of the block- A. Horner's syndrome B. Pallor C. Diaphoresis D. Vasoconstriction at the site of the block A patient who weighs 137 kg is admitted for a procedure requiring general anesthesia. The perianesthesia nurse should be aware of which of the following? A. Airway classification score B. Abbreviated injury score C. Hemoglobin S concentration level D. Carboxyhemoglobin level- A. Airway classification score B. Abbreviated injury score C. Hemoglobin S concentration level D. Carboxyhemoglobin level A patient is admitted to the PACU following a laparoscopic Nissen fundoplication. Intraoperatively the patient required a chest tube placement for development of a tension pneumothorax. The perianesthesia nurse understands that which of the following in the patient's history could be problematic at this time? A. Diabetes B. COPD C. Osteoporosis D. Angina- A. Diabetes B. COPD C. Osteoporosis D. Angina A 4-year-old patient arrives to the PACU with a croupy cough that progresses to stridor circumoral cyanosis and substernal retractions with diminished breath sounds. The perianesthesia nurse's next appropriate intervention is to: A. Intubate B. Administer neuromuscular blockade C. Obtain arterial blood gases D. Ventilate with positive pressure- A. Intubate B. Administer neuromuscular blockade C. Obtain arterial blood gases D. Ventilate with positive pressure A patient has been admitted following a tonsillectomy and adenoidectomy. The patient has slight upper airway congestion and vital signs remain stable. The perianesthesia nurse should initiate which of the following first? A. Administration of humidified oxygen B. Administration of albuterol C. Nasopharyngeal suctioning D. Administration of racemic epinephrine- A. Administration of humidified oxygen B. Administration of albuterol C. Nasopharyngeal suctioning D. Administration of racemic epinephrine The drug of choice for postoperative nausea and vomiting for post-surgical patients with a history of Parkinson's Disease is: A. Droperidol B. Ondansetron C. Promethazine D. metoclopramide- A. Droperidol B. Ondansetron C. Promethazine D. metoclopramide A post lumbar diskectomy patient arrives in the PACU with stable vital signs. Thirty minutes after extubation the patient then becomes anxious dyspneic tachypneic and complains of substernal pain. The perianesthesia nurse suspects: A. A pulmonary embolism B. Pulmonary hypertension C. Gastric reflux D. Aortic insufficiency- A. A pulmonary embolism B. Pulmonary hypertension C. Gastric reflux D. Aortic insufficiency A patient in the PACU is experiencing Type I IgE-mediated anaphylaxis from latex exposure. The perianesthesia nurse would first anticipate giving: A. Methylprednisolone B. Epinephrine C. Dimenhydrinate D. Diphenhydramine- A. Methylprednisolone B. Epinephrine C. Dimenhydrinate D. Diphenhydramine After arrival in the PACU following a radical neck dissection the patient becomes tachypneic with tracheal deviation and oxygen desaturation. The perianesthesia nurse suspects: A. Anterior cervical edema B. Vocal cord paralysis C. Tension pneumothorax D. Cervical facet displacement- A. Anterior cervical edema B. Vocal cord paralysis C. Tension pneumothorax D. Cervical facet displacement A patient is admitted to the PACU with laryngeal mask airway (LMA) in place. The perianesthesia nurse understands that a properly placed LMA: A. Conforms to the hypopharynx B. Passes through the glottic opening C. Prevents aspiration D. Prevents laryngospasm- A. Conforms to the hypopharynx B. Passes through the glottic opening C. Prevents aspiration D. Prevents laryngospasm A patient in the PACU has ABG lab values of pH= 7.25 pCO2= 50 pO2= 99% HCO3-= 12. The patient received pancuronium intra-op. The perianesthesia nurse observes for which possible neuromuscular blockade interaction? A. Inhibition of the setup of the block B. Reversal of the effect of the block C. Prolongation of the duration of the block D. Increases in the level of the block- A. Inhibition of the setup of the block B. Reversal of the effect of the block C. Prolongation of the duration of the block D. Increases in the level of the block A patient arrives in the PACU following a coronary artery bypass graft. The patient is on a ventilator with the following settings: Vt= 650 ml FiO2= 100% AC mode set RR= 10 and PEEP= 5cm. Critical ABG results are: pH= 7.24 pCO2= 56 pO2= 80 HCO3-= 22 SaO2= 91%. The perianesthesia nurse anticipates which of the following interventions? A. Increasing the Vt and the RR B. Decreasing the PEEP and FiO2 C. Increasing the Vt and decreasing the RR D. Increasing the PEEP and the RR- A. Increasing the Vt and the RR B. Decreasing the PEEP and FiO2 C. Increasing the Vt and decreasing the RR D. Increasing the PEEP and the RR A patient arrives in the PACU following a coronary artery bypass graft. The patient is on a ventilator with the following settings: Vt= 650 ml FiO2= 100% AC mode set RR= 10 and PEEP= 5cm. Critical ABG results are: pH= 7.24 pCO2= 56 pO2= 80 HCO3-= 22 SaO2= 91%. The perianesthesia nurse is aware that the ABG values indicate: A. Metabolic acidosis B. Metabolic and respiratory acidosis C. Respiratory acidosis D. Uncompensated respiratory alkalosis- A. Metabolic acidosis B. Metabolic and respiratory acidosis C. Respiratory acidosis D. Uncompensated respiratory alkalosis The perianesthesia nurse is aware that one of the first signs of laryngospasm in the pediatric patient is: A. Decreased oxygen saturation B. Use of accessory muscles C. Increased sedation D. Bradycardia- A. Decreased oxygen saturation B. Use of accessory muscles C. Increased sedation D. Bradycardia A patient complains of not feeling well and becomes unresponsive. The patient is pulseless and has the EKG rhythm below: (v-tach) After initiation of CPR the perianesthesia nurse should: A. Defibrillate at 360 joules (monophasic) B. Administer atropine 1 mg C. Administer 300 mg amiodarone D. Defibrillate at 200 joules (laryngospasm)- A. Defibrillate at 360 joules (monophasic) B. Administer atropine 1 mg C. Administer 300 mg amiodarone D. Defibrillate at 200 joules (laryngospasm) A patient in the PACU becomes tachypneic and complains of dyspnea and chest pain when taking a deep breath. The patient is expectorating blood-tinged sputum. The perianesthesia nurse expects the immediate medical management of the patient is to include: A. O2, morphine sulfate, and heparin B. codeine , O2, and erythromycin C. Fentanyl, thoracentesis, and albuterol D. Meperidine, O2, and warfarin- A. O2, morphine sulfate, and heparin B. codeine , O2, and erythromycin C. Fentanyl, thoracentesis, and albuterol D. Meperidine, O2, and warfarin The perianesthesia nurse is aware that which of the following cardiac rhythm is more clinically ominous and may progress to a lethal dysrhythmia? A. Atrial flutter 1:4 response B. Second-degree type II heart block C. Atrial fibrillation D. First-degree AV block- A. Atrial flutter 1:4 response B. Second-degree type II heart block C. Atrial fibrillation D. First-degree AV block The perianesthesia nurse explains to the patient that pulse oximetry is used: A. As a noninvasive way to determine O2 saturation B. Because it is not affected by peripheral vascular disease C. As a replacement for the need of other indices of oxygenation D. Because it is unaffected by hemoglobin and hematocrit levels- A. As a noninvasive way to determine O2 saturation B. Because it is not affected by peripheral vascular disease C. As a replacement for the need of other indices of oxygenation D. Because it is unaffected by hemoglobin and hematocrit levels A 2-month-old patient is admitted to the PACU following a cardiac catheterization for atrial septal defect (ASD) closure. The perianesthesia nurse carefully monitors fluid and electrolyte balance in this patient because infants: A. Are able to communicate thirst B. Have a slower rate of peristalsis C. Are less able to concentrate urine D. Can easily compensate for acidosis- A. Are able to communicate thirst B. Have a slower rate of peristalsis C. Are less able to concentrate urine D. Can easily compensate for acidosis Thyroid storm is characterized by: A. Hypothermia, somnolence, and bradycardia B. Fever, bradycardia, and vasoconstriction C. Excitement, hypothermia, and bradycardia D. Fever, tachycardia, and cutaneous vasodilation- A. Hypothermia, somnolence, and bradycardia B. Fever, bradycardia, and vasoconstriction C. Excitement, hypothermia, and bradycardia D. Fever, tachycardia, and cutaneous vasodilation A patient who has been taking digoxin preoperatively is having frequent premature ventricular contractions (PVCs). The perianesthesia nurse suspects: A. Hypokalemia B. Hyperkalemia C. Hypernatremia D. Hyponatremia- A. Hypokalemia B. Hyperkalemia C. Hypernatremia D. Hyponatremia With regard to airway management of an infant in the immediate postoperative phase it is critical for the perianesthesia nurse to recall that an infant's: A. Larynx is funnel shaped and easily compressed B. Epiglottis is long and floppy C. Accessory muscles contribute to inspiration D. Intercostal musculature are fully developed- A. Larynx is funnel shaped and easily compressed B. Epiglottis is long and floppy C. Accessory muscles contribute to inspiration D. Intercostal musculature are fully developed During right knee arthroscopy a healthy 24-year-old patient develops a post-extubation laryngospasm that is resolved in the operative room. Twenty minutes after admission to the PACU the patient exhibits a moist cough dyspnea and expectoration of pink frothy sputum. Assessment reveals moist crackles in all lung fields and SpO2 of 85%. The PACU nurse suspects that the patient has developed: A. A tracheal hemorrhage B. Acute respiratory failure C. Noncardiogenic pulmonary edema D. A pulmonary embolism- A. A tracheal hemorrhage B. Acute respiratory failure C. Noncardiogenic pulmonary edema D. A pulmonary embolism A patient experiences a sudden rise in temperature post shock wave lithotripsy. The PACU nurse may suspect: A. Ureteral obstruction B. Malignant hyperthermia C. Sepsis D. Renal contusion- A. Ureteral obstruction B. Malignant hyperthermia C. Sepsis D. Renal contusion A patient experiences a sudden rise in temperature after extracorporeal shock wave lithotripsy under GETA with nitrous oxide O2 midazolam fentanyl and rocuronium. The PACU nurse may suspect: A. Kava kava B. Alcohol C. Echinacea D. St. John's wort- A. Kava kava B. Alcohol C. Echinacea D. St. John's wort A 12-year-old patient weighing 50 kg is in the Phase I PACU following ORIF of the right femur. Intraoperatively the patient received morphine 3mg ketorolac 15mg and fentanyl 50mcg. The patient is awake crying and gives a pain rating of 8/10. The perianesthesia nurse recalls that children: A. Have the same amount of pain as an adult B. Are not in pain if they can be distracted C. Can be more tolerant of pain with repeated experience of pain D. Do not heal quickly from surgery so their pain is more severe that the adult- A. Have the same amount of pain as an adult B. Are not in pain if they can be distracted C. Can be more tolerant of pain with repeated experience of pain D. Do not heal quickly from surgery so their pain is more severe that the adult Postoperative pain is most likely to: A. Activate the body's neuroendocrine stress response B. Cause more stimulation of kappa receptors than mu1 receptors C. Decrease the coagulability of blood D. Increase the body's immune response- A. Activate the body's neuroendocrine stress response B. Cause more stimulation of kappa receptors than mu1 receptors C. Decrease the coagulability of blood D. Increase the body's immune response The recommended opioid dose for individuals 70 years of age and older is: A. Decreased by 25%-50% B. Decreased by 60%-75% C. Increased by 10%-25% D. Increased by 5% for each year over 70- A. Decreased by 25%-50% B. Decreased by 60%-75% C. Increased by 10%-25% D. Increased by 5% for each year over 70 According to ASPAN Standards family presence in the postoperative phase: A. Compromises patient privacy B. Increases septic complications C. Increases procedural pain D. Reduces cardiovascular complications- A. Compromises patient privacy B. Increases septic complications C. Increases procedural pain D. Reduces cardiovascular complications The patient states that he does not want to use crutches because they interfere with his job as a salesman. The nurse's best response is to emphasize that crutches: A. Are optional for a particular weight-bearing order B. Strengthen the nonoperative extremity C. Decrease postoperative motion-induced edema D. Promote healing of fractured bones- A. Are optional for a particular weight-bearing order B. Strengthen the nonoperative extremity C. Decrease postoperative motion-induced edema D. Promote healing of fractured bones A family reports overhearing hospital staff members discussing a combative patient who required restraint. The liability issue of concern is: A. Personal accountability B. Medical malpractice C. Invasion of privacy D. Defamation of character- A. Personal accountability B. Medical malpractice C. Invasion of privacy D. Defamation of character The perianesthesia nurse demonstrates understanding that language and readable instructions are important to patient safety after discharge, by ensuring patient discharge instructions are written in the vocabulary of grade level: A. 3 B. 5 C. 9 D. 12- A. 3 B. 5 C. 9 D. 12 While assessing an elderly patient who is anxious and fearful, a perianesthesia nurse observes old and new bruises with torn skin on the patient's arms, face, and hairline. The perianesthesia nures's best action is to: A. approach the family about possible abuse B. evaluate, observe, and further assess the patient C. use appropriate paper tape on the patient's skin D. report this information to social services- A. approach the family about possible abuse B. evaluate, observe, and further assess the patient C. use appropriate paper tape on the patient's skin D. report this information to social services The perianesthesia nurse instructs a patient scheduled for a laparoscopic cholecystectomy to remove body piercings prior to arrival as they may cause: A. injury and infection B. increased pain in the incision site C. adverse medication interaction D. EKG monitoring interference- A. injury and infection B. increased pain in the incision site C. adverse medication interaction D. EKG monitoring interference The perianesthesia nurse suspects a Type IV latex allergy in a patient exhibiting: A. tachyphylaxis B. erythema C. hypotension D. bronchospasm- A. tachyphylaxis B. erythema C. hypotension D. bronchospasm A pt with VRE is being admitted to the PACU following surgery. A perianesthesia nurse should know which precaution provides the safest enviornment for both the pt and others in the PACU? A. having the anesthesiologist recover the pt in the OR B. placing a special respirator mask over the nasal cannula on the pt C. providing a 1:1 nurse to pt ratio for the pt D. having the anesthesiologist bypass the PACU and transporting the pt directly to the surgical floor- A. having the anesthesiologist recover the pt in the OR B. placing a special respirator mask over the nasal cannula on the pt C. providing a 1:1 nurse to pt ratio for the pt D. having the anesthesiologist bypass the PACU and transporting the pt directly to the surgical floor A combative, restless, and thrashing pt arrives in the Phase I PACU. After an initial assessment of the pt's airway, the next intervention for the nurse is to: A. bring family members to bedside B. arouse the pt C. provide safe environment D. medicate pt for pain- A. bring family members to bedside B. arouse the pt C. provide safe environment D. medicate pt for pain The perianesthesia nurse is aware that the most important intervention for the pediatric pt in emergence delirium is: A. monitoring and controlling body temperature B. having a parent present C. the presence of padded side rails D. providing tender loving care- A. monitoring and controlling body temperature B. having a parent present C. the presence of padded side rails D. providing tender loving care A pt is admitted to the Phase I PACU following a cleft palate repair. Which of the following is the proper positioning of this pt in the immediate postop phase? A. Semi-prone B. High Fowler's C. Reverse Trendelenburg D. Lateral recumbent- A. Semi-prone B. High Fowler's C. Reverse Trendelenburg D. Lateral recumbent A pt with active TB is expected in PACU. The perianesthesia nurse prepares for: A. airborne precautions B. droplet precautions C. contact precautions D. standard precautions- A. airborne precautions B. droplet precautions C. contact precautions D. standard precautions The perianesthesia nurse is aware that according to Centers for Disease Control and Prevention recommendations: A. artificial nails should not be worn for direct pt care B. wedding bands or ring use should be avoided in direct pt care C. hands should be washed vigorously with soap for at least 30 secs D. alcohol-based hand rub is approved for minimally soiled hands- A. artificial nails should not be worn for direct pt care B. wedding bands or ring use should be avoided in direct pt care C. hands should be washed vigorously with soap for at least 30 secs D. alcohol-based hand rub is approved for minimally soiled hands During postop coughing and deep breathing regimens, the perianesthesia nurse instructs the pt that the most important element of effective pulmonary care is the: A. timing of the cough B. expiratory effort C. number of deep breaths D. inspiratory hold- A. timing of the cough B. expiratory effort C. number of deep breaths D. inspiratory hold Upon waking up in the PACU, A 3 y/o pt is inconsolable and refuses the attention of the nurse. The perianesthesia nurse is aware that this behavior is considered: A. a normal response of the protest of separation anxiety B. passive resistance which is often used by toddlers C. to be related to the pain of surgery D. to be frustration related to the lack of privacy- A. a normal response of the protest of separation anxiety B. passive resistance which is often used by toddlers C. to be related to the pain of surgery D. to be frustration related to the lack of privacy A pt with limited English proficiency presents to the preoperative holding area. The perianesthesia nurse understands that the most appropriate interpreter is a/an: A. multilingual ancillary staff member B. family member who speaks english C. anesthesiologist who speaks the pt's language D. professional medical interpreter- A. multilingual ancillary staff member B. family member who speaks english C. anesthesiologist who speaks the pt's language D. professional medical interpreter An 80 y/o hearing-impaired pt is being d/c home following cataract removal. In planning the d/c the perianesthesia nurse should: A. avoid low lighting and noisy teaching environments B. avoid using written instructions C. provide small print d/c material D. provide audiovisual aids in a teaching packet- A. avoid low lighting and noisy teaching environments B. avoid using written instructions C. provide small print d/c material D. provide audiovisual aids in a teaching packet A 5 y/o pt has undergone a laparoscopic procedure and will be d/c home. The perianesthesia nurse understands that evaluation of preoperative education is: A. dependent on parent preparation B. not required d/t the child's age C. inappropriate for this procedure D. varied by physician demand- A. dependent on parent preparation B. not required d/t the child's age C. inappropriate for this procedure D. varied by physician demand A pt undergoing shoulder surgery is receiving a brachial plexus block. Teaching should include: A. frequent abduction exercises to shoulder B. results of postoperative chest x-ray C. minimal need for analgesic for 24 hrs D. proper use of arm slings- A. frequent abduction exercises to shoulder B. results of postoperative chest x-ray C. minimal need for analgesic for 24 hrs D. proper use of arm slings A pt who is cognitively impaired is admitted to the PACU. The pt becomes frightened and combative and attempts to get out of bed. The perianesthesia nurse's best response is: A. reassure the pt and play relaxing music B. reunite the pt with the caregiver as soon as possible C. gently restrain the pt's arms D. anticipate administration of anxiolytic- A. reassure the pt and play relaxing music B. reunite the pt with the caregiver as soon as possible C. gently restrain the pt's arms D. anticipate administration of anxiolytic In order to provide meaningful spiritual care for a pt, it is important for the perianesthesia nurse to: A. provide the pt with objects and materials such as incense B. provide time for ritual and devotional practices C. call a chaplain for the pt D. share the same religion as the pt- A. provide the pt with objects and materials such as incense B. provide time for ritual and devotional practices C. call a chaplain for the pt D. share the same religion as the pt When planning care for a Chinese-American pt, the perianesthesia nurse should understand that pt from a Chinese cultural background : A. tend to be very expressive B. like to be asked lots of questions C. want their family involved in plan of care D. prefer that you maintain eye contact at all times- A. tend to be very expressive B. like to be asked lots of questions C. want their family involved in plan of care D. prefer that you maintain eye contact at all times The perianesthesia nurse should offer the parents of an infant in the PACU gentle comfort and instruct them: A. to talk in whispers so the child will not be afraid B. not to offer the child nourishment C. that their fears may be transferred to the infant D. to avoid use of a pacifier until the infant is fully awake- A. to talk in whispers so the child will not be afraid B. not to offer the child nourishment C. that their fears may be transferred to the infant D. to avoid use of a pacifier until the infant is fully awake Assessment by the perianesthesia nurse of a mechanically-ventilated pt who is post craniotomy reveals: ICP=40, pH=7.31 pCO2= 56 pO2 = 75. The perianesthesia nurse notifies the anesthesiologist and anticipates that which priority intervention will be performed next? A. Increasing the respiratory rate B. Decreasing the respiratory rate C. Increasing the FiO2 D. Decreasing pressure support- A. Increasing the respiratory rate B. Decreasing the respiratory rate C. Increasing the FiO2 D. Decreasing pressure support A pt with head trauma arrives in the Phase I PACU with an intraparenchymal bolt in place. ICP measurements are 30-40 mm Hg. With these measurements, the perianesthesia nurse knows that cerebral hypoxia may be aggravated by: A. mannitol administration B. raising the head of the bed C. hypercapnia D. tachycardia- A. mannitol administration B. raising the head of the bed C. hypercapnia D. tachycardia The perianesthesia nurse recognizes that the postop orthopedic pt, the earliest recognizable signs/symptom of compartment syndrome is: A. altered tissue turgor in the affect limb B. absence of peripheral pulses C. pain unrelieved by medication D. decreased temperature in the affected limb- A. altered tissue turgor in the affect limb B. absence of peripheral pulses C. pain unrelieved by medication D. decreased temperature in the affected limb A healthy, young female is admitted to the PACU after a tubal ligation. The pt received a general anesthetic that included nitrous oxide, sevoflurane, vecuronium, and succinylcholine. The pt still requires mechanical ventilation 30 mins after the procedure as ended. ABGs drawn before transfer the PACU are normal, axillary temp was 36.1 lab studies reveal elevated serum potassium and low serum albumin. The perianesthesia nurse is aware that this could indicate: A. decrease in the possibility of a phase II (dual) block B. deficiency in pseudocholinesterase levels C. deficiency in renal metabolism D. decrease in central nervous system response- A. decrease in the possibility of a phase II (dual) block B. deficiency in pseudocholinesterase levels C. deficiency in renal metabolism D. decrease in central nervous system response A healthy, young female is admitted to the PACU after a tubal ligation. The pt received a general anesthetic that included nitrous oxide, sevoflurane, vecuronium, and succinylcholine. After 1 hr in the PACU the pt still requires mechanical ventilation. B/P and pulse are stable, temp and ABGs are within normal limits. Peripheral nerve stimulation elicits a weak response. A this point the primary duty fo the perianesthesia nurse is to: A. contact family members about the pt's condition B. wean the pt from the mechanical ventilator C. document the sequence of events up to and including the present D. provide psychological support to the pt through direct communication- A. contact family members about the pt's condition B. wean the pt from the mechanical ventilator C. document the sequence of events up to and including the present D. provide psychological support to the pt through direct communication The perianesthesia nurse is aware that the neurotransmitter released at the presynaptic membrane and blocked by non depolarizing muscle relaxants is: A. norepinephrine B. cholinesterase C. acetylcholine D. epinephrine- A. norepinephrine B. cholinesterase C. acetylcholine D. epinephrine A pt is admitted to the PACU following a palliative colostomy to relieve an intestinal obstruction. The perianesthesia nurse recognizes that relieving the obstruction places the pt at risk for: A. bladder atony B. interstitial fluid shift C. DVT D. pulmonary atelectasis- A. bladder atony B. interstitial fluid shift C. DVT D. pulmonary atelectasis A pt has undergone a radical prostatectomy. During surgery, his EBL of 3500 ml was replaced with 4 units of whole blood, 2 units of packed cells, 2500 ml LR and 1900 ml of NS. The pt was extubated after 20 mins and remains drowsy but arousable, and is now complaining of leg cramps and tingling of the fingers. The perianesthesia nurse should suspect: A. citrate intoxication B. allergic reaction C. fluid overload D. hyponatremia- A. citrate intoxication B. allergic reaction C. fluid overload D. hyponatremia The perianesthesia nurse is aware that the plan of care for a pt with oliguria resulting from prerenal failure may include: A. monitoring fluids and electrolytes B. restricting fluid volume replacement C. placing a stent to maintain patency D. administering antibiotics to prevent infection- A. monitoring fluids and electrolytes B. restricting fluid volume replacement C. placing a stent to maintain patency D. administering antibiotics to prevent infection A pt is admitted to the PACU after excision and grafting of a full thickness burn on the right arm. When performing the assessment, it is noted that fluid is collecting under the graft site. The perianesthesia nurse anticipates: A. aspirating the fluid B. applying a pressure dressing C. changing the dressing D. applying ice to the graft site- A. aspirating the fluid B. applying a pressure dressing C. changing the dressing D. applying ice to the graft site Coughing at the end of an opthalmic procedure could result in : A. the rupture of the globe B. an increase in intraocular pressure C. oculocardiac reflux D. Sjogren's syndrome- A. the rupture of the globe B. an increase in intraocular pressure C. oculocardiac reflux D. Sjogren's syndrome A pt with a history of DM 1 is admitted to the PACU status post bronchoscopy. After 1 hr, the pt remains unresponsive. BP = 110/50; HR=140; RR=28; SpO2=97% (room air); serum glucose=350 mg/dl; potassium=6.2 mg/dl. The priority nursing action is to assess for possible: A. hypoglycemic reaction B. diabetic coma C. hyperkalemia D. hyperinsulinemia- A. hypoglycemic reaction B. diabetic coma C. hyperkalemia D. hyperinsulinemia A pt is admitted to the Phase I PACU following a hepatic lobectomy. While obtaining the pt's blood pressure postop, the perianesthesia nurse observes the pt's hand clenching during cuff inflation. The most probable cause of the clenching is: A. hypermagnesemia B. hypokalemia C. hypocalcemia D. hypernatremia- A. hypermagnesemia B. hypokalemia C. hypocalcemia D. hypernatremia A pt is admitted to the PACU with malignant hyperthermia. The perianesthesia nurse is aware the pathophysiology of malignant hyperthermia is related to decreased uptake of: A. calcium B. cholinesterase C. acetylcholine D. potassium- A. calcium B. cholinesterase C. acetylcholine D. potassium The perianesthesia nurse is aware that a pt with history of hypertension is at increased risk of an intraoperative myocardial event if the pt develops: A. hyponatremia B. hypoglycemia C. hypocalcemia D. hypotension- A. hyponatremia B. hypoglycemia C. hypocalcemia D. hypotension The perianesthesia nurse would discontinue narcotic administration when the pt's: A. blood pressure is 10% of baseline B. FLACC scale is 6 C. Pasero Opioid Induced Sedation Scale is 4 D. respiratory rate is 12 breaths per minute- A. blood pressure is 10% of baseline B. FLACC scale is 6 C. Pasero Opioid Induced Sedation Scale is 4 D. respiratory rate is 12 breaths per minute A pt with hx of chronic pain and opioid use at home is admitted to the Phase I PACU. Ketamine IV is used as part of the anesthetic regimen. The perianesthesia nurse anticipates providing: A. a quiet, calm environment B. frequent stimulation to rouse the pt C. oral swabs for dry mouth D. vasopressors for hypotension treatment- A. a quiet, calm environment B. frequent stimulation to rouse the pt C. oral swabs for dry mouth D. vasopressors for hypotension treatment A 7 kg pt is admitted to the PACU following a Nissen fundoplication. The perianesthesia nurse understands that the hourly fluid intake for this pt is: A. 2 ml/kg/hr B. 3 ml/kg/hr C. 4 ml/kg/hr D. 5 ml/kg/hr- A. 2 ml/kg/hr B. 3 ml/kg/hr C. 4 ml/kg/hr D. 5 ml/kg/hr A pt is admitted to the PACU following a L4-5 laminectomy with fusion. 30 mins after admission, drainage from the surgically placed drain is 500 ml of blood. Vital signs are: BP = 96/40, HR=116, R=30, and SpO2 93%. Hgb is 8.5 and Hct is 28. The perianesthesia nurse anticipates administering: A. crystalloid solution B. RBC C. dextran 40 D. albumin- A. crystalloid solution B. RBC C. dextran 40 D. albumin A geriatric pt is admitted to the preoperative holding area prior to vascular surgery. Midazolam IV is ordered for preoperative anxiety. The perianesthesia nurse recognizes that the dose of midazolam should be: A. reduced by 25-30% B. unchanged C. increased by 50% D. avoided in this pt- A. reduced by 25-30% B. unchanged C. increased by 50% D. avoided in this pt During the preop assessment, a pt denied having any drug allergies but neglected to tell anyone about a "severe" allergy to soy. Upon hearing this information, the perianesthesia nurse: A. notifies the anesthesiologist B. arranges to have the surgery rescheduled C. ensures that the patient has allergy testing for verification D. ignores the statement, since it is not drug related- A. notifies the anesthesiologist B. arranges to have the surgery rescheduled C. ensures that the patient has allergy testing for verification D. ignores the statement, since it is not drug related A pt is admitted to the PACU with vivid hallucinations, irrational behavior, and confusion. The perianesthesia nurse suspects these reactions may be the results of the administration of: A. ketamine B. midazolam C. dolasetron D. methohexital- A. ketamine B. midazolam C. dolasetron D. methohexital A pt in the PACU has developed respiratory failure and requires intubation by the anesthesia provider. Succinylcholine IV will be administered as part of the rapid sequence induction. Which class of drugs would the perianesthesia nurse have ready to counteract fasciculations? A. benzodiazepines B. non-depolarizing muscle relaxants C. antihistamines D. anticonvulsants- A. benzodiazepines B. non-depolarizing muscle relaxants C. antihistamines D. anticonvulsants A pt arrives in the PACU with minimal response to verbal stimuli and respirations of 6. The pt received hydromorphone 3 mg intraoperatively, and naloxone 0.2 mg IV was given as ordered in the PACU. The perianesthesia nurse would consider repeating the dose again in: A. 1 min B. 3 min C. 10 min D. 20 min- A. 1 min B. 3 min C. 10 min D. 20 min A pt is being treated for suspected malignant hyperthermia. Which of the following drugs should the perianesthesia nurse question before administering? A. amiodarone B. sodium bicarbonate C. procainamide D. quinidine- A. amiodarone B. sodium bicarbonate C. procainamide D. quinidine When a transdermal nitroglycerin patch must be applied on a patient requiring an extended PACU stay, the perianesthesia nurse knows to: A. remove the patch after 24 hours B. clip the hair at the application site C. identify the level of current anginal discomfort D. place the patch on an inner forearm for quick identification- A. remove the patch after 24 hours B. clip the hair at the application site C. identify the level of current anginal discomfort D. place the patch on an inner forearm for quick identification A 20 y/o male with a history of spina bifida latex allergy is admitted to the preop holding area. The pt history reveals a family member with an unexplained death during an operative procedure. The perianesthesia regimen could consist of: A. sevoflurane, O2, fentanyl, and pancuronium bromide B. etomidate, nitrous oxide, propofol, and fentanyl C. succinylcholine, nitrous oxide, fentanyl, and droperidol D. tetracaine epidural, desflurane, propofol, and fentanyl- A. sevoflurane, O2, fentanyl, and pancuronium bromide B. etomidate, nitrous oxide, propofol, and fentanyl C. succinylcholine, nitrous oxide, fentanyl, and droperidol D. tetracaine epidural, desflurane, propofol, and fentanyl Preop, a pt is administered an H2 antagonist. The perianesthesia nurse knows this helps reduce the risk of aspiration in surgical pts by: A. inhibiting the secretion of gastric acid B. increasing the pH of gastric fluid C. decreasing the pH of gastric fluid D. promoting gastric emptying- A. inhibiting the secretion of gastric acid B. increasing the pH of gastric fluid C. decreasing the pH of gastric fluid D. promoting gastric emptying A pt ha received pancuronium bromide IV as part of the anesthesia regimen. The perianesthesia nurse anticipates which of the following to be given for reversal of the effects? A. droperidol with atropine IV B. diphenhydramine IV C. naloxone IV D. neostigmine with glycopyrrolate IV- A. droperidol with atropine IV B. diphenhydramine IV C. naloxone IV D. neostigmine with glycopyrrolate IV The anesthesiologist informs the PACU nurse on duty that an arriving pt has had a dilation and curettage after a failed self-abortion attempt. The nurse requested in the past not to care for pt having abortions. According to the ANA Code for Nurses, the: A. nurse is obligated to provide for the pt's safety B. anesthesiologist must provide care fo the pt C. nurse has the right to refuse care for this pt D. manager must provide another nurse- A. nurse is obligated to provide for the pt's safety B. anesthesiologist must provide care fo the pt C. nurse has the right to refuse care for this pt D. manager must provide another nurse Sleep apnea in severely obese pts is related to: A. excess pharyngeal tissue B. hypoglossal nerve paralysis C. hypocarbia with acidosis D. supine lateral- A. excess pharyngeal tissue B. hypoglossal nerve paralysis C. hypocarbia with acidosis D. supine lateral A pt reports lightheadedness, mouth numbness, and ringing in the ears following a regional block. The perianesthesia nurse recognizes this as: A. allergic reaction B. transient hypotension C. local anesthesia toxicity D. acute stroke- A. allergic reaction B. transient hypotension C. local anesthesia toxicity D. acute stroke Based on the SCIP protocol use of which class of medication is associated with decreased morbidity and mortality in vascular surgery pts? A. calcium channel blockers B. diuretics C. anxiolytics D. beta blockers- A. calcium channel blockers B. diuretics C. anxiolytics D. beta blockers A pt with a history of bronchial asthma and hypertension is admitted to the PACU following an outpatient procedure. The patient is drowsy but responsive, bilateral breath sounds are clear, and vital signs are: BP=220/110, HR=72, and R=16. The perianesthesia nurse will anticipate the administration of: A. propranolo B. hydralazine C. labtalol D. nitroprusside- A. propranolo B. hydralazine C. labtalol D. nitroprusside An ambulatory surgery patient who is post direct laryngoscopy with general anesthesia exhibits stridor. The perianesthesia nurse anticipates orders for: A. percussion of the anterior chest B. administration of nebulized racemic epinephrine C. administration of naloxone IV D. suctioning the pharynx- A. percussion of the anterior chest B. administration of nebulized racemic epinephrine C. administration of naloxone IV D. suctioning the pharynx A pt is admitted to the PACU following a thoracic aneurysm repair. Once extubated, the pt is exhibiting positive Trousseau's sign and skeletal muscle weakness. The perianesthesia nurse anticipates evaluating the pt's: A. serum calcium level B. serum potassium level C. extremities for pulses D. heart for new murmurs- A. serum calcium level B. serum potassium level C. extremities for pulses D. heart for new murmurs Restraining a pt without consent or proper authorization could result in an allegation against the perianesthesia nurse of: A. breach of contract B. legal irresponsibility C. assault and battery D. malpractice- A. breach of contract B. legal irresponsibility C. assault and battery D. malpractice The safest time to remove the LMA is: A. when the pt is in high Fowler's position and awake B. after the pt is suctioned during light anesthesia C. during stage II recovery from anesthesia D. when the pt is able to follow commands and open the mouth- A. when the pt is in high Fowler's position and awake B. after the pt is suctioned during light anesthesia C. during stage II recovery from anesthesia D. when the pt is able to follow commands and open the mouth A postop tonsillectomy pt has become restless and tachycardic, and is observed swallowing excessively. The perianesthesia nurse interprets this as: A. emergence delirium B. swelling of the palate C. hemorrhage D. respiratory impairment- A. emergence delirium B. swelling of the palate C. hemorrhage D. respiratory impairment Postop teaching for a pt with sickle cell anemia following surgery for priapism should emphasize the importance of : A. applying emollient lotion after bathing B. reporting itching or discoloration of the scrotum C. promptly reporting dehydration and/or infection D. rest, ice, and elevation- A. applying emollient lotion after bathing B. reporting itching or discoloration of the scrotum C. promptly reporting dehydration and/or infection D. rest, ice, and elevation Postoperative teaching for a patient with sickle cell anemia following surgery for priapism should emphasize the importance of: A. applying emollient lotion after bathing B. reporting itching or discoloration of the scrotum C. promptly reporting dehydration and/or infection D. rest, ice and elevation- A. applying emollient lotion after bathing B. reporting itching or discoloration of the scrotum C. promptly reporting dehydration and/or infection D. rest, ice and elevation According to the ASPAN 2017-2018 Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements, a hemodynamically stable 9 y/o patient who is not yet conscious without complications requires which nurse-patient ratio? A. 1:1 B. 1:2 C. 1:3 D. 2:1- A. 1:1 B. 1:2 C. 1:3 D. 2:1 A patient is admitted to the PACU post cardiac cathererization. Thirty minutes post hemostasis, the patient begins to bleed at the incision site. The perianesthesia nurse know that immediate care for this patient includes. A. placing a 2.5 lbs sandbag on the percutaneous puncture skin site B. applying continuous pressure directly to the percutaneous puncture skin site C. applying direct sontinuous pressure 2.5 cm above the percutaneous puncture skin site D. placing a pressure dressing on the percutaneous puncture skin site.- A. placing a 2.5 lbs sandbag on the percutaneous puncture skin site B. applying continuous pressure directly to the percutaneous puncture skin site C. applying direct sontinuous pressure 2.5 cm above the percutaneous puncture skin site D. placing a pressure dressing on the percutaneous puncture skin site. After receiving an interscalene block, the patient complains of shortness of breath. The perianesthesia nurse is aware that the block may have affected which nerve? A. transverse cervical B. supraclavicular C. phrenic D. recurrent laryngeal- A. transverse cervical B. supraclavicular C. phrenic D. recurrent laryngeal The perianesthesia nurse is aware that safe medication administration is regulated by: A. HIPPA B. State Nurse Practice Act and ASPAN standards guidelines C. ASPAN standards guidelines and the National Nurse Practice Act D. the National Nurse Practice Act- A. HIPPA B. State Nurse Practice Act and ASPAN standards guidelines C. ASPAN standards guidelines and the National Nurse Practice Act D. the National Nurse Practice Act A 35 y/o female is admitted intubated and requiring ventilation on arrival to the Phase I PACU following a gastric bypass with Roux-en-Y procedure. Anesthesia medication included inhaled sevoflurane, IV vecuronium, and IV fentanyl. The perianesthesia nurse recognizes the delay in emergence could be related to: A. sevoflurane potentiation of the neuromuscular blockade B. the administration of intravenous plasmalyte C. airway irritation from the endotracheal tube D. prolonged use of positive end-expiratory pressure during the procedure.- A. sevoflurane potentiation of the neuromuscular blockade B. the administration of intravenous plasmalyte C. airway irritation from the endotracheal tube D. prolonged use of positive end-expiratory pressure during the procedure. A patient in Phase I PACU has a serum potassium level of 6.1 mmol/l. The perianesthesia nurse anticipates the ECG waveform consisting of: A. Vfib B. low T waves with U waves C. peaked T waves D. Afib- A. Vfib B. low T waves with U waves C. peaked T waves D. Afib While caring for a 2 month old infant the perianesthesia nurse is aware the normal sleeping heart rate is: A. 70-120 B. 90-160 C. 85-205 D. 100-175- A. 70-120 B. 90-160 C. 85-205 D. 100-175 A patient in the PACU has an elevated pulmonary artery wedge pressure. The perianesthesia nurse's initial intervention is directed toward decreasing: A. afterload B. contractility C. central venous pressure D. preload- A. afterload B. contractility C. central venous pressure D. preload Preoperatively, a patient is evaluated in the perianesthesia clinic prior to bilateral femoral to femoral bypass grafting. History obtained by the perianesthesia nurse reveals severe cardiovascular disease with limited activity but no incapacitation. According to the American Anesthesiology Association, this patient would be an: A. ASA I B. ASA II C. ASA III D. ASA IV- A. ASA I B. ASA II C. ASA III D. ASA IV