ABPANC ABPANC Perianesthesia Complications 2 — Questions and Answers
Question 1: A patient in Phase I PACU develops laryngospasm after extubation. Which intervention is performed first?
- Immediate oral suctioning and jaw thrust with 100% O2 by tight mask (Correct answer)
- Administer IV atropine 0.5 mg
- Position in prone position
- Administer oral antihistamine
Correct answer: Immediate oral suctioning and jaw thrust with 100% O2 by tight mask
Jaw thrust, oral suctioning of secretions, and 100% oxygen by tight-fitting mask with positive pressure are the initial interventions for laryngospasm.
Question 2: Which postoperative patient is at highest risk for developing emergence delirium in the PACU?
- A 35-year-old with appendectomy under general anesthesia
- A 4-year-old after tonsillectomy under sevoflurane (Correct answer)
- A 60-year-old after carpal tunnel release under local anesthesia
- A 25-year-old after laparoscopic procedure under propofol TIVA
Correct answer: A 4-year-old after tonsillectomy under sevoflurane
Young children, particularly those under 5, are at highest risk for emergence delirium after volatile anesthetic agents such as sevoflurane.
Question 3: A patient returns to the PACU after abdominal surgery with a blood pressure of 200/110. Which finding would most concern the nurse as a sign of hypertensive emergency?
- Mild headache with BP 200/110 only
- Severe headache, visual changes, and altered mental status with BP 200/110 (Correct answer)
- Anxiety and restlessness with BP 200/110
- Tachycardia at 100 bpm with BP 200/110
Correct answer: Severe headache, visual changes, and altered mental status with BP 200/110
Severe headache, visual disturbances, and altered mental status with markedly elevated BP indicate end-organ damage, defining a hypertensive emergency.
Question 4: A patient post-thyroidectomy develops progressive stridor, neck swelling, and dyspnea 2 hours after surgery. What is the priority intervention?
- Administer nebulized racemic epinephrine and observe
- Open the wound at the bedside to relieve hematoma compression on the airway (Correct answer)
- Administer IV methylprednisolone and transfer to the floor
- Apply ice pack to neck and reassess in 30 minutes
Correct answer: Open the wound at the bedside to relieve hematoma compression on the airway
Post-thyroidectomy neck hematoma is a surgical emergency requiring immediate wound opening at the bedside to relieve tracheal compression before airway loss occurs.
Question 5: Which electrolyte imbalance most commonly causes postoperative cardiac dysrhythmias in the PACU?
- Hypokalemia (Correct answer)
- Hypercalcemia
- Hypernatremia
- Hyperphosphatemia
Correct answer: Hypokalemia
Hypokalemia increases cardiac membrane excitability, predisposing patients to atrial and ventricular dysrhythmias in the postoperative period.
Question 6: A patient develops shivering in the PACU with a core temperature of 35.2°C (95.4°F). Which intervention helps reduce the metabolic demand caused by postoperative shivering?
- Apply cold blankets to lower fever
- Apply warm blankets and administer IV meperidine as ordered (Correct answer)
- Restrict all fluids
- Administer IV potassium chloride
Correct answer: Apply warm blankets and administer IV meperidine as ordered
Warm blankets raise core temperature while IV meperidine is the most effective pharmacological agent for suppressing postoperative shivering and its associated oxygen demand.
ABPANC ABPANC Perianesthesia Complications 2
A patient in Phase I PACU develops laryngospasm after extubation.
Which intervention is performed first?