ABPANC ABPANC Perianesthesia Complications 1 — Questions and Answers
Question 1: A patient in the PACU becomes agitated, tachycardic, and diaphoretic 20 minutes after receiving succinylcholine. Temperature is rising rapidly. What complication should the nurse suspect?
- Neuroleptic malignant syndrome
- Malignant hyperthermia (Correct answer)
- Septic shock
- Hypertensive emergency
Correct answer: Malignant hyperthermia
Malignant hyperthermia is a life-threatening hypermetabolic crisis triggered by volatile anesthetics or succinylcholine, characterized by rapid temperature rise, rigidity, and tachycardia.
Question 2: What is the first-line treatment for malignant hyperthermia?
- Haloperidol IV
- Dantrolene sodium IV (Correct answer)
- Propofol infusion
- Magnesium sulfate IV
Correct answer: Dantrolene sodium IV
Dantrolene sodium is the specific antidote for malignant hyperthermia; it inhibits calcium release from the sarcoplasmic reticulum to stop muscle hypermetabolism.
Question 3: A patient emerges from general anesthesia with stridor and increased work of breathing. Which intervention is the priority?
- Administer IV furosemide
- Apply jaw thrust and call for anesthesia provider immediately (Correct answer)
- Increase IV fluid rate
- Administer oral diphenhydramine
Correct answer: Apply jaw thrust and call for anesthesia provider immediately
Stridor post-extubation indicates partial airway obstruction; a jaw thrust opens the airway while immediately summoning anesthesia support for potential reintubation.
Question 4: A patient develops hypotension (BP 80/50) in the PACU after spinal anesthesia. Which intervention is most appropriate as the initial response?
- Administer IV epinephrine 1 mg
- Position the patient in Trendelenburg and administer IV fluid bolus as ordered (Correct answer)
- Apply a tourniquet to both legs
- Administer oral hydration only
Correct answer: Position the patient in Trendelenburg and administer IV fluid bolus as ordered
Spinal anesthesia causes sympathetic blockade leading to vasodilation; Trendelenburg positioning and IV fluid bolus are first-line treatments to restore preload and blood pressure.
Question 5: Which assessment finding is an early sign of postoperative pulmonary embolism (PE) in a PACU patient?
- Sudden onset tachycardia, dyspnea, and decreased SpO2 (Correct answer)
- Bradycardia with widened pulse pressure
- Gradual-onset hypertension over 2 hours
- Productive cough with purulent sputum
Correct answer: Sudden onset tachycardia, dyspnea, and decreased SpO2
Sudden tachycardia, dyspnea, and SpO2 drop are early warning signs of PE caused by obstruction of pulmonary blood flow.
Question 6: A patient becomes unresponsive with no palpable pulse in the PACU. What is the nurse's immediate priority action?
- Call the surgeon to the bedside
- Activate the emergency response system and begin CPR (Correct answer)
- Administer IV atropine
- Obtain a 12-lead ECG before intervening
Correct answer: Activate the emergency response system and begin CPR
In a pulseless patient, immediate activation of the emergency response system and initiation of CPR are the highest priorities per ACLS guidelines.
ABPANC ABPANC Perianesthesia Complications 1
A patient in the PACU becomes agitated, tachycardic, and diaphoretic 20 minutes after receiving succinylcholine.
Temperature is rising rapidly.
What complication should the nurse suspect?