2015 CPAN® Answers

QUESTION OF THE WEEK | December 30, 2015

While planning care for patients in the perianesthesia setting the nurse is aware that the MOST effective infection prevention method is the use of:

  • 1. droplet precautions.
  • 2. cleaning of common items.
  • 3. standard precautions.
  • 4. limited traffic patterns.

Domain: Safety Needs

Content Area: Protect patient from harm and take preventive measures related to exposure to infections and diseases

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 46.

American Society of PeriAnesthesia Nurses. Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements 2015 – 2017. ASPAN, Cherry Hill, NJ, 2015. Pg 39.

QUESTION OF THE WEEK | December 23, 2015

In developing a care plan for a patient following an abdominal surgery, the NURSING PRIORITY is the prevention of:

  • 1. thrombophlebitis.
  • 2. hemorrhage.
  • 3. paralytic ileus.
  • 4. pneumonia.

Domain: Physiological Needs

Content Area: Stability of Respiratory System

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 585.

QUESTION OF THE WEEK | December 16, 2015

The patient status post cerclage is told to expect:

  • 1. a minimal amount of bloody spotting.
  • 2. postoperative abdominal cramping.
  • 3. frequent uterine contractions.
  • 4. dull low back pain.

Domain: Behavioral and Cognitive Needs

Content Area: Provide patient/family/significant other education, and evaluate understanding related to discharge care (including, but not limited to, wound care, diet, ambulation, physical therapy, effects on sexuality, pain management, catheter care, equipment and medical devices, routine course, and/or potential complications)

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 613.

QUESTION OF THE WEEK | December 09, 2015

The perianesthesia nurse caring for an infant in the PACU is aware that a side effect of ketamine is:

  • 1. an absent sucking/gag reflex.
  • 2. vertical nystagmus.
  • 3. 24 hours of restlessness.
  • 4. tachycardia.

Domain: Physiological Needs

Content Area: Stability of Cardiovascular System

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. Pg 216-217.

QUESTION OF THE WEEK | December 02, 2015

In caring for a patient following a radical prostatectomy, the perianesthesia nurse avoids the most common complication by application of:

  • 1. an abdominal binder.
  • 2. scrotal support.
  • 3. a hypothermia blanket
  • 4. antiembolism stockings.

Domain: Safety Needs

Content Area: Protect patient from harm and take preventive measures related to immobility and/or positioning.

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 606.

QUESTION OF THE WEEK | November 25, 2015

Physiologic anemia is a normal syndrome in infants at the age of:

  • 1. 3 months.
  • 2. 1 month.
  • 3. 12 months.
  • 4. 8 months.

Domain: Physiological Needs

Content Area: Stability of cardiovascular/peripheral vascular/hematological systems

Reference:

Hockenberry, M., Wilson, D. Wong’s Nursing Care of Infants and Children. 10th Ed. CV. Mosby, 2015. Pg 416.

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 692.

QUESTION OF THE WEEK | November 18, 2015

Hyponatremia following transurethral resection of the prostate is caused by:

  • 1. hemorrhage with subsequent sodium loss
  • 2. over hydration with hypotonic IV solutions
  • 3. excessive absorption of hypotonic irrigation solution
  • 4. sodium loss in the urine due to renal tubular damage

Domain: Physiological Needs

Content Area: Stability of fluids and electrolytes

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 604.

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. Pp 306, 879-880.

QUESTION OF THE WEEK | November 11, 2015

The post anesthesia nurse understands that oximetry monitoring may show a given SpO2 corresponding to a lower than normal PaO2 when the patient:

  • 1. has increased blood pressure.
  • 2. is severely hypothermic.
  • 3. is in excruciating pain.
  • 4. has had regional anesthesia.

Domain: Physiological Needs

Content Area: Stability of respiratory system

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pp 356-357.

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. Pg 1236.

QUESTION OF THE WEEK | November 04, 2015

The perianesthesia nurse questions a sudden withdrawal of beta blockers in the post coronary artery bypass patient because it may cause:

  • 1. ventricular fibrillation.
  • 2. atrial fibrillation.
  • 3. sinus tachycardia.
  • 4. sinus bradycardia.

Domain: Physiological Needs

Content Area: stability of cardiovascular/peripheral vascular/hematological systems

Reference:

Urden, L., et al. Thelan’s Critical Care Nursing, Diagnosis and Management, 7th Ed. Elsevier, 2014. Pg. 441-442.

QUESTION OF THE WEEK | October 28, 2015

After extubation of a patient, which of the following would be considered MOST serious?

  • 1. Sore throat
  • 2. Impaired swallowing ability
  • 3. Inspiratory stridor
  • 4. Hoarseness

Domain: Physiological Needs

Content Area: Airway management

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. andWindle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. Pg 227.

QUESTION OF THE WEEK | October 21, 2015

The best position for an unconscious patient who is post tonsillectomy and adenoidectomy would be:

  • 1. supine with the neck hyperextended.
  • 2. supine with the head of the bed elevated 45 degrees.
  • 3. side-lying with neck hyperextended.
  • 4. side-lying, with face partially down.

Domain: Safety Needs

Content Area: Protect patient from harm and take preventive measures related to positioning.

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. andWindle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. Pg. 1065-1066.

QUESTION OF THE WEEK | October 14, 2015

A 32-year-old patient is admitted to the PACU following a cesarean birth under epidural anesthesia. Her vital signs on admission are BP = 110/68 mm Hg, Pulse = 76, Respirations = 16. The patient is receiving magnesium sulfate IV 1.5 g/hour. One hour after admission, her signs are BP = 90/58 mm Hg, Pulse = 68, Respirations = 12. One and a half hours after admission, the patient becomes diaphoretic, her BP = 70/50 mm Hg, Pulse = 56, and Respirations = 8. The PACU nurse knows that these signs and symptoms indicate:

  • 1. magnesium deficiency.
  • 2. magnesium toxicity.
  • 3. vagal nerve stimulation.
  • 4. HELLP Syndrome.

Domain: Physiological Needs

Content Area: Stability of cardiovascular/peripheral vascular/hematological systems.

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 200.

QUESTION OF THE WEEK | October 07, 2015

The perianesthesia nurse is aware that a dramatic decrease in the serum calcium level may be caused by removal of the:

  • 1. parathyroid glands.
  • 2. pineal gland.
  • 3. adrenal glands.
  • 4. pituitary gland.

Domain: Physiological Needs

Content Area: Stability of endocrine system

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 579.

QUESTION OF THE WEEK | September 30, 2015

Since the demand has increased to improve postoperative quality of care while at the same time reducing the cost of health care, the perianesthesia nurse recognizes that it is most important to:

  • 1. network with colleagues.
  • 2. adopt evidence-based practice.
  • 3. formulate quality nursing care plans.
  • 4. adopt healthy habits.

Domain: Behavioral and Cognitive Needs

Content Area: Recognize and respect patient/family/significant other diversity (for example, cultural, religious, physical, age-related, cognitive, and language differences)

Reference:

Odom-Forren, J, Drain’s Peri-Anesthesia Nursing: A Critical Care Approach (6th). Elsevier Saunders, 2013. pp 66-67.

QUESTION OF THE WEEK | September 23, 2015

In caring for an epileptic, postoperative patient, the PACU nurse assesses muscle rigidity and jerking body movements as a result of:

  • 1. reversal with Flumazenil.
  • 2. an excessive dose of Neostigmine.
  • 3. a combination of Neostigmine with glycopyrrolate.
  • 4. a side effect of Ondansetron.

Domain: Physiological Needs

Content Area: Appropriate medication regimen (including, but not limited to, minimal interruption of normal medication regimen, preemptive interventions)

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. P 374.

QUESTION OF THE WEEK | September 16, 2015

In answer to a preoperative patient’s question about why gum chewing is not allowed before surgery, the perianesthesia nurse explains that chewing can:

  • 1. increase intra-abdominal gas pressure.
  • 2. promote gastric emptying.
  • 3. increase upper airway irritation.
  • 4. increase gastric acid secretions.

Domain: Behavioral and Cognitive Needs

Content Area: Assess patient/family/significant other's ability to learn, learning style (for example kinetic, auditory, visual), readiness to learn, and barriers to learning

Reference:

Odom-Forren, J. Drain’s PeriAnesthesia Nursing: A Critical Care Approach. 6th Ed. Elsevier Saunders, 2013. Pg 653.

QUESTION OF THE WEEK | September 09, 2015

An unrestrained, intubated patient is admitted to the PACU. The patient extubates himself 45 minutes after arrival with the cuff inflated, damaging the vocal cords. The PACU nurse is held liable for:

  • 1. assault.
  • 2. negligence.
  • 3. battery.
  • 4. error in use of equipment.

Domain: Safety Needs

Content Area: Facilitate patient access to appropriate resources and referrals (including, but not limited to, medical equipment, pharmaceutical care, pastoral care, nutritional education, physical therapy, case management/social services.

Reference:

Urden, L., et al. Thelan’s Critical Care Nursing, Diagnosis and Management, 7th Ed. Elsevier, 2014. p 32-42.

QUESTION OF THE WEEK | September 02, 2015

In providing preoperative teaching to a patient requesting spinal anesthesia, the perianesthesia nurse is aware that an absolute contraindication for spinal anesthesia is:

  • 1. patient refusal.
  • 2. chronic back pain.
  • 3. sickle cell anemia.
  • 4. multiple sclerosis.

Domain: Behavioral and Cognitive Needs

Content Area: Provide patient/family/significant other education and evaluate understanding related to advance directives, Patient Bill of Rights and informed consent

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. P 361.

QUESTION OF THE WEEK | August 26, 2015

When caring for a hypothermic patient, the PACU nurse questions a high SpO2 value when the patient has:

  • 1. an elevated platelet count.
  • 2. a decreased serum sodium.
  • 3. a low hemoglobin level.
  • 4. a high glucose level.

Domain: Physiological Needs

Content Area: Stability of cardiovascular/peripheral vascular/hematological systems

Reference:

Urden, L., et al. Thelan’s Critical Care Nursing, Diagnosis and Management, 7th Ed. Elsevier, 2014. p 512.

QUESTION OF THE WEEK | August 19, 2015

The PACU nurse evaluates the patient’s urine amount and color, intravenous fluid types and amounts, and pulmonary secretion characteristics after a major abdominal surgery in order to assess the patient for:

  • 1. third spacing.
  • 2. hyponatremia.
  • 3. abdominal distention.
  • 4. atelectasis.

Domain: Physiological Needs

Content Area: Stability of renal system

Reference:

Litwack, K. Clinical Coach for Effective Perioperative Nursing Care, F.A. Davis Co., 2009. pp 113-114, 168-9.

QUESTION OF THE WEEK | August 12, 2015

A perianesthesia nurse communicates with the postoperative patient for the first time. Culturally sensitive communication (listening) is demonstrated by:

  • 1. addressing the patient by the last name.
  • 2. asking about the surgical pain.
  • 3. addressing the patient by first name.
  • 4. asking the patient what name should be used.

Domain: Behavioral and Cognitive Needs

Content Area: Recognize and respect patient/family/significant other diversity (for example, cultural, religious, physical, age-related, cognitive, and language differences)

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. P 128.

QUESTION OF THE WEEK | August 05, 2015

OSHA mandates that when inserting an intravenous fluid access in a patient, the PACU nurse must:

  • 1. wash hands.
  • 2. wear gloves.
  • 3. use an antibacterial gel.
  • 4. wear eye goggles.

Domain: Safety Needs

Content Area: Protect patient from harm and take preventive measures related to exposure to infections and diseases.

Reference:

Odom-Forren, J, Drain’s Peri-Anesthesia Nursing: A Critical Care Approach (6th). Elsevier Saunders, 2013. pp 45-46.

QUESTION OF THE WEEK | July 29, 2015

In the event that a pharmacologically paralyzed pediatric patient is inadvertently extubated, the first priority of the PACU nurse is to:

  • 1. notify anesthesiologist and prepare intubation tray.
  • 2. administer an anticholinesterase drug immediately.
  • 3. reassure patient and observe fall precaution.
  • 4. establish and maintain the airway and ventilation.

Domain: Physiological Needs

Content Area: Stability of neurological system

Reference:

Urden, L., et al. Thelan’s Critical Care Nursing, Diagnosis and Management, 7th Ed. Elsevier, 2014. p 1099.

QUESTION OF THE WEEK | July 22, 2015

The perianesthesia nurse is aware that the type of pain rating scale that is most appropriate for the preschool child is the:

  • 1. descriptive scale.
  • 2. faces scale.
  • 3. chips scale.
  • 4. numeric scale.

Domain: Behavioral and Cognitive Needs

Content Area: Recognize and respect patient/family/significant other diversity (for example, cultural, religious, physical, age-related, cognitive, and language differences)

Reference:

Wong, D. Nursing Care of Infants and Children. 9th Ed. CV. Mosby, 2011. Pg 182t.

QUESTION OF THE WEEK | July 13, 2015

In caring for a patient with sickle cell anemia, the perianesthesia nurse applies measures to prevent a crisis by:

  • 1. limiting fluid intake.
  • 2. maintaining body temperature below 36 degrees.
  • 3. administering a vasodilator.
  • 4. maintaining body temperature between 36 to 37 degrees.

Domain: Physiological Needs

Content Area: Stability of respiratory system

Reference:

American Society of PeriAnesthesia Nurses. Schick, L. and Windle, P., (Editors) Third Edition. Perianesthesia Nursing Core Curriculum – Preoperative, Phase I and Phase II PACU Nursing. WB Saunders, St. Louis, MO., 2015. P 115-116.

If you would like to have the question delivered to your inbox each week you can sign up for the Study Question of the Week program.