NURS 5450 Exam 3 (Post-Anesthesia Care & Recovery):
Questions With Solutions
What is postanesthetic recovery? Correct Answer - Activities to manage
the patient after the completion of a surgical or non-surgical procedure in
which sedation, anesthesia, or analgesia was administered
What is required of a Postanesthetic Recovery Unit? Correct Answer -
Fully equipped with monitors, medications, and RN personnel to assist in a
smooth transition to the ICU, post-surgical floor, ambulatory care unit, or
home
What is PHASE I RECOVERY? Correct Answer - Immediate ICU level care -
from emergence and awakening until standard discharge criteria are met
What is PHASE II RECOVERY? Correct Answer - Less intensive care that
ensures the patient is ready to go home. Some situations allow for a patient to
bypass PHASE I Recovery and go directly to PHASE II, but patient must meet
same criteria...
What is the primary purpose of postanesthesia care? Correct Answer - 1.
Critical assessment and stabilization of patients
2. Emphasis on prevention and detection of COMPLICATIONS
What is the most frequent cause of delayed emergence? Correct Answer -
Residual drug effects (30-60 minutes post-general anesthesia)
What are the adult pharmacologic treatment for residual anesthetic drug
effects? Correct Answer - 1. Naloxone (80mcg increments) - narcotic
reversal
2. Flumazenil (0.2 mg increments) - benzodiazepine reversal
3. Physostigmine (1-2 mg) - barbiturate, benzo, anticholinergic reversal
Besides residual drug effects, what are other causes of delayed emergence?
Correct Answer - 1. Hypothermia
2. Metabolic disturbances
3. Perioperative stroke
,What patient conditions must be present before the anesthesia provider can
leave the patient with PACU staff? Correct Answer - 1. Patent airway
2. Adequate oxygenation/ventilation
3. Hemodynamically stable
What must the anesthesia provider do if the patient remains unstable or does
not meet extubation criteria upon transfer to PACU? Correct Answer - 1.
LEAVE INTUBATED
2. Transport patient with appropriate monitors, medications, and adequate
supplemental O2 to PACU
How should airway patency be monitored during transport? Correct
Answer - 1. Hypoventilation while receiving supplemental O2 is not reliably
detected with pulse oximetry
2. Adequate monitoring must include: look, listen, feel
What patient positioning must the transport stretcher be capable of?
Correct Answer - 1. Trendelenberg - in case of hypotension
2. Reverse Trendelenberg - r/t aspiration risk, also easier for obese pts to
breathe
What should PACU assessment and monitoring focus on? Correct Answer -
1. Oxygenation - Pulse Ox
2. Ventilation - RR, patent airway, chest movement, capnography
3. Circulation - BP, HR, ECG
4. Vital Signs - Every 15 minutes
What should a good handoff report to PACU include? Correct Answer - 1.
General info - name, age, procedure, surgeon
2. History - allergies, indications for surg, chronic issues, meds
3. Intraoperative Management - type of anesthesia, narcotic and versed totals,
antibiotics given, diuretics, vasopressors, fluids and blood given, blood loss,
urine output
4. Complications - anesthetic or surgical
5. Needs in PACU - Xray, ABG, Meds, Pain management, CPAP
What is the most common cause of UPPER airway obstruction in the
UNCONSCIOUS patient? Correct Answer - Tongue falling back along the
posterior pharynx
, What are other causes of upper airway obstruction? Correct Answer - 1.
Laryngospasm
2. Glottic edema
3. Retained throat packing
4. Bloody airway
5. External pressure - e.g., from neck hematoma
6. Residual NMBA
What are signs/symptoms of upper airway obstruction? Correct Answer -
1. Snoring
2. Absence of breath sounds
3. Paradoxical chest movement
How is upper airway obstruction treated? Correct Answer - 1.
Supplemental O2
2. Jaw thrust
3. Chin-lift maneuver
4. Nasal or Airway Insertion
What do you hear with a laryngospasm? Correct Answer - 1. High pitched
crowing noise OR
2. SILENT, with complete glottic closure
How do you treat laryngospasm? Correct Answer - 1. Jaw Thrust
2. Apply gentle Positive Pressure (up to 40cm H2O)
3. May need airway
4. Suction
5. May use 10-20mg of Succinycholine
What do you NOT do if vocal cords are in spasm or closed? Correct Answer
- DO NOT TRY TO INTUBATE!!!
When is glottic edema most commonly seen? Correct Answer - 1. Children
cases
2. ENT cases
How is glottic edema treated? Correct Answer - 1. Decadron (0.5mg/kg)
and
Questions With Solutions
What is postanesthetic recovery? Correct Answer - Activities to manage
the patient after the completion of a surgical or non-surgical procedure in
which sedation, anesthesia, or analgesia was administered
What is required of a Postanesthetic Recovery Unit? Correct Answer -
Fully equipped with monitors, medications, and RN personnel to assist in a
smooth transition to the ICU, post-surgical floor, ambulatory care unit, or
home
What is PHASE I RECOVERY? Correct Answer - Immediate ICU level care -
from emergence and awakening until standard discharge criteria are met
What is PHASE II RECOVERY? Correct Answer - Less intensive care that
ensures the patient is ready to go home. Some situations allow for a patient to
bypass PHASE I Recovery and go directly to PHASE II, but patient must meet
same criteria...
What is the primary purpose of postanesthesia care? Correct Answer - 1.
Critical assessment and stabilization of patients
2. Emphasis on prevention and detection of COMPLICATIONS
What is the most frequent cause of delayed emergence? Correct Answer -
Residual drug effects (30-60 minutes post-general anesthesia)
What are the adult pharmacologic treatment for residual anesthetic drug
effects? Correct Answer - 1. Naloxone (80mcg increments) - narcotic
reversal
2. Flumazenil (0.2 mg increments) - benzodiazepine reversal
3. Physostigmine (1-2 mg) - barbiturate, benzo, anticholinergic reversal
Besides residual drug effects, what are other causes of delayed emergence?
Correct Answer - 1. Hypothermia
2. Metabolic disturbances
3. Perioperative stroke
,What patient conditions must be present before the anesthesia provider can
leave the patient with PACU staff? Correct Answer - 1. Patent airway
2. Adequate oxygenation/ventilation
3. Hemodynamically stable
What must the anesthesia provider do if the patient remains unstable or does
not meet extubation criteria upon transfer to PACU? Correct Answer - 1.
LEAVE INTUBATED
2. Transport patient with appropriate monitors, medications, and adequate
supplemental O2 to PACU
How should airway patency be monitored during transport? Correct
Answer - 1. Hypoventilation while receiving supplemental O2 is not reliably
detected with pulse oximetry
2. Adequate monitoring must include: look, listen, feel
What patient positioning must the transport stretcher be capable of?
Correct Answer - 1. Trendelenberg - in case of hypotension
2. Reverse Trendelenberg - r/t aspiration risk, also easier for obese pts to
breathe
What should PACU assessment and monitoring focus on? Correct Answer -
1. Oxygenation - Pulse Ox
2. Ventilation - RR, patent airway, chest movement, capnography
3. Circulation - BP, HR, ECG
4. Vital Signs - Every 15 minutes
What should a good handoff report to PACU include? Correct Answer - 1.
General info - name, age, procedure, surgeon
2. History - allergies, indications for surg, chronic issues, meds
3. Intraoperative Management - type of anesthesia, narcotic and versed totals,
antibiotics given, diuretics, vasopressors, fluids and blood given, blood loss,
urine output
4. Complications - anesthetic or surgical
5. Needs in PACU - Xray, ABG, Meds, Pain management, CPAP
What is the most common cause of UPPER airway obstruction in the
UNCONSCIOUS patient? Correct Answer - Tongue falling back along the
posterior pharynx
, What are other causes of upper airway obstruction? Correct Answer - 1.
Laryngospasm
2. Glottic edema
3. Retained throat packing
4. Bloody airway
5. External pressure - e.g., from neck hematoma
6. Residual NMBA
What are signs/symptoms of upper airway obstruction? Correct Answer -
1. Snoring
2. Absence of breath sounds
3. Paradoxical chest movement
How is upper airway obstruction treated? Correct Answer - 1.
Supplemental O2
2. Jaw thrust
3. Chin-lift maneuver
4. Nasal or Airway Insertion
What do you hear with a laryngospasm? Correct Answer - 1. High pitched
crowing noise OR
2. SILENT, with complete glottic closure
How do you treat laryngospasm? Correct Answer - 1. Jaw Thrust
2. Apply gentle Positive Pressure (up to 40cm H2O)
3. May need airway
4. Suction
5. May use 10-20mg of Succinycholine
What do you NOT do if vocal cords are in spasm or closed? Correct Answer
- DO NOT TRY TO INTUBATE!!!
When is glottic edema most commonly seen? Correct Answer - 1. Children
cases
2. ENT cases
How is glottic edema treated? Correct Answer - 1. Decadron (0.5mg/kg)
and
