CPAN Certification Practice Examination: Post-Anesthesia
Nursing in the PACU Comprehensive 150-Question Advanced
Practice Examination for CPAN Certification: Post-Anesthesia
Care Unit Nursing, Individually Scheduled Recovery, and
Evidence-Based Perianesthesia Practice Across the Continuum
Difficulty Level: Advanced / Hard
Target Audience: Post-anesthesia care unit (PACU) registered nurses preparing for CPAN certification
Instructions: Select the single best answer for each question. Answers and rationales follow each item.
References: This examination is derived from the CPAN® Test Blueprint (ABPANC, 2023), the ASPAN
2025-2026 Perianesthesia Nursing Standards, Drain's PeriAnesthesia Nursing: A Critical Care Approach
(8th ed.), and Certification Review for PeriAnesthesia Nursing (5th ed., ASPAN).
TABLE OF CONTENTS
Section Topic Questions
I Anesthesia Techniques and Agents (24%) 1–36
II Physiology and Pathophysiology (18%) 37–63
III Perianesthesia Monitoring and Intervention (35%) 64–116
IV Perianesthesia Care Considerations (14%) 117–138
V Professional Nursing Practice and Guidelines (9%) 139–150
SECTION I: ANESTHESIA TECHNIQUES AND AGENTS (Questions 1–36)
🟢 1. A 68-year-old patient arrives in the PACU with the following vital signs: BP 88/52 mmHg, HR 118
bpm, RR 24/min, SpO₂ 93% on 4 L nasal cannula, and temperature 35.8°C. The patient received general
anesthesia with sevoflurane and fentanyl. Which assessment finding is the priority concern?
A. Blood pressure of 88/52 mmHg
B. Heart rate of 118 bpm
C. Respiratory rate of 24/min
D. Core temperature of 35.8°C
🔴🔴 Correct Answer: D. Core temperature of 35.8°C indicates inadvertent perioperative hypothermia,
which is associated with impaired coagulation, increased surgical site infection risk, delayed drug
,metabolism, and prolonged PACU stay. While hypotension and tachycardia require attention,
hypothermia is the underlying cause of these hemodynamic changes and must be addressed first to
prevent further complications. The ASPAN Standards recommend measuring temperature on admission
to the PACU and initiating active warming measures for patients with core temperature below 36°C.
🟢 2. Which volatile anesthetic agent is most commonly associated with triggering malignant
hyperthermia?
A. Desflurane
B. Sevoflurane
C. Isoflurane
D. All of the above
🔴🔴 Correct Answer: D. All volatile halogenated anesthetic agents (desflurane, sevoflurane, isoflurane,
and halothane) are known triggers for malignant hyperthermia, along with the depolarizing muscle
relaxant succinylcholine. The PACU nurse must maintain a high index of suspicion for MH when a patient
presents with unexplained hypercarbia, tachycardia, and hyperthermia in the immediate postoperative
period.
🟢 3. A patient who received a spinal anesthetic for total knee arthroplasty arrives in the PACU with a
sensory block level of T10 and inability to move the lower extremities. The patient's blood pressure is
82/48 mmHg. What is the most appropriate initial nursing intervention?
A. Administer ephedrine 5 mg IV
B. Increase IV fluid rate and reposition the patient
C. Place the patient in Trendelenburg position
D. Notify the anesthesia provider immediately
🔴🔴 Correct Answer: B. Hypotension following spinal anesthesia is primarily due to sympathetic
blockade-induced vasodilation. The initial intervention should be to increase IV crystalloid infusion rate
and reposition the patient to optimize venous return. Vasopressors should be administered if fluid
resuscitation alone is insufficient. Notifying the anesthesia provider is appropriate but not the first
action.
🟢 4. Which of the following best describes the mechanism of action of sugammadex?
A. It inhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction
B. It encapsulates and inactivates aminosteroid neuromuscular blocking agents
C. It directly stimulates nicotinic receptors at the motor end plate
D. It blocks presynaptic calcium channels, reducing acetylcholine release
🔴🔴 Correct Answer: B. Sugammadex is a modified gamma-cyclodextrin that selectively encapsulates
and inactivates aminosteroid neuromuscular blocking agents (rocuronium and vecuronium), forming a
,complex that is excreted renally. Unlike neostigmine, sugammadex does not require
acetylcholinesterase inhibition and can rapidly reverse even deep neuromuscular blockade.
🟢 5. A 45-year-old patient received ketamine for induction of anesthesia. Upon arrival in the PACU, the
patient is agitated, confused, and reports vivid visual hallucinations. What is the most appropriate
pharmacological intervention?
A. Haloperidol 2 mg IV
B. Midazolam 1–2 mg IV
C. Diphenhydramine 25 mg IV
D. Naloxone 0.4 mg IV
🔴🔴 Correct Answer: B. Ketamine is a dissociative anesthetic that can cause emergence delirium
characterized by hallucinations, agitation, and confusion. Benzodiazepines such as midazolam are the
treatment of choice because they enhance GABAergic inhibition and counteract ketamine's excitatory
effects. Haloperidol is not first-line, and naloxone is ineffective because ketamine does not act on opioid
receptors.
🟢 6. Which statement regarding the pharmacodynamics of propofol is accurate?
A. Propofol has a rapid onset due to its high lipid solubility
B. Propofol provides significant analgesia at therapeutic doses
C. Propofol undergoes primarily renal excretion
D. Propofol causes hypertension through sympathetic stimulation
🔴🔴 Correct Answer: A. Propofol is highly lipid-soluble, which allows rapid crossing of the blood-brain
barrier and rapid onset of anesthesia. It does not provide analgesia and may actually cause hypotension
through vasodilation and myocardial depression. Propofol is metabolized primarily in the liver and
excreted renally as inactive metabolites.
🟢 7. A patient in the PACU who received vecuronium intraoperatively has a train-of-four (TOF) ratio of
0.7. Which of the following assessments is most consistent with this finding?
A. Adequate reversal of neuromuscular blockade
B. Residual neuromuscular blockade requiring intervention
C. Normal neuromuscular function
D. Overdose of neuromuscular blocking agent
🔴🔴 Correct Answer: B. A TOF ratio of less than 0.9 indicates residual neuromuscular blockade, which is
associated with impaired airway protection, aspiration risk, and respiratory insufficiency. The PACU
nurse should monitor for signs of weakness, difficulty swallowing, and inadequate respiratory effort, and
administer reversal agents as ordered.
, 🟢 8. Which of the following is a contraindication to the use of succinylcholine?
A. History of malignant hyperthermia
B. Renal insufficiency
C. Hepatic cirrhosis
D. Chronic obstructive pulmonary disease
🔴🔴 Correct Answer: A. Succinylcholine is absolutely contraindicated in patients with a personal or
family history of malignant hyperthermia because it is a potent trigger of MH crises. Other absolute
contraindications include hyperkalemia, burns older than 24–48 hours, spinal cord injury, and
denervation injuries due to the risk of massive potassium release.
🟢 9. A patient who received a lumbar plexus block for hip surgery arrives in the PACU. The nurse notes
that the patient has a foot drop on the operative side. What is the most appropriate nursing action?
A. Elevate the affected extremity
B. Document the finding and continue monitoring
C. Apply ice to the affected area
D. Notify the surgeon immediately
🔴🔴 Correct Answer: B. Foot drop following a lumbar plexus block is an expected finding due to the
motor blockade of the femoral nerve and its branches. It is a temporary effect that resolves as the local
anesthetic wears off. The nurse should document the finding, ensure patient safety (e.g., prevent falls),
and continue monitoring. Immediate surgical notification is not required unless the finding persists
beyond the expected duration of the block.
🟢 10. Which monitoring parameter is the most sensitive indicator of adequate reversal of neuromuscular
blockade?
A. Sustained head lift for 5 seconds
B. Tidal volume greater than 5 mL/kg
C. Train-of-four ratio greater than 0.9
D. Negative inspiratory force greater than 25 cm H₂O
🔴🔴 Correct Answer: C. A TOF ratio greater than 0.9 is the most sensitive and objective indicator of
adequate recovery from neuromuscular blockade. Clinical tests such as head lift and negative inspiratory
force are less sensitive and may be normal even in the presence of residual blockade.
🟢 11. A 32-year-old woman who is 34 weeks pregnant undergoes emergency appendectomy under
general anesthesia. Which anesthetic consideration is unique to this patient population?
A. Increased minimum alveolar concentration (MAC) requirement
B. Decreased risk of aspiration
Nursing in the PACU Comprehensive 150-Question Advanced
Practice Examination for CPAN Certification: Post-Anesthesia
Care Unit Nursing, Individually Scheduled Recovery, and
Evidence-Based Perianesthesia Practice Across the Continuum
Difficulty Level: Advanced / Hard
Target Audience: Post-anesthesia care unit (PACU) registered nurses preparing for CPAN certification
Instructions: Select the single best answer for each question. Answers and rationales follow each item.
References: This examination is derived from the CPAN® Test Blueprint (ABPANC, 2023), the ASPAN
2025-2026 Perianesthesia Nursing Standards, Drain's PeriAnesthesia Nursing: A Critical Care Approach
(8th ed.), and Certification Review for PeriAnesthesia Nursing (5th ed., ASPAN).
TABLE OF CONTENTS
Section Topic Questions
I Anesthesia Techniques and Agents (24%) 1–36
II Physiology and Pathophysiology (18%) 37–63
III Perianesthesia Monitoring and Intervention (35%) 64–116
IV Perianesthesia Care Considerations (14%) 117–138
V Professional Nursing Practice and Guidelines (9%) 139–150
SECTION I: ANESTHESIA TECHNIQUES AND AGENTS (Questions 1–36)
🟢 1. A 68-year-old patient arrives in the PACU with the following vital signs: BP 88/52 mmHg, HR 118
bpm, RR 24/min, SpO₂ 93% on 4 L nasal cannula, and temperature 35.8°C. The patient received general
anesthesia with sevoflurane and fentanyl. Which assessment finding is the priority concern?
A. Blood pressure of 88/52 mmHg
B. Heart rate of 118 bpm
C. Respiratory rate of 24/min
D. Core temperature of 35.8°C
🔴🔴 Correct Answer: D. Core temperature of 35.8°C indicates inadvertent perioperative hypothermia,
which is associated with impaired coagulation, increased surgical site infection risk, delayed drug
,metabolism, and prolonged PACU stay. While hypotension and tachycardia require attention,
hypothermia is the underlying cause of these hemodynamic changes and must be addressed first to
prevent further complications. The ASPAN Standards recommend measuring temperature on admission
to the PACU and initiating active warming measures for patients with core temperature below 36°C.
🟢 2. Which volatile anesthetic agent is most commonly associated with triggering malignant
hyperthermia?
A. Desflurane
B. Sevoflurane
C. Isoflurane
D. All of the above
🔴🔴 Correct Answer: D. All volatile halogenated anesthetic agents (desflurane, sevoflurane, isoflurane,
and halothane) are known triggers for malignant hyperthermia, along with the depolarizing muscle
relaxant succinylcholine. The PACU nurse must maintain a high index of suspicion for MH when a patient
presents with unexplained hypercarbia, tachycardia, and hyperthermia in the immediate postoperative
period.
🟢 3. A patient who received a spinal anesthetic for total knee arthroplasty arrives in the PACU with a
sensory block level of T10 and inability to move the lower extremities. The patient's blood pressure is
82/48 mmHg. What is the most appropriate initial nursing intervention?
A. Administer ephedrine 5 mg IV
B. Increase IV fluid rate and reposition the patient
C. Place the patient in Trendelenburg position
D. Notify the anesthesia provider immediately
🔴🔴 Correct Answer: B. Hypotension following spinal anesthesia is primarily due to sympathetic
blockade-induced vasodilation. The initial intervention should be to increase IV crystalloid infusion rate
and reposition the patient to optimize venous return. Vasopressors should be administered if fluid
resuscitation alone is insufficient. Notifying the anesthesia provider is appropriate but not the first
action.
🟢 4. Which of the following best describes the mechanism of action of sugammadex?
A. It inhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction
B. It encapsulates and inactivates aminosteroid neuromuscular blocking agents
C. It directly stimulates nicotinic receptors at the motor end plate
D. It blocks presynaptic calcium channels, reducing acetylcholine release
🔴🔴 Correct Answer: B. Sugammadex is a modified gamma-cyclodextrin that selectively encapsulates
and inactivates aminosteroid neuromuscular blocking agents (rocuronium and vecuronium), forming a
,complex that is excreted renally. Unlike neostigmine, sugammadex does not require
acetylcholinesterase inhibition and can rapidly reverse even deep neuromuscular blockade.
🟢 5. A 45-year-old patient received ketamine for induction of anesthesia. Upon arrival in the PACU, the
patient is agitated, confused, and reports vivid visual hallucinations. What is the most appropriate
pharmacological intervention?
A. Haloperidol 2 mg IV
B. Midazolam 1–2 mg IV
C. Diphenhydramine 25 mg IV
D. Naloxone 0.4 mg IV
🔴🔴 Correct Answer: B. Ketamine is a dissociative anesthetic that can cause emergence delirium
characterized by hallucinations, agitation, and confusion. Benzodiazepines such as midazolam are the
treatment of choice because they enhance GABAergic inhibition and counteract ketamine's excitatory
effects. Haloperidol is not first-line, and naloxone is ineffective because ketamine does not act on opioid
receptors.
🟢 6. Which statement regarding the pharmacodynamics of propofol is accurate?
A. Propofol has a rapid onset due to its high lipid solubility
B. Propofol provides significant analgesia at therapeutic doses
C. Propofol undergoes primarily renal excretion
D. Propofol causes hypertension through sympathetic stimulation
🔴🔴 Correct Answer: A. Propofol is highly lipid-soluble, which allows rapid crossing of the blood-brain
barrier and rapid onset of anesthesia. It does not provide analgesia and may actually cause hypotension
through vasodilation and myocardial depression. Propofol is metabolized primarily in the liver and
excreted renally as inactive metabolites.
🟢 7. A patient in the PACU who received vecuronium intraoperatively has a train-of-four (TOF) ratio of
0.7. Which of the following assessments is most consistent with this finding?
A. Adequate reversal of neuromuscular blockade
B. Residual neuromuscular blockade requiring intervention
C. Normal neuromuscular function
D. Overdose of neuromuscular blocking agent
🔴🔴 Correct Answer: B. A TOF ratio of less than 0.9 indicates residual neuromuscular blockade, which is
associated with impaired airway protection, aspiration risk, and respiratory insufficiency. The PACU
nurse should monitor for signs of weakness, difficulty swallowing, and inadequate respiratory effort, and
administer reversal agents as ordered.
, 🟢 8. Which of the following is a contraindication to the use of succinylcholine?
A. History of malignant hyperthermia
B. Renal insufficiency
C. Hepatic cirrhosis
D. Chronic obstructive pulmonary disease
🔴🔴 Correct Answer: A. Succinylcholine is absolutely contraindicated in patients with a personal or
family history of malignant hyperthermia because it is a potent trigger of MH crises. Other absolute
contraindications include hyperkalemia, burns older than 24–48 hours, spinal cord injury, and
denervation injuries due to the risk of massive potassium release.
🟢 9. A patient who received a lumbar plexus block for hip surgery arrives in the PACU. The nurse notes
that the patient has a foot drop on the operative side. What is the most appropriate nursing action?
A. Elevate the affected extremity
B. Document the finding and continue monitoring
C. Apply ice to the affected area
D. Notify the surgeon immediately
🔴🔴 Correct Answer: B. Foot drop following a lumbar plexus block is an expected finding due to the
motor blockade of the femoral nerve and its branches. It is a temporary effect that resolves as the local
anesthetic wears off. The nurse should document the finding, ensure patient safety (e.g., prevent falls),
and continue monitoring. Immediate surgical notification is not required unless the finding persists
beyond the expected duration of the block.
🟢 10. Which monitoring parameter is the most sensitive indicator of adequate reversal of neuromuscular
blockade?
A. Sustained head lift for 5 seconds
B. Tidal volume greater than 5 mL/kg
C. Train-of-four ratio greater than 0.9
D. Negative inspiratory force greater than 25 cm H₂O
🔴🔴 Correct Answer: C. A TOF ratio greater than 0.9 is the most sensitive and objective indicator of
adequate recovery from neuromuscular blockade. Clinical tests such as head lift and negative inspiratory
force are less sensitive and may be normal even in the presence of residual blockade.
🟢 11. A 32-year-old woman who is 34 weeks pregnant undergoes emergency appendectomy under
general anesthesia. Which anesthetic consideration is unique to this patient population?
A. Increased minimum alveolar concentration (MAC) requirement
B. Decreased risk of aspiration
