The perianesthesia nurse is titrating pain medications for a postoperative patient in Phase I
PACU. Pain medication orders have changed from IV fentanyl to IV morphine. The
perianesthesia nurse knows that an equivalent analgesic of fentanyl 0.1 mg is:
1. methadone 20 mg.
2. morphine 10 mg.
3. butorphanol 10 mg.
4. meperidine 125 mg. correct answers 2. morphine 10 mg.
According to ASPAN Standards of Perianesthesia Nursing Practice, care in the post
anesthesia Phase I focuses on:
1. preparation of patient and family for home care.
2. preparation of patient for extended care.
3. transition of the patient from an anesthetized state to Phase II or an inpatient setting.
4. transition of the patient from the preoperative to the intraoperative phase. correct answers
3. transition of the patient from an anesthetized state to Phase II or an inpatient setting.
The perianesthesia nurse is aware that the most important intervention for the pediatric
patient in emergence delirium is:
1. monitoring and controlling body temperature.
2. having a parent present.
3. the presence of padded side rails.
4. providing tender loving care. correct answers 3. the presence of padded side rails
An agitated, restless, and inconsolable patient arrives in the Phase I PACU. After initial
assessment, the perianesthesia nurse's next intervention is to:
1. bring family members to the bedside.
2.arouse the patient.
3. provide a safe environment.
4. medicate the patient for pain. correct answers 3. provide a safe environment
It is important for a perianesthesia nurse to understand that a child's ability to classify and
estimate pain normally develops around the age of:
1. 4 or 5 years.
2. 7 or 8 years.
3. 10 or 11 years.
4. 13 or 14 years. correct answers 1. 4 or 5 years
A 9-year-old child post appendectomy is in the PACU and is receiving morphine via patient-
controlled analgesia (PCA). The nurse observes the mother activating the PCA. The
perianesthesia nurse's most appropriate action is to:
1. notify the provider.
2. encourage the parent to activate the PCA as needed.
3. explain that only the patient is to operate the pump.
4. discontinue the PCA. correct answers 3. explain that only the patient is to operate the
pump.
The occurrence of post-dural puncture headache is most frequently attributed to:
1. a history of migraine headaches.
, 2. poor positioning.
3. a slow loss of cerebrospinal fluid at puncture site.
4. caffeine deprivation. correct answers 3. a slow loss of cerebrospinal fluid at puncture site.
According to ASPAN Standards of Perianesthesia Nursing Practice, staffing of perianesthesia
units should be based on:
1. a standard ratio regardless of acuity.
2. vacation schedules and bed availability.
3. patient acuity and physical facility.
4. the number of staff with ACLS and PALS. correct answers 3. patient acuity and physical
facility.
Upon awakening in the PACU, a 3-year-old patient is inconsolable and refuses the attention
of the nurse. The perianesthesia nurse is aware that this behavior is considered:
1. a normal response of the protest phase of separation anxiety.
2. passive resistance which is often used by toddlers.
3. to be related to the pain of surgery.
4. to be frustration related to the lack of privacy. correct answers 1. a normal response of the
protest phase of separation anxiety.
A patient is admitted to the PACU following a laparoscopic Nissen fundoplication.
Intraoperatively, the patient required chest tube placement for development of a tension
pneumothorax. The perianesthesia nurse understands that which of the following in the
patient's history could be problematic at this time?
1. Diabetes
2. COPD
3. Osteoporosis
4. Angina correct answers 2. COPD
After receiving an interscalene block, the patient complains of shortness of breath. The
perianesthesia nurse is aware that the block may have affected which nerve?
1. Transverse cervical
2. Supraclavicular
3. Phrenic
4. Recurrent laryngeal correct answers 3. Phrenic
While assisting an anesthesiologist performing a block for reflex sympathetic dystrophy, the
perianesthesia nurse observes that the affected arm becomes warm to the touch and flushed.
The patient reports a sensation of heaviness in the arm. The perianesthesia nurse knows that
this indicates which of the following?
1. Ineffective regional block
2. Severe allergic reaction
3. Successful therapeutic block
4. Extravasation of the medication correct answers 3. successful therapeutic block
While caring for a patient after lumbar posterior nerve root rhizotomy, the perianesthesia
nurse notes the patient has no movement or sensation to the lower extremities. The priority
nursing action is to notify the:
1. anesthesiologist of muscle paralysis.
2. operating room of the complications.