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Prophecy PACU RN A V1 2025 Questions &
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Meperidine (Demerol) 12.5mg every 15 minutes, IV prn is ordered for shivering in the PACU. Meperidine is available in 50mg/1ml. How many mililiters should be given? 0.25 mililiters Upon inspecting a patient’s epidural insertion site, you notice swelling around the catheter. What should you do? A) Position the patient on their side B) Place the patient in a prone position C) Check the epidural line for kinks *****D) Contact the anesthesia provider** What set of findings indicates a patient is likely to be ready for phase 1 discharge? A) Has received discharge instructions, pain level 9 out 10, shortness of breath B) Drowsy, blood pressure returned to preoperative levels, on 6 liters oxygen via face mask *****C) Drowsy, oxygen saturation of 96%, able to cough, and move all extremities** D) Fully alert, shallow breathing, on 3 liters via T-piece, can move 2 extremities What do you consider to be a safe dose of intravenous fentanyl for an adult who does not have tolerance to opioids? A) 1.5 miligrams *****B) 25 micrograms** C) 100 micrograms D 25 miligrams
Your patient in the PACU has a blood pressure of 171/92 mmHg, a heart rate of 120, respiratory rate of 24, is grimacing, restless, and moaning in bed. What medication should you prepare to give FIRST? A) 10 mg hydralazine IV push *****B) 50 mcg fentanyl IV push** C) 2 mg lorazepam IV push D) 5 mg metoprolol IV push You are about to discharge a day surgery patient with aphasia and you discover the family members are not available for the discharge instructions and are not responding to your phone calls. Business hours are over and the PACU is about to close. How will you handle the situation? *****A) Wait until the family returns** B) Leave the discharge education on voicemail and discharge patient C) Discharge patient with non-emergency transport D) Take patient home yourself You received a patient from OR post hip replacement surgery. The anesthesiologist is planning a nerve block in PACU, but the patient did not sign the consent for the nerve block. How will you proceed? A) Wake up the patient to sign the consent B) Ask a friend to sign the consent *****C) Obtain the consent from medical POA** D) Proceed with the procedure What position would help alleviate headaches after spinal anesthesia? A) Prone B) Trendelenburg C) Semi-fowlers *****D) Flat to supine**
WRONGYou are reviewing your orders for you 8 year-old patient that recently arrive in PACU. Which PRN pain order would you question? A) IV acetaminophen (maybe??? bc super expensive???) B) PO acetaminophen C) PO ketorolac (maybe???? bc shows increased risk of bleeding than tylenol, and is oral, which maybe they’re trying to avoid PO after surgery) WRONGD) IV ketorolac What is a physiologic effect related to unrelieved pain? A) Hypoglycemia B) Bradycardia C) Decreased metabolism ***D) Decreased healing You are caring for a patient after placement of a percutaneous J tube. A student nurse asks you, ” Where does this tube go in the patient?” How should you answer? ***A) The tube is placed into the Jejunum B) The tube passes from the esophagus into the jejunum This tube is inserted into the stomach D) The tube is inserted directly into the colon WRONGWhen caring for a patient who is recovering from placement of a new arteriovenous fistula in their right arm, you observe the presence of mild edema at the site. What should you do? A) Hold pressure on the anastomosis graft B) Elevate the right arm above the heart WRONGC) Apply an ice pack to the arm D) Contact the surgical team You are caring for patient who is intubated, receiving ventilatory support, and is sedated with a propofol infusion. Over the last 5 minutes you have decreased the propofol infusion in
preparation for extubation. The patient is now opening their eyes to voice and following commands. What should you do NEXT to prepare the patient for immediate extubation? A) Place a manual, resuscitator device at the bedside B) Insert an oral airway ***C) Stop the propofol infusion D) As the patient to cough When caring for a patient who is receiving outpatient surgery, what is the BEST way to know that a patient’s post-operative blood pressure is sufficient for discharge to home? A) The pressure is greater than 100 mmHg SBP ***B) It is +/- 20% of baseline pre-operative levels C) Adhere to professional standards D) Follow the anesthesia order set WRONGAfter surgery, a sleepy yet responsive patient with an intact gag reflex has a large amount of salivary secretions. What should you do? WRONGA) Turn the patient on their side B) Provide oral suctioning C) Contact the anesthesia provider D) Insert an oral airway Where is the phlebostatic axis for leveling the transducer of an arterial line? ***A) Fourth intercostal level at the midaxillary line B) Fourth intercostal level at the midclavicular line C) Fifth intercostal level at the midaxillary line D) Fifth intercostal level at the midclavicular line A carotid endarterectomy patient arrives to you in the PACU. What initial assessment is MOST important? ***A) pupil checks B) pain scale C) capillary refill D) blood glucose
A) Inflate the hover mat yourself and move the patient to his desired position B) Ask patient to move himself up in the bed ***C) Wait for additional assistance before moving the patient D) Tell your patient it is unsafe to move at this time What is an example of Phase 1 discharge criteria? A) The patient’s family member has arrived to take them home B) The patient is ready and able to ambulate to the bathroom ***C) The patient can maintain their airway D) The patient’s vital signs have been monitored for 60 minutes You were called in at 2am and did not leave the hospital until 4am. However, your regular shift starts at 7am, and you are extremely tired. What is the appropriate action? D) Call your manager and ask for the unit protocol WRONG You are caring for a patient in Phase 1 recovery and they appear ready to transfer except that their blood pressure continues to stay 50mmHg above their pre-anesthetic SBP. At home the patient takes a diuretic and beta-blocker for hypertension. What should you do? A) Evaluate the patient’s pain level (probs correct) WRONGB) Administer 20mg furosemide orally C) Transfer the patient to the unit D) Contact the anesthesia provider You receive a patient to Phase I recovery from IR status post cerebral aneurysm clipping. Which assessment is most important for you to perform? A) Cardiac rhythm, heart rate, blood pressure ***B) Pupil response, facial and extremity movement C) Bowel sounds, urinary output, and oral cavity D) RR, BP, Temp
Which patient is MOST at risk for developing postoperative cardiogenic shock? A) A 78 year old male adult with CKD ***B) Pt with recent MI C) Female pt with ES liver disease D) Pediatric patient with metastatic lymphadenopathy WRONG When setting up a morphine PCA pump for a 5’10” female patient recovering from hip surgery who is 49 years old, 180 lb, and has no history of sleep apnea, what is an expected 4-hr dose limit? *WRONGA) 5 mg B) 20 mg (probs correct) C) 3 mg D) 40 mg You are caring for a postoperative thyroidectomy patient in the PACU. What is the least likely finding for this patient? A) Paresthesia of the fingers and toes **B) Low Hgb C) Muscle Cramps D) Tingling in hands and feet WRONG After a 6 - hour abdominal surgery during which a patient was on their back, a patient reports persistent lower back pain. What should you do next? WRONGA) Help them to a new position B) Administer pain medication C) Inspect their lower back (probs correct, pt might be bleeding into back) D) Check their hematocrit What is a result of shivering? A) Decreased oxygen consumption ***B) Increased oxygen demand C) Peripheral vasoconstriction D) Elevated end tidal CO
helps prevent accumulation of bile D) Remove the safety pin at the end of the tube when you get home You are caring for a patient with a continuous basal rate PCA infusion when the patient becomes difficult to awaken. What should you do FIRST? ***A) Hold the PCA infusion B) Elevate the head of bed 45 degrees C) Stay with patient D) Contact anesthesia provider Which factor puts a patient MOST at risk for confusion upon awakening from general anesthesia? B) Advanced Age You are providing care for a diabetic patient in the PACU. What care should you provide to decrease their risk of surgical site infections? B) Maintain blood glucose levels per protocol and hand hygiene What department approves and reviews medical aspects of care in the PACU including policies and procedures? Department of Anesthesia When providing care to a patient in the PACU who is receiving placement of a new permanent vascular access graft, what finding should you report immediately to the surgeon? Inability to palpate a thrill
While helping to prepare a patient for surgery, you notice that their medical record indicates DNR. What should you do? Ask the patient to explain their wishes about resuscitation A patient’s DNR order was revoked during surgery. When can it be reinstated? Per institutional policy A patient who received general anesthesia tells you that their throat is sore and you notice their voice is hoarse. What should you do? provide ice chips and sips of water WRONG There are 4 patients in PACU: a patient who received surgery to repair their maxilla bone fracture, a patient recovering from esophageal resection for squamous cell cancer, a patient who is recovering from surgical placement of a tracheostomy, and a patient who is recovering from Roux-en Y gastric bypass surgery. For which of the patient is the insertion of a nasopharyngeal airway contraindicated? C) Maxilla bone fracture (probs correct) WRONG D) Patient recovering from tracheostomy WRONG You are caring for a patient when suddenly their ECG monitor shows coarse ventricular fibrillation. They become unable to rouse and pulseless. What is the PRIORITY intervention for this patient?
What safety measure should you take when applying a fentanyl transdermal patch? Wear gloves WRONG (very confused) You are caring for a patient in the PACU who is receiving an interscalene block for an upper extremity operation. When assessing the patient, you discover bilateral numbness of the chest and neck. What should you do NEXT? A) Clamp the infusion tubing B) Stop the infusion pump WRONGC) Double check the pump settings D) Provide supplemental oxygen To whom might you ask to apply a BiPAP? Respiratory Therapy WRONG A patient in phase 2 recovery has yet to urinate after surgery. You take the patient to the bathroom, and they are still unable to void. What should you do FIRST? WRONGA) Offer the patient a cup of water B) Perform a bladder scan (probs correct) C) Document unable to void D) Obtain an order for a catheter WRONG What sign or symptom should you closely monitor for in a patient after they have neck surgery? WRONGA) Severe Headache B) Tracheal Deviation C) Sudden disorientation D) Pain at incision site
A patient had malignant hyperthermia during surgery. What kind of monitoring should they receive? Intensive care unit monitoring for 24 hours Threshold for hypothermia in PACU? Less than 36 degrees Celsius WRONG You receive a patient who has just arrived from surgery and is in Phase 1 PACU. The patient is unresponsive to name, has a respiratory rate of 12, is receiving 6 L with a face mask, and is making a gurgling sound with each exhalation. What action is MOST appropriate? A) Ask the patient to state their name WRONGB) Turn patient on their side C) Insert oral airway (maybe???) D) Increase oxygen level After day surgery, a patient is drowsy, nauseated, reporting 7 out of 10 pain, and requiring 4 liters oxygen to maintain sat greater than 92%. What level of care should this patient receive? Phase 1 What condition increases a patient’s risk of respiratory depression when using a PCA pump? Sleep apnea What assessment finding indicates that a patient is ready to tolerate ice chips? Patient is able to cough
Secure the tooth by packing folded or rolled gauze around it D) Contact the surgical team and ask them to inspect the patient’s throat What would delay discharge home when caring for a patient who received spinal anesthesia? Inability to void
