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Prophecy PACU RN A V1 & V2, RN Pharmacology,
and Emergency Department Full Course Exam
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1. Meperidine (Demerol) Dose Calculation Q: Meperidine (Demerol) 12.5 mg IV every 15 minutes PRN is ordered for shivering in the PACU. The medication is available as 50 mg/mL. How many mL should be administered? A) 0.50 mL B) 0.75 mL C) 0.25 mL D) 1.0 mL Correct Answer: C) 0.25 mL Rationale: To calculate: 12.5 mg ÷ 50 mg/mL = 0.25 mL Accurate dosage calculation prevents medication errors. 2. Swelling at Epidural Site Q: Upon inspecting a patient's epidural insertion site, you notice swelling around the catheter. What is the most appropriate nursing action? 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 Correct Answer: D) Contact the anesthesia provider Rationale: Swelling may indicate a hematoma or infection; urgent evaluation is needed by the anesthesia team to prevent complications like nerve damage.
3. Phase 1 Discharge Readiness Q: Which of the following patient conditions indicates readiness for Phase 1 discharge? A) Received instructions, pain level 9/10, shortness of breath B) Drowsy, BP returned to baseline, on 6L O2 via mask C) Drowsy, O2 saturation 96%, able to cough and move all extremities D) Fully alert, shallow breathing, on 3L via T-piece, moves 2 extremities Correct Answer: C) Rationale: Phase 1 discharge criteria include stable vitals, adequate oxygenation, airway protection (cough reflex), and motor response. 4. Safe IV Fentanyl Dose in Opioid-Naive Adult Q: What is a safe IV fentanyl dose for an opioid-naïve adult? A) 1.5 mg B) 25 mcg C) 100 mcg D) 25 mg Correct Answer: B) 25 mcg Rationale: 25 mcg is a common safe initial IV dose for opioid-naïve adults. Larger doses (e.g., 100 mcg) are for tolerant patients; mg doses are dangerously high. 5. Priority Intervention for High BP and Pain in PACU Q: A patient in PACU is hypertensive, tachycardic, and in visible distress. What medication should you administer first? A) 10 mg Hydralazine IV B) 50 mcg Fentanyl IV C) 2 mg Lorazepam IV D) 5 mg Metoprolol IV Correct Answer: B) Rationale: Pain is likely causing the hypertension and tachycardia. Treating pain first addresses the underlying issue. Fentanyl is rapid-acting and appropriate here.
9. Neuromuscular Blockade Effect Q: Which of the following is a physical manifestation of neuromuscular blockade (e.g., Rocuronium)? A) Decreased consciousness B) Decreased pupillary reflex C) Decreased respiratory effort D) Decreased pain sensation Correct Answer: C) Rationale: Neuromuscular blockers paralyze skeletal muscles including the diaphragm. They do not affect consciousness or pain perception. 10. Penicillin Allergy and Ancef Order Q: The provider orders Ancef (cefazolin) for a patient with a penicillin allergy. What is the best action? A) Give with diphenhydramine B) Ask patient to describe reaction C) Contact pharmacist D) Contact provider to question order Correct Answer: D) Rationale: Ancef is a cephalosporin, which has a cross-sensitivity risk with penicillins. Always clarify with provider first before administration. 11. Dressing After Angioplasty Q: After a right lower extremity angioplasty, what dressing should you expect? A) JP drain on lateral calf B) Small calf/groin incisions with gauze C) Clear dressing over right groin D) 3-inch incision with bulky dressing Correct Answer: C) Rationale: PTA usually involves femoral artery access via right groin and a clear occlusive dressing is standard post-op.
12. Unprofessional Behavior During Handoff Q: During OR to PACU handoff, the OR nurse becomes rude and uncooperative. What should you do? A) Report the incident to the charge nurse B) Refuse to accept patient C) Accept report as given D) Rely on EMR to clarify Correct Answer: A) Rationale: This is a breakdown in communication and patient safety. Reporting ensures accountability and protects future patients. 13. Pain Medication Order for 8-Year-Old (Wrong Answer Corrected) Q: Which PRN order should you question for an 8-year-old post-op patient? A) IV Acetaminophen B) PO Acetaminophen C) PO Ketorolac D) IV Ketorolac Correct Answer: D) Rationale: IV Ketorolac is contraindicated in pediatric populations due to risk of GI bleeding, renal effects, and platelet dysfunction. Use with caution. 14. Physiologic Effect of Unrelieved Pain Q: Which is a physiologic effect of unrelieved pain? A) Hypoglycemia B) Bradycardia C) Decreased metabolism D) Decreased healing Correct Answer: D) Rationale: Uncontrolled pain increases stress hormones, which impair immune function and delay healing.
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?
- correct ans- - 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? - - correct ans- - 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? - - correct ans- - ***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? - - correct ans- - ***A) pupil checks B) pain scale C) capillary refill D) blood glucose WRONGThere are 4 patients in PACU: A patient who is alert but disoriented to time, a patient who reports dizziness upon sitting upright, a patient who has partial return of sensation after spinal, and a patient who is drowsy but awakens to touch.
Which patient is MOST ready to transfer to phase 2 post-anesthesia care? - - correct ans- - A) The patient who has partial return of sensation after spinal block B) The patient who is alert but disoriented to time C) The patient who is drowsy but awakens to touch WRONGD) The patient who reports dizziness upon sitting upright Your patient arrives to PACU with lactated ringer's ordered at 100ml/hr. Which pre- existing condition would make you question this order? - - correct ans- - A) Sickle cell anemia ***B) End Stage Renal Disease C) Gastroesophageal reflux D) Diabetes Mellitus While assessing your post-op patient with a new dialysis graft, what should the PACU nurse monitor to evaluate the functionality of the graft? - - correct ans- - A) Brisk capillary refill at the access site B) No numbness or tingling of the hand C) Clean, dry, and intact dressing ***D) A palpable thrill and audible bruit You are taking care of a 300lb male status post abdominal surgery, and he requests to be repositioned. He is currently on a hover mat. What is the BEST way to achieve this? - - correct ans- - 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? - - correct ans- - A) The patient's family member has arrived to take them home B) The patient is ready and able to ambulate to the bathroom
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? - - correct ans- - *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? - - correct ans- - 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? - - correct ans- - 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? - - correct ans- - A) Decreased oxygen consumption ***B) Increased oxygen demand C) Peripheral vasoconstriction D) Elevated end tidal CO WRONG What combination of medications is an example of multi-modal pain management? - - correct ans- - A) IV PCA morphine with IV fentanyl WRONGB) Oral morphine ER and IV morphine
C) IV hydromorphone and IV acetaminophen (probs correct, one is opioid, other is not) D) IV hydromorphone and IV morphine You are caring for a patient with a brachial plexus block after surgery. The patient begins to report chest discomfort on the side where the block was placed. A 12 lead EKG was normal. What order do you expect to be completed NEXT for this patient? - - correct ans- - A) Echo B) Cardiac biomarkers C) CMP ***D) Chest X-ray You need to obtain consent from a sedated patient post hip replacement surgery for a regional block. Two women showed up at bedside as next of kin. One has a child with patient and the other is the patient's girlfriend. How will you obtain the consent? - - correct ans- - A) Proceed with patient signature ***B) Look for patient's parents or immediate family members C) Allow one of the women to sign D) Allow both women to sign WRONG What instructions for care should you include when educating a patient about their Penrose drain? - - correct ans- - WORNGA) You will have bright red drainage from the tube for several days B) Change your dressing 2 times a day or when it becomes wet (very probs correct) C) This drainage tube 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? - - correct ans- - ***A) Hold the PCA infusion B) Elevate the head of bed 45 degrees
is recovering from Roux-en Y gastric bypass surgery. For which of the patient is the insertion of a nasopharyngeal airway contraindicated? - - correct ans- - 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? - - correct ans- - A) IV Epi B) IV Amio C) Chest compressions (probs correct) ****WRONG***D) Defib You're about to discharge a patient who speaks a Vietnamese dialect. The patient has a friend who speaks that same dialect but this friend is at home. What will you do in order to give patient appropriate discharge instructions? - - correct ans- - Use your organization's designated translating system What do you consider to be the SAFEST initial dose of IV hydromorphone for a 70 year- old without renal impairment? - - correct ans- - A) 0.5 mg B) 1 mg ***C) 0.2 mg D) 0.5 mcg WRONG In PACU, upon reviewing the order for a PCA, you have a question about it. Who should you contact? - - correct ans- - WRONGA) Hospitalist B) Anesthesiologist C) Critical Care Intensivist D) Surgeon
What information is important to include when providing patient education about the use of a PCA? - - correct ans- - Only you should press the button to receive pain medicine WRONG You observe a small amount of blood in the tubing of a continuous regional nerve block. What should you do FIRST? - - correct ans- - A) Look for signs of anesthesia toxicity B) Call anesthesia provider WRONGC) Asses patient's vital signs D) Apply ice pack to insertion site What safety measure should you take when applying a fentanyl transdermal patch? - - correct ans- - 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? - - correct ans- - 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? - - correct ans- - 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? - - correct ans- - WRONGA) Offer the patient a cup of water B) Perform a bladder scan (probs correct) C) Document unable to void
What assessment finding indicates that a patient is ready to tolerate ice chips? - - correct ans- - Patient is able to cough After day surgery, the patient is awake, reports 2 out of 10 pain, denies nausea, has voided, has stable vital signs, but has yet to receive discharge instructions. What level of care should this patient receive? - - correct ans- - Phase 2 Reversal of Midazolam - - correct ans- - Flumazenil A sedated patient has just arrived to the PACU from the operating room with the anesthesia provider and a member of the surgical team. What should you do next? - - correct ans- - Assess their airway and oxygenation WRONG (no idea what correct answer is) What drug is MOST effective in upper airway emergencies? - - correct ans- - A) Terbutaline B) Nebulized albuterol WRONGC) Humidified oxygen D) Racemic epinephrine WRONG You are caring for a patient in the PACU who was intubated and received general anesthesia during surgery. Now extubated, the patient reports feeling pain in their front tooth. Upon inspection, the tooth appears loose. What should you do? - - correct ans- - A) Contact the anesthesia provider and ask them to inspect the oral cavity (probs correct) WRONGB) Review the preoperative documentation about the patient's dentition C) 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? - - correct ans- - Inability to void A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. Which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl? A.Ampicillin B.Diazepam C.Furosemide D.Prednisone - - correct ans- - B. Diazepam, a benzodiazepine, is a CNS depressant, which can interact by causing the client to become severely sedated when administered concurrently with an opioid agonist or agonist/antagonist. A nurse is caring for a client who has cancer and is taking morphine and carbamazepine or pain. Which of the following effects should the nurse monitor for when giving the medications together? (Select all that apply.) A.Need for reduced dosage of the opioid B.Reduced adverse effects of the opioid C.Increased analgesic effects
should the nurse take when administering pamidronate? A.Inspect the skin for redness and irritation when changing the intradermal patch. B.Assess the IV site for thrombophlebitis frequently during administration. C.Instruct the client to sit upright or stand for 30 min following oral administration. D.Watch for manifestations of anaphylaxis for 20 min after Im administration - - correct ans- - B. Pamidronate is administered by IV infusion. This medication is irritating to veins, and the nurse should assess for thrombophlebitis during administration A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. monitor for urinary retention. B. monitor serum glucose. C. monitor serum potassium level.
D. monitor for gastric bleeding. E. monitor for respiratory depression - - correct ans- - B.monitoring serum glucose is important because glucocorticoids raise the glucose level, especially in clients who have diabetes mellitus. C.monitoring serum potassium level is important because glucocorticoids can cause hypokalemia. D.monitoring for gastric bleeding is important because glucocorticoids irritate the gastric mucosa and put the client at risk for a peptic ulcer. A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A.Decreased appetite B.Explosive diarrhea C.Decreased pulse rate D.Orthostatic hypotension - - correct ans- - D. Amitriptyline can cause orthostatic hypotension. The nurse should assess for this effect and instruct the client to move slowly from lying down or sitting after taking this medication.
