Free CPAN Exam Flashcards

Phase I covers immediate recovery, including airway, ventilation, circulation and emergence. Phase II prepares a stabilized patient for home or continued care. Readiness for transfer follows clinical and facility criteria. CPAN focuses on Phase I care.

Airway and effective ventilation before any lower-priority intervention. Confirm a patent airway, adequate respiratory effort, and gas exchange first, then assess circulation, neurologic status, pain, and temperature. A normal single vital sign does not override a deteriorating airway.

On supplemental oxygen, SpO2 can stay falsely reassuring while ventilation is already failing because the oxygen reservoir delays desaturation. Capnography, respiratory rate and depth, chest movement, airway sounds, and mental status detect hypoventilation earlier than SpO2 alone.

Assess breathing and call for help as needed. Reposition the head and jaw, clear visible secretions, give oxygen, and assist ventilation if ineffective. Select an airway adjunct based on airway reflexes and contraindications. Escalate promptly if obstruction persists.

Sustained reflex glottic closure presenting as stridor, retractions, paradoxical chest movement, or silent (complete) obstruction. Call for help, apply jaw thrust and positive-pressure oxygen, remove airway stimulation, suction secretions, and prepare for medication support per protocol. Untreated laryngospasm leads to hypoxemia rapidly.

Forceful inspiration against an obstructed airway can produce pulmonary edema after laryngospasm or another obstruction. Hypoxemia, crackles and pink frothy secretions can appear soon after relief or after a delay. Maintain airway patency and provide oxygen or positive-pressure support as needed.

A physician is responsible for discharge from the PACU. When the responsible physician is absent, a PACU nurse may determine whether approved discharge criteria are met and records the name of the physician accepting responsibility. Criteria may vary by destination.

Weak cough, shallow breathing or upper airway collapse after a neuromuscular blocker can signal residual weakness. Support the airway and ventilation as needed, notify anesthesia, and check quantitative train-of-four monitoring.

The ASA recommends confirming a quantitative train-of-four ratio of at least 0.9 at the adductor pollicis before extubation after neuromuscular blockade. A patient can sustain a five-second head lift despite clinically important residual paralysis.

Sugammadex binds rocuronium or vecuronium and can reverse deep block at an appropriate dose. ASA recommends it over neostigmine for deep, moderate and shallow block from those drugs. Neostigmine with an antimuscarinic is an alternative at minimal block. Verify recovery quantitatively.

Neostigmine increases acetylcholine everywhere, causing muscarinic effects such as bradycardia, salivation, and bronchospasm. It is co-administered with an anticholinergic (glycopyrrolate or atropine) to block those muscarinic effects while still reversing neuromuscular blockade at the junction.

Succinylcholine is a rapid, short-acting depolarizing neuromuscular blocker. Key risks include hyperkalemia in susceptible patients, bradycardia, postoperative myalgia, and triggering malignant hyperthermia.

Paralysis is not sleep. Neuromuscular blockers produce skeletal muscle paralysis with no analgesia, no amnesia, and no unconsciousness. A weak patient may still be in pain or aware, so sedation and pain must be assessed separately from motor recovery.

Naloxone reverses opioid-induced respiratory depression. Abrupt reversal can cause severe pain, sympathetic surge, hypertension, nausea/vomiting, and rarely pulmonary edema, plus withdrawal in opioid-dependent patients. Critically, naloxone can wear off before the opioid does, so monitoring must continue after the patient improves.

Flumazenil reverses benzodiazepine sedation but may precipitate seizures in benzodiazepine-dependent patients or mixed overdose. It does NOT reverse opioid respiratory depression, residual neuromuscular blockade, inhalational anesthetic effect, hypoglycemia, or stroke. Re-sedation can occur as it wears off.

Produces rapid, smooth hypnosis with quick offset. PACU concerns are airway obstruction, apnea, and hypotension from vasodilation and reduced cardiac output. Hypotension after propofol-based anesthesia should still be evaluated against bleeding and hypovolemia rather than assumed to be only drug effect.

An alpha-2 agonist providing sedation and analgesia with comparatively little respiratory depression. The trade-off is bradycardia, hypotension, and sometimes delayed wakefulness. It is useful for opioid-sparing sedation but still requires hemodynamic surveillance.

Ketamine provides dissociative anesthesia and analgesia. Watch for emergence reactions, secretions, increased blood pressure or heart rate, and respiratory complications. Monitor ventilation and airway patency, especially with rapid IV dosing or other sedatives.

Ventilation helps eliminate inhaled anesthetic agents during emergence. Potent volatile anesthetics also increase PONV risk and trigger malignant hyperthermia in susceptible patients.

Suspect MH after exposure to a potent volatile anesthetic or succinylcholine when unexplained rising EtCO2, tachycardia, rigidity or acidosis develops. Hyperkalemia and dysrhythmias can follow. A rising temperature can occur later, so activate the response based on the clinical pattern.

Activate the MH response, stop trigger exposure, ventilate with 100% oxygen and give IV dantrolene promptly. The team also treats complications such as hyperkalemia and cools the patient when indicated.

Perioral numbness, metallic taste, tinnitus, agitation or seizure can follow local anesthetic administration. LAST can also present with isolated hypotension, conduction changes or arrhythmia, and onset can be delayed.

Stop local anesthetic administration, activate help, support oxygenation and ventilation, and obtain the LAST rescue kit. Prepare early 20% lipid emulsion for severe toxicity. When epinephrine is needed during LAST resuscitation, the ASRA checklist favors a smaller initial dose.

After witnessed aspiration or new cough, wheeze or hypoxemia with emesis, call for help, protect the airway, suction accessible material, and support oxygenation and ventilation. Assess promptly for ongoing respiratory compromise.

Increasing neck swelling, pressure, voice change or stridor after neck surgery requires immediate activation of the airway emergency response. Call anesthesia and the surgeon, give oxygen, and prepare for airway management and urgent decompression by the response team.

Postoperative agitation has many causes: hypoxia, hypercarbia, pain, bladder distention, hypoglycemia, residual anesthetic, and emergence delirium. Rule out physiologic causes — especially hypoxia and hypoventilation — before attributing agitation to emergence delirium. Sedating an agitated, hypoxic patient is dangerous.

Look for tachycardia, narrowing pulse pressure, cool skin, restlessness and falling urine output. Hypotension can appear later. Escalate signs of poor perfusion or increasing bleeding and compare drainage with the operation and previous trends.

Neuraxial blockade causes sympathetic blockade (vasodilation), producing hypotension; a high block can also block cardiac accelerator fibers, causing bradycardia. Management per orders typically includes fluids, positioning, vasopressors, and oxygen. Monitor block level — an ascending block threatens respiration.

An ascending neuraxial block causing progressive hypotension, bradycardia, dyspnea, hand/arm numbness, difficulty speaking, and ultimately apnea and loss of consciousness. This is a respiratory and hemodynamic emergency requiring airway/ventilatory support, circulatory support, and immediate anesthesia escalation.

Report the block type, expected duration, current motor and sensory findings, and mobility and fall precautions. Verify a safe transfer plan for the intended destination. Use assistance and protect the blocked limb until function returns as expected.

Classic for compartment syndrome, especially after extremity trauma or surgery. This is not a routine analgesia situation — perform an urgent neurovascular check and notify the provider immediately. Treating it as ordinary postoperative pain delays a limb-threatening diagnosis.

Interpret the rating with procedure, baseline opioid use, sedation level, respiratory rate and depth, blood pressure, and complication clues. Before giving more opioid, verify airway and ventilation. A somnolent, hypoventilating patient with high pain needs ventilatory support and a revised plan — not automatic dose escalation.

Combining mechanisms (acetaminophen, NSAIDs when appropriate, regional/local techniques, ice, positioning, and titrated opioids) reduces opioid burden. Cautions: NSAIDs in bleeding, renal impairment, or ulcer history; acetaminophen dose limits in liver disease or heavy alcohol use. Match the adjunct to the patient.

Increasing sedation can precede opioid-induced respiratory depression. Assess arousability, respiratory rate and depth, and capnography when indicated. Hold further opioid and support breathing if ventilation is impaired. Supplemental oxygen can delay desaturation.

Postoperative nausea and vomiting is a comfort issue that can also threaten the airway, wounds, and hemodynamics. Protect the airway first: position laterally or turn the head when appropriate, suction, withhold oral intake until safe, and assess for aspiration. Then give ordered antiemetics and support hydration.

Persistent vomiting with abdominal distention, blood in emesis, hypotension, severe headache, or new neurologic changes is not ordinary PONV. Connect the symptom to the procedure and anesthetic history and evaluate for bleeding, ileus, raised intracranial pressure, or a transfusion reaction before treating it as nausea.

Core temperature below about 36 C delays drug metabolism, worsens coagulopathy, increases wound complications, and triggers shivering. Use forced-air warming, warm blankets, warmed IV fluids if ordered, and continued temperature monitoring. Hypothermia also slows emergence and prolongs PACU stay.

Shivering sharply increases oxygen consumption and cardiac workload. In patients with coronary disease, anemia, limited pulmonary reserve, or major blood loss, this added demand can precipitate ischemia or hypoxemia. Active warming and ordered measures reduce shivering and its metabolic cost.

Communicate the resuscitation measures the patient or authorized surrogate agreed to, when any temporary change expires, and who is responsible for follow-up. Verify the documented plan during handoff.

Stop the transfusion immediately, assess the patient and notify the provider and blood bank. Maintain IV access with compatible normal saline using new tubing per protocol, without flushing the implicated tubing. Keep the product and tubing for investigation.

Oliguria may reflect hypovolemia, renal hypoperfusion, catheter obstruction or kinking, urinary retention (especially after neuraxial anesthesia or opioids), or medication/endocrine effects. Assess catheter patency and volume status before assuming intrinsic renal injury, and trend output against vital signs.

Renal impairment, tissue injury and succinylcholine in susceptible patients can raise potassium. Peaked T waves, conduction delay and QRS widening are possible, and an initially normal ECG can occur. Escalate promptly and follow the treatment protocol.

The Modified Aldrete score rates activity, respiration, circulation relative to baseline, consciousness, and oxygen saturation from 0 to 2 each, for a total of 0–10. It replaced the original color item with oxygen saturation.

Use the facility-approved scoring method and threshold for the intended destination. Assess airway, ventilation, hemodynamics and current complications alongside the score. Persistent instability requires escalation even if the total meets the threshold.

Confirm a responsible adult escort, safe transport and clear medication, activity and return precautions. Follow the patient-specific plan for supervision at home and driving restrictions. Escalate missing arrangements before discharge.

Teach-back has the patient or caregiver demonstrate or restate instructions, verifying what they can actually do after anesthesia-related sedation, anxiety, or limited health literacy. A yes/no question ("Do you understand?") only confirms agreement, not comprehension, and is weaker for discharge teaching.

SBAR (Situation, Background, Assessment, Recommendation) structures the anesthesia-to-PACU and PACU-to-unit handoff: anesthetic course, airway events, medications, fluids/blood loss, lines, drains, orders, allergies, and unresolved concerns. The nurse must clarify or escalate an unsafe or incomplete handoff before accepting routine transfer responsibility.

In pregnant patients (typically beyond mid-pregnancy), the supine position lets the gravid uterus compress the aorta and vena cava, reducing venous return and causing hypotension. Apply left uterine displacement or lateral tilt, and coordinate fetal and obstetric communication as ordered.

Report airway obstruction or desaturation during recovery, recent opioids, the prescribed positive airway pressure plan, and monitoring needs. Confirm the receiving team can provide the indicated level of care.

Chart objective findings, interventions, reassessments and notifications promptly. Follow the facility’s separate event-reporting and disclosure procedures. Include the clinical facts and care provided in the health record.