1. PACUs are:

• a. Under the direction of the surgery department.
• b. Under the direction of the anesthesiology department.
• c. Identical to ICUs.
• d. Staffed by specialists in all aspects of critical care.

2. All PACU bed spaces should:

• a. Have their own mechanical ventilation equipment.
• b. Be walled-off and separately ventilated for care of infectious patients.
• c. Have pulse oximeters, oxygen flow meters, and blood pressure monitoring equipment.
• d. Have a door leading directly to an OR.

3. A PACU nurse:

• a. Needs at least 60 minutes to take a patient from admission to discharge.
• b. Is assigned full-time to one patient for the duration of the patient's recovery.
• c. Is assigned full-time to two patients for the duration of their recovery.
• d. Must be trained to work in an ICU as needed.

4. During a typical day, PACUs tend to have the most patients:

• a. At night.
• b. In the late afternoon and evening.
• c. In the late morning and early afternoon.
• d. In the early morning.

5. When a patient is admitted to the PACU, the anesthesiologist:

• a. Remains in the PACU for the first 15 minutes to monitor the patient's emergence.
• b. Turns over medical responsibility to a PACU physician.
• c. Gives care orders and a report to the PACU nurse and remains medically responsible for the patient.
• d. Transmits a report electronically to the PACU nurse.

6. Oxygen supplementation is:

• a. Recommended for all PACU patients until they awaken.
• b. Recommended only for PACU patients with pre-existing respiratory or cardiovascular problems.
• c. Not needed by any conscious patients.
• d. Used only for patients on mechanical ventilation.

7. Most forms of general anesthesia:

• a. Can provide analgesia without affecting the patient's consciousness.
• b. Use tranquilizers and do not require intubation of the patient.
• c. Employ intravenous anesthetics.
• d. Use anesthetic gases.

8. Postoperative patients tend to recover from anesthesia more slowly in presence of this factor:

• a. The anesthetic is relatively insoluble.
• b. The surgery was short.
• c. The anesthetic's duration of action is long.
• d. The patient has poor ventilation.

9. A muscle relaxant reversal agent is:

• a. A drug that reverses the effect of local anesthetics, such as lidocaine.
• b. An anticholinesterase drug that allows postoperative patients to regain the use of their muscles more quickly.
• c. A nondepolarizing neuromuscular blocker used during surgery to paralyze the patient's muscles.
• d. A massage technique for increasing the tone of deep-tendon reflexes after surgery.

10. When discharged home from the PACU, all patients should:

• a. Have no pain, no nausea, and be able to drive themselves home.
• b. Be accompanied by an adult who will take responsibility for them.
• c. Have arranged in-home nursing care for the next few days.
• d. Refrain from eating solid food for 24 hours.

11. The Aldrete Scoring System is a standardized way to measure a postoperative patient's:

• a. Degree of nausea.
• b. Severity of pain.
• c. Readiness for discharge from the PACU.
• d. Blood oxygenation level.

12. Most antiemetic drugs used in the PACU are:

• a. Beta-adrenergic blockers.
• b. Antagonists or blockers of dopamine, acetylcholine, histamine, or serotonin.
• c. Vasopressors.
• d. Artificial adrenergic neurotransmitters.

13. Patients consider the worst parts of recovery from anesthesia to be:

• a. The nightmares remembered from when they were "under."
• b. The inability to drink, no matter how thirsty they are.
• c. Postoperative itching.
• d. Postoperative pain and nausea.

14. When preparing a patient for surgery resulting in postoperative pain, it is best to:

• a. Not mention pain.
• b. Promise that the pain will be minimal.
• c. Explain that pain is rare but that it can be completely relieved.
• d. Explain that postoperative pain is a normal occurrence after this surgery.

15. The Visual Analog Scale (VAS) for rating pain is:

• a. A horizontal line with "no pain" at the left end and "worst pain imaginable" at the right end.
• b. A clock face with "no pain" at 12 o'clock and "worst pain imaginable" at 6 o'clock.
• c. A vertical list of five degrees of pain (from top to bottom): "no pain," "minimal pain," "moderate pain," "severe pain," and "worst pain imaginable."
• d. A number line containing the integers 0–10 with the instructions: "Rate your degree of pain from 0=no pain to 10=worst imaginable pain."

16. Postoperative pain:

• a. Can't be relieved for most patients, so they kept sedated as long as possible.
• b. Is a necessary evil because it keeps the patient from movements that could reopen the incision.
• c. Can worsen the outcome of surgery.
• d. Is usually psychological, so counseling is the best pain reliever.

17. Intravenous morphine:

• a. Is dangerously addictive, even when used in the PACU.
• b. Will produce quick (4–5 minutes) pain relief.
• c. Is generally not as effective as oral NSAIDs.
• d. Will produce repiratory depression in 4–5 minutes.

18. Epidural anesthesia:

• a. Is used almost exclusively for relief of labor pains.
• b. Is an effective way to control postoperative pain.
• c. Is short-acting and must be repeated every 15–20 minutes.
• d. Has been rejected as an effective way to control postoperative pain.

19. Opioids:

• a. Can cause respiratory depression.
• b. Are a different class of drugs from narcotics.
• c. Cannot safely be given epidurally.
• d. Cannot safely be given intravenously.

20. The first step in treating an apparent airway obstruction in the PACU is:

• a. Administration of vasopressors.
• b. An emergency tracheotomy.
• c. Reintubation.
• d. Administration of oxygen.

21. Airway obstruction:

• a. Is rarely seen in a modern PACU.
• b. Usually requires a tracheotomy.
• c. Can be caused by laryngospasm.
• d. Cannot occur in an intubated patient unless the endotracheal tube is disconnected from the ventilator.

22. Postoperative hypoxemia:

• a. Is a common consequence of oxygen administration during surgery.
• b. Is a classic sign of hyperventilation; therefore, the response should be to drastically slow the patient's rate of breathing.
• c. Is lethal in less than 3 minutes so vasopressors must be administered quickly.
• d. Is indicated by a blood oxygen saturation (SpO₂) of <89–90%.

23. Hypercapnia:

• a. Means "retention of excess carbon dioxide in the blood."
• b. Can easily be recognized by the combination of cyanosis and hypotension.
• c. Can be measured at the bedside using pulse oximetry.
• d. Means "retention of excess capnic acid."

24. Hypoventilation:

• a. Is essentially the same thing as airway obstruction.
• b. Means "poor movement of air into and out of the alveoli of the lung."
• c. Means "a circulating blood volume that is less than normal."
• d. Is essentially the same thing as tachypnea.

25. Postoperative hypertension:

• a. Is usually caused by an in appropriate mix of anesthetics and opioids during surgery.
• b. Is surprisingly uncommon in patients with pre-existing hypertension.
• c. Requires that postoperative patients should be sent to a cardiac ICU.
• d. Is treated by relieving the stressor causing it; if unsuccessful, beta-adrenergic blockers are usually administered.

26. Hypovolemia:

• a. Is caused by too many IV fluid pushes.
• b. Is the most common cause of postoperative hypertension.
• c. Is indicated by tachycardia, cool extremities, dry mucous membranes, weak pulses, and scanty urine.
• d. Cannot be confidently diagnosed without measuring electrolytes.

27. Mild hypotension in the PACU:

• a. Requires immediate treatment with vasopressors.
• b. Usually can be managed by regular monitoring of the patient's condition.
• c. Is a blood pressure of 20–30% below the patient's preoperative baseline levels.
• d. Is typically the precursor to a hypertensive crisis.

28. In postoperative patients, tachycardia:

• a. Usually indicates stress, and the cause need not be a cardiac dysfunction.
• b. Usually indicates cardiac injury, most commonly a ruptured valve.
• c. Should be quickly controlled with vasopressors.
• d. Usually indicates cardiac injury, most commonly right-sided heart failure.

29. Core body temperature is most conveniently measured:

• a. In the armpit.
• b. Under the tongue.
• c. At the eardrum.
• d. Along the forehead.

30. Shivering during postoperative recovery:

• a. Is a sign of hyperthermia and best treated by cooling the patient with ice baths.
• b. Is a sign of unconscious fear and is best treated by psychological counseling.
• c. Can use a significant amount of oxygen and produce serious physiologic stress>
• d. Is a rebound reaction to muscle relaxants and is actually unrelated to a patient's body temperature.

31. Postoperative hyperglycemia:

• a. Is a crisis that must be treated with vasopressors.
• b. Only occurs in patients who have been on insulin preoperatively.
• c. Is caused in susceptible patients by the body's release of cortisol and glucagon in response to the surgery.
• d. Requires arterial blood gas testing to diagnose.

32. Delayed emergence from anesthesia:

• a. Describes the condition of a patient who has not awakened during the first 5–10 minutes after admission to the PACU.
• b. Usually results from lingering effects of anesthetics or other intraoperative medication.
• c. Usually means that the patient either does not want to awaken or is pretending to be asleep.
• d. Describes the condition of a patient who is still asleep when admitted to the PACU.

33. In the PACU, medication errors:

• a. Are extremely rare.
• b. Are usually caused by pressure from demanding patients.
• c. Are usually made by nurses, so pharmacists/physicians should dispense all PACU drugs.
• d. Include mistakes made by both nurses and physicians.

34. PACUs:

• a. May sometimes have to admit non-postoperative patients.
• b. Cannot be expected to take non-postoperative patients.
• c. Should care for the same variety of critically ill patients as any other ICU.
• d. Are surgical ICUs and should be expected to care for postoperative patients as long as needed.

35. Visitors to the PACU:

• a. Should be allowed when appropriate for nurses and patients.
• b. Should not be allowed because they pose a risk to other patient's safety.
• c. Should not be allowed because they upset the patients they are visiting.
• d. Should not be allowed because they violate other patients' privacy.

36. When there is no available PACU nurse to take a new admission, the best plan is probably to:

• a. Keep any postoperative patients in the OR under the care of the anesthesiologist.
• b. Move any postoperative patients to the ED.
• c. Transport postoperative patients to the PACU, where they can be held in a waiting line.
• d. Encourage the surgeon to use the available time to improve the suturing and bandaging on any waiting postoperative patients.

37. One safe and effective way to reduce patient discharge delays from the PACU is:

• a. Waiting to send the discharge information to the receiving unit until the next day.
• b. Skipping the calculation of discharge scores.
• c. Reducing the number of beds in the PACU.
• d. Notifying the receiving floor 15–30 minutes ahead of time for each discharge.