Hematalogical
A patient's recovery from vascular surgery is uneventful and the patient has been started on heparin intraoperatively for the prevention of thromboembolism. On routine assessment the nurse notes the patient has developed bleeding gums. The nurse reviews the labs and notes that the platelet count is 98,000. What should the nurse do?
A. Nothing as this is an expected side effect of heparin therapy
B. Call the physician and ask if he or she would like to decrease the heparin dose
C. Call the physician and ask if he or she would like to increase the heparin dose
D. Call the physician and ask if he or she would like to discontinue the heparin
✅ Answer: D. Call the physician and ask if he or she would like to discontinue the heparin
Rationale:
The patient has:
This raises concern for heparin-induced thrombocytopenia (HIT).
The nurse should recognize that HIT is potentially life-threatening because it can cause thrombosis despite the low platelet count. Heparin should be discontinued when HIT is suspected, and the provider should be notified promptly.
A is incorrect: Thrombocytopenia with bleeding is not something to simply accept as an expected effect.
B is incorrect: Decreasing the dose does not adequately address suspected HIT.
C is incorrect: Increasing heparin could worsen the situation.
What is the most common site of pulmonary aspiration?
A. Right lung
B. Left lung
C. Left bronchus
D. Pharynx
✅ Answer: A. Right lung
Rationale:
The right mainstem bronchus is more vertical, shorter, and wider than the left mainstem bronchus. Therefore, aspirated material is more likely to enter the right lung.
CAPA Tip:
Aspiration → RIGHT side.
The anesthesia provider administered a nondepolarizing neuromuscular blocking agent (NMBA) during induction. A reversal agent was given before admission to the Phase I PACU. The patient initially was awake and talking. After 20 minutes, the patient becomes unarousable, with shallow respirations at 6/minute, BP 90/60, and HR 70.
The initial nursing intervention is:
A. Apply O₂ by nasal cannula at 4 L/min
B. Administer a repeat dose of the NMBA reversal agent
C. Apply a bag-valve-mask device for ventilation support
D. Initiate cardiopulmonary resuscitation (CPR)
✅ Answer: C. Apply a bag-valve-mask device for ventilation support
Rationale:
The patient has severe respiratory depression with a respiratory rate of only 6/min and is unarousable. The priority is airway and ventilation.
The nurse should immediately provide positive-pressure ventilation with a bag-valve-mask and oxygen while calling for assistance and preparing for further airway management.
The patient's problem may represent residual neuromuscular blockade, but the immediate priority is correcting inadequate ventilation.
🧠 CAPA Tip:
Unresponsive + RR 6 = ventilate FIRST.
ABC → Airway → Breathing → Circulation.
A 57-year-old male has had a left iliac thrombectomy. He has been in the Phase I PACU for 45 minutes. The nurse is giving a handoff report. Included in the handoff of care should be the condition of the surgical site dressing and:
A. Pulses and temperature of the lower extremities
B. Color and pulses of the left lower extremity
C. Color, warmth, and pulses of the affected extremities
D. Color, warmth, sensation, and pulses of both lower extremities
✅ Answer: D. Color, warmth, sensation, and pulses of both lower extremities
Rationale:
After vascular surgery, a complete neurovascular assessment is essential.
The nurse should assess:
Both extremities should be assessed so the affected limb can be compared with the unaffected limb.
This helps identify impaired circulation, ischemia, thrombosis, or other postoperative complications.
🧠 CAPA Memory Trick:
Vascular patient = 4 things:
Color + Warmth + Sensation + Pulses
A patient has a platelet count of 50,000 and is diagnosed with immune thrombocytopenic purpura. The nurse would expect initial treatment to include:
A. Splenectomy
B. Corticosteroids
C. Administration of platelets
D. Immunosuppressive therapy
✅ Answer: B. Corticosteroids
Rationale:
ITP is an autoimmune disorder in which the immune system destroys platelets, resulting in thrombocytopenia.
Corticosteroids are commonly used as initial therapy because they suppress the immune-mediated destruction of platelets.
🧠 CAPA Tip:
ITP = immune destruction of platelets → steroids first.
A patient in the Phase I PACU after repair of an abdominal aortic aneurysm is receiving a low-dose intravenous ketamine infusion as part of the pain-management plan. The nurse recognizes that addition of ketamine to the regimen is associated with all of the following EXCEPT:
A. Improved pain control
B. Lower opioid requirements
C. Less nausea
D. Increased psychomimetic effects
✅ Answer: D. Increased psychomimetic effects
Rationale:
Low-dose ketamine can be used as an analgesic adjunct. It can:
At low doses used for analgesia, significant psychomimetic effects are generally minimized. Therefore, increased psychomimetic effects are the exception in this context.
CAPA Tip:
Low-dose ketamine = better analgesia + opioid-sparing.
The anesthesia provider returns to the patient's bedside and prepares to administer:
A. Neostigmine and epinephrine
B. Phenylephrine or glycopyrrolate
C. Phenylephrine or atropine
D. Neostigmine and glycopyrrolate
✅ Answer: D. Neostigmine and glycopyrrolate
Rationale:
Neostigmine is used to reverse the effects of many nondepolarizing neuromuscular blocking agents.
Neostigmine increases acetylcholine at the neuromuscular junction, helping restore muscle strength.
Glycopyrrolate is administered with neostigmine to reduce unwanted muscarinic effects such as:
🧠 CAPA Memory Trick:
Neostigmine = reverses paralysis
Glycopyrrolate = protects against muscarinic effects
A patient with thrombocytopenia and active bleeding has 2 units of platelets prescribed. To administer the platelets, the nurse:
A. Checks for ABO compatibility
B. Agitates the bag periodically during the transfusion
C. Takes vital signs every 15 minutes during the procedure
D. Refrigerates the second unit until the first unit has transfused
✅ Answer:B
Laboratory values for a patient with hypotension and abdominal bleeding include a hematocrit of 30%, platelets 50,000/mm³, and INR 1.3. In addition to administering a fluid bolus of 250 mL of normal saline, the nurse anticipates administration of which of the following?
A. 1 unit of packed red blood cells (RBCs)
B. 6 units/300 mL of platelets
C. Fresh-frozen plasma 4 units/250 mL
D. 50 mL of salt-poor albumin/25% albumin
✅ Answer: B. 6 units/300 mL of platelets
Rationale:
The most significant abnormality is the platelet count of 50,000/mm³ in a patient who is actively bleeding. Platelets are needed to help form an effective platelet plug and control bleeding.
The INR of 1.3 is only mildly elevated, so FFP is not the best choice based on the information given. A hematocrit of 30% alone does not necessarily indicate the need for RBC transfusion.
CAPA Tip:
Active bleeding + very low platelets → think platelet transfusion.
On physical assessment of the patient with severe anemia, the nurse would expect to find:
A. Nervousness and agitation
B. Fever and peeling of the skin
C. Systolic murmur and tachycardia
D. Bluish mucous membranes and reddened tissues
✅ Answer: C. Systolic murmur and tachycardia
Rationale:
With severe anemia, the blood has a reduced oxygen-carrying capacity. The cardiovascular system compensates by increasing cardiac output.
Expected findings can include:
A systolic flow murmur may occur because blood flows more rapidly through the heart.
D is incorrect: Bluish mucous membranes suggest cyanosis and are not a classic finding of uncomplicated anemia.
CAPA Tip:
Anemia → less oxygen carried → heart works harder → tachycardia + flow murmur.
Assessment findings associated with laryngospasm may include all of the following EXCEPT:
A. Absence of breath sounds
B. Continuous musical rhonchi
C. Paradoxical rocking motion of chest wall
D. Diminished breath sounds
✅ Answer: B. Continuous musical rhonchi
Rationale:
Laryngospasm is an involuntary closure of the vocal cords that can cause severe upper-airway obstruction.
Findings may include:
Continuous musical rhonchi are more characteristic of secretions or lower-airway obstruction rather than laryngospasm.
🧠 CAPA Tip:
Laryngospasm = upper airway closure → STRIDOR or NO AIR MOVEMENT.
An elderly patient with a history of congestive heart failure (CHF) in the Phase I PACU develops an abnormal breathing pattern of rhythmic waxing and waning of the depth of respirations along with regularly recurring periods of apnea. This abnormal breathing pattern is known as:
A. Tachypnea
B. Kussmaul breathing
C. Cheyne-Stokes breathing
D. Biot's breathing
✅ Answer: C. Cheyne-Stokes breathing
Rationale:
Cheyne-Stokes respirations are characterized by:
Increasing depth → decreasing depth → apnea → repeat
This waxing-and-waning pattern is classically associated with conditions such as heart failure and certain neurologic disorders.
Kussmaul breathing is deep, rapid respirations commonly associated with metabolic acidosis.
Biot's breathing is characterized by irregular respirations with periods of apnea.
🧠 CAPA Memory Trick:
Cheyne-Stokes = Crescendo → Decrescendo → Apnea
Think "wax and wane."
A 73-year-old patient arrives in the procedural Phase II PACU after his fistulogram. Vital signs are stable. He has a good thrill and bruit on his left AV fistula. Preoperatively he was not assessed to be a fall risk. The patient tells the nurse that he needs to urinate and cannot urinate in a supine position. What should the nurse do?
A. Because the patient needs to remain supine for 1 hour, provide a urinal
B. Offer to raise the head of the bed so the patient can try to urinate in a sitting position
C. Assist the patient to ambulate to the bathroom to urinate
D. Allow the patient to stand at the bedside with the curtain pulled for privacy
✅ Answer C According to the Radiologic and imaging nurses patient may get up ad lib after this procedure as long as the patient is hemodynamically stabler: According to the
After a minor vascular procedure, the nurse is reviewing discharge instructions with the patient. The physician has ordered acetaminophen with oxycodone tablets for pain management. Which medication would concern the nurse most if it appeared on the patient's home medication list?
A. Celecoxib
B. Ibuprofen
C. Acetaminophen with hydrocodone
D. Diclofenac sodium
✅ Answer: C. Acetaminophen with hydrocodone
Rationale:
The prescribed medication contains acetaminophen + oxycodone.
If the patient's home medication is acetaminophen + hydrocodone, the patient would have two medications containing:
This creates a risk of duplicate opioid therapy and excessive total acetaminophen intake, which can increase the risk of sedation, respiratory depression, and acetaminophen-related liver toxicity.
The NSAIDs listed in the other choices also require consideration depending on the patient's condition and bleeding risk, but C is the most concerning because of the direct duplication of acetaminophen and opioid therapy.
CAPA Tip:
When reviewing discharge medications, always check for duplicate drugs and duplicate ingredients.
A 24-year-old patient with no previous medical history develops a moist cough, dyspnea, and pink frothy sputum after extubation. Lung auscultation reveals bilateral coarse crackles at the bases. An appropriate treatment plan would include:
A. Esmolol 1 gm intravenously piggyback immediately
B. Furosemide 1 mg intravenously push now; follow with a furosemide drip
C. 1 liter bolus of 0.9% normal saline
D. Bumetanide 1 mg intravenously push now; follow with a bumetanide drip
✅ Answer: D. Bumetanide 1 mg IV push now; follow with a bumetanide drip
Rationale:
The patient's findings are strongly suggestive of acute pulmonary edema:
A loop diuretic such as bumetanide helps reduce intravascular volume and pulmonary congestion.
A large normal saline bolus would worsen pulmonary edema.
🧠 CAPA Memory Trick:
Pink frothy sputum + crackles = pulmonary edema.
Think DIURETIC, not more fluid.
Three initial responses to vascular injury include:
A. Inflammation, hemodilution, and vasoconstriction
B. Necrosis, platelet adhesion, and thrombin generation
C. Vasoconstriction, platelet adhesion, and thrombin generation
D. Thrombin generation, inflammation, and vasoconstriction
✅ Answer: C. Vasoconstriction, platelet adhesion, and thrombin generation
Rationale:
When a blood vessel is injured, the body immediately begins hemostasis:
CAPA Memory Trick:
Vessel constricts → Platelets stick → Thrombin/fibrin stabilizes the clot.
The anesthesia provider administered a nondepolarizing neuromuscular blocking agent (NMBA) during induction. A reversal agent was given before admission to the Phase I PACU. The patient initially was awake and talking. After 20 minutes, the patient becomes unarousable, with shallow respirations at 6/minute, BP 90/60, and HR 70.
The initial nursing intervention is:
A. Apply O₂ by nasal cannula at 4 L/min
B. Administer a repeat dose of the NMBA reversal agent
C. Apply a bag-valve-mask device for ventilation support
D. Initiate cardiopulmonary resuscitation (CPR)
✅ Answer: C. Apply a bag-valve-mask device for ventilation support
Rationale:
The patient has severe respiratory depression with a respiratory rate of only 6/min and is unarousable. The priority is airway and ventilation.
The nurse should immediately provide positive-pressure ventilation with a bag-valve-mask and oxygen while calling for assistance and preparing for further airway management.
The patient's problem may represent residual neuromuscular blockade, but the immediate priority is correcting inadequate ventilation.
🧠 CAPA Tip:
Unresponsive + RR 6 = ventilate FIRST.
ABC → Airway → Breathing → Circulation.
Anesthesia affects the mechanical properties of the lungs and chest wall. Patients emerging from anesthesia have:
A. Decreased lung volumes and increased lung capacity
B. Decreased lung volumes and decreased lung capacity
C. Increased lung volumes and decreased lung capacity
D. Increased lung volumes and increased lung capacity
✅ Answer: B. Decreased lung volumes and decreased lung capacity
Rationale:
General anesthesia causes changes in respiratory mechanics. Patients emerging from anesthesia can have decreased functional residual capacity (FRC) and reduced lung volumes.
This can contribute to:
This is one reason postoperative patients need careful respiratory assessment, positioning, coughing/deep breathing, and appropriate oxygen therapy.
🧠 CAPA Tip:
Anesthesia → ↓ lung volumes → ↑ risk of atelectasis.