Exam (elaborations)
PACU TEST QUESTIONS AND VERIFIED ANSWERS
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PACU TEST QUESTIONS AND VERIFIED ANSWERS...
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PACU TEST QUESTIONS AND VERIFIEDANSWERS
Immediate post-operative care - ANSWER Check and maintain ABCs, V/S,
fluids, I&O's, incisions/tubes, pain management, LOC, and responsiveness to
stimuli. Nurses receive additional training in ACLS, anaesthesia, pharmacology,
and pain management to serve on this floor.
Will D/C to the floor. - ANSWER At least one hour later, the patient must have
a satisfactory recovery score, stable V/S, no overt bleeding, and the gag, cough,
and swallow reflexes have returned. Call the report before transferring. A
PACU registered nurse must transfer the patient.
Post-operative Nursing Care - ANSWER Focused assessment of the type of
surgery
O2/IVs, dressings/wounds, tubes, and drains,
V/S - Q15x4, Q30x2, Q60x4 (any deviation from the baseline is the first sign of
difficulty).
Respiratory - respiration sounds and rate, effects of anaesthetic and pain
medication.
Cardiac/circulation: pulses, colour, temperature.
Neurological - cerebral; sensory/motor
F&E - hydration evaluation, I&D (IVs, tubes, drains)
Renal/Urinary system - Special attention to the initial void, DC Foley. ASAP
GI System - Nausea/vomiting, return of BS (to determine oral fluids and food
return).
Skin assessment: normal wound healing, drainage, and wound healing
problems.
Interventions: ANSWER Pain management is critical, especially within the first
48 hours. Assess the nature of pain. Be mindful of narcotic side effects and their
half-life. Use diversional interventions.
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