Certified Ambulatory Perianesthesia Nurse (CAPA) Practice Exam

A patient with a BMI of 42 is in the phase I PACU with noisy respirations. What should the perianesthesia nurse consider?

1. Left ventricular hypertrophy increases the cardiac workload

2. Adipose tissue can cause chest wall stiffness

3. Large body mass hinders breathing and movement

4. The patient has three or more times normal oxygen capacity

The correct answer is: Large body mass hinders breathing and movement

In patients with a BMI of 42, obesity can significantly impact respiratory function. The presence of a high body mass can indeed hinder effective breathing and movement due to several physiological factors. Excess adipose tissue, particularly around the chest and abdomen, can restrict lung expansion, reducing overall lung volumes and effective respiratory mechanics. This can lead to noisy respirations due to shallow breathing, increased effort to breathe, or even airway obstruction. The other options touch upon related issues but do not fully encompass the primary concern for a perianesthesia nurse when assessing a patient with a high BMI, particularly in the immediate post-anesthesia care unit (PACU) setting. Issues like left ventricular hypertrophy are relevant to cardiac function but do not directly explain noisy respirations. Similarly, while chest wall stiffness and potential reductions in oxygen capacity due to obesity are valid points, they do not directly illustrate how the increased body mass restricts respiration in a clinically observable manner. Hence, recognizing that large body mass hinders breathing and movement provides an essential consideration in ensuring patient safety and adequate respiratory support in the PACU.