Certified Ambulatory Perianesthesia Nurse (CAPA) Practice Exam

What should the PACU nurse's next action be if a patient's blood pressure drops after receiving fluids?

1. Prepare to intubate

2. Recheck blood pressure in 2 minutes

3. Prepare to transfuse blood products

4. Reposition to facilitate venous return

The correct answer is: Reposition to facilitate venous return

When a patient's blood pressure drops after receiving fluids, the priority is ensuring optimal blood flow back to the heart and, subsequently, to the rest of the body. Repositioning the patient to facilitate venous return is a highly effective initial intervention in this scenario. By changing the patient's position, particularly placing them in a supine position with legs elevated, you can help improve venous return, thus potentially correcting the drop in blood pressure. Assessing the body's response through repositioning can be crucial as it helps in determining whether the drop in blood pressure is related to factors like hypovolemia, inadequate circulating volume, or other causes. Following this intervention, if the blood pressure continues to remain low, further actions, such as rechecking the blood pressure or other medical interventions, may be warranted. While the other options involve various potential responses to a decrease in blood pressure, they are generally not the immediate actions one would take. Intubation is a more drastic measure and is typically reserved for patients who exhibit compromised respiratory status rather than solely a decrease in blood pressure. Rechecking blood pressure after a brief wait may not provide immediate insight or intervention that directly addresses the cause. Preparing to transfuse blood products is appropriate in situations where there is clear evidence