Certified Post Anesthesia Nurse (CPAN) Practice Exam

When monitoring a patient after a radical neck dissection, what change warrants immediate attention?

1. Increased heart rate

2. Tracheal deviation

3. Temperature increase

4. Increase oxygen saturation

The correct answer is: Tracheal deviation

Tracheal deviation indicates a potential shift in mediastinal structures and can be a sign of life-threatening complications such as tension pneumothorax, tracheal injury, or large pleural effusion. After a radical neck dissection, the anatomy of the airway and surrounding structures is altered, making the airway management critical. Noticing any changes in the position of the trachea suggests pressure or mass effect that could compromise the patient’s airway or respiratory status. Immediate assessment and intervention are needed to ensure the airway remains patent and that the patient is not in respiratory distress or at risk for more severe complications. While increased heart rate, temperature increase, and increased oxygen saturation are important to monitor, they are not as immediately concerning as tracheal deviation. An increased heart rate could indicate pain, anxiety, or early signs of hypovolemia. A temperature increase could suggest infection or an inflammatory response but is not an acute emergency. Increased oxygen saturation typically indicates effective oxygen delivery, which is favorable. Therefore, tracheal deviation stands out as a critical sign requiring swift evaluation and potential intervention.