# The circulating nurse reviews intraoperative findings after a triggering anesthetic was started. Which findings require immediate follow-up? Highlight the findings associated with possible malignant hyperthermia. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=495002&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question The circulating nurse reviews intraoperative findings after a triggering anesthetic was started. Which findings require immediate follow-up? Highlight the findings associated with possible malignant hyperthermia. Nurses' Notes 1022: General anesthesia was induced with a volatile agent, and succinylcholine was administered. The oxygen saturation is 99% with the current airway and oxygen settings. At 1027, the value moved from 38 to 65 mm Hg with rising end-tidal carbon dioxide despite increased ventilation. The nurse confirms that the operative field remains dry with minimal visible blood loss. The anesthesia professional notes persistent generalized rigidity after succinylcholine. The blood pressure is 126/74 mm Hg without a new vasopressor requirement. The surgical incision and drapes remain intact. The anesthetic depth indicator is unchanged from the value recorded after induction. The circulating nurse confirms that the initial surgical count was correct before the next incision. Urine in the drainage tubing remains clear yellow without visible sediment or blood. At 1030, the heart rate moved from 82 to 148/min with tachycardia and a rapidly rising core temperature. The electrocardiogram leads remain attached. The medication cart is immediately available outside the room. The client had no fever in the preoperative area. No equipment disconnection is found. The nurse prepares to call the malignant hyperthermia response team. ## Explanation A rapid unexplained rise in end-tidal carbon dioxide, generalized rigidity, and tachycardia with a rising core temperature require immediate follow-up. These findings support an acute malignant hyperthermia crisis. ## In-depth explanation Quick answer Highlight the rising end-tidal carbon dioxide despite increased ventilation, generalized muscle rigidity after succinylcholine, and rapid heart rate with a rising core temperature. Treat this cluster as possible malignant hyperthermia. Why this is correct Triggering anesthetics can cause uncontrolled calcium release in susceptible skeletal muscle. Muscles contract and consume energy rapidly, producing carbon dioxide, heat, acid, and potassium. Rising end-tidal carbon dioxide and rigidity can appear before marked fever, so the team must stop triggers, call for help, hyperventilate with oxygen, and prepare dantrolene promptly.[2] Easy analogy or mental picture Imagine an engine stuck at full throttle. Carbon dioxide is the exhaust, rigidity shows the engine cannot relax, and rising heat follows the overwork. The engine picture explains the hypermetabolic pattern but not every anesthetic complication. Memory hook Rising carbon dioxide plus rigid muscle means act before the fever peaks. NCLEX decision rule When end-tidal carbon dioxide rises without a ventilation explanation and rigidity or rapid hypermetabolic changes appear after a trigger, think malignant hyperthermia and activate the emergency response. Do not wait for extreme hyperthermia. Why the other choices are wrong Normal oxygen saturation, a dry incision, stable blood pressure, an unchanged anesthetic depth, clear urine, and a correct surgical count do not explain the coordinated carbon dioxide, muscle, heart-rate, and temperature changes.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]MHAUS: Managing an Acute Malignant Hyperthermia CrisisMalignant Hyperthermia Association of the United States ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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