Certified Ambulatory Perianesthesia Nurse (CAPA) — Questions and Answers

Question 1: A 45-year-old female patient reports menstrual irregularity and hot flashes. The surgeon orders a pregnancy test. She refuses, stating she cannot be pregnant. What is the nurse's BEST response?

Notify security
Explain that facility policy requires the test for patient safety (Correct answer)
Document the refusal and proceed without the test
Cancel the surgery immediately

Correct answer: Explain that facility policy requires the test for patient safety

The nurse should explain institutional policy and the safety rationale because pregnancy significantly alters anesthetic risk and medication safety.

Question 2: A patient exhibits confusion, tachycardia, and hypertension 1 hour after receiving scopolamine patch preoperatively. Which condition is most likely?

Anticholinergic toxidrome (Correct answer)
Emergence delirium
Serotonin syndrome
Malignant hyperthermia

Correct answer: Anticholinergic toxidrome

Scopolamine, an anticholinergic, can cause confusion, tachycardia, dry skin, and urinary retention — classic anticholinergic toxidrome.

Question 3: A patient in Phase I PACU after general anesthesia has a respiratory rate of 8 breaths/min and SpO2 of 90% on 4L nasal cannula. What is the priority intervention?

Increase oxygen flow to 6L
Notify the surgeon immediately
Administer naloxone 0.4 mg IV
Apply jaw thrust and stimulate the patient (Correct answer)

Correct answer: Apply jaw thrust and stimulate the patient

Stimulation and airway positioning are the first steps for opioid-related respiratory depression before pharmacologic reversal.

Question 4: A diabetic patient is being discharged after ambulatory cholecystectomy. Which additional discharge instruction is MOST critical for this patient?

Monitor blood glucose closely and adjust insulin per physician guidance during NPO/diet transition (Correct answer)
Increase carbohydrate intake to prevent hypoglycemia during recovery
Resume all diabetes medications immediately regardless of oral intake status
Avoid all oral hypoglycemics for one week

Correct answer: Monitor blood glucose closely and adjust insulin per physician guidance during NPO/diet transition

Postoperative changes in oral intake, stress response, and activity require close blood glucose monitoring and individualized insulin adjustment.

Question 5: A patient in the PACU develops acute pulmonary edema with pink frothy secretions and SpO2 of 78%. What is the IMMEDIATE nursing action?

Obtain a stat portable chest X-ray to confirm diagnosis
Administer furosemide 40 mg IV to reduce preload
Insert a Foley catheter to monitor urine output and fluid balance
Sit the patient upright, apply high-flow oxygen, and call the anesthesia provider (Correct answer)

Correct answer: Sit the patient upright, apply high-flow oxygen, and call the anesthesia provider

Upright positioning reduces preload and improves diaphragm excursion; high-flow oxygen corrects hypoxia — both are immediate nursing actions while the provider is notified.

Question 6: What is the earliest and most sensitive sign of malignant hyperthermia (MH) in the perioperative setting?

Unexplained rise in end-tidal CO2 (Correct answer)
Masseter muscle rigidity after succinylcholine
Hyperthermia greater than 40°C
Tachycardia with hypertension

Correct answer: Unexplained rise in end-tidal CO2

An unexplained rise in end-tidal CO2 is the earliest and most sensitive indicator of MH, reflecting the hypermetabolic crisis before temperature elevation occurs.

Question 7: Which patient is at HIGHEST risk for perioperative hypothermia in the ambulatory setting?

An 80-year-old undergoing 3-hour shoulder repair (Correct answer)
A 25-year-old having a laparoscopic appendectomy
A 35-year-old with BMI 32 undergoing knee arthroscopy
A 45-year-old diabetic having cataract surgery (20 minutes)

Correct answer: An 80-year-old undergoing 3-hour shoulder repair

Advanced age impairs thermoregulatory mechanisms and longer surgical duration increases heat loss, making elderly patients with lengthy procedures highest risk.

Question 8: A patient in the PACU develops sudden onset stridor after extubation. Which intervention should the nurse perform FIRST?

Administer IV neostigmine
Apply jaw thrust and supplemental oxygen (Correct answer)
Reintubate immediately
Administer IV succinylcholine

Correct answer: Apply jaw thrust and supplemental oxygen

Initial management of post-extubation stridor includes positioning, jaw thrust, and supplemental oxygen before escalating to pharmacologic or airway interventions.

Question 9: In which situation would a perianesthesia nurse be JUSTIFIED in contacting the surgeon before discharging a patient?

Nausea that resolved after one dose of ondansetron
Patient requests a follow-up appointment in two weeks
Unexpected drainage saturating the surgical dressing within 30 minutes (Correct answer)
Mild incisional discomfort rated 3/10 controlled with ibuprofen

Correct answer: Unexpected drainage saturating the surgical dressing within 30 minutes

Rapidly saturating surgical dressings suggest active bleeding requiring immediate surgical evaluation before the patient is discharged.

Question 10: Which medication class is most commonly implicated in delayed awakening from general anesthesia in the elderly ambulatory patient?

Benzodiazepines (Correct answer)
Neuromuscular blocking agents
Volatile anesthetics
Opioids

Correct answer: Benzodiazepines

Benzodiazepines have prolonged half-lives in elderly patients due to reduced hepatic metabolism and increased volume of distribution, leading to delayed emergence.

Question 11: A 6-year-old with a history of severe needle phobia is scheduled for ambulatory surgery. Which premedication is most commonly used to reduce preoperative anxiety in pediatric patients?

Oral diazepam the night before surgery
IM ketamine 4 mg/kg in the preoperative holding area
Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction (Correct answer)
IV lorazepam given on arrival to pre-op

Correct answer: Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction

Oral midazolam 0.5 mg/kg (max 15 mg) given 20–30 minutes before induction is the most widely used and effective pediatric anxiolytic premedication.

Question 12: What intervention is important for managing postoperative nausea?

Restrict fluids
Administer prescribed antiemetic (Correct answer)
Provide carbonated drinks
Apply a heating pad

Correct answer: Administer prescribed antiemetic

Administering antiemetics can reduce nausea and vomiting, which are common after anesthesia.

Question 13: When performing a pain assessment in a 5-year-old, which scale is most age-appropriate?

Numeric Rating Scale 0–10
Visual Analog Scale (VAS)
Faces Pain Scale–Revised (FPS-R) (Correct answer)
CPOT (Critical-Care Pain Observation Tool)

Correct answer: Faces Pain Scale–Revised (FPS-R)

The Faces Pain Scale–Revised (FPS-R) is validated for children aged 4 and older and uses facial expressions that children can reliably self-report.

Question 14: Which vital sign parameter is typically required before ambulatory surgery discharge per Modified Aldrete criteria?

Blood pressure within 20% of preoperative baseline (Correct answer)
Blood pressure within 20 mmHg of preoperative baseline
Mean arterial pressure above 70 mmHg
Heart rate below 80 bpm

Correct answer: Blood pressure within 20% of preoperative baseline

The Modified Aldrete Score requires blood pressure within 20% (not 20 mmHg) of the preoperative baseline value to score maximum points.

Question 15: A parent asks to stay with their child during IV placement before surgery. What is the recommended nursing response?

Decline due to infection control concerns
Allow only if the child is under 2 years old
Decline as it increases procedure time
Allow parental presence as it reduces child anxiety (Correct answer)

Correct answer: Allow parental presence as it reduces child anxiety

Evidence supports parental presence during preoperative procedures as it significantly reduces pediatric anxiety and improves cooperation.

Question 16: A Phase II patient who received bupivacaine via femoral nerve block for knee surgery reports that their leg is completely numb 4 hours postoperatively. The nurse should:

Immediately call the anesthesiologist for suspected local anesthetic toxicity
Administer IV lipid emulsion prophylactically
Reassure the patient that prolonged sensory block is expected with bupivacaine and instruct them not to bear weight (Correct answer)
Remove the nerve block catheter and apply heat to the extremity

Correct answer: Reassure the patient that prolonged sensory block is expected with bupivacaine and instruct them not to bear weight

Bupivacaine has a longer duration of action and sensory block can persist well beyond the analgesic period; fall prevention and non-weight-bearing instructions are the appropriate response.

Question 17: A patient develops sudden-onset chest pain, tachycardia, and hypotension in the PACU after a right femoral hernia repair. SpO2 drops to 88%. Which diagnosis must be considered first?

Pneumothorax
Myocardial infarction
Pulmonary embolism (Correct answer)
Anaphylaxis

Correct answer: Pulmonary embolism

Pulmonary embolism presents with sudden hypoxia, tachycardia, chest pain, and hypotension and should be the priority differential in postoperative patients.

Question 18: A 7-year-old child is in Phase II recovery and reports nausea. The nurse notes no vomiting has occurred. What is the most appropriate initial intervention?

Administer ondansetron IV and encourage slow deep breathing (Correct answer)
Hold all oral intake and reassess in 1 hour
Discharge the child immediately before vomiting occurs
Administer metoclopramide IM as first-line antiemetic

Correct answer: Administer ondansetron IV and encourage slow deep breathing

Ondansetron is the first-line antiemetic in pediatric patients, and non-pharmacologic measures like deep breathing can also reduce nausea in the ambulatory setting.

Question 19: A patient reports she took her prescribed oxycodone 5 mg and 'two extra Tylenol' at home. The nurse calculates her total acetaminophen intake. What is the maximum safe daily dose of acetaminophen for a healthy adult?

4,000 mg/day (Correct answer)
3,000 mg/day
2,000 mg/day
6,000 mg/day

Correct answer: 4,000 mg/day

The FDA-recommended maximum acetaminophen dose for healthy adults is 4,000 mg per day, though many guidelines recommend ≤3,000 mg/day for chronic use or liver risk.

Question 20: When assessing a patient for signs of LAST after a brachial plexus block, which neurological symptom would appear FIRST?

Perioral numbness and metallic taste (Correct answer)
Respiratory arrest
Loss of consciousness
Generalized tonic-clonic seizure

Correct answer: Perioral numbness and metallic taste

Early CNS excitatory signs of LAST include perioral numbness, metallic taste, and tinnitus before progression to seizures and cardiovascular collapse.

Question 21: Which intervention is MOST appropriate for a postoperative patient with a systolic BP of 190 mmHg and headache?

Place patient in Trendelenburg position
Administer prescribed antihypertensive and notify the provider (Correct answer)
Reassure the patient and recheck in 1 hour
Administer an additional dose of opioid analgesic

Correct answer: Administer prescribed antihypertensive and notify the provider

Hypertension with headache post-operatively requires antihypertensive treatment per order and provider notification to prevent cerebrovascular complications.

Question 22: In the ambulatory PACU, which patient is LEAST appropriate for fast-tracking directly to Phase II recovery?

Patient after spinal anesthesia for knee arthroscopy with motor function returning
ASA I patient after local anesthesia with sedation, Aldrete score 9
Healthy adult after brief general anesthesia, fully awake and oriented
Patient with BMI 42 and OSA after monitored anesthesia care (Correct answer)

Correct answer: Patient with BMI 42 and OSA after monitored anesthesia care

Patients with OSA and high BMI require closer Phase I monitoring due to elevated risk of airway obstruction and hypoxia during recovery.

Question 23: A patient in Phase I PACU has a core temperature of 35.1°C after a 90-minute laparoscopic procedure. Which intervention is MOST effective for rewarming?

Warm blankets alone
Increased room temperature
Forced-air warming device (Correct answer)
Warm IV fluids at 100 mL/hr

Correct answer: Forced-air warming device

Forced-air warming devices are the most effective non-invasive method for rewarming hypothermic postoperative patients.

Question 24: A patient in Phase I PACU develops sudden onset atrial fibrillation with a ventricular rate of 140 bpm and a blood pressure of 88/54 mmHg. The priority intervention is:

Administer amiodarone 150 mg IV over 10 minutes
Synchronized cardioversion after notifying the anesthesiologist/cardiologist (Correct answer)
Administer adenosine 6 mg rapid IV push
Apply carotid massage and reassess in 5 minutes

Correct answer: Synchronized cardioversion after notifying the anesthesiologist/cardiologist

Hemodynamically unstable atrial fibrillation with hypotension requires immediate synchronized cardioversion per ACLS guidelines.

Question 25: Which maneuver is MOST effective for opening the airway in a patient suspected of having a cervical spine injury?

Modified jaw thrust without head extension (Correct answer)
Head-tilt chin-lift
Neck flexion with chin tuck
Lateral neck rotation to 45 degrees

Correct answer: Modified jaw thrust without head extension

The modified jaw thrust without head extension opens the airway while maintaining cervical spine neutrality, making it the preferred technique when spinal injury is suspected.

Question 26: A 68-year-old patient on ACE inhibitors presents for ambulatory knee replacement. Intraoperatively, BP drops to 75/40 despite 1 L LR bolus. The MOST likely cause and treatment is:

Cardiac tamponade treated with pericardiocentesis
Anaphylaxis treated with epinephrine
Vasoplegic syndrome treated with vasopressors and possibly vasopressin (Correct answer)
Hypovolemia treated with additional fluid boluses only

Correct answer: Vasoplegic syndrome treated with vasopressors and possibly vasopressin

ACE inhibitors impair the renin-angiotensin system, causing vasoplegic (distributive) shock refractory to fluids alone, requiring vasopressors.

Question 27: Which preoperative fasting guideline (NPO) applies to a healthy 5-year-old scheduled for elective ambulatory surgery?

Formula and solid food may be given up to 4 hours before surgery
Nothing by mouth for 8 hours for all substances
Clear liquids up to 4 hours, solids up to 8 hours before surgery
Clear liquids up to 2 hours, breast milk up to 4 hours, solids up to 6 hours before surgery (Correct answer)

Correct answer: Clear liquids up to 2 hours, breast milk up to 4 hours, solids up to 6 hours before surgery

ASA fasting guidelines: clear liquids 2h, breast milk 4h, formula/non-human milk/solids 6h, and fatty meals 8h before elective anesthesia.

Question 28: A patient's ECG shows ST-segment elevation in the PACU. The nurse should:

Continue monitoring and reassess in 30 minutes
Reposition the patient and repeat the tracing
Administer aspirin and notify the physician stat (Correct answer)
Document the finding and notify at end of shift

Correct answer: Administer aspirin and notify the physician stat

ST-segment elevation may indicate acute myocardial infarction and requires immediate physician notification and aspirin administration.

Question 29: When assessing breath sounds in a PACU patient, the nurse auscultates absent sounds over the left lung base with dullness to percussion. This finding is MOST consistent with:

Pneumothorax
Atelectasis of a small segment
Pleural effusion or hemothorax (Correct answer)
Pulmonary embolism

Correct answer: Pleural effusion or hemothorax

Absent breath sounds with dullness to percussion indicate fluid in the pleural space, consistent with pleural effusion or hemothorax, not pneumothorax (which causes hyperresonance).

Question 30: A patient with obstructive sleep apnea (OSA) presents for ambulatory surgery. Which preoperative factor MOST supports proceeding in an outpatient setting?

Moderate OSA with planned opioid analgesia
Morbid obesity with BMI of 48
CPAP-compliant patient with mild OSA and no comorbidities (Correct answer)
Uncontrolled hypertension requiring IV antihypertensives

Correct answer: CPAP-compliant patient with mild OSA and no comorbidities

CPAP-compliant patients with mild OSA and no significant comorbidities can safely undergo ambulatory surgery with appropriate monitoring.

Certified Ambulatory Perianesthesia Nurse (CAPA)

The CAPA certification exam, administered by ABPANC, validates the specialized knowledge and skills of registered nurses working in ambulatory perianesthesia settings, covering anesthesia care, patient monitoring, physiology, and professional nursing practice across the perioperative continuum.

Questions

35 min

Time Limit

65%

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