Certified Ambulatory Perianesthesia Nurse (CAPA) — Questions and Answers

Question 1: During Phase I PACU recovery, a patient suddenly develops rigidity, hyperthermia (40.1°C), tachycardia, and hypercapnia. Which condition requires immediate action?

Malignant hyperthermia (Correct answer)
Serotonin syndrome
Thyroid storm
Neuroleptic malignant syndrome

Correct answer: Malignant hyperthermia

Malignant hyperthermia presents with hypercarbia, muscle rigidity, rapid temperature rise, and tachycardia after volatile anesthetic or succinylcholine exposure.

Question 2: A nurse is preparing to administer IV acetaminophen (Ofirmev) 1000 mg. For which patient population should the dose be reduced to 650 mg every 8 hours?

Patients with a history of asthma
Patients over age 65
Patients weighing less than 50 kg (Correct answer)
Patients with mild renal impairment (CrCl 30-60 mL/min)

Correct answer: Patients weighing less than 50 kg

IV acetaminophen dosing should be reduced in patients weighing less than 50 kg to 15 mg/kg (max 750 mg) to avoid hepatotoxicity from standard adult doses.

Question 3: Which action by the discharging nurse BEST demonstrates adherence to the 'teach-back' method?

Having the patient sign the instruction sheet confirming understanding
Asking the patient to repeat back key instructions in their own words (Correct answer)
Reading all discharge instructions aloud to the patient and escort
Providing written instructions and asking if the patient has questions

Correct answer: Asking the patient to repeat back key instructions in their own words

Teach-back requires the patient to demonstrate understanding by restating information in their own words, not just acknowledging receipt of instructions.

Question 4: How should CAPA professionals handle confidential information related to discharge criteria & planning?

Delete all records after project completion
Share freely with all colleagues for transparency
Store information without any security measures
Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 5: When assessing a patient for signs of LAST after a brachial plexus block, which neurological symptom would appear FIRST?

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

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 6: Evidence-based practice for preventing emergence delirium in pediatric PACU patients most strongly supports which intervention?

Routine use of physostigmine upon awakening
Restricting sensory stimulation by keeping lights off
Prophylactic haloperidol for all pediatric patients
Parental presence during emergence from anesthesia (Correct answer)

Correct answer: Parental presence during emergence from anesthesia

Research supports parental presence during emergence as an effective, low-risk strategy to reduce emergence delirium in children.

Question 7: A 58-year-old patient with a 40-pack-year smoking history is post-op day 0 after abdominal surgery. Which incentive spirometry instruction is MOST appropriate?

Take a slow, sustained maximal inhalation and hold for 5-10 seconds (Correct answer)
Perform 2 repetitions every hour
Use the device only when feeling short of breath
Breathe in as fast as possible to move the ball quickly

Correct answer: Take a slow, sustained maximal inhalation and hold for 5-10 seconds

A slow, sustained maximal inhalation held for 5-10 seconds maximally expands alveoli and prevents atelectasis, which is the therapeutic goal of incentive spirometry.

Question 8: A patient reports taking herbal supplements including St. John's Wort. Why is this information relevant to discharge planning?

The patient should stop all supplements immediately upon discharge
It should be documented only for future anesthesia planning
Herbal supplements are irrelevant in the ambulatory surgery setting
It may interact with discharge analgesics and affect recovery at home (Correct answer)

Correct answer: It may interact with discharge analgesics and affect recovery at home

St. John's Wort induces CYP enzymes and interacts with many medications including opioids, requiring medication reconciliation before discharge.

Question 9: Which vital sign parameter is typically required before ambulatory surgery discharge per Modified Aldrete criteria?

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

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 10: A patient in the PACU following shoulder surgery with an interscalene block has an oxygen saturation of 91% on 2L nasal cannula. The nurse notes absent breath sounds on the blocked side. Which is the MOST likely cause?

Pulmonary embolism from venous stasis
Mucous plugging from inadequate cough effort
Atelectasis from prolonged supine positioning
Pneumothorax from interscalene block needle placement (Correct answer)

Correct answer: Pneumothorax from interscalene block needle placement

Pneumothorax is a known complication of interscalene block due to the proximity of the needle to the pleural apex, presenting with absent breath sounds and desaturation.

Question 11: Which assessment finding would MOST concern the perianesthesia nurse in a patient who received an interscalene nerve block?

Shoulder muscle weakness on the blocked side
SpO2 of 94% with dyspnea (Correct answer)
Mild paresthesia along the forearm
Ipsilateral ptosis and miosis

Correct answer: SpO2 of 94% with dyspnea

Interscalene blocks commonly cause ipsilateral phrenic nerve palsy, reducing diaphragmatic function; SpO2 of 94% with dyspnea indicates significant respiratory compromise.

Question 12: A patient exhibits confusion, tachycardia, and hypertension 1 hour after receiving scopolamine patch preoperatively. Which condition is most likely?

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

Correct answer: Anticholinergic toxidrome

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

Question 13: What is the recommended initial IV dose of dantrolene when treating a confirmed malignant hyperthermia crisis?

0.5 mg/kg IV
2.5 mg/kg IV (Correct answer)
5 mg/kg IV
1 mg/kg IV

Correct answer: 2.5 mg/kg IV

The initial dose is 2.5 mg/kg IV, repeated every 5 minutes as needed to a maximum of 10 mg/kg until symptoms resolve.

Question 14: Which factor most predisposes ambulatory surgical patients to PONV compared to inpatients?

Reduced opioid use in ambulatory settings
Earlier ambulation and oral intake post-procedure (Correct answer)
Shorter anesthesia duration
Lower baseline anxiety levels

Correct answer: Earlier ambulation and oral intake post-procedure

Early mandatory discharge in ambulatory settings means patients ambulate, eat, and drink sooner, all of which can trigger or worsen PONV.

Question 15: Emergence delirium is MOST commonly seen in which patient population in the PACU?

Middle-aged adults with anxiety disorders
Elderly patients on beta-blockers
Young children and older adults (Correct answer)
Patients who received spinal anesthesia

Correct answer: Young children and older adults

Young children (especially ages 2-6) and elderly adults are most susceptible to emergence delirium due to developmental and neurological factors.

Question 16: A patient scores 9 on the Modified Aldrete Score after ambulatory surgery. Which single criterion is most likely keeping the score below 10?

Fully awake and oriented
Oxygen saturation of 94% on room air (Correct answer)
Able to move all four extremities
Blood pressure within 20% of baseline

Correct answer: Oxygen saturation of 94% on room air

An SpO2 of 94% on room air scores 1 instead of 2, commonly preventing a perfect Modified Aldrete Score.

Question 17: Post-extubation stridor heard in the PACU most commonly indicates which underlying problem?

Pulmonary embolism
Lower airway bronchospasm
Subglottic edema or partial laryngospasm (Correct answer)
Pneumothorax

Correct answer: Subglottic edema or partial laryngospasm

Stridor is a high-pitched inspiratory sound indicating upper airway obstruction, most commonly from subglottic edema or incomplete laryngospasm after extubation.

Question 18: A patient receiving a regional nerve block is in Phase II recovery when they report metallic taste and circumoral numbness. The nurse should FIRST:

Apply supplemental oxygen and reassure the patient
Check blood pressure and administer ephedrine if hypotensive
Administer IV diphenhydramine
Assess for signs of local anesthetic systemic toxicity (LAST) and call for help (Correct answer)

Correct answer: Assess for signs of local anesthetic systemic toxicity (LAST) and call for help

Metallic taste and circumoral numbness are early CNS signs of LAST; immediate recognition, calling for help, and preparation for treatment (lipid emulsion) are the priority.

Question 19: A patient in the PACU develops acute bronchospasm. What is the FIRST nursing action?

Administer IV epinephrine immediately
Apply supplemental oxygen and notify the anesthesia provider (Correct answer)
Prepare for emergency intubation
Administer IV methylprednisolone 125 mg

Correct answer: Apply supplemental oxygen and notify the anesthesia provider

The initial priority is to support oxygenation and promptly notify the anesthesia provider, who will order bronchodilator therapy and further management.

Question 20: What is the MOST appropriate patient positioning for a postoperative patient with hypotension unrelated to cardiac failure?

Reverse Trendelenburg (head elevated 30°)
Left lateral decubitus
High Fowler's position
Supine with legs elevated (Correct answer)

Correct answer: Supine with legs elevated

Elevating the legs in supine position augments venous return and increases preload, helping restore blood pressure in hypovolemic hypotension.

Question 21: A patient develops urticaria, hypotension, and wheezing minutes after receiving IV antibiotics in the PACU. What is the FIRST-LINE treatment?

Diphenhydramine 50 mg IV
Albuterol via nebulizer
Methylprednisolone 125 mg IV
Epinephrine 0.3 mg IM into the anterolateral thigh (Correct answer)

Correct answer: Epinephrine 0.3 mg IM into the anterolateral thigh

Epinephrine is the first-line treatment for anaphylaxis, addressing vasodilation, bronchoconstriction, and angioedema through alpha and beta adrenergic receptor activation.

Question 22: A 4-year-old weighing 16 kg is to receive ketamine for procedural sedation. What is the appropriate IV sedation dose?

1–2 mg/kg (16–32 mg) (Correct answer)
0.1–0.2 mg/kg (1.6–3.2 mg)
5 mg/kg (80 mg)
0.5 mg/kg only for induction

Correct answer: 1–2 mg/kg (16–32 mg)

IV ketamine for procedural sedation in children is dosed at 1–2 mg/kg; the dissociative state provides analgesia and sedation while maintaining airway reflexes.

Question 23: Which assessment tool is specifically designed to evaluate readiness for discharge from Phase II (ambulatory surgery discharge)?

Richmond Agitation-Sedation Scale (RASS)
Ramsay Sedation Scale
Post-Anesthetic Discharge Scoring System (PADSS) (Correct answer)
Modified Aldrete Score

Correct answer: Post-Anesthetic Discharge Scoring System (PADSS)

PADSS evaluates vital signs, ambulation, nausea/vomiting, pain, and surgical bleeding specifically for Phase II ambulatory discharge readiness.

Question 24: A PACU patient who received a bupivacaine femoral nerve block develops sudden seizures and progressive QRS widening on the monitor. The nurse should FIRST:

Administer amiodarone IV for the wide-complex rhythm
Activate the LAST protocol and prepare 20% lipid emulsion (Correct answer)
Call for the MH cart and begin cooling measures
Administer phenytoin IV for seizure control

Correct answer: Activate the LAST protocol and prepare 20% lipid emulsion

Sudden seizures followed by cardiac conduction abnormalities in a patient who received a bupivacaine block are classic LAST presentation, requiring immediate LAST protocol activation including intralipid.

Question 25: Which patient factor is a CONTRAINDICATION to performing a peripheral nerve block in the ambulatory surgery setting?

History of mild anxiety requiring preoperative anxiolytic
BMI of 32 requiring ultrasound-guided technique
Patient refusal to consent to the block procedure (Correct answer)
Mild chronic obstructive pulmonary disease (GOLD Stage I)

Correct answer: Patient refusal to consent to the block procedure

Patient refusal is an absolute contraindication to any regional anesthesia procedure regardless of its clinical benefits.

Question 26: Which clinical finding BEST indicates upper airway obstruction in a post-anesthesia patient?

Decreased SpO2 with expiratory wheezing
Shallow breathing with bilateral crackles
Tachypnea with accessory muscle use only
Stridor with paradoxical chest-abdominal movement (Correct answer)

Correct answer: Stridor with paradoxical chest-abdominal movement

Stridor combined with paradoxical (seesaw) chest-abdominal movement is the hallmark of upper airway obstruction, where the diaphragm descends but the airway blockage prevents chest rise.

Question 27: A patient is unable to void 4 hours after ambulatory urological surgery under spinal anesthesia. What is the MOST appropriate intervention?

Discharge the patient with bladder scan instructions for home
Discharge immediately as voiding is not required post-spinal
Perform bladder ultrasound; if >400 mL, perform straight catheterization (Correct answer)
Administer furosemide IV to stimulate voiding

Correct answer: Perform bladder ultrasound; if >400 mL, perform straight catheterization

Bladder scan followed by catheterization for volumes >400 mL prevents overdistension injury in patients with urinary retention after spinal anesthesia.

Question 28: Which finding in the PACU would indicate the need to defer ambulatory discharge and arrange inpatient admission?

Mild dizziness resolving with IV fluid bolus
Pain score of 5/10 controlled with oral analgesics
PONV requiring one additional dose of ondansetron
Persistent SpO2 88% on 4L nasal cannula after 90 minutes (Correct answer)

Correct answer: Persistent SpO2 88% on 4L nasal cannula after 90 minutes

Persistent hypoxemia requiring supplemental oxygen beyond 90 minutes indicates the patient cannot safely be discharged to an unmonitored home environment.

Question 29: Which Phase I PACU discharge criterion is specific to the ambulatory setting according to ASPAN standards?

Patient must have voided prior to discharge
Patient must be accompanied by a responsible adult escort (Correct answer)
Patient must ambulate 50 feet independently
Patient must tolerate oral fluids without nausea

Correct answer: Patient must be accompanied by a responsible adult escort

ASPAN standards require ambulatory surgery patients to be discharged in the care of a responsible, competent adult who can observe for complications at home.

Question 30: When reviewing a patient's medication list preoperatively, which herbal supplement is MOST associated with increased perioperative bleeding risk?

Melatonin
Probiotics
Valerian root
Ginkgo biloba (Correct answer)

Correct answer: Ginkgo biloba

Ginkgo biloba inhibits platelet-activating factor and has anticoagulant properties that increase bleeding risk perioperatively.

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%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds