CAPA Discharge Criteria & Planning 3 — Questions and Answers
Question 1: Which postoperative nausea and vomiting (PONV) score tool is commonly used to identify high-risk ambulatory surgery patients requiring prophylaxis?
- Ramsay Sedation Scale
- Apfel Simplified Risk Score (Correct answer)
- PRST Score
- Numeric Rating Scale
Correct answer: Apfel Simplified Risk Score
The Apfel Simplified Risk Score uses four predictors (female sex, non-smoker, history of PONV/motion sickness, opioid use) to stratify PONV risk.
Question 2: 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
- Perform bladder ultrasound; if >400 mL, perform straight catheterization (Correct answer)
- Administer furosemide IV to stimulate voiding
- Discharge immediately as voiding is not required post-spinal
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 3: Which element is REQUIRED on an ambulatory surgery discharge instruction sheet per ASPAN standards?
- Surgeon's home phone number
- Emergency contact information and when to seek emergency care (Correct answer)
- Insurance authorization number
- Names of all medications administered intraoperatively
Correct answer: Emergency contact information and when to seek emergency care
ASPAN standards mandate discharge instructions include symptoms requiring emergency evaluation and how to access emergency services.
Question 4: A patient who received midazolam for procedural sedation wants to sign a consent form for a future procedure before leaving. How should the nurse respond?
- Allow signing since the procedure is already over
- Witness the signature as required by hospital policy
- Advise the patient to wait 24 hours before signing legal documents (Correct answer)
- Call the physician to authorize the signing
Correct answer: Advise the patient to wait 24 hours before signing legal documents
Benzodiazepines cause anterograde amnesia and impaired judgment; patients should not sign legal documents for 24 hours post-sedation.
Question 5: What is the primary purpose of a structured telephone follow-up call 24 hours after ambulatory surgery?
- Collect quality improvement data only
- Assess for complications, answer questions, and reinforce discharge instructions (Correct answer)
- Confirm the patient's next appointment date
- Bill for post-procedure nursing services
Correct answer: Assess for complications, answer questions, and reinforce discharge instructions
The 24-hour follow-up call identifies early complications, reinforces instructions, and provides an opportunity to triage concerns that require medical attention.
Question 6: A patient reports taking herbal supplements including St. John's Wort. Why is this information relevant to discharge planning?
- It may interact with discharge analgesics and affect recovery at home (Correct answer)
- Herbal supplements are irrelevant in the ambulatory surgery setting
- It should be documented only for future anesthesia planning
- The patient should stop all supplements immediately upon discharge
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 7: Which finding in a patient 90 minutes post-laparoscopic procedure warrants CONTINUED Phase I monitoring rather than Phase II transfer?
- Respiratory rate of 16 breaths per minute
- Blood pressure 148/88 vs. baseline 140/82
- Oxygen saturation 89% requiring supplemental oxygen (Correct answer)
- Mild throat discomfort after LMA removal
Correct answer: Oxygen saturation 89% requiring supplemental oxygen
SpO2 of 89% requiring supplemental oxygen indicates respiratory compromise requiring continued Phase I monitoring and intervention.
CAPA Discharge Criteria & Planning 3
Which postoperative nausea and vomiting (PONV) score tool is commonly used to identify high-risk ambulatory surgery patients requiring prophylaxis?