CAPA Nausea & Vomiting Prevention 2

Question 1

A patient with a documented history of motion sickness is scheduled for laparoscopic cholecystectomy. Which combination prophylaxis is most appropriate?

Accepted Answer

Dexamethasone at induction plus ondansetron near end of surgery

Answer

Multimodal prophylaxis using dexamethasone at induction and a 5-HT3 antagonist near emergence is the evidence-based standard for high-risk patients.

Question 2

Which patient characteristic is NOT an independent risk factor in the Apfel simplified risk score for PONV?

Accepted Answer

Use of regional anesthesia

Answer

The Apfel score uses female sex, non-smoking status, history of PONV/motion sickness, and postoperative opioid use — regional anesthesia is not one of its four factors.

Question 3

A patient receives ondansetron 4 mg IV at the end of surgery. Two hours later in the PACU they are vomiting. What is the most appropriate rescue antiemetic?

Accepted Answer

Metoclopramide 10 mg IV

Answer

When a 5-HT3 antagonist fails or its duration has elapsed, a drug from a different class such as metoclopramide (dopamine antagonist) should be used for rescue.

Question 4

Which anesthetic technique most significantly reduces the baseline risk of PONV compared to general anesthesia with volatile agents?

Accepted Answer

Total intravenous anesthesia (TIVA) with propofol

Answer

TIVA with propofol eliminates exposure to emetogenic volatile agents and nitrous oxide, significantly lowering the incidence of PONV.

Question 5

How does scopolamine transdermal patch work as a PONV prophylactic?

Accepted Answer

Antagonizes muscarinic cholinergic receptors in the vestibular system

Answer

Scopolamine is an anticholinergic agent that reduces PONV by blocking muscarinic receptors in the vestibular apparatus and central nervous system.

(CAPA) Certified Ambulatory Perianesthesia Nurse Practice Test

(CAPA) Certified Ambulatory Perianesthesia Nurse Practice Test

CAPA Nausea & Vomiting Prevention 2