CAPA Nausea & Vomiting Prevention 3 — Questions and Answers
Question 1: A patient undergoing gynecologic laparoscopy begins vomiting in Phase I PACU. She received ondansetron and dexamethasone intraoperatively. Which rescue agent acts via a different mechanism than both prophylactic drugs?
- Granisetron 1 mg IV
- Prochlorperazine 10 mg IV (Correct answer)
- Repeat ondansetron 4 mg IV
- Repeat dexamethasone 4 mg IV
Correct answer: Prochlorperazine 10 mg IV
Prochlorperazine is a phenothiazine/dopamine antagonist, offering a different mechanism from the serotonin antagonist and corticosteroid already used.
Question 2: Which factor most predisposes ambulatory surgical patients to PONV compared to inpatients?
- Shorter anesthesia duration
- Earlier ambulation and oral intake post-procedure (Correct answer)
- Reduced opioid use in ambulatory settings
- 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 3: Which statement about nitrous oxide and PONV is accurate?
- Nitrous oxide reduces PONV by providing analgesia and lowering volatile agent requirements
- Nitrous oxide increases PONV risk by distending the bowel and stimulating the middle ear (Correct answer)
- Nitrous oxide has no clinically significant effect on PONV incidence
- Nitrous oxide only increases PONV in patients with a prior history of motion sickness
Correct answer: Nitrous oxide increases PONV risk by distending the bowel and stimulating the middle ear
Nitrous oxide increases PONV through bowel distension, middle ear pressure changes, and direct stimulation of the chemoreceptor trigger zone.
Question 4: An ambulatory patient is being discharged after knee arthroscopy. She reports mild nausea but no vomiting. What is the appropriate nursing intervention?
- Administer IV ondansetron and observe for 30 additional minutes before discharge
- Discharge immediately since vomiting has not occurred
- Provide an oral antiemetic for home use and reinforce discharge instructions (Correct answer)
- Delay discharge until all nausea resolves completely
Correct answer: Provide an oral antiemetic for home use and reinforce discharge instructions
Mild nausea without vomiting in a patient who meets other discharge criteria can be managed with an oral antiemetic prescription and thorough patient education.
Question 5: Acupressure at the P6 (Neiguan) point has been studied for PONV prevention. Where is this point located?
- Two finger-breadths below the popliteal fossa
- Three finger-breadths proximal to the wrist crease on the inner forearm (Correct answer)
- On the dorsum of the hand between the first and second metacarpals
- Just anterior to the tragus of the ear
Correct answer: Three finger-breadths proximal to the wrist crease on the inner forearm
The P6 (pericardium 6) point is located three finger-breadths proximal to the wrist crease between the palmaris longus and flexor carpi radialis tendons.
Question 6: A perianesthesia nurse is evaluating a patient for PONV risk. The patient is a 45-year-old female non-smoker with no history of PONV scheduled for laparoscopic hysterectomy with planned morphine PCA. What is her Apfel score?
- 1
- 2
- 3 (Correct answer)
- 4
Correct answer: 3
She scores 1 point each for female sex, non-smoker status, and postoperative opioid use — history of PONV/motion sickness is absent — giving an Apfel score of 3.
Question 7: Which of the following is an appropriate non-pharmacologic nursing measure to reduce PONV in the PACU?
- Encouraging deep breathing exercises every 2 hours
- Keeping the head of bed flat to reduce vestibular stimulation
- Minimizing unnecessary movement and maintaining a calm environment (Correct answer)
- Providing early carbohydrate-rich oral intake to stabilize blood glucose
Correct answer: Minimizing unnecessary movement and maintaining a calm environment
Minimizing unnecessary patient movement and maintaining a quiet, calm environment reduces vestibular and sensory triggers for nausea and vomiting.
CAPA Nausea & Vomiting Prevention 3
A patient undergoing gynecologic laparoscopy begins vomiting in Phase I PACU.
She received ondansetron and dexamethasone intraoperatively.
Which rescue agent acts via a different mechanism than both prophylactic drugs?