CAPA Nausea & Vomiting Prevention 5 — Questions and Answers
Question 1: Which surgery type carries one of the highest inherent risks for PONV independent of patient factors?
- Inguinal hernia repair under spinal anesthesia
- Strabismus surgery in pediatric patients (Correct answer)
- Knee arthroscopy under total IV anesthesia
- Cataract extraction under monitored anesthesia care
Correct answer: Strabismus surgery in pediatric patients
Strabismus surgery has one of the highest PONV rates (up to 80%) due to oculomotor stimulation activating the vomiting center via the oculoemetic reflex.
Question 2: A patient is receiving IV fluid hydration as part of PONV prophylaxis strategy. What is the recommended minimum volume of crystalloid for ambulatory patients?
- 250 mL
- 500 mL
- 1,000 mL (Correct answer)
- 2,000 mL
Correct answer: 1,000 mL
Studies support administering at least 1,000 mL (1-2 mL/kg/hr or 20-30 mL/kg total) of crystalloid to reduce PONV by correcting relative hypovolemia.
Question 3: A patient in Phase II recovery reports feeling nauseated and says 'the room is spinning.' Which type of PONV trigger should the nurse prioritize addressing?
- Opioid-induced chemoreceptor trigger zone stimulation
- Vestibular-mediated nausea likely worsened by position changes or movement (Correct answer)
- Delayed gastric emptying from residual anesthetic agents
- Visceral afferent stimulation from abdominal distension
Correct answer: Vestibular-mediated nausea likely worsened by position changes or movement
Vertigo-associated nausea described as the room spinning suggests vestibular involvement, best addressed by minimizing movement and considering anticholinergic or antihistamine agents.
Question 4: According to SAMBA consensus guidelines, which Apfel score threshold typically warrants two-agent prophylaxis?
- Score of 1
- Score of 2 (Correct answer)
- Score of 3-4
- Prophylaxis is only warranted when score is 4
Correct answer: Score of 2
SAMBA guidelines recommend one antiemetic for Apfel score 1, two agents for score 2, and multimodal triple or quadruple therapy for scores 3-4.
Question 5: A patient with diabetes is prescribed dexamethasone for PONV prophylaxis. What is the primary concern the perianesthesia nurse should monitor for postoperatively?
- Hypoglycemia due to increased insulin sensitivity
- Hyperglycemia due to glucocorticoid-induced glucose elevation (Correct answer)
- Adrenal suppression after a single prophylactic dose
- Fluid retention causing acute pulmonary edema
Correct answer: Hyperglycemia due to glucocorticoid-induced glucose elevation
Dexamethasone, even as a single prophylactic dose, can cause significant postoperative hyperglycemia in diabetic patients and requires blood glucose monitoring.
Question 6: Which nursing assessment finding would most support delaying discharge of an ambulatory patient due to PONV?
- Patient reports mild queasiness but denies vomiting and has tolerated sips of water
- Patient has vomited twice in the last 30 minutes and cannot retain oral fluids or medications (Correct answer)
- Patient's Apfel score was 3 and she received three prophylactic antiemetics preoperatively
- Patient requests an antiemetic before eating the discharge snack
Correct answer: Patient has vomited twice in the last 30 minutes and cannot retain oral fluids or medications
Repeated vomiting with inability to retain fluids or oral medications represents inadequate symptom control and a safety risk that prevents safe discharge.
Question 7: A patient is prescribed a scopolamine transdermal patch for PONV prophylaxis. When should the patch be applied to ensure adequate plasma levels by the time of surgery?
- 30 minutes before induction
- 1 hour before induction
- The evening before or at least 4 hours prior to surgery (Correct answer)
- Immediately upon arrival to the preoperative holding area
Correct answer: The evening before or at least 4 hours prior to surgery
Scopolamine transdermal requires 4 hours to reach effective plasma levels; applying it the evening before surgery ensures optimal antiemetic coverage.
CAPA Nausea & Vomiting Prevention 5
Which surgery type carries one of the highest inherent risks for PONV independent of patient factors?