CAPA Patient Safety & Monitoring 5 — Questions and Answers
Question 1: A patient in ambulatory surgery Phase II recovery has a pain score of 8/10 and has already received the maximum ordered opioid dose. Which multimodal approach should the nurse advocate for?
- Request additional opioid prescription from the anesthesiologist
- Suggest IV ketorolac if not contraindicated and apply ice to the surgical site (Correct answer)
- Encourage deep breathing and distraction techniques only
- Prepare for hospital admission for pain management
Correct answer: Suggest IV ketorolac if not contraindicated and apply ice to the surgical site
Multimodal analgesia with NSAIDs like ketorolac combined with non-pharmacologic measures (ice, positioning) provides opioid-sparing pain control in ambulatory patients.
Question 2: The Joint Commission's National Patient Safety Goal regarding medication reconciliation is MOST applicable in the perianesthesia setting when:
- Administering PRN analgesics in the PACU
- Transferring a patient from Phase I to Phase II recovery
- Discharging a patient home with written instructions (Correct answer)
- Checking the anesthesia record for intraoperative medications
Correct answer: Discharging a patient home with written instructions
Medication reconciliation at discharge ensures patients understand their home medications and any new prescriptions, preventing errors at a high-risk care transition.
Question 3: A PACU patient develops hypertension to 190/110 mmHg and complains of a headache. Which action should the nurse prioritize?
- Administer PRN labetalol and document
- Perform a neurological assessment and notify the physician immediately (Correct answer)
- Increase pain medication as hypertension may be pain-related
- Reassess in 15 minutes before notifying the physician
Correct answer: Perform a neurological assessment and notify the physician immediately
Severe hypertension with headache in the postoperative period may indicate hypertensive emergency or intracranial event, requiring immediate neurological assessment and physician notification.
Question 4: Which postoperative assessment finding is MOST suggestive of emergence delirium in an adult PACU patient?
- Somnolence with slow response to stimulation
- Purposeless agitation, disorientation, and thrashing not responsive to reassurance (Correct answer)
- Complaints of pain with grimacing
- Intermittent confusion that resolves with orientation cues
Correct answer: Purposeless agitation, disorientation, and thrashing not responsive to reassurance
Emergence delirium is characterized by non-purposeful agitation, disorientation, and thrashing that does not respond to verbal reassurance, distinguishing it from pain or normal emergence.
Question 5: Which patient population has the HIGHEST risk of postoperative respiratory complications in the ambulatory surgery setting, requiring extended monitoring?
- Patients with well-controlled type 2 diabetes
- Morbidly obese patients with OSA on CPAP therapy (Correct answer)
- Patients with a history of mild hypertension
- Non-smokers undergoing procedures under 1 hour
Correct answer: Morbidly obese patients with OSA on CPAP therapy
Morbidly obese patients with OSA are at highest risk for postoperative upper airway obstruction and oxygen desaturation, requiring extended monitoring before Phase II or home discharge.
Question 6: During handoff from OR to PACU, the SBAR communication tool is used. What information belongs in the 'Background' section?
- Current vital signs and airway status
- Patient's relevant medical history, allergies, and baseline status (Correct answer)
- The nurse's recommendation for immediate monitoring needs
- Description of the current patient situation and chief concern
Correct answer: Patient's relevant medical history, allergies, and baseline status
The Background section of SBAR contains pertinent history, allergies, medications, and baseline information that contextualizes the current patient situation.
Question 7: A patient is ready for Phase II discharge from ambulatory surgery. Which criterion from the Post-Anesthetic Discharge Scoring System (PADSS) addresses the risk of falls at home?
- Vital signs
- Activity level (Correct answer)
- Nausea and vomiting
- Pain
Correct answer: Activity level
The Activity level component of PADSS assesses whether the patient can ambulate steadily without dizziness, directly reflecting fall risk and readiness for home discharge.
CAPA Patient Safety & Monitoring 5
A patient in ambulatory surgery Phase II recovery has a pain score of 8/10 and has already received the maximum ordered opioid dose.
Which multimodal approach should the nurse advocate for?