CAPA Phase I & Phase II Recovery Care 3 — Questions and Answers
Question 1: A Phase I PACU patient who received spinal anesthesia can move both legs but reports inability to void despite feeling the urge. What is the most likely cause?
- Urinary tract infection
- Residual sympathetic blockade inhibiting bladder contraction (Correct answer)
- Anticholinergic side effects from atropine
- Hypovolemia causing renal hypoperfusion
Correct answer: Residual sympathetic blockade inhibiting bladder contraction
Spinal anesthesia blocks sacral nerve roots S2-S4, impairing detrusor muscle contraction and causing urinary retention even as motor block resolves.
Question 2: Which parameter is the most sensitive early indicator of internal hemorrhage in the immediate postoperative period?
- Decrease in blood pressure
- Increase in heart rate (Correct answer)
- Decrease in urine output
- Change in mental status
Correct answer: Increase in heart rate
Tachycardia is typically the earliest compensatory response to hypovolemia and hemorrhage before blood pressure drops significantly.
Question 3: A patient in Phase II PACU rates pain at 7/10 but has already received the maximum dose of IV ketorolac. What is the most appropriate next step?
- Administer additional IV ketorolac at half the dose
- Offer an oral opioid analgesic if the patient can tolerate oral intake (Correct answer)
- Return the patient to Phase I for IV opioid administration
- Apply ice packs and distract the patient
Correct answer: Offer an oral opioid analgesic if the patient can tolerate oral intake
Transitioning to oral multimodal analgesia, including oral opioids when appropriate, is standard Phase II pain management when IV NSAID maximum doses are reached.
Question 4: Laryngospasm in the immediate postoperative period is BEST managed initially by:
- Immediate oral intubation
- Applying continuous positive airway pressure (CPAP) with 100% oxygen and jaw thrust (Correct answer)
- Administering succinylcholine 1.5 mg/kg IV
- Inserting a nasopharyngeal airway
Correct answer: Applying continuous positive airway pressure (CPAP) with 100% oxygen and jaw thrust
Initial laryngospasm management uses positive pressure ventilation with 100% oxygen and jaw thrust to break the spasm before resorting to pharmacologic paralysis.
Question 5: A perianesthesia nurse notes that a patient's train-of-four (TOF) ratio is 0.7 after reversal with neostigmine. What does this indicate?
- Full neuromuscular recovery; the patient can be safely discharged from Phase I
- Residual neuromuscular blockade; the patient may have impaired airway protection (Correct answer)
- The patient is over-reversed and at risk for cholinergic crisis
- The TOF ratio is invalid without a baseline measurement
Correct answer: Residual neuromuscular blockade; the patient may have impaired airway protection
A TOF ratio below 0.9 indicates residual neuromuscular blockade, which can impair airway reflexes and increase aspiration risk.
Question 6: Which of the following patients is at HIGHEST risk for postoperative pulmonary complications in Phase I PACU?
- A 35-year-old non-smoker after a 45-minute laparoscopic procedure under general anesthesia
- A 68-year-old with COPD after a 3-hour open abdominal procedure under general anesthesia (Correct answer)
- A 50-year-old ASA II patient after knee arthroscopy under spinal anesthesia
- A 42-year-old after shoulder arthroplasty under interscalene nerve block with sedation
Correct answer: A 68-year-old with COPD after a 3-hour open abdominal procedure under general anesthesia
Advanced age, pre-existing pulmonary disease, longer operative duration, and upper abdominal surgery under general anesthesia compound the risk for postoperative pulmonary complications.
Question 7: A Phase II patient who is ready for discharge asks the nurse if they can drive themselves home since they feel completely normal. The appropriate response is:
- Allow discharge if the patient demonstrates coordination by walking steadily down the hall
- Explain that driving is prohibited for 24 hours after general or regional anesthesia regardless of how they feel (Correct answer)
- Discharge the patient if their Aldrete score is 10/10
- Allow driving if the patient received only local anesthesia with minimal sedation
Correct answer: Explain that driving is prohibited for 24 hours after general or regional anesthesia regardless of how they feel
Residual anesthetic and sedative effects impair judgment and reaction time even when patients feel subjectively normal, making driving unsafe for at least 24 hours.
CAPA Phase I & Phase II Recovery Care 3
A Phase I PACU patient who received spinal anesthesia can move both legs but reports inability to void despite feeling the urge.
What is the most likely cause?