CAPA Phase I & Phase II Recovery Care 4 — Questions and Answers
Question 1: A patient in Phase I PACU develops sudden onset atrial fibrillation with a ventricular rate of 140 bpm and a blood pressure of 88/54 mmHg. The priority intervention is:
- Administer amiodarone 150 mg IV over 10 minutes
- Synchronized cardioversion after notifying the anesthesiologist/cardiologist (Correct answer)
- Administer adenosine 6 mg rapid IV push
- Apply carotid massage and reassess in 5 minutes
Correct answer: Synchronized cardioversion after notifying the anesthesiologist/cardiologist
Hemodynamically unstable atrial fibrillation with hypotension requires immediate synchronized cardioversion per ACLS guidelines.
Question 2: Which position is CONTRAINDICATED for a patient in Phase I PACU who is still sedated and has not yet regained protective airway reflexes?
- Left lateral (recovery) position
- Supine with head of bed elevated 30 degrees
- Semi-prone position
- Supine flat position (Correct answer)
Correct answer: Supine flat position
A fully supine flat position increases aspiration risk in a sedated patient without protective airway reflexes; lateral or semi-prone positioning protects the airway.
Question 3: Malignant hyperthermia (MH) is triggered by which of the following agents used in the perioperative setting?
- Propofol and ketamine
- Succinylcholine and volatile inhalation agents such as sevoflurane (Correct answer)
- Rocuronium and fentanyl
- Nitrous oxide and neostigmine
Correct answer: Succinylcholine and volatile inhalation agents such as sevoflurane
MH is triggered by succinylcholine and all volatile halogenated anesthetic agents; propofol is a safe alternative for MH-susceptible patients.
Question 4: A patient recovering in Phase I PACU after laparoscopic cholecystectomy develops right shoulder pain. The nurse understands this is most likely caused by:
- Positioning injury to the brachial plexus during surgery
- Referred pain from residual diaphragmatic irritation due to CO2 insufflation (Correct answer)
- Myocardial ischemia radiating to the shoulder
- Rotator cuff strain from intraoperative positioning
Correct answer: Referred pain from residual diaphragmatic irritation due to CO2 insufflation
Residual CO2 from laparoscopic insufflation irritates the diaphragm, causing referred phrenic nerve pain perceived in the ipsilateral shoulder.
Question 5: When assessing a patient's readiness to transfer from Phase I to Phase II PACU, which criterion is MOST important to verify first?
- The patient has voided at least 30 mL of urine
- The patient's airway is patent and ventilation is adequate with a stable SpO2 (Correct answer)
- The patient can state their name and date of birth correctly
- The patient's pain is rated 0/10
Correct answer: The patient's airway is patent and ventilation is adequate with a stable SpO2
Airway patency and adequate ventilation are the most critical safety parameters before any PACU phase transition.
Question 6: A Phase II patient who received bupivacaine via femoral nerve block for knee surgery reports that their leg is completely numb 4 hours postoperatively. The nurse should:
- Reassure the patient that prolonged sensory block is expected with bupivacaine and instruct them not to bear weight (Correct answer)
- Immediately call the anesthesiologist for suspected local anesthetic toxicity
- Administer IV lipid emulsion prophylactically
- Remove the nerve block catheter and apply heat to the extremity
Correct answer: Reassure the patient that prolonged sensory block is expected with bupivacaine and instruct them not to bear weight
Bupivacaine has a longer duration of action and sensory block can persist well beyond the analgesic period; fall prevention and non-weight-bearing instructions are the appropriate response.
Question 7: Which of the following is the MOST appropriate discharge instruction to provide to a Phase II patient after ambulatory surgery with general anesthesia?
- Resume all pre-operative medications including anticoagulants immediately
- Do not make important legal or financial decisions for 24 hours due to lingering cognitive effects of anesthesia (Correct answer)
- You may drink alcohol in moderation this evening as long as you feel well
- Resume normal diet immediately regardless of the type of surgery performed
Correct answer: Do not make important legal or financial decisions for 24 hours due to lingering cognitive effects of anesthesia
Residual cognitive effects of general anesthesia impair judgment and decision-making capacity for up to 24 hours, making important legal or financial decisions unsafe.
CAPA Phase I & Phase II Recovery Care 4
A patient in Phase I PACU develops sudden onset atrial fibrillation with a ventricular rate of 140 bpm and a blood pressure of 88/54 mmHg.
The priority intervention is: