CAPA Phase I & Phase II Recovery Care 5 — Questions and Answers
Question 1: A patient in Phase I PACU begins to exhibit signs of local anesthetic systemic toxicity (LAST) including perioral numbness, tinnitus, and agitation. The FIRST drug to prepare is:
- Epinephrine 1 mg IV push
- 20% lipid emulsion (Intralipid) IV infusion (Correct answer)
- Naloxone 0.4 mg IV
- Sodium bicarbonate 1 mEq/kg IV
Correct answer: 20% lipid emulsion (Intralipid) IV infusion
20% lipid emulsion is the primary antidote for LAST and should be immediately drawn up and administered at the first signs of systemic local anesthetic toxicity.
Question 2: Which of the following interventions BEST reduces the risk of postoperative nausea and vomiting (PONV) in a high-risk ambulatory surgery patient?
- Restricting all oral intake including water until 6 hours post-procedure
- Multimodal prophylaxis combining a 5-HT3 antagonist with dexamethasone and TIVA technique (Correct answer)
- Administering morphine PCA for pain control to reduce overall opioid requirements
- Maintaining the patient in supine position throughout the recovery period
Correct answer: Multimodal prophylaxis combining a 5-HT3 antagonist with dexamethasone and TIVA technique
Multimodal PONV prophylaxis using agents from different classes combined with TIVA (avoiding volatile anesthetics) significantly reduces PONV incidence in high-risk patients.
Question 3: A patient arrives in Phase I PACU with pinpoint pupils, a respiratory rate of 6 breaths/min, and SpO2 of 82%. The most likely etiology and initial intervention are:
- Hypoglycemia; administer 50% dextrose 25g IV
- Opioid-induced respiratory depression; administer naloxone titrated in small doses with airway support (Correct answer)
- Residual neuromuscular blockade; administer neostigmine 5mg with glycopyrrolate
- Pulmonary embolism; administer anticoagulation and call a code
Correct answer: Opioid-induced respiratory depression; administer naloxone titrated in small doses with airway support
The classic triad of pinpoint pupils, bradypnea, and hypoxia indicates opioid overdose; titrated naloxone with airway support is the appropriate reversal strategy.
Question 4: When is it appropriate to use the 'fast-track' protocol that bypasses Phase I PACU and admits the patient directly to Phase II?
- After any laparoscopic procedure under general anesthesia
- When the patient meets predetermined criteria including an Aldrete-equivalent score ≥ 12 immediately upon OR exit (Correct answer)
- After any procedure performed under monitored anesthesia care (MAC)
- When the Phase I PACU is at full capacity and staff request expedited transfer
Correct answer: When the patient meets predetermined criteria including an Aldrete-equivalent score ≥ 12 immediately upon OR exit
Fast-tracking is appropriate only when patients meet validated scoring criteria demonstrating adequate recovery from anesthesia immediately post-procedure, not based on capacity or procedure type alone.
Question 5: A patient in Phase II PACU who underwent inguinal hernia repair under spinal anesthesia complains of a severe bilateral positional headache that worsens when sitting up. This presentation is most consistent with:
- Tension headache from intraoperative positioning
- Post-dural puncture headache (PDPH) from cerebrospinal fluid leak (Correct answer)
- Hypertensive urgency requiring immediate blood pressure management
- Hypoglycemia requiring blood glucose check and treatment
Correct answer: Post-dural puncture headache (PDPH) from cerebrospinal fluid leak
Postural bilateral headache worse in upright position following spinal anesthesia is the classic presentation of post-dural puncture headache caused by CSF leak.
Question 6: A perianesthesia nurse is caring for a pediatric patient age 4 in Phase I PACU after tonsillectomy who is inconsolably crying and thrashing. The nurse's FIRST assessment priority is to distinguish emergence delirium from:
- Hunger and thirst from prolonged NPO status
- Pain, since both conditions require different management approaches (Correct answer)
- Separation anxiety from parents
- Normal developmental response to an unfamiliar environment
Correct answer: Pain, since both conditions require different management approaches
Distinguishing emergence delirium from pain is the critical first step because pain requires analgesia while emergence delirium may worsen with opioids and requires reassurance or procedural sedation reversal.
Question 7: Which of the following is a recommended component of Phase II discharge teaching to minimize the risk of aspiration at home after ambulatory surgery?
- Resume a full regular diet immediately to replenish nutritional stores
- Begin with clear liquids, advance diet slowly, and avoid alcohol which increases aspiration risk (Correct answer)
- Lie flat for 4 hours after discharge to allow anesthetic agents to metabolize
- Avoid all oral intake for 8 hours following discharge from the PACU
Correct answer: Begin with clear liquids, advance diet slowly, and avoid alcohol which increases aspiration risk
Graduated diet initiation starting with clear liquids and avoidance of alcohol reduces aspiration risk during the period of residual sedation and impaired protective reflexes.
CAPA Phase I & Phase II Recovery Care 5
A patient in Phase I PACU begins to exhibit signs of local anesthetic systemic toxicity (LAST) including perioral numbness, tinnitus, and agitation.
The FIRST drug to prepare is: