CAPA Postanesthesia Care 4 — Questions and Answers
Question 1: A patient's PACU temperature is 35.2°C (95.4°F) after a 3-hour abdominal procedure under general anesthesia. Which complication is most directly associated with this finding?
- Increased bleeding risk due to platelet dysfunction (Correct answer)
- Hypertensive crisis
- Malignant hyperthermia
- Serotonin syndrome
Correct answer: Increased bleeding risk due to platelet dysfunction
Hypothermia impairs platelet aggregation and coagulation enzyme function, significantly increasing perioperative bleeding risk.
Question 2: Which multimodal analgesia component is contraindicated in a patient with a creatinine of 2.8 mg/dL in the ambulatory PACU?
- Acetaminophen 1,000 mg IV
- Ketorolac 15 mg IV (Correct answer)
- Gabapentin 300 mg PO
- Hydromorphone 0.2 mg IV PRN
Correct answer: Ketorolac 15 mg IV
NSAIDs like ketorolac are contraindicated in renal impairment as they inhibit prostaglandin-mediated renal perfusion and can worsen kidney function.
Question 3: Which intervention is most effective in preventing postoperative nausea and vomiting (PONV) in a high-risk female patient undergoing laparoscopic surgery?
- Administer neostigmine at end of case
- Use propofol-based TIVA with multimodal antiemetic prophylaxis (Correct answer)
- Limit IV fluid administration intraoperatively
- Delay opioid administration until Phase II
Correct answer: Use propofol-based TIVA with multimodal antiemetic prophylaxis
Total intravenous anesthesia (TIVA) with propofol combined with multimodal antiemetics is the most effective PONV prevention strategy for high-risk patients.
Question 4: A patient develops sudden-onset chest pain, tachycardia, and hypotension in the PACU after a right femoral hernia repair. SpO2 drops to 88%. Which diagnosis must be considered first?
- Pneumothorax
- Pulmonary embolism (Correct answer)
- Myocardial infarction
- Anaphylaxis
Correct answer: Pulmonary embolism
Pulmonary embolism presents with sudden hypoxia, tachycardia, chest pain, and hypotension and should be the priority differential in postoperative patients.
Question 5: Which Phase I PACU discharge criterion is specific to the ambulatory setting according to ASPAN standards?
- Patient must have voided prior to discharge
- Patient must be accompanied by a responsible adult escort (Correct answer)
- Patient must tolerate oral fluids without nausea
- Patient must ambulate 50 feet independently
Correct answer: Patient must be accompanied by a responsible adult escort
ASPAN standards require ambulatory surgery patients to be discharged in the care of a responsible, competent adult who can observe for complications at home.
Question 6: A patient in Phase II PACU is prescribed oxycodone 5 mg PO for pain. Which assessment is essential before administration?
- Verify the patient has a driver before administering
- Assess pain level and sedation score (Correct answer)
- Confirm patient has eaten within the last 2 hours
- Check blood pressure before every opioid dose
Correct answer: Assess pain level and sedation score
Before administering oral opioids, the nurse must assess both pain intensity and current sedation level to prevent over-sedation in the ambulatory setting.
Question 7: During Phase I PACU recovery, a patient suddenly develops rigidity, hyperthermia (40.1°C), tachycardia, and hypercapnia. Which condition requires immediate action?
- Neuroleptic malignant syndrome
- Malignant hyperthermia (Correct answer)
- Serotonin syndrome
- Thyroid storm
Correct answer: Malignant hyperthermia
Malignant hyperthermia presents with hypercarbia, muscle rigidity, rapid temperature rise, and tachycardia after volatile anesthetic or succinylcholine exposure.
CAPA Postanesthesia Care 4
A patient's PACU temperature is 35.2°C (95.4°F) after a 3-hour abdominal procedure under general anesthesia.
Which complication is most directly associated with this finding?