CAPA Postanesthesia Care 5 — Questions and Answers
Question 1: Which medication class is most commonly implicated in delayed awakening from general anesthesia in the elderly ambulatory patient?
- Opioids
- Benzodiazepines (Correct answer)
- Volatile anesthetics
- Neuromuscular blocking agents
Correct answer: Benzodiazepines
Benzodiazepines have prolonged half-lives in elderly patients due to reduced hepatic metabolism and increased volume of distribution, leading to delayed emergence.
Question 2: A patient in Phase I PACU has a blood pressure of 190/110 mmHg following general anesthesia for cataract surgery. Which factor should be assessed first?
- Fluid balance
- Pain and bladder distension (Correct answer)
- Core body temperature
- Serum potassium level
Correct answer: Pain and bladder distension
Pain and bladder distension are common, reversible causes of postoperative hypertension that should be assessed and treated before antihypertensive medications.
Question 3: Which assessment tool is recommended by ASPAN for screening obstructive sleep apnea risk in pre-admission ambulatory surgery patients?
- Epworth Sleepiness Scale
- STOP-BANG questionnaire (Correct answer)
- Berlin Questionnaire
- Pittsburgh Sleep Quality Index
Correct answer: STOP-BANG questionnaire
The STOP-BANG questionnaire is widely recommended and validated for preoperative OSA screening due to its simplicity and high sensitivity.
Question 4: A patient is receiving IV patient-controlled analgesia (PCA) with morphine in Phase I PACU. The nurse finds the patient sedated with a respiratory rate of 7. What is the correct intervention sequence?
- Stop PCA, stimulate, administer oxygen, prepare naloxone if no response (Correct answer)
- Administer naloxone immediately, then stop PCA
- Increase oxygen flow, notify physician, continue monitoring
- Obtain ABG, reduce PCA demand dose, reassess in 15 minutes
Correct answer: Stop PCA, stimulate, administer oxygen, prepare naloxone if no response
PCA should be stopped immediately, followed by stimulation and supplemental oxygen; naloxone is reserved if the patient does not respond to these measures.
Question 5: Which patient factor increases the minimum score required on a PACU scoring system before discharge to Phase II?
- History of hypertension
- Chronic opioid use
- Difficult airway history (Correct answer)
- Presence of a responsible adult escort
Correct answer: Difficult airway history
Patients with a history of difficult airway require closer airway monitoring and may require higher discharge thresholds due to risk of rebound obstruction.
Question 6: Which finding in the PACU would indicate the need to defer ambulatory discharge and arrange inpatient admission?
- Pain score of 5/10 controlled with oral analgesics
- Persistent SpO2 88% on 4L nasal cannula after 90 minutes (Correct answer)
- PONV requiring one additional dose of ondansetron
- Mild dizziness resolving with IV fluid bolus
Correct answer: Persistent SpO2 88% on 4L nasal cannula after 90 minutes
Persistent hypoxemia requiring supplemental oxygen beyond 90 minutes indicates the patient cannot safely be discharged to an unmonitored home environment.
Question 7: A patient undergoing monitored anesthesia care (MAC) receives dexmedetomidine intraoperatively. Which PACU assessment finding is most expected?
- Hypertension and tachycardia
- Bradycardia and sedation without respiratory depression (Correct answer)
- Nausea and vomiting
- Prolonged neuromuscular blockade
Correct answer: Bradycardia and sedation without respiratory depression
Dexmedetomidine causes alpha-2 mediated sedation and analgesia with bradycardia but preserves respiratory drive, distinguishing it from opioids.
CAPA Postanesthesia Care 5
Which medication class is most commonly implicated in delayed awakening from general anesthesia in the elderly ambulatory patient?