CAPA Regional Anesthesia Recovery Care 2 — Questions and Answers
Question 1: A patient recovering from a femoral nerve block reports inability to flex the knee 4 hours post-procedure. What is the PRIORITY nursing action?
- Reassure the patient this is expected and document the finding
- Assess for signs of compartment syndrome and notify the anesthesia provider (Correct answer)
- Apply a compression bandage to reduce edema
- Encourage the patient to ambulate to restore motor function
Correct answer: Assess for signs of compartment syndrome and notify the anesthesia provider
Prolonged motor block with inability to flex the knee may indicate complications such as compartment syndrome, requiring immediate assessment and provider notification.
Question 2: Which assessment finding would MOST concern the perianesthesia nurse in a patient who received an interscalene nerve block?
- Mild paresthesia along the forearm
- Ipsilateral ptosis and miosis
- SpO2 of 94% with dyspnea (Correct answer)
- Shoulder muscle weakness on the blocked side
Correct answer: SpO2 of 94% with dyspnea
Interscalene blocks commonly cause ipsilateral phrenic nerve palsy, reducing diaphragmatic function; SpO2 of 94% with dyspnea indicates significant respiratory compromise.
Question 3: A patient with a popliteal sciatic nerve block is being prepared for discharge. Which instruction is MOST important regarding foot safety?
- Elevate the foot above heart level for 24 hours
- Inspect the foot for injury frequently since sensation is impaired (Correct answer)
- Apply heat to the foot to promote circulation
- Begin full weight-bearing immediately to restore function
Correct answer: Inspect the foot for injury frequently since sensation is impaired
With impaired sensation from a sciatic block, patients cannot feel injury, so frequent inspection is essential to prevent unrecognized trauma.
Question 4: During recovery from an epidural block, the nurse notes the patient's blood pressure drops from 118/72 to 82/50 mmHg. What is the FIRST intervention?
- Administer epinephrine 0.1 mg IV
- Place the patient in Trendelenburg position and increase IV fluid rate (Correct answer)
- Discontinue the epidural infusion immediately
- Notify the surgeon and prepare for emergency surgery
Correct answer: Place the patient in Trendelenburg position and increase IV fluid rate
Sympathetic blockade from epidural anesthesia causes vasodilation and hypotension; initial management includes positioning and IV fluid bolus to restore preload.
Question 5: A patient who received a spinal anesthetic complains of a severe positional headache 24 hours post-procedure. Which action is MOST appropriate initially?
- Administer IV caffeine and maintain bed rest with increased oral fluid intake (Correct answer)
- Perform an immediate blood patch at the bedside
- Order a CT scan to rule out intracranial hemorrhage
- Discharge the patient with oral analgesics and follow-up in one week
Correct answer: Administer IV caffeine and maintain bed rest with increased oral fluid intake
Conservative management of post-dural puncture headache includes bed rest, hydration, and caffeine administration before escalating to an epidural blood patch.
Question 6: Which patient is at HIGHEST risk for local anesthetic systemic toxicity (LAST) following a regional nerve block?
- A 45-year-old with no comorbidities receiving a femoral block
- A 70-year-old with hepatic impairment receiving a brachial plexus block (Correct answer)
- A 30-year-old with well-controlled hypertension receiving a digital block
- A 55-year-old with mild asthma receiving an ankle block
Correct answer: A 70-year-old with hepatic impairment receiving a brachial plexus block
Hepatic impairment reduces metabolism of amide local anesthetics, significantly increasing the risk of systemic toxicity through drug accumulation.
Question 7: When assessing a patient for signs of LAST after a brachial plexus block, which neurological symptom would appear FIRST?
- Loss of consciousness
- Generalized tonic-clonic seizure
- Perioral numbness and metallic taste (Correct answer)
- Respiratory arrest
Correct answer: Perioral numbness and metallic taste
Early CNS excitatory signs of LAST include perioral numbness, metallic taste, and tinnitus before progression to seizures and cardiovascular collapse.
CAPA Regional Anesthesia Recovery Care 2
A patient recovering from a femoral nerve block reports inability to flex the knee 4 hours post-procedure.
What is the PRIORITY nursing action?