CAPA Regional Anesthesia Recovery Care 3 — Questions and Answers
Question 1: A patient with a thoracic paravertebral block develops hypotension and bradycardia in the PACU. Which mechanism BEST explains these findings?
- Systemic absorption of local anesthetic causing cardiac depression
- Sympathetic blockade reducing vascular resistance and cardiac output
- Vasovagal response triggered by postoperative pain
- Epidural spread of local anesthetic affecting cardiac accelerator fibers (Correct answer)
Correct answer: Epidural spread of local anesthetic affecting cardiac accelerator fibers
Paravertebral blocks can spread epidurally, blocking cardiac accelerator fibers (T1-T4), causing bradycardia and hypotension.
Question 2: Which finding would indicate INADEQUATE regional anesthesia recovery before safe discharge in a patient who received a spinal anesthetic?
- Ability to perform straight leg raises bilaterally
- Return of perianal sensation (S4-S5 dermatome) (Correct answer)
- Blood pressure within 20% of baseline
- Minimal sensory loss at the L2 dermatome
Correct answer: Return of perianal sensation (S4-S5 dermatome)
Return of sacral sensation (S4-S5), including perianal sensation, is the last indicator of complete spinal regression and is required before discharge.
Question 3: A patient recovering from a TAP (transversus abdominis plane) block reports sudden onset of nausea and lightheadedness. The nurse notes the patient is pale and diaphoretic. What should the nurse suspect FIRST?
- Opioid-related side effects from pre-operative medication
- Local anesthetic systemic toxicity from the TAP block (Correct answer)
- Postoperative nausea and vomiting related to general anesthesia
- Vasovagal syncope from postoperative anxiety
Correct answer: Local anesthetic systemic toxicity from the TAP block
Sudden onset of systemic symptoms following a TAP block—a high-volume technique—should prompt suspicion of LAST, especially with CNS and cardiovascular signs.
Question 4: The nurse is caring for a patient with a continuous adductor canal catheter. Which catheter-related complication requires IMMEDIATE intervention?
- Mild erythema at the insertion site
- Leakage of clear fluid from the dressing
- Fever of 38.9°C with catheter site purulence (Correct answer)
- Patient reports catheter feels slightly uncomfortable
Correct answer: Fever of 38.9°C with catheter site purulence
Fever with purulence at a nerve catheter site indicates infection and requires immediate catheter removal and antibiotic management.
Question 5: During recovery from a caudal epidural block in an adult patient, the nurse should PRIORITIZE monitoring for which complication?
- Delayed motor recovery compared to lumbar epidural
- Inadvertent intravascular injection causing cardiac arrhythmia (Correct answer)
- Bilateral lower extremity weakness lasting more than 8 hours
- Postoperative shivering from hypothermia
Correct answer: Inadvertent intravascular injection causing cardiac arrhythmia
The caudal space is highly vascular; inadvertent intravascular injection of local anesthetic can cause rapid systemic toxicity including cardiac arrhythmia.
Question 6: A patient in the PACU following shoulder surgery with an interscalene block has an oxygen saturation of 91% on 2L nasal cannula. The nurse notes absent breath sounds on the blocked side. Which is the MOST likely cause?
- Pulmonary embolism from venous stasis
- Pneumothorax from interscalene block needle placement (Correct answer)
- Mucous plugging from inadequate cough effort
- Atelectasis from prolonged supine positioning
Correct answer: Pneumothorax from interscalene block needle placement
Pneumothorax is a known complication of interscalene block due to the proximity of the needle to the pleural apex, presenting with absent breath sounds and desaturation.
Question 7: Which documentation element is MOST critical when discharging a patient with a residual peripheral nerve block?
- The exact time the block was placed in the OR
- Written instructions on limb protection, fall prevention, and when to seek care (Correct answer)
- The brand name and lot number of the local anesthetic used
- The surgeon's name and contact information for billing purposes
Correct answer: Written instructions on limb protection, fall prevention, and when to seek care
Patients with residual sensory or motor block must receive written instructions on protecting the affected limb, fall prevention, and criteria for seeking emergency care.
CAPA Regional Anesthesia Recovery Care 3
A patient with a thoracic paravertebral block develops hypotension and bradycardia in the PACU.
Which mechanism BEST explains these findings?