CAPA Regional Anesthesia Recovery Care 4 — Questions and Answers
Question 1: A patient who received a spinal anesthetic for knee arthroscopy is now in phase II recovery. The nurse notes the patient cannot plantar-flex the foot against resistance. What should the nurse do?
- Allow additional recovery time and reassess in 30 minutes
- Discharge the patient with instructions to follow up if weakness persists
- Notify the anesthesia provider, as this may indicate neurological injury (Correct answer)
- Apply a splint to the foot and reassess in the morning
Correct answer: Notify the anesthesia provider, as this may indicate neurological injury
Persistent unilateral motor deficit beyond expected block duration may indicate neurological injury, requiring prompt anesthesia provider notification and evaluation.
Question 2: Which patient factor is a CONTRAINDICATION to performing a peripheral nerve block in the ambulatory surgery setting?
- History of mild anxiety requiring preoperative anxiolytic
- Patient refusal to consent to the block procedure (Correct answer)
- BMI of 32 requiring ultrasound-guided technique
- Mild chronic obstructive pulmonary disease (GOLD Stage I)
Correct answer: Patient refusal to consent to the block procedure
Patient refusal is an absolute contraindication to any regional anesthesia procedure regardless of its clinical benefits.
Question 3: A patient recovering from a digital nerve block for finger surgery reports increasing throbbing pain and tightness 2 hours post-procedure. The fingertip appears pale and capillary refill is 4 seconds. What is the PRIORITY action?
- Reassure the patient and administer oral analgesics as prescribed
- Immediately notify the surgeon for potential vascular compromise (Correct answer)
- Apply a warm compress to promote circulation to the finger
- Elevate the hand above heart level and recheck in 1 hour
Correct answer: Immediately notify the surgeon for potential vascular compromise
Pallor, prolonged capillary refill, and pain after a digital block suggest vascular compromise, which is a surgical emergency requiring immediate physician notification.
Question 4: When preparing Intralipid 20% for treatment of LAST, which administration approach is CORRECT for an adult patient experiencing cardiovascular collapse?
- 1.5 mL/kg bolus IV over 2-3 minutes, followed by 0.25 mL/kg/min infusion (Correct answer)
- 0.5 mL/kg bolus IV over 5 minutes, followed by 0.1 mL/kg/min infusion
- 2.0 mL/kg bolus IV over 10 minutes, then repeat every 30 minutes
- 3 mL/kg bolus IV immediately, then discontinue
Correct answer: 1.5 mL/kg bolus IV over 2-3 minutes, followed by 0.25 mL/kg/min infusion
ASRA guidelines recommend 20% lipid emulsion 1.5 mL/kg IV bolus over 2-3 minutes followed by a 0.25 mL/kg/min infusion for LAST with cardiovascular collapse.
Question 5: A patient with a thoracic epidural for post-operative pain control reports sudden severe back pain at the catheter insertion site with new onset lower extremity weakness. The nurse's PRIORITY action is:
- Increase the epidural infusion rate to improve analgesia
- Immediately notify the anesthesiologist of possible epidural hematoma (Correct answer)
- Position the patient prone to relieve spinal cord pressure
- Administer IV ketorolac for breakthrough pain management
Correct answer: Immediately notify the anesthesiologist of possible epidural hematoma
Sudden back pain with new neurological deficits is a hallmark of epidural hematoma, a neurosurgical emergency requiring immediate evaluation and possible intervention within hours.
Question 6: Which assessment tool is MOST appropriate for evaluating the degree of sensory regression following spinal anesthesia in the PACU?
- Visual analog pain scale (VAS)
- Pin-prick or ice assessment of dermatome levels (Correct answer)
- Glasgow Coma Scale
- Modified Aldrete scoring system
Correct answer: Pin-prick or ice assessment of dermatome levels
Pin-prick or ice assessment allows the nurse to map the cephalad level of sensory block and track its regression through dermatome levels.
Question 7: A patient who received bupivacaine for a supraclavicular nerve block develops cardiovascular toxicity. Why is bupivacaine considered MORE cardiotoxic than lidocaine?
- Bupivacaine causes greater systemic vasodilation and histamine release
- Bupivacaine binds more avidly to cardiac sodium channels and dissociates slowly (Correct answer)
- Bupivacaine has a faster onset, allowing less time for cardiac monitoring
- Bupivacaine is more rapidly absorbed through tissue membranes
Correct answer: Bupivacaine binds more avidly to cardiac sodium channels and dissociates slowly
Bupivacaine's high lipid solubility and slow dissociation from cardiac sodium channels ('fast-in, slow-out') makes it profoundly cardiotoxic compared to lidocaine.
CAPA Regional Anesthesia Recovery Care 4
A patient who received a spinal anesthetic for knee arthroscopy is now in phase II recovery.
The nurse notes the patient cannot plantar-flex the foot against resistance.
What should the nurse do?