CAPA Regional Anesthesia Recovery Care 5 — Questions and Answers
Question 1: A patient receiving a continuous peripheral nerve block infusion at home calls the ambulatory surgery unit reporting that the catheter has dislodged. The nurse's BEST response is:
- Instruct the patient to reinsert the catheter and restart the pump
- Tell the patient to stop the pump, secure the site, and come to the facility for evaluation (Correct answer)
- Advise the patient to double the oral analgesic dose to compensate for lost block
- Reassure the patient that the block medication is already absorbed and no further action is needed
Correct answer: Tell the patient to stop the pump, secure the site, and come to the facility for evaluation
A dislodged catheter requires the patient to stop the infusion and return for evaluation, as reinsertion at home is not appropriate and additional local anesthetic may cause pooling or toxicity.
Question 2: Which patient would be BEST suited for a spinal anesthetic rather than general anesthesia in the ambulatory setting?
- A patient with severe aortic stenosis undergoing lower extremity surgery
- A morbidly obese patient with sleep apnea scheduled for knee arthroscopy
- A patient with a history of malignant hyperthermia undergoing inguinal hernia repair (Correct answer)
- A patient with coagulopathy and platelet count of 45,000 scheduled for anal surgery
Correct answer: A patient with a history of malignant hyperthermia undergoing inguinal hernia repair
Patients with malignant hyperthermia risk benefit from spinal anesthesia because it avoids triggering agents; it is a preferred technique for this high-risk group.
Question 3: During assessment of a patient in the PACU after an axillary brachial plexus block, the nurse notes a large, expanding hematoma at the block site. The PRIORITY nursing action is:
- Apply a pressure dressing and monitor closely
- Alert the physician immediately and prepare for potential airway compromise
- Notify the physician, apply firm manual pressure, and monitor neurovascular status (Correct answer)
- Reassure the patient, document the finding, and recheck in 30 minutes
Correct answer: Notify the physician, apply firm manual pressure, and monitor neurovascular status
An expanding hematoma at a nerve block site requires immediate physician notification, direct pressure, and neurovascular assessment for possible nerve compression.
Question 4: A patient is being evaluated before discharge after a femoral nerve block for knee surgery. Which finding indicates SAFE discharge readiness?
- Patient reports mild paresthesia along the medial thigh
- Patient ambulates safely with crutches and verbalized limb protection precautions (Correct answer)
- Knee flexion strength is 4/5 compared to 5/5 preoperatively
- Patient is pain-free and states they do not need discharge instructions
Correct answer: Patient ambulates safely with crutches and verbalized limb protection precautions
Safe ambulation with crutches and demonstrated understanding of limb protection indicates the patient has the necessary function and knowledge for safe discharge with a residual femoral block.
Question 5: Which LOCAL anesthetic is SAFEST to use for a digital ring block, and why?
- Bupivacaine with epinephrine, because it provides the longest duration
- Lidocaine without epinephrine, because epinephrine causes digital vasospasm and ischemia (Correct answer)
- Ropivacaine with epinephrine, because the vasoconstrictive effect reduces bleeding
- Mepivacaine with epinephrine, because it has a favorable safety profile for all block types
Correct answer: Lidocaine without epinephrine, because epinephrine causes digital vasospasm and ischemia
Epinephrine causes vasospasm in end-arterial digital circulation and should be avoided; plain lidocaine provides effective anesthesia without ischemia risk.
Question 6: In the context of ambulatory regional anesthesia recovery, what does the term 'fast-track recovery' mean?
- Bypassing phase I PACU and moving directly to phase II recovery when criteria are met (Correct answer)
- Administering reversal agents to accelerate block resolution
- Reducing the recovery room stay to less than 30 minutes for all patients
- Using light sedation instead of general anesthesia to avoid PACU entirely
Correct answer: Bypassing phase I PACU and moving directly to phase II recovery when criteria are met
Fast-track recovery allows patients who meet specific criteria (stable vitals, adequate pain control, no complications) to bypass phase I PACU and go directly to phase II, reducing recovery time.
Question 7: A perianesthesia nurse is educating a patient about what to expect from a residual popliteal sciatic nerve block after foot surgery. Which statement by the patient indicates CORRECT understanding?
- I can remove my boot to shower since I won't feel any pain if I injure my foot
- I should keep my foot protected, inspect it for injury, and not put weight on it until feeling returns (Correct answer)
- I should apply ice packs to my foot to help the block wear off more quickly
- I can drive myself home since my foot is numb and I won't have to use it
Correct answer: I should keep my foot protected, inspect it for injury, and not put weight on it until feeling returns
Patients must protect the anesthetized limb from injury, perform regular visual inspections, and avoid weight-bearing until sensation and motor function fully return.
CAPA Regional Anesthesia Recovery Care 5
A patient receiving a continuous peripheral nerve block infusion at home calls the ambulatory surgery unit reporting that the catheter has dislodged.
The nurse's BEST response is: