CAPA Exam Flashcards

Q: What is on the CAPA exam?

The CAPA exam covers five domains: Anesthesia (20%), Physiology (16%), Perianesthesia Monitoring and Intervention (30%), Perianesthesia Care Considerations (25%), and Professional Nursing Practice and Guidelines (9%). It contains 185 multiple-choice questions (140 scored, 45 unscored pretest) administered over 3 hours at PSI testing centers. The Care Considerations domain is weighted more heavily than on CPAN, reflecting the importance of discharge planning in ambulatory settings.

Q: What is the passing score for the CAPA exam?

CAPA uses scaled scoring on a 200-800 range, with 450 required to pass. Pass rates vary by administration; ABPANC publishes recent CPAN and CAPA pass-rate rows on its About Exams page. Treat those rows as context, not as a personal probability of passing.

Q: Who is eligible to sit for the CAPA exam?

You need a current unrestricted RN license in the U.S. or a U.S. territory that uses NCLEX for RN licensure, plus at least 1,200 hours of direct perianesthesia clinical experience in the 2 years before applying. Relevant experience is in preanesthesia, day-of-procedure, Postanesthesia Phase II, and extended-care settings.

Q: How long is CAPA certification valid?

CAPA certification is valid for 3 years. Recertification is achieved through continuing education contact hours or by retaking the exam. ABPANC requires perianesthesia-related continuing education across the 3-year cycle.

Q: What is the difference between CAPA and CPAN?

CAPA (Certified Ambulatory Perianesthesia Nurse) focuses on preoperative assessment and Phase II/III ambulatory recovery and discharge. CPAN (Certified Post Anesthesia Nurse) focuses on Phase I PACU care and immediate post-anesthesia recovery. The exams share a similar format but weight content differently to reflect their practice settings; many nurses hold both.

Q: How should I prepare for the CAPA exam?

Prioritize the largest domains: Monitoring and Intervention (30%) and Care Considerations (25%). Master ASA physical status classification, NPO guidelines, PADSS discharge scoring, PONV prophylaxis, and short-acting anesthetic pharmacology. Plan roughly 80-140 hours of study over 8-14 weeks.

Question 1

ASA Physical Status Classification

Accepted Answer

Preoperative risk grading from ASA I (healthy) to ASA VI (brain-dead organ donor). 'E' is appended for emergency cases. It estimates anesthetic risk but does not by itself predict surgical outcome or disqualify a patient from ambulatory surgery.

Question 2

Moderate (Conscious) Sedation

Accepted Answer

Drug-induced depression of consciousness where the patient responds purposefully to verbal commands and maintains a patent airway independently. The nurse monitoring sedation must have no other competing duties and must be able to rescue from one level deeper than intended.

Question 3

Malignant Hyperthermia

Accepted Answer

A hypermetabolic crisis triggered by volatile anesthetics or succinylcholine. Earliest reliable sign is an unexplained rise in end-tidal CO2; later signs are masseter rigidity, tachycardia, and hyperthermia. Treatment: stop trigger, give IV dantrolene, cool the patient.

Question 4

Succinylcholine

Accepted Answer

A depolarizing neuromuscular blocker with rapid onset and short duration, useful for ambulatory intubation. Causes transient muscle fasciculations and can raise serum potassium; contraindicated in patients at risk for hyperkalemia or malignant hyperthermia.

Question 5

Propofol

Accepted Answer

A rapid-onset, rapid-offset IV anesthetic favored in ambulatory care for quick emergence. Causes dose-dependent hypotension and respiratory depression, has no analgesic effect, and supports bacterial growth—discard opened vials within the manufacturer's time limit.

Question 6

Spinal vs. Epidural Anesthesia

Accepted Answer

Spinal injects anesthetic into the subarachnoid (CSF) space for fast, dense block from a single dose. Epidural places anesthetic in the epidural space, often via catheter for titratable, slower-onset block. Spinal carries higher risk of post-dural-puncture headache.

Question 7

Local Anesthetic Systemic Toxicity (LAST)

Accepted Answer

Caused by excessive local anesthetic plasma levels. Early CNS signs: perioral numbness, tinnitus, metallic taste, agitation, then seizures. Cardiovascular collapse follows. Treatment includes airway support and IV lipid emulsion therapy.

Question 8

Multimodal Analgesia

Accepted Answer

Combining agents with different mechanisms (acetaminophen, NSAIDs, regional blocks, low-dose opioids) to control pain while limiting opioid dose. It is a core ambulatory strategy because it reduces sedation, PONV, and discharge delay.

Question 9

Reversal Agents: Naloxone vs. Flumazenil

Accepted Answer

Naloxone reverses opioid-induced respiratory depression; flumazenil reverses benzodiazepine sedation. Both have shorter half-lives than many of the drugs they reverse, so re-sedation can occur—continue monitoring after administration.

Question 10

Minute Ventilation

Accepted Answer

Tidal volume multiplied by respiratory rate—the total volume of air moved per minute. A patient can maintain minute ventilation with rapid shallow breaths while still being hypoxic, so rate alone is not a reliable measure of adequate ventilation.

Question 11

Oxyhemoglobin Dissociation Curve Shift

Accepted Answer

A right shift (fever, acidosis, high CO2, increased 2,3-DPG) releases oxygen more readily to tissues. A left shift (hypothermia, alkalosis, low CO2) increases hemoglobin's oxygen affinity, holding oxygen and reducing tissue delivery.

Question 12

Cardiac Output Determinants

Accepted Answer

Cardiac output = heart rate x stroke volume. Stroke volume depends on preload, afterload, and contractility. Anesthetic-induced vasodilation lowers preload and afterload, a common cause of perianesthesia hypotension.

Question 13

Perioperative Hypothermia

Accepted Answer

Core temperature below 36°C from anesthetic-impaired thermoregulation and cool environments. Consequences include impaired coagulation, increased surgical site infection, shivering with raised oxygen demand, and delayed drug metabolism and discharge.

Question 14

Third Spacing

Accepted Answer

Fluid shifting from the intravascular space into a non-functional interstitial or cavity compartment. It reduces effective circulating volume and can cause hypotension and oliguria despite total body fluid being normal or increased.

Question 15

Stress Response to Surgery

Accepted Answer

Neuroendocrine activation releasing cortisol, catecholamines, and ADH, causing hyperglycemia, sodium and water retention, and a hypercoagulable state. Adequate analgesia and anesthesia blunt this response.

Question 16

Pulse Oximetry Limitations

Accepted Answer

SpO2 reflects hemoglobin saturation, not ventilation or PaCO2. It can read normal during early hypoventilation, especially with supplemental oxygen, and is falsely high in carbon monoxide poisoning. Capnography detects hypoventilation earlier.

Question 17

Capnography (EtCO2)

Accepted Answer

Continuous measurement of exhaled CO2. A sudden drop toward zero signals airway loss or apnea; a rising waveform suggests hypoventilation or rebreathing. It is the earliest detector of respiratory compromise during sedation.

Question 18

Laryngospasm

Accepted Answer

Reflex closure of the vocal cords, often during emergence or with airway secretions. Presents as stridor or no air movement with respiratory effort. Management: remove stimulus, apply positive-pressure oxygen with jaw thrust; succinylcholine if it persists.

Question 19

Negative-Pressure Pulmonary Edema

Accepted Answer

Pulmonary edema from forceful inspiration against an obstructed airway (often after laryngospasm). Presents with hypoxemia, pink frothy sputum, and crackles shortly after a relieved obstruction. Treat with oxygen and supportive ventilation.

Question 20

Jaw Thrust vs. Head-Tilt-Chin-Lift

Accepted Answer

Both open an obstructed airway by displacing the tongue. Jaw thrust is preferred when cervical spine injury is possible because it opens the airway without extending the neck.

Question 21

Postoperative Hypotension Priority

Accepted Answer

First confirm the reading and assess airway, breathing, and perfusion. Common ambulatory causes are residual anesthetic vasodilation and hypovolemia; initial intervention is usually a fluid bolus and positioning before vasopressors.

Question 22

Aldrete Score

Accepted Answer

A Phase I recovery scoring tool rating activity, respiration, circulation, consciousness, and oxygen saturation (0-2 each, max 10). It assesses readiness to progress from PACU, distinct from ambulatory home-discharge criteria.

Question 23

Hypoxemia vs. Hypoventilation

Accepted Answer

Hypoxemia is low arterial oxygen, detected by SpO2. Hypoventilation is inadequate CO2 clearance, detected by capnography. Supplemental oxygen can mask hypoventilation by keeping SpO2 normal while CO2 rises—monitor both.

Question 24

Emergence Delirium

Accepted Answer

Acute agitation, disorientation, or thrashing during anesthetic emergence. Rule out reversible physiologic causes first—hypoxia, hypercapnia, pain, bladder distension, hypoglycemia—before attributing it to the anesthetic alone.

Question 25

Bradycardia After Spinal Anesthesia

Accepted Answer

High spinal blockade can block cardiac accelerator fibers (T1-T4), causing bradycardia and hypotension. Treatment includes fluids, atropine for symptomatic bradycardia, and vasopressors; severe high spinal can impair respiratory muscles.

Question 26

PADSS (Post Anesthesia Discharge Scoring System)

Accepted Answer

A scored tool for ambulatory home readiness assessing vital sign stability, ambulation, nausea/vomiting, pain, and surgical bleeding. A passing score (commonly 9 of 10 with no zero category) plus a responsible escort supports discharge.

Question 27

Responsible Adult Escort Requirement

Accepted Answer

Ambulatory patients who received sedation or anesthesia must be discharged to a responsible adult who can accompany them home and stay with them. Surgery is generally postponed or the patient is admitted if no escort is available.

Question 28

Voiding as a Discharge Criterion

Accepted Answer

Routine mandatory voiding before discharge is no longer required for all patients. It remains important for high-risk groups—spinal/epidural anesthesia, urologic or pelvic surgery, or a history of retention—where urinary retention risk is elevated.

Question 29

PONV Risk Factors (Apfel)

Accepted Answer

Four predictors: female sex, nonsmoker, history of PONV or motion sickness, and postoperative opioid use. More risk factors mean higher PONV probability and support multimodal prophylaxis with agents from different drug classes.

Question 30

NPO Guidelines (ASA)

Accepted Answer

Typical minimum fasting before elective sedation/anesthesia: 2 hours for clear liquids, 6 hours for a light meal, and 8 hours for fried or fatty foods. Reducing prolonged fasting improves patient comfort and hydration.

Question 31

Teach-Back Method

Accepted Answer

Asking the patient or caregiver to restate discharge instructions in their own words to confirm understanding. It is more reliable than asking 'Do you understand?' because sedation and anxiety impair recall after ambulatory surgery.

Question 32

Discharge Warning Instructions

Accepted Answer

Ambulatory patients must leave with clear written guidance on when to seek care—uncontrolled pain, bleeding, fever, breathing difficulty, or surgical-site changes—plus medication, activity, and follow-up details, and a 24-hour contact number.

Question 33

Unplanned Admission After Ambulatory Surgery

Accepted Answer

Common reasons to convert an ambulatory case to admission include uncontrolled pain or PONV, bleeding, persistent hypotension or hypoxia, surgical complications, and lack of a responsible escort. Patient safety overrides same-day discharge.

Question 34

Phase II Recovery Focus

Accepted Answer

Phase II prepares the ambulatory patient for discharge: pain and nausea control, ambulation, tolerating oral intake when indicated, education, and confirming a safe home plan. It follows Phase I and emphasizes self-care readiness.

Question 35

Fast-Tracking

Accepted Answer

Bypassing Phase I PACU and admitting an eligible patient directly to Phase II when emergence criteria are met in the OR. It requires meeting defined readiness criteria and does not reduce the level of required monitoring.

Question 36

Older Adult Perianesthesia Considerations

Accepted Answer

Aging reduces drug clearance and physiologic reserve, increasing sensitivity to sedatives and risk of postoperative delirium, hypothermia, and falls. Lower doses, careful titration, and early cognitive baseline assessment are important.

Question 37

Pediatric Ambulatory Considerations

Accepted Answer

Children have higher airway-event and laryngospasm risk and benefit from caregiver presence and weight-based dosing. Discharge teaching is directed to the caregiver, and emergence agitation is common after short procedures.

Question 38

Obstructive Sleep Apnea Screening

Accepted Answer

OSA increases perioperative airway obstruction and opioid-induced respiratory depression risk. Screening (e.g., STOP-Bang) guides extended monitoring, opioid-sparing analgesia, and careful selection for ambulatory surgery.

Question 39

Latex Allergy Precautions

Accepted Answer

Patients with latex allergy should be scheduled as the first case of the day in a latex-safe environment with latex-free supplies. Cross-reactivity with foods such as banana, avocado, and kiwi is recognized.

Question 40

Universal Protocol / Time-Out

Accepted Answer

A pre-procedure pause to verify correct patient, correct procedure, and correct site, with active participation by the whole team. It is performed before the procedure starts to prevent wrong-site and wrong-patient events.

Question 41

Two Patient Identifiers

Accepted Answer

Patient identity must be confirmed with two identifiers (such as full name and date of birth) that are not the room or location. This is required before medication administration, procedures, and specimen collection.

Question 42

Informed Consent: Nurse's Role

Accepted Answer

The provider performing the procedure explains its nature, risks, benefits, and alternatives. The nurse verifies the patient is informed and voluntarily consenting and witnesses the signature—not to obtain or explain the consent itself.

Question 43

Patient Self-Determination

Accepted Answer

A competent adult may refuse or withdraw consent for any procedure even after pre-procedure preparation. The nurse documents the refusal, notifies the provider, and ensures the patient understands the consequences without coercion.

Question 44

Hand-Off (SBAR) Communication

Accepted Answer

Structured transfer of care using Situation, Background, Assessment, Recommendation. Standardized hand-off at each perianesthesia phase reduces omitted information and is a recognized patient-safety practice.

Question 45

Sentinel Event

Accepted Answer

A patient-safety event resulting in death, permanent harm, or severe temporary harm requiring intervention. It triggers immediate response and root cause analysis aimed at system improvement, not individual blame.

Question 46

Evidence-Based Practice

Accepted Answer

Integrating the best available research, clinical expertise, and patient values into care decisions. ASPAN perianesthesia standards are evidence-based references that should guide protocols over tradition or anecdote.

Question 47

Delegation to Unlicensed Personnel

Accepted Answer

An RN may delegate tasks but retains accountability for the outcome. Assessment, evaluation, patient teaching, and clinical judgment about an unstable perianesthesia patient cannot be delegated.

Question 48

HIPAA in the Perianesthesia Setting

Accepted Answer

Protected health information must be shared on a minimum-necessary, need-to-know basis. Discussing patients in public areas or with unauthorized family members without patient authorization is a violation.

Question 49

Patient Advocacy

Accepted Answer

Acting to protect the patient's rights, safety, and preferences—for example, halting a procedure when consent or identification is in question, or escalating an unaddressed safety concern through the chain of command.

Question 50

Just Culture

Accepted Answer

A safety model that distinguishes human error, at-risk behavior, and reckless behavior, encouraging staff to report errors and near misses without fear of punishment so systems can be improved.

Free CAPA Exam Flashcards

Filter by Topic

Jump to Card

About These CAPA Flashcards

Topics Covered

Frequently Asked Questions

CAPA