AORN Anesthesia Basics 3 — Questions and Answers
Question 1: What is the mechanism of action of neuromuscular blocking agents (NMBAs) classified as non-depolarizing?
- They stimulate acetylcholine receptors causing sustained depolarization
- They competitively block acetylcholine at the neuromuscular junction without causing depolarization (Correct answer)
- They inhibit acetylcholinesterase at the synapse
- They block sodium channels in motor neurons
Correct answer: They competitively block acetylcholine at the neuromuscular junction without causing depolarization
Non-depolarizing NMBAs competitively antagonize acetylcholine at nicotinic receptors, preventing muscle contraction without causing initial fasciculations.
Question 2: The ASA Physical Status Classification System is used to:
- Determine the type of anesthesia to be used
- Assess perioperative risk and communicate patient health status (Correct answer)
- Calculate the required dose of anesthetic agents
- Document surgical consent
Correct answer: Assess perioperative risk and communicate patient health status
The ASA-PS classification (I–VI) standardizes communication about a patient's physical health status and correlates with perioperative morbidity and mortality risk.
Question 3: Which of the following is the correct treatment for opioid-induced respiratory depression in the PACU?
- Flumazenil 0.2 mg IV
- Neostigmine 2.5 mg IV with glycopyrrolate
- Naloxone 0.04–0.4 mg IV titrated to effect (Correct answer)
- Physostigmine 1 mg IV
Correct answer: Naloxone 0.04–0.4 mg IV titrated to effect
Naloxone, an opioid antagonist, is titrated in small doses IV to reverse respiratory depression while minimizing abrupt reversal of analgesia.
Question 4: Which nerve block provides anesthesia for the entire upper extremity below the shoulder?
- Femoral nerve block
- Brachial plexus block (Correct answer)
- Intercostal nerve block
- Cervical plexus block
Correct answer: Brachial plexus block
A brachial plexus block anesthetizes the C5–T1 nerve roots that supply the arm, forearm, and hand, making it ideal for upper extremity surgery.
Question 5: What is the significance of a 'cannot intubate, cannot oxygenate' (CICO) emergency?
- It requires immediate cricothyrotomy as a rescue airway technique (Correct answer)
- It is managed by inserting a laryngeal mask airway
- It resolves with bag-mask ventilation using two hands
- It requires repositioning the patient to the prone position
Correct answer: It requires immediate cricothyrotomy as a rescue airway technique
A CICO emergency is life-threatening and mandates emergency front-of-neck airway access (cricothyrotomy) as the definitive rescue maneuver.
Question 6: Spinal anesthesia produces its effect primarily at which anatomical location?
- The epidural space surrounding the dura
- The intrathecal space within the cerebrospinal fluid (Correct answer)
- The peripheral nerve sheaths of the lower limbs
- The dorsal horn of the spinal cord directly
Correct answer: The intrathecal space within the cerebrospinal fluid
Spinal (intrathecal) anesthesia involves injecting local anesthetic into the CSF within the subarachnoid space, producing rapid dense block.
Question 7: A perioperative nurse assisting with monitored anesthesia care (MAC) should be prepared to:
- Administer all anesthetic drugs independently
- Rescue the patient from an unintended level of deep sedation (Correct answer)
- Perform laryngoscopy if needed
- Manage the surgical field without the anesthesia provider present
Correct answer: Rescue the patient from an unintended level of deep sedation
During MAC, the perioperative nurse must be capable of rescuing a patient who unintentionally reaches a deeper level of sedation than intended.
AORN Anesthesia Basics 3
What is the mechanism of action of neuromuscular blocking agents (NMBAs) classified as non-depolarizing?