Certified Gastroenterology RN Moderate Sedation and Anesthesia 3 — Questions and Answers
Question 1: A patient received fentanyl and midazolam for ERCP and now has a respiratory rate of 6 with pinpoint pupils. Which reversal agent addresses the respiratory depression?
- Naloxone (Correct answer)
- Flumazenil
- Atropine
- Epinephrine
Correct answer: Naloxone
Pinpoint pupils and respiratory depression point to opioid effect, which naloxone reverses.
Question 2: Why must patients be monitored after receiving flumazenil or naloxone before discharge?
- The reversal agents may wear off before the sedative, causing resedation (Correct answer)
- The reversal agents cause delayed allergic reactions
- The reversal agents prolong the sedative's half-life
- The reversal agents cause rebound hypertension in all patients
Correct answer: The reversal agents may wear off before the sedative, causing resedation
Both reversal agents have shorter half-lives than many sedatives and opioids, so resedation can occur.
Question 3: Which pre-sedation airway finding predicts difficult mask ventilation or intubation?
- Mallampati class IV with limited neck extension (Correct answer)
- Mallampati class I with full neck mobility
- Thyromental distance greater than 6 cm
- Ability to protrude the mandible past the upper teeth
Correct answer: Mallampati class IV with limited neck extension
A high Mallampati class combined with restricted neck movement is a classic predictor of a difficult airway.
Question 4: A patient with obstructive sleep apnea is scheduled for moderate sedation during colonoscopy. Which precaution is most appropriate?
- Have airway equipment ready and titrate sedatives cautiously with capnography (Correct answer)
- Cancel the procedure since sedation is contraindicated
- Double the initial midazolam dose to ensure adequate sedation
- Skip supplemental oxygen to preserve hypoxic drive
Correct answer: Have airway equipment ready and titrate sedatives cautiously with capnography
OSA patients are prone to airway obstruction, so cautious titration, capnography, and ready airway equipment are the standard precautions.
Question 5: Which vital sign change most often follows administration of IV midazolam in an elderly patient?
- Hypotension and respiratory depression (Correct answer)
- Severe hypertension
- Reflex tachycardia with fever
- Bradypnea with hypertension
Correct answer: Hypotension and respiratory depression
Elderly patients are especially sensitive to midazolam's hypotensive and respiratory depressant effects.
Question 6: What is the recommended initial dosing approach for midazolam in adults over age 60?
- Use smaller increments with longer intervals between doses (Correct answer)
- Give a single large bolus to reach sedation quickly
- Use the same dosing as younger adults
- Administer intramuscularly instead of intravenously
Correct answer: Use smaller increments with longer intervals between doses
Older adults require reduced increments and slower titration due to increased sensitivity and slower drug clearance.
Question 7: During sedation, the nurse administering medications and monitoring the patient should have which restriction on other duties?
- No responsibilities that would leave the patient unattended or unmonitored (Correct answer)
- May circulate and assist with biopsy specimen handling freely
- May leave briefly to retrieve supplies from another room
- May monitor two sedated patients simultaneously
Correct answer: No responsibilities that would leave the patient unattended or unmonitored
Standards require the monitoring nurse to have no duties that compromise continuous patient observation.
Certified Gastroenterology RN Moderate Sedation and Anesthesia 3
A patient received fentanyl and midazolam for ERCP and now has a respiratory rate of 6 with pinpoint pupils.
Which reversal agent addresses the respiratory depression?