CGRN Patient Assessment and Monitoring 2 — Questions and Answers
Question 1: Which assessment finding would most likely lead to a higher ASA physical status classification?
- BMI of 24
- Well-controlled type 2 diabetes
- Severe COPD requiring home oxygen (Correct answer)
- History of appendectomy 10 years ago
Correct answer: Severe COPD requiring home oxygen
Severe COPD requiring home oxygen represents ASA III or higher, impacting sedation planning.
ASA III = severe systemic disease that limits activity. Severe COPD on home O2 significantly impacts sedation risk due to decreased respiratory reserve, sensitivity to depressants, and potential for rapid desaturation.
Question 2: During moderate sedation, which Ramsay Sedation Scale level indicates the target depth?
- Level 1 — anxious and agitated
- Level 2 — cooperative, tranquil
- Level 3 — responds to commands only (Correct answer)
- Level 5 — sluggish response to light stimulation
Correct answer: Level 3 — responds to commands only
Ramsay level 3 represents appropriate moderate sedation where the patient is sedated but maintains protective reflexes.
For moderate sedation, the target is level 3 (responds to commands only) to level 4 (brisk response to light glabellar tap). The patient maintains their airway and has intact protective reflexes.
Question 3: A patient with a Mallampati score of IV is scheduled for upper endoscopy. What does this indicate?
- Low aspiration risk
- Potentially difficult airway management if intervention is needed (Correct answer)
- No sedation is needed
- The procedure should be cancelled
Correct answer: Potentially difficult airway management if intervention is needed
Mallampati IV (only hard palate visible) indicates a potentially difficult airway.
Mallampati IV means only the hard palate is visible. If respiratory compromise occurs during sedation, rescue airway management may be challenging. Ensure difficult airway equipment is available and consider anesthesia consultation.
Question 4: What is the minimum monitoring requirement during the recovery phase after moderate sedation?
- Pulse oximetry until discharge
- Vital signs every 5 minutes until discharge criteria are met (Correct answer)
- Heart rate monitoring only
- No monitoring required once the procedure ends
Correct answer: Vital signs every 5 minutes until discharge criteria are met
Post-procedure monitoring should include vital signs at least every 5 minutes until discharge criteria are met.
Monitor BP, HR, RR, SpO2, consciousness, and pain every 5 minutes initially, transitioning to every 15 minutes. Continue until meeting discharge criteria (typically modified Aldrete score ≥9/10).
Question 5: Which laboratory value is most important before endoscopic variceal band ligation?
- Serum albumin
- Platelet count and INR/coagulation studies (Correct answer)
- Hemoglobin A1C
- Serum creatinine
Correct answer: Platelet count and INR/coagulation studies
Platelet count and coagulation studies are essential to assess bleeding risk in patients with portal hypertension.
Cirrhotic patients have thrombocytopenia (splenic sequestration), elevated INR (decreased clotting factor synthesis), and platelet dysfunction. Transfuse platelets if <50,000. Have blood products ready.
Question 6: A patient with obstructive sleep apnea needs colonoscopy with moderate sedation. What monitoring modification is recommended?
- No modifications needed
- Continuous capnography in addition to standard monitoring (Correct answer)
- Deeper sedation to prevent airway obstruction
- Only local anesthesia without sedation
Correct answer: Continuous capnography in addition to standard monitoring
Continuous capnography provides early detection of respiratory depression in OSA patients.
OSA patients have collapsible upper airways more susceptible to sedative effects. Capnography detects hypoventilation 60+ seconds before pulse oximetry desaturates. Also use lower initial doses, elevated head position, and have oral/nasal airways ready.
CGRN Patient Assessment and Monitoring 2
Which assessment finding would most likely lead to a higher ASA physical status classification?