CMSRN Anesthetist 2 — Questions and Answers
Question 1: A patient receiving general anesthesia develops sudden onset masseter muscle rigidity after succinylcholine administration. Which condition should the nurse immediately suspect?
- Malignant hyperthermia (Correct answer)
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Pseudocholinesterase deficiency
Correct answer: Malignant hyperthermia
Masseter muscle rigidity following succinylcholine is a classic early warning sign of malignant hyperthermia, a life-threatening hypermetabolic crisis.
Question 2: Which reversal agent is used to antagonize non-depolarizing neuromuscular blocking agents such as rocuronium?
- Flumazenil
- Naloxone
- Sugammadex (Correct answer)
- Neostigmine only
Correct answer: Sugammadex
Sugammadex is a selective relaxant binding agent that directly encapsulates rocuronium and vecuronium, providing rapid and complete reversal.
Question 3: A patient in the PACU has a respiratory rate of 6 breaths/min and is unresponsive 30 minutes after receiving fentanyl. What is the priority nursing intervention?
- Administer flumazenil IV
- Administer naloxone IV (Correct answer)
- Apply a non-rebreather mask
- Perform endotracheal intubation immediately
Correct answer: Administer naloxone IV
Naloxone rapidly reverses opioid-induced respiratory depression and is the first-line pharmacological intervention in this scenario.
Question 4: Which intraoperative finding is MOST consistent with an air embolism during surgery?
- Increased end-tidal CO2
- Decreased end-tidal CO2 with hypotension (Correct answer)
- Hypertension and bradycardia
- Increased oxygen saturation
Correct answer: Decreased end-tidal CO2 with hypotension
Air embolism causes a sudden decrease in end-tidal CO2 due to increased dead space, accompanied by cardiovascular collapse and hypotension.
Question 5: A nurse is assisting with a regional nerve block. The patient suddenly reports ringing in the ears, metallic taste, and perioral numbness. These signs indicate:
- Allergic reaction to the local anesthetic
- Local anesthetic systemic toxicity (LAST) (Correct answer)
- Vasovagal syncope
- Hypoglycemia
Correct answer: Local anesthetic systemic toxicity (LAST)
Tinnitus, metallic taste, and perioral numbness are classic early CNS signs of local anesthetic systemic toxicity from intravascular injection or rapid absorption.
Question 6: During spinal anesthesia, a patient's blood pressure drops from 130/80 to 75/40 mmHg. Which intervention should the nurse anticipate FIRST?
- Administer epinephrine 1 mg IV
- Administer ephedrine or phenylephrine and IV fluid bolus (Correct answer)
- Place the patient in Trendelenburg position only
- Administer atropine 1 mg IV
Correct answer: Administer ephedrine or phenylephrine and IV fluid bolus
Hypotension following spinal anesthesia results from sympathetic blockade; vasopressors (ephedrine or phenylephrine) combined with IV fluids are the first-line treatment.
Question 7: Which patient factor MOST increases the risk of difficult intubation and should be documented in the pre-anesthetic assessment?
- BMI of 22 kg/m²
- Mallampati class IV airway (Correct answer)
- Age over 40 years
- History of mild hypertension
Correct answer: Mallampati class IV airway
Mallampati class IV indicates minimal oropharyngeal visibility, which strongly correlates with difficult laryngoscopy and intubation.
CMSRN Anesthetist 2
A patient receiving general anesthesia develops sudden onset masseter muscle rigidity after succinylcholine administration.
Which condition should the nurse immediately suspect?