CMSRN Anesthetist 4 — Questions and Answers
Question 1: A patient undergoing a procedure under moderate (conscious) sedation stops responding to verbal stimuli. The nurse should FIRST:
- Administer flumazenil to reverse the sedation
- Stimulate the patient and assess airway patency (Correct answer)
- Immediately call a code blue
- Increase the supplemental oxygen flow rate only
Correct answer: Stimulate the patient and assess airway patency
The immediate priority is to assess responsiveness and airway patency, as the patient may have inadvertently progressed to deep sedation requiring airway intervention.
Question 2: Which electrolyte abnormality is MOST dangerous in a patient receiving succinylcholine and should be assessed before administration?
- Hyponatremia
- Hyperkalemia (Correct answer)
- Hypocalcemia
- Hypomagnesemia
Correct answer: Hyperkalemia
Succinylcholine causes a transient rise in serum potassium; administering it to a patient with pre-existing hyperkalemia (e.g., burns, crush injuries, renal failure) can cause fatal cardiac arrest.
Question 3: In the immediate postoperative period, which assessment finding indicates the patient is NOT yet ready for extubation?
- Train-of-four ratio ≥ 0.9
- Ability to sustain head lift for 5 seconds
- Respiratory rate of 8 breaths/min with shallow tidal volumes (Correct answer)
- Oxygen saturation of 98% on supplemental oxygen
Correct answer: Respiratory rate of 8 breaths/min with shallow tidal volumes
A respiratory rate of 8 with shallow tidal volumes suggests residual neuromuscular blockade or opioid effect, indicating inadequate ventilatory drive for safe extubation.
Question 4: A patient develops bronchospasm during general anesthesia. Which inhalational agent should be AVOIDED as it is most likely to worsen airway reactivity?
- Sevoflurane
- Isoflurane
- Desflurane (Correct answer)
- Halothane
Correct answer: Desflurane
Desflurane is a potent airway irritant that can cause bronchospasm, laryngospasm, and increased secretions, making it the worst choice for patients with reactive airways.
Question 5: Which is the MOST important nursing action when a patient with a history of latex allergy is scheduled for a procedure?
- Premedicate with diphenhydramine only
- Schedule the patient as the first case of the day and use latex-free equipment (Correct answer)
- Keep epinephrine available but proceed normally
- Obtain informed consent documenting the allergy
Correct answer: Schedule the patient as the first case of the day and use latex-free equipment
Scheduling first case of the day minimizes airborne latex particles from previous cases, and using a fully latex-free environment is essential to prevent anaphylaxis.
Question 6: A medical-surgical nurse is monitoring a patient receiving a continuous epidural infusion of bupivacaine and fentanyl. The patient's respiratory rate is 7/min. What is the FIRST nursing action?
- Stop the epidural infusion and administer naloxone
- Decrease the epidural infusion rate by 50%
- Notify the anesthesia provider immediately while preparing naloxone (Correct answer)
- Reposition the patient in the lateral decubitus position
Correct answer: Notify the anesthesia provider immediately while preparing naloxone
Respiratory depression from epidural opioids requires immediate provider notification and preparation of naloxone while maintaining close monitoring and airway readiness.
Question 7: Propofol infusion syndrome (PRIS) is a rare but fatal complication associated with prolonged high-dose propofol. Which early warning sign should alert the nurse?
- Metabolic alkalosis and hyperglycemia
- Metabolic acidosis, elevated triglycerides, and cardiac arrhythmias (Correct answer)
- Respiratory alkalosis and hypokalemia
- Hypernatremia and decreased BUN
Correct answer: Metabolic acidosis, elevated triglycerides, and cardiac arrhythmias
PRIS presents with high anion gap metabolic acidosis, hypertriglyceridemia, rhabdomyolysis, hepatomegaly, and cardiac failure, often after >48 hours of high-dose infusion.
CMSRN Anesthetist 4
A patient undergoing a procedure under moderate (conscious) sedation stops responding to verbal stimuli.
The nurse should FIRST: