CMSRN Anesthetist 5 — Questions and Answers
Question 1: A patient is having a procedure under spinal anesthesia and complains of a severe headache that worsens when sitting up and improves when lying flat. This presentation is MOST consistent with:
- Meningitis from contaminated spinal needle
- Post-dural puncture headache (PDPH) (Correct answer)
- Hypertensive crisis
- Migraine triggered by the stress of surgery
Correct answer: Post-dural puncture headache (PDPH)
Post-dural puncture headache is positional (worse upright, relieved supine) and results from CSF leakage through the dural puncture site reducing intracranial pressure.
Question 2: During induction of anesthesia, the anesthesiologist requests cricoid pressure (Sellick maneuver). The nurse applies pressure to which landmark?
- The thyroid cartilage (Adam's apple)
- The cricoid cartilage to compress the esophagus (Correct answer)
- The hyoid bone
- The sternal notch
Correct answer: The cricoid cartilage to compress the esophagus
Cricoid pressure is applied to the cricoid cartilage to occlude the esophagus and prevent passive regurgitation of gastric contents during rapid sequence induction.
Question 3: A patient's temperature rises to 40.2°C (104.4°F) intraoperatively, along with muscle rigidity, tachycardia, and rising EtCO2. The nurse should anticipate administration of:
- Acetaminophen and cooling blanket only
- Dantrolene sodium 2.5 mg/kg IV and discontinue volatile anesthetics (Correct answer)
- Haloperidol and benzodiazepines
- Epinephrine and antihistamines
Correct answer: Dantrolene sodium 2.5 mg/kg IV and discontinue volatile anesthetics
This clinical picture is malignant hyperthermia; dantrolene is the specific antidote and all triggering agents (volatile anesthetics, succinylcholine) must be immediately discontinued.
Question 4: Which assessment is the nurse's PRIMARY responsibility when monitoring a patient receiving IV moderate sedation per institutional protocol?
- Measuring urine output every 30 minutes
- Continuously monitoring level of consciousness, respiratory rate, and oxygen saturation (Correct answer)
- Titrating the sedation infusion rate based on pain scores
- Documenting the surgeon's technique every 15 minutes
Correct answer: Continuously monitoring level of consciousness, respiratory rate, and oxygen saturation
The dedicated monitoring nurse must continuously assess LOC, respiratory status, and oxygen saturation to detect early respiratory depression or over-sedation.
Question 5: When preparing a patient for general anesthesia who takes daily aspirin, the nurse understands that aspirin is typically:
- Stopped 24 hours before all surgical procedures
- Continued for most procedures but stopped 7 days before neurosurgery or high bleeding-risk cases (Correct answer)
- Always stopped 30 days before any surgery
- Replaced with heparin bridging therapy
Correct answer: Continued for most procedures but stopped 7 days before neurosurgery or high bleeding-risk cases
Aspirin is often continued perioperatively for cardiac risk reduction, but is typically held 7-10 days before high bleeding-risk surgeries per surgeon and anesthesia team guidance.
Question 6: A patient in the PACU is shivering uncontrollably following general anesthesia. Which medication is commonly administered to treat postanesthetic shivering?
- Ondansetron IV
- Meperidine (Demerol) 12.5-25 mg IV (Correct answer)
- Lorazepam IV
- Haloperidol IV
Correct answer: Meperidine (Demerol) 12.5-25 mg IV
Low-dose meperidine is the most effective pharmacological treatment for postanesthetic shivering by acting on kappa opioid receptors and reducing the shivering threshold.
Question 7: A patient is brought to the OR for an emergent procedure and states they last ate a full meal 2 hours ago. The anesthesia provider will MOST likely use which induction technique?
- Standard slow inhalational induction
- Awake fiber-optic intubation or rapid sequence induction (RSI) (Correct answer)
- LMA placement without intubation
- Spinal anesthesia only
Correct answer: Awake fiber-optic intubation or rapid sequence induction (RSI)
RSI or awake intubation is used for patients at high aspiration risk (full stomach) to rapidly secure the airway and minimize the window for passive regurgitation.
CMSRN Anesthetist 5
A patient is having a procedure under spinal anesthesia and complains of a severe headache that worsens when sitting up and improves when lying flat.
This presentation is MOST consistent with: