CNOR - Certification Anesthesia and Sedation Principles Questions and Answers — Questions and Answers
Question 1: A patient under general anesthesia with succinylcholine and a volatile anesthetic develops sudden tachycardia, masseter muscle rigidity, and a sharp increase in end-tidal CO2. What is the perioperative nurse's priority action?
- Apply cooling blankets and prepare chilled IV fluids.
- Notify the anesthesia professional and prepare to stop the triggering agents. (Correct answer)
- Draw blood for an arterial blood gas (ABG) and electrolyte panel.
- Prepare for immediate administration of intravenous dantrolene.
Correct answer: Notify the anesthesia professional and prepare to stop the triggering agents.
The immediate priority in managing a suspected malignant hyperthermia (MH) crisis is to alert the anesthesia professional to stop the administration of all triggering agents (e.g., volatile anesthetics, succinylcholine). This action is the first and most crucial step to halt the underlying hypermetabolic process. Subsequent actions, while also critical, include administering dantrolene, initiating cooling measures, and obtaining lab work.
Question 2: Which of the following best describes the emergence phase of general anesthesia?
- The period when anesthetic agents are discontinued and the patient begins to awaken, continuing until airway reflexes return. (Correct answer)
- The period from the administration of induction agents to the loss of consciousness.
- The period starting from when the patient begins to awaken until they are safely discharged from the post-anesthesia care unit (PACU).
- The period from the surgical incision until near the completion of the procedure.
Correct answer: The period when anesthetic agents are discontinued and the patient begins to awaken, continuing until airway reflexes return.
Emergence is the phase that begins when anesthetic agents are stopped, leading to the patient awakening and regaining consciousness and protective airway reflexes. The other options describe induction, the broader recovery period including PACU stay, and the maintenance phase, respectively.
Question 3: A patient is scheduled for a procedure under Monitored Anesthesia Care (MAC). What is a key characteristic that distinguishes MAC from moderate (conscious) sedation?
- The patient is expected to lose consciousness and all airway reflexes.
- Only a specially trained registered nurse is required to administer the sedative medications.
- Capnography monitoring is considered optional and not a standard of care.
- An anesthesia professional must be present and prepared to convert to general anesthesia if needed. (Correct answer)
Correct answer: An anesthesia professional must be present and prepared to convert to general anesthesia if needed.
The defining characteristic of Monitored Anesthesia Care (MAC) is the continuous presence of a qualified anesthesia professional (anesthesiologist or CRNA). This provider is skilled in managing the patient's airway and is prepared to deepen the level of sedation or convert to a general anesthetic if the patient's condition or surgical needs change, a requirement not present for nurse-administered moderate sedation.
Question 4: A patient who received spinal anesthesia 24 hours prior calls the hospital complaining of a severe headache that is significantly worse when sitting up and relieved by lying flat. The perioperative nurse should recognize these symptoms as characteristic of which complication?
- Meningitis
- Anesthetic neurotoxicity
- Post-dural puncture headache (PDPH) (Correct answer)
- Subdural hematoma
Correct answer: Post-dural puncture headache (PDPH)
The hallmark symptom of a post-dural puncture headache (PDPH) is its positional nature; it intensifies in an upright position and is alleviated by lying supine. This is caused by the leakage of cerebrospinal fluid from the puncture site in the dura mater, which reduces the fluid cushion around the brain.
Question 5: During a procedure with sedation, the perioperative nurse observes a sudden drop in the end-tidal CO2 (EtCO2) waveform on the capnography monitor, which quickly becomes a flat line. This finding is the earliest and most reliable indicator of what condition?
- Hypertensive crisis
- Apnea or total airway obstruction (Correct answer)
- Malignant hyperthermia
- Anaphylactic reaction
Correct answer: Apnea or total airway obstruction
Capnography provides a real-time, breath-by-breath measurement of ventilation. A sudden loss of the EtCO2 waveform indicates that the patient is no longer exhaling carbon dioxide, which is the most immediate sign of apnea or a complete airway obstruction. This change is detected much earlier by capnography than by pulse oximetry, which can lag for several minutes.
Question 6: A patient is undergoing a procedure on their arm using intravenous regional anesthesia (Bier block). Which safety measure is MOST critical for the perioperative nurse to ensure throughout the procedure?
- Continuously monitoring the dual-cuff tourniquet pressure and inflation time. (Correct answer)
- Placing a warming blanket over the operative extremity to enhance the anesthetic effect.
- Administering a prophylactic antiemetic before the procedure begins.
- Ensuring the patient has a patent intravenous line in the non-operative arm.
Correct answer: Continuously monitoring the dual-cuff tourniquet pressure and inflation time.
The safety of a Bier block is entirely dependent on the proper function of the pneumatic tourniquet, which isolates the limb's circulation and prevents the large volume of local anesthetic from entering the systemic circulation. Systemic release can cause severe toxicity. The nurse's most critical role is to monitor the tourniquet's pressure and total inflation time to prevent this complication.
CNOR - Certification Anesthesia and Sedation Principles Questions and Answers
A patient under general anesthesia with succinylcholine and a volatile anesthetic develops sudden tachycardia, masseter muscle rigidity, and a sharp increase in end-tidal CO2.
What is the perioperative nurse's priority action?