CNOR Anesthesia and Sedation Principles 2 — Questions and Answers
Question 1: Which neuromuscular blocking agent is considered a depolarizing agent?
- Vecuronium
- Rocuronium
- Succinylcholine (Correct answer)
- Cisatracurium
Correct answer: Succinylcholine
Succinylcholine is the only commonly used depolarizing neuromuscular blocking agent, causing persistent depolarization of the motor end plate.
Question 2: When a patient is placed in the Trendelenburg position during surgery under general anesthesia, which respiratory complication is most likely?
- Bronchospasm
- Reduced functional residual capacity (Correct answer)
- Increased tidal volume
- Hypocapnia
Correct answer: Reduced functional residual capacity
Trendelenburg position causes abdominal contents to press on the diaphragm, reducing functional residual capacity and worsening ventilation.
Question 3: The perioperative nurse notes the anesthesia provider is using a laryngeal mask airway (LMA). This device is BEST described as:
- An endotracheal tube inserted nasally
- A supraglottic airway device that sits above the larynx (Correct answer)
- A device inserted through the cricothyroid membrane
- An oral airway adjunct to maintain tongue position
Correct answer: A supraglottic airway device that sits above the larynx
An LMA is a supraglottic airway that forms a seal over the laryngeal inlet without entering the trachea.
Question 4: A patient receiving monitored anesthesia care (MAC) becomes unresponsive to verbal stimulation and requires airway intervention. This represents a transition to:
- Deep sedation
- General anesthesia (Correct answer)
- Moderate sedation
- Minimal sedation
Correct answer: General anesthesia
When a patient requires airway intervention under MAC, the level has progressed to general anesthesia regardless of the original intent.
Question 5: Which volatile anesthetic agent is associated with the highest risk of malignant hyperthermia triggering?
- Nitrous oxide
- Desflurane (Correct answer)
- Sevoflurane
- Propofol
Correct answer: Desflurane
All halogenated volatile agents including desflurane can trigger malignant hyperthermia, but desflurane is particularly potent; propofol and nitrous oxide are considered safe.
Question 6: During spinal anesthesia, hypotension occurs most commonly due to:
- Increased cardiac output
- Sympathetic blockade causing vasodilation (Correct answer)
- Parasympathetic blockade
- Hyperventilation by the patient
Correct answer: Sympathetic blockade causing vasodilation
Spinal anesthesia blocks sympathetic nerve fibers, causing vasodilation and venous pooling that reduces preload and blood pressure.
Question 7: The scrub person observes that the surgical field begins to bleed more briskly. The anesthesia provider states the patient is on heparin. Which agent would be given to reverse heparin?
- Vitamin K
- Protamine sulfate (Correct answer)
- Fresh frozen plasma
- Tranexamic acid
Correct answer: Protamine sulfate
Protamine sulfate neutralizes heparin by forming a stable complex with it, reversing its anticoagulant effects.
CNOR Anesthesia and Sedation Principles 2
Which neuromuscular blocking agent is considered a depolarizing agent?