CNOR Anesthesia and Sedation Principles 3 — Questions and Answers
Question 1: A patient develops stridor immediately upon extubation. The FIRST priority nursing action is to:
- Administer IV dexamethasone
- Call the surgeon
- Apply 100% oxygen and assess airway patency (Correct answer)
- Position the patient supine
Correct answer: Apply 100% oxygen and assess airway patency
Stridor indicates partial airway obstruction; immediate application of oxygen and airway assessment are the first priorities.
Question 2: Ketamine is unique among anesthetic induction agents because it:
- Causes significant respiratory depression
- Produces a dissociative anesthetic state with maintained airway reflexes (Correct answer)
- Is the only agent without analgesic properties
- Reliably decreases blood pressure
Correct answer: Produces a dissociative anesthetic state with maintained airway reflexes
Ketamine produces dissociative anesthesia while typically preserving airway reflexes and hemodynamic stability, making it useful in trauma settings.
Question 3: The bispectral index (BIS) monitor is used intraoperatively to:
- Measure neuromuscular blockade recovery
- Assess depth of anesthesia and reduce awareness risk (Correct answer)
- Monitor cardiac output continuously
- Detect malignant hyperthermia early
Correct answer: Assess depth of anesthesia and reduce awareness risk
BIS monitoring analyzes EEG data to provide a numerical score reflecting depth of anesthesia, helping to prevent awareness under anesthesia.
Question 4: Which of the following is the MOST reliable sign of adequate reversal of neuromuscular blockade before extubation?
- Train-of-four ratio ≥ 0.9 (Correct answer)
- Spontaneous respiratory rate > 8 breaths/min
- SpO2 > 95% on room air
- Absence of fasciculations
Correct answer: Train-of-four ratio ≥ 0.9
A train-of-four (TOF) ratio of 0.9 or greater indicates adequate recovery of neuromuscular function and is the gold standard before extubation.
Question 5: A patient receiving epidural anesthesia for a thoracic procedure suddenly complains of difficulty breathing and bilateral arm weakness. The nurse should suspect:
- Opioid-induced sedation
- Total spinal anesthesia (Correct answer)
- Epidural hematoma
- Allergic reaction to local anesthetic
Correct answer: Total spinal anesthesia
Total spinal anesthesia occurs when local anesthetic spreads to high cervical levels, causing respiratory muscle paralysis and loss of upper extremity function.
Question 6: Which of the following medications is used to treat opioid-induced respiratory depression in the PACU?
- Flumazenil
- Neostigmine
- Naloxone (Correct answer)
- Sugammadex
Correct answer: Naloxone
Naloxone is a pure opioid antagonist that reverses respiratory depression, sedation, and analgesia caused by opioids.
Question 7: The nurse assisting with a regional nerve block under ultrasound guidance should be prepared to treat local anesthetic systemic toxicity (LAST) FIRST with:
- Epinephrine 1 mg IV push
- Intravenous lipid emulsion 20% (Correct answer)
- Sodium bicarbonate IV
- Calcium gluconate IV
Correct answer: Intravenous lipid emulsion 20%
Intravenous lipid emulsion (Intralipid 20%) is the primary treatment for local anesthetic systemic toxicity by acting as a lipid sink.
CNOR Anesthesia and Sedation Principles 3
A patient develops stridor immediately upon extubation.
The FIRST priority nursing action is to: