CNOR Anesthesia and Sedation Principles 5 — Questions and Answers
Question 1: Which opioid analgesic is most commonly used intraoperatively due to its rapid onset and short duration of action?
- Morphine
- Meperidine
- Fentanyl (Correct answer)
- Hydromorphone
Correct answer: Fentanyl
Fentanyl has a rapid onset (1–2 minutes) and relatively short duration, making it ideal for intraoperative titration and analgesia.
Question 2: A patient is receiving epidural patient-controlled analgesia (PCEA) postoperatively. The nurse assesses hypotension and bradycardia. The priority intervention is:
- Increase IV fluid rate and notify anesthesia provider (Correct answer)
- Reduce the PCEA basal rate immediately
- Administer epinephrine 1 mg IV push
- Position patient in Trendelenburg and obtain ECG
Correct answer: Increase IV fluid rate and notify anesthesia provider
Hypotension and bradycardia from epidural sympathectomy are managed initially with IV fluid bolus and prompt notification of the anesthesia provider for further orders.
Question 3: The purpose of applying cricoid pressure (Sellick's maneuver) during rapid sequence induction (RSI) is to:
- Facilitate laryngoscopy visualization
- Occlude the esophagus to prevent passive regurgitation (Correct answer)
- Prevent laryngospasm
- Increase oxygen delivery to the alveoli
Correct answer: Occlude the esophagus to prevent passive regurgitation
Cricoid pressure compresses the esophagus against the vertebral body, reducing the risk of passive regurgitation and aspiration during RSI.
Question 4: Which monitoring modality is REQUIRED by ASA standards during general anesthesia to confirm endotracheal tube placement?
- Chest auscultation alone
- Pulse oximetry
- Continuous end-tidal CO2 (capnography) (Correct answer)
- Chest X-ray immediately post-intubation
Correct answer: Continuous end-tidal CO2 (capnography)
ASA standards mandate continuous capnography to confirm and monitor endotracheal tube placement throughout general anesthesia.
Question 5: When preparing the OR for a patient with a known latex allergy, the perioperative nurse should:
- Use powdered latex gloves to reduce direct contact
- Schedule the case as the last case of the day
- Ensure the room is stocked with latex-free supplies and schedule the case first (Correct answer)
- Administer prophylactic epinephrine before arrival
Correct answer: Ensure the room is stocked with latex-free supplies and schedule the case first
A latex-free environment must be established using all latex-free supplies, and scheduling the case first reduces aerosolized latex particle exposure in the room.
Question 6: A patient emerges from general anesthesia with severe shivering. The nurse should recognize that shivering increases:
- Core body temperature by vasoconstriction
- Oxygen consumption by up to 400% (Correct answer)
- Depth of sedation
- Risk of bradycardia
Correct answer: Oxygen consumption by up to 400%
Postoperative shivering dramatically increases metabolic rate and oxygen consumption, which can compromise patients with limited cardiopulmonary reserve.
Question 7: Sugammadex (Bridion) is used intraoperatively to reverse which class of neuromuscular blocking agents?
- Depolarizing agents such as succinylcholine
- Aminosteroid non-depolarizing agents such as rocuronium and vecuronium (Correct answer)
- Benzylisoquinolinium agents such as cisatracurium
- All benzodiazepines used for sedation
Correct answer: Aminosteroid non-depolarizing agents such as rocuronium and vecuronium
Sugammadex is a modified cyclodextrin that selectively encapsulates aminosteroid non-depolarizing agents, rapidly reversing their neuromuscular blockade.
CNOR Anesthesia and Sedation Principles 5
Which opioid analgesic is most commonly used intraoperatively due to its rapid onset and short duration of action?