CNOR Managing Emergency Situations 2 — Questions and Answers
Question 1: During a malignant hyperthermia (MH) crisis, which medication is the FIRST-LINE treatment?
- Succinylcholine
- Dantrolene sodium (Correct answer)
- Propofol
- Epinephrine
Correct answer: Dantrolene sodium
Dantrolene sodium is the specific antidote for malignant hyperthermia and must be administered immediately upon recognition of MH crisis.
Question 2: A patient undergoing general anesthesia develops masseter muscle rigidity after succinylcholine administration. The perioperative nurse should FIRST:
- Administer a second dose of succinylcholine
- Alert the team to potential malignant hyperthermia (Correct answer)
- Increase the anesthetic gas concentration
- Position the patient in Trendelenburg
Correct answer: Alert the team to potential malignant hyperthermia
Masseter muscle rigidity after succinylcholine is a classic early warning sign of malignant hyperthermia and the entire team must be alerted immediately.
Question 3: When managing a malignant hyperthermia crisis, which cooling measure is appropriate?
- Warm saline irrigation of body cavities
- Applying ice to the groin and axillae only
- Iced saline lavage of open body cavities and IV cold saline (Correct answer)
- Passive air cooling with fan only
Correct answer: Iced saline lavage of open body cavities and IV cold saline
Active cooling in MH includes iced saline lavage of accessible body cavities, cold IV saline infusion, and surface cooling to rapidly lower core temperature.
Question 4: A scrub technician reports the electrosurgical unit (ESU) is not functioning during a procedure. The IMMEDIATE priority of the circulating nurse is to:
- Continue the procedure without electrosurgery
- Obtain a replacement ESU without stopping the procedure
- Alert the surgeon and prepare for manual hemostasis alternatives (Correct answer)
- Reset the circuit breaker in the OR
Correct answer: Alert the surgeon and prepare for manual hemostasis alternatives
Patient safety requires alerting the surgeon immediately so hemostasis can be maintained via alternative methods while the equipment issue is resolved.
Question 5: During a laparotomy, the surgeon inadvertently enters the aorta. Which nursing action is HIGHEST priority?
- Document the event in the incident report
- Obtain additional suture and prepare for vascular repair (Correct answer)
- Call for break relief for the scrub person
- Prepare the specimen for pathology
Correct answer: Obtain additional suture and prepare for vascular repair
Life-threatening hemorrhage requires immediate preparation of vascular repair supplies to support the surgeon in controlling bleeding.
Question 6: A patient in the OR develops pulseless ventricular tachycardia. The FIRST action by the perioperative nurse should be:
- Administer amiodarone IV push
- Begin CPR and call for the defibrillator (Correct answer)
- Perform a precordial thump
- Increase IV fluid rate
Correct answer: Begin CPR and call for the defibrillator
Pulseless VT is a shockable cardiac arrest rhythm; initiating CPR and obtaining the defibrillator are the immediate priorities per ACLS guidelines.
Question 7: Which laboratory value is MOST consistent with malignant hyperthermia?
- Metabolic alkalosis with hypokalemia
- Respiratory alkalosis with hypocapnia
- Metabolic acidosis with hypercapnia and hyperkalemia (Correct answer)
- Respiratory acidosis with hyponatremia
Correct answer: Metabolic acidosis with hypercapnia and hyperkalemia
MH produces intense cellular metabolism causing metabolic acidosis, CO2 accumulation (hypercapnia), and potassium release from muscle cells (hyperkalemia).
CNOR Managing Emergency Situations 2
During a malignant hyperthermia (MH) crisis, which medication is the FIRST-LINE treatment?