NBCRNA Obstetric Anesthesia 2 — Questions and Answers
Question 1: Which intrathecal opioid is most commonly added to spinal bupivacaine to improve intraoperative analgesia for cesarean delivery?
- Morphine
- Fentanyl (Correct answer)
- Sufentanil
- Hydromorphone
Correct answer: Fentanyl
Intrathecal fentanyl (10-25 mcg) is commonly added to spinal bupivacaine to improve intraoperative visceral analgesia without prolonged respiratory depression risk.
Question 2: A parturient develops a total spinal block after epidural catheter injection. What is the FIRST priority in management?
- Administer intralipid 20%
- Secure the airway with rapid sequence intubation (Correct answer)
- Administer vasopressors for hypotension
- Place the patient in Trendelenburg position
Correct answer: Secure the airway with rapid sequence intubation
Airway management is the immediate priority in total spinal block because apnea and unconsciousness are life-threatening; securing the airway takes precedence over other interventions.
Question 3: Which of the following does NOT contribute to the increased risk of difficult intubation in obstetric patients?
- Mucosal edema of the airway
- Decreased functional residual capacity
- Large breasts
- Increased lower esophageal sphincter tone (Correct answer)
Correct answer: Increased lower esophageal sphincter tone
Pregnancy decreases lower esophageal sphincter tone (due to progesterone), which increases aspiration risk rather than intubation difficulty.
Question 4: A patient with severe preeclampsia develops a seizure intrapartum. Which drug is the treatment of choice?
- Diazepam IV
- Phenytoin IV
- Magnesium sulfate IV bolus (Correct answer)
- Lorazepam IV
Correct answer: Magnesium sulfate IV bolus
Magnesium sulfate is the drug of choice for treating and preventing eclamptic seizures; it reduces neuromuscular excitability and cerebral vasospasm.
Question 5: What finding indicates early magnesium toxicity in a preeclamptic patient receiving magnesium sulfate infusion?
- Loss of deep tendon reflexes (Correct answer)
- Respiratory arrest
- Cardiac arrest
- Widening of QRS complex
Correct answer: Loss of deep tendon reflexes
Loss of deep tendon reflexes (patellar reflex) occurs at serum magnesium levels of 7-10 mEq/L and is the earliest clinical sign of magnesium toxicity.
Question 6: Which drug is the antidote for magnesium toxicity causing respiratory depression?
- Naloxone
- Flumazenil
- Calcium gluconate (Correct answer)
- Neostigmine
Correct answer: Calcium gluconate
Calcium gluconate (1 g IV) antagonizes the effects of magnesium and is the antidote for life-threatening magnesium toxicity.
Question 7: Which antihypertensive agent is CONTRAINDICATED in the management of severe hypertension in a breastfeeding mother with preeclampsia?
- Labetalol
- Hydralazine
- Nicardipine
- Atenolol (Correct answer)
Correct answer: Atenolol
Atenolol is contraindicated in breastfeeding mothers because it concentrates in breast milk at high levels and can cause neonatal bradycardia and hypoglycemia.
NBCRNA Obstetric Anesthesia 2
Which intrathecal opioid is most commonly added to spinal bupivacaine to improve intraoperative analgesia for cesarean delivery?