1.  Which of the following define a state of deep sedation/analgesia?

A. The patient responds purposefully to repeated or painful stimulation.
B. The patient may require airway support to maintain a patent airway.
C. Cardiovascular function is usually maintained.
D. The patient may require rescue from a state of anesthesia, including intubation of the trachea.
E. All of the above.

2.  All patents receiving procedural sedation should be monitored using:

A. Continuous pulse oximetry
B. Automatic, non-invasive blood pressure monitor
C. Observation of chest excursions (ventilation)
D. All of the above

3.  A patient receiving sedation/analgesia for a procedure who responds to a painful stimulus with reflex withdrawal only is in a state of moderate sedation.

A. True
B. False

4.  Which of the following statements is false?

A. Pre-procedure evaluation of a patient having sedation/analgesia increases the likelihood of satisfactory sedation and decreases the likelihood of adverse outcomes in both moderate and deep sedation.
B. Dosages of sedating medicines often need to be reduced in patients with significant cardiac or pulmonary disease.
C. History of difficulty with intubation for surgery has no significance in planning for sedation for a procedure.
D. Factors that may delay gastric emptying and thus may increase the risk of aspiration include: pain, anxiety, opioid use, bowel obstruction, trauma, diabetes, or pregnancy.

5.  Anesthesia consultants feel that the primary cause of morbidity associated with sedation/analgesia is drug induced respiratory depression and airway obstruction.

A. True
B. False

6.  Which of the following statements concerning propofol is false?

A. The usual dose for induction of general anesthesia in healthy adults is about 2.5mg/kg.
B. A rapid IV bolus dose may cause apnea and/or hypotension.
C. It is hard to overdose a patient with propofol because it is so short acting.
D. For maintenance of sedation, an infusion of 25-75mcg/kg/min. is usually appropriate.

7.  Which of the following are appropriate initial treatments for a patient with respiratory depression due to IV sedation/analgesia?

A. Supplemental O2
B. Jaw thrust maneuver
C. Vigorous stimulation
D. Reversal drug administration
E. A, B and C

8.  Each of the following is true except:

A. The peak analgesic effect of Morphine given IV occurs in about 20 minutes.
B. Major predictors of sedative drug dosing include age, weight, prior sedative drug administration, and the sex of the patient.
C. Normeperidine may be responsible for causing myoclonus, seizures, or delirium.
D. Fentanyl is 75-125 times more potent than Morphine.

9.  Which of the following is most likely to cause truncal rigidity or "stiff chest" if given rapidly IV?

A. Morphine
B. Fentanyl
C. Demerol
D. Romazicon

10.  Effects of benzodiazepines include all of the following except:

A. Sedation
B. Analgesia
C. Muscle relation
D. Amnesia

11.  The most likely cause of morbidity associated with sedation/analgesia is:

A. Cardiovascular depression
B. Drug error
C. Respiratory depression
D. Arrhythmia

12.  In administering an initial dose of Midazolam (Versed), which of the following are true:

A. It is important to allow 2-4 minutes to evaluate the sedative effect before another dose is given.
B. Dosing should be individualized with a recommended upper limit of approximately 1mg/kg.
C. Versed has analgesic properties.
D. Lower doses may be required for the elderly and peak effect may take longer to occur.
E. A and D.

13.  You patient has an O2 saturation of 85% after sedation with Versed and Fentanyl. You should:

A. Give Narcan immediately.
B. Give supplemental O2 and, if necessary support the patient's airway.
C. Consider assisting ventilation with bag-valve-mask device if ventilation is inadequate.
D. Give Romazicon immediately.
E. B and C

14.  Which of the following statements is false regarding Narcan?

A. Narcan is indicated for partial or complete reversal of opioid induced sedation and respiratory depression.
B. Narcan enhances the elimination of opioid agonists.
C. Cardiovascular stimulation following Narcan administration manifests as increased sympathetic nervous system activity.
D. The duration of action is short, so respiratory depression may reoccur.

15.  Which of the following characteristics of Demerol is false?

A. Slightly faster onset and somewhat shorter duration than Morphine.
B. Less likely than Morphine to cause seizures or delirium.
C. Orthostatic hypotension is more frequent and profound than with comparable doses of Morphine.
D. Contraindicated in patients receiving MAOI's (Monoamine Oxidase Inhibitors).

16.  Your patient has a history of hypertension and had an MI two years ago. He had CABG at that time and is currently stable. Routine monitoring for procedural sedation should include:

A. Pulse oximetry.
B. Non-invasive blood pressure monitor
C. Continuous ECG monitoring.
D. Swan Ganz catheter
E. A, B and C

17.  Which of the following concerning a state of moderate sedation is not true?

A. Cardiovascular function is usually maintained.
B. Spontaneous ventilation is usually adequate.
C. A patient in this state is often unarousable even with painful stimulus.
D. Airway patency usually requires no intervention.

18.  An RN with basic life support skills is preparing a patient to receive procedural sedation. The physician who will be performing the procedure and prescribing the sedation has not arrived in the hospital yet. Which of the following is inappropriate for the RN to do now?

A. Start an IV.
B. Apply monitors
C. Give Versed 5mg IV push because the patient is very anxious
D. Apply O2.

19.  Which of the following may make mask ventilation more difficult?

A. Full beard
B. Obesity
C. Trisomy 21 syndrome
D. Edentulous patient
E. All of the above

20.  Predictive factors in determining dosages of sedating drugs include:

A. Height
B. Weight
C. Age
D. Prior administration of sedative drugs
E. B, C and D