CNUR 203 COMPREHENSIVE EXAM UPDATED
QUESTIONS AND SOLUTIONS GRADED A+
✔✔What is the scrub nurse responsible for? - ✔✔1. Gown and glove the surgeon
2. Load the needle drivers
3. Drapes the mayo stand
4. Drapes the pt.
5. Arranges instruments
6. Counts unused sponges
✔✔Which anaesthetic agent has inherent anti-emetic properties? - ✔✔Propofol
✔✔What additional quality does ketamine have as a general anesthetic? - ✔✔Amnesiac
as well
✔✔How is general anesthesia administered? - ✔✔inhalation and IV meds used
✔✔Where is spinal anesthesia injected? - ✔✔subarachnoid space
✔✔Where is an epidural given? - ✔✔epidural space- drug does not mix with CSF,
rather it *binds to nerve fibres
✔✔What is a nerve block? - ✔✔anesthetic agent is injected into and around a nerve
that supplies sensation to a small area of the body ( one limb)
✔✔What is malignant hyperthermia? - ✔✔Severe genetic side effect from general
anesthesia- metabolic disease resulting in rigidity of skeletal muscles
✔✔Which local anesthetic is often used with general anesthetic? - ✔✔Epidural
✔✔Which surgeries may utilize both general and local anesthetic? Why? - ✔✔Bowel
resection, thoracotomy, gynaecological CA surgeries, cystectomy, AAA repair - helps
significantly with post-op pain control
✔✔What dermatome is the umbilicus? - ✔✔dermatome T10
✔✔What dermatone is the groin? - ✔✔S2
✔✔What dermatone is mid-thigh? - ✔✔L3 ( L4 is knee)
✔✔What dermstone is at the armpit? - ✔✔T1
✔✔What additional orders usually accompany PCA? - ✔✔Supplemental oxygen and is
usually naloxone - specific monitoring and documentation is also required
, ✔✔What are possible complications of patient-controlled analgesia? - ✔✔Respiratory
depression, hypotension, N&V, pruritus, and inadequate analgesia
✔✔When should you discontinue patient-controlled analgesia? - ✔✔During the day, and
only after you have post PCA analgesic orders in place. Communicate with patient.
✔✔What are the advantages of post-op epidural analgesia? - ✔✔Better pain
management, less sedation, improves bowel recovery/decreased constipation,
decreased incidence of post-op MI, increased oxygen and decreased infections -
**allows patients to ambulate sooner!
✔✔What is a PCEA pump? - ✔✔Patient controlled epidural analgesia pump
✔✔What are drugs used for epidural analgesics for local anesthetics? - ✔✔Lidocaine,
bupivocaine
✔✔Who can order adjunct sedatives or analgesics when an epidural is in place? -
✔✔The anesthetist!!
✔✔What do you report when assessing an epidural site? - ✔✔Discharge! This is not
normal
✔✔What must the patient have at all times while receiving an epidural? - ✔✔Patent IV
ACCESS
✔✔What kind of pump can be used for epidural continuous infusions? - ✔✔And infusion
pump ONLY- RNs may NOT increase the rate
✔✔What is the Bromage score used for? - ✔✔The Bromage score is a numeric scale
used to assess motor block following the administration of neuraxial anesthesia, such
as epidural or spinal anesthesia. It helps quantify the extent of motor weakness or
paralysis experienced by the patient. (0= no weakness, 3= unable to move ankles or
knees)
✔✔At What level of sensory block do you need to notify the anesthetist? - ✔✔Above
nipple line (T4)
✔✔What events require notifying the anesthetist? - ✔✔RR<40% of baseline
Signs of leakage at catheter site
Changes of anticoagulant or ante platelet drug
Patient is unable to bend knees
Pt. Excessively drowsy ( 3 or 4 on POSS)
QUESTIONS AND SOLUTIONS GRADED A+
✔✔What is the scrub nurse responsible for? - ✔✔1. Gown and glove the surgeon
2. Load the needle drivers
3. Drapes the mayo stand
4. Drapes the pt.
5. Arranges instruments
6. Counts unused sponges
✔✔Which anaesthetic agent has inherent anti-emetic properties? - ✔✔Propofol
✔✔What additional quality does ketamine have as a general anesthetic? - ✔✔Amnesiac
as well
✔✔How is general anesthesia administered? - ✔✔inhalation and IV meds used
✔✔Where is spinal anesthesia injected? - ✔✔subarachnoid space
✔✔Where is an epidural given? - ✔✔epidural space- drug does not mix with CSF,
rather it *binds to nerve fibres
✔✔What is a nerve block? - ✔✔anesthetic agent is injected into and around a nerve
that supplies sensation to a small area of the body ( one limb)
✔✔What is malignant hyperthermia? - ✔✔Severe genetic side effect from general
anesthesia- metabolic disease resulting in rigidity of skeletal muscles
✔✔Which local anesthetic is often used with general anesthetic? - ✔✔Epidural
✔✔Which surgeries may utilize both general and local anesthetic? Why? - ✔✔Bowel
resection, thoracotomy, gynaecological CA surgeries, cystectomy, AAA repair - helps
significantly with post-op pain control
✔✔What dermatome is the umbilicus? - ✔✔dermatome T10
✔✔What dermatone is the groin? - ✔✔S2
✔✔What dermatone is mid-thigh? - ✔✔L3 ( L4 is knee)
✔✔What dermstone is at the armpit? - ✔✔T1
✔✔What additional orders usually accompany PCA? - ✔✔Supplemental oxygen and is
usually naloxone - specific monitoring and documentation is also required
, ✔✔What are possible complications of patient-controlled analgesia? - ✔✔Respiratory
depression, hypotension, N&V, pruritus, and inadequate analgesia
✔✔When should you discontinue patient-controlled analgesia? - ✔✔During the day, and
only after you have post PCA analgesic orders in place. Communicate with patient.
✔✔What are the advantages of post-op epidural analgesia? - ✔✔Better pain
management, less sedation, improves bowel recovery/decreased constipation,
decreased incidence of post-op MI, increased oxygen and decreased infections -
**allows patients to ambulate sooner!
✔✔What is a PCEA pump? - ✔✔Patient controlled epidural analgesia pump
✔✔What are drugs used for epidural analgesics for local anesthetics? - ✔✔Lidocaine,
bupivocaine
✔✔Who can order adjunct sedatives or analgesics when an epidural is in place? -
✔✔The anesthetist!!
✔✔What do you report when assessing an epidural site? - ✔✔Discharge! This is not
normal
✔✔What must the patient have at all times while receiving an epidural? - ✔✔Patent IV
ACCESS
✔✔What kind of pump can be used for epidural continuous infusions? - ✔✔And infusion
pump ONLY- RNs may NOT increase the rate
✔✔What is the Bromage score used for? - ✔✔The Bromage score is a numeric scale
used to assess motor block following the administration of neuraxial anesthesia, such
as epidural or spinal anesthesia. It helps quantify the extent of motor weakness or
paralysis experienced by the patient. (0= no weakness, 3= unable to move ankles or
knees)
✔✔At What level of sensory block do you need to notify the anesthetist? - ✔✔Above
nipple line (T4)
✔✔What events require notifying the anesthetist? - ✔✔RR<40% of baseline
Signs of leakage at catheter site
Changes of anticoagulant or ante platelet drug
Patient is unable to bend knees
Pt. Excessively drowsy ( 3 or 4 on POSS)
