MODERATE SEDATION EVALUATION EXAM 2026
QUESTIONS AND ANSWERS RATED A+
✔✔Narcan Pediatric Dose and Administration - ✔✔-Initial dose 0.01mg
-If initial dose does not potentiate desired effect, administer an additional 0.01mg
-If the additional 0.01mg does not result in the desired effect, administer 0.1mg/kg for a
total maximum pediatric dose of 0.2mg/kg
✔✔Narcan Adverse Reactions - ✔✔-Pulmonary edema
-Hypotension, HTN, arrhythmias, V-Tach, V-Fib
-Excitement, tremors, seizures, reversal of analgesia
-N/V
✔✔Anesthesia Class Medications - ✔✔-Ketamine
-Propofol
-Thiopental
-Brevital
✔✔Ketamine (Ketalar) - ✔✔-Dissociative anesthetic and analgesic
-Produces analgesic and amnestic effects
-Indicated for short term procedures that require intense analgesia
-Used especially for deep sedation in pediatrics
-Causes dissociative anesthesia
✔✔Dissociative Anesthesia - ✔✔-A form of general anesthesia, but not necessarily
complete unconsciousness, characterized by catalepsy, catatonia, and amnesia
-Anesthesia characterized by analgesia and amnesia with minimal effect on respiratory
function. The patient does not appear to be anesthetized and can swallow and open
eyes but does not process information
✔✔Ketamine Contraindications - ✔✔-Increase ICP as it increases ICP
-Corneal lacerations as it increases intraocular pressure
-Children with active upper respiratory infections as it stimulates oral secretions
-Children with psychiatric disorders as it may cause extreme mood alteration
-Children with compromised airways
-No reversal agents
✔✔Ketamine IV - ✔✔-Recommended dosage 0.25-1.0mg/kg
-Dose is based on patient response to the medication
-Infusion should not exceed 50mcg/kg/min
-Onset is immediate
-Peaks in 1 minutes (15-30 seconds)
-Lasts 5 to 10 minutes
,✔✔Ketamine IM - ✔✔-Recommended dosage 1-2 mg/kg
-Onset 3 to 4 minutes
-Peaks 6 to 8 minutes
-Lasts 12 to 25 minutes
✔✔Ketamine Adverse Reactions - ✔✔-Bradypnea, dyspnea, respiratory depression,
apnea, bronchial smooth muscle relaxation, increased trachea-bronchial tree secretions
-Bradycardia, tachycardia, HTN, hypotension, arrhythmias
-Enhanced skeletal tone
-Uncontrolled muscle movements
-Visual illusions
-Vomiting, increased salivary secretions
✔✔Ketamine Special Considerations - ✔✔-Monitor for emergent reactions including
vivid dreams or hallucinations
-Consider premedication with midazolam to reduce potential for adverse reactions.
✔✔Diprivan (Propofol) - ✔✔-Sedative Hypnotic Agent = rapid hypnosis with minimal
excitation
-Onset 40 seconds
-Peak 1 minute
-Lasts 5 to 10 minutes
-Considerations: Strict aseptic technique while handling as it is preservative free and will
thus support bacterial growth
-Prepared for single patient use only, just prior to beginning the procedure
-Discard after opened for 6 hours
-Has antioxidant, immunomodulatory, analgesic, antiemetic, anxiolytic, neuroprotective
effects
✔✔Diprivan Adult Dose - ✔✔-25 to 50mg IV (0.5 to 1 mg /kg) given in 10 mg increments
over several minutes
✔✔Diprivan Pediatric Dose - ✔✔-0.5 to 1.0 mg/kg infused slowly, titrate to desired effect
✔✔Diprivan Adverse Reactions - ✔✔-Respiratory depression, apnea, hiccup,
bronchospasm, laryngospasm
-Hypotension, HTN, arrhythmia, tachycardia, bradycardia
-N/V, abdominal cramps
✔✔Special Considerations Diprivan - ✔✔-Titrated to effect and given slowly
-Reduce dosage in elderly, hypovolemia, high-risk patient
-Potentiation occurs when combined with narcotic analgesics and CNS depressants
-NO REVERSAL AGENT
, ✔✔SEDASYS/CAPS - ✔✔-Computer Assisted Personalized Sedation System
-Approved by FDA on May 3, 2013
-Allows the on-label administration of propofol by nurses as a member of the trained,
physician-led team
✔✔Propofol Adverse Reactions - ✔✔-Respiratory: Depression; apnea; hiccup;
bronchospasm; laryngospasm
-Cardiovascular: Hypotension; arrhythmia; tachycardia; bradycardia; hypertension
-CNS: HA; Dizziness; Euphoria; Myoclonic/clonic movement; seizures; sexual illusions
✔✔Propofol Concerns - ✔✔-Responses unpredictable
-Airway management requirements are extremely demanding
-No reversal agents
✔✔Arguments for RN Giving Propofol - ✔✔-Painless exams
-Amnesia
-Rapid discharge (15-20 minutes)
-Rapid return of patients to work/leisure
-Improved provider efficiency
-Believed to be safer than traditional sedation
✔✔Considerations when Propofol given for Ventilator Support - ✔✔-Should not be
infused for longer than 5 days without providing a drug holiday
-If the patient is at risk for renal impairment, urinalysis and urine sediment rate should
be checked before initiation of sedation and then monitored on alternate days during
sedation
-Diprivan injectable emulsion is formulated in an oil-in-water emulsion, thus elevations in
serum triglycerides may occur when it is administered for extended periods of time
✔✔Chloral Hydrate - ✔✔-Pure sedative hypnotic
-May produce a state of dis-inhibition with an agitated response to noxious stimuli
-NO analgesic properties
-Used as a adjunct for painful therapeutic procedures
-Most effective in <4 years of age
-No antagonist available
✔✔Chloral Hydrate Dose and Route of Administration - ✔✔-Oral
-25 to 100 mg/kg up to 1 gram
-Max of 2 grams in 2 divided doses
-Onset of 15 to 30 minutes
-Peak effect in 30-60 minutes
-Duration of 60 minutes
-Residual sedation may last for 10 or more hours in toddlers, but 20 hours or more in
neonates
QUESTIONS AND ANSWERS RATED A+
✔✔Narcan Pediatric Dose and Administration - ✔✔-Initial dose 0.01mg
-If initial dose does not potentiate desired effect, administer an additional 0.01mg
-If the additional 0.01mg does not result in the desired effect, administer 0.1mg/kg for a
total maximum pediatric dose of 0.2mg/kg
✔✔Narcan Adverse Reactions - ✔✔-Pulmonary edema
-Hypotension, HTN, arrhythmias, V-Tach, V-Fib
-Excitement, tremors, seizures, reversal of analgesia
-N/V
✔✔Anesthesia Class Medications - ✔✔-Ketamine
-Propofol
-Thiopental
-Brevital
✔✔Ketamine (Ketalar) - ✔✔-Dissociative anesthetic and analgesic
-Produces analgesic and amnestic effects
-Indicated for short term procedures that require intense analgesia
-Used especially for deep sedation in pediatrics
-Causes dissociative anesthesia
✔✔Dissociative Anesthesia - ✔✔-A form of general anesthesia, but not necessarily
complete unconsciousness, characterized by catalepsy, catatonia, and amnesia
-Anesthesia characterized by analgesia and amnesia with minimal effect on respiratory
function. The patient does not appear to be anesthetized and can swallow and open
eyes but does not process information
✔✔Ketamine Contraindications - ✔✔-Increase ICP as it increases ICP
-Corneal lacerations as it increases intraocular pressure
-Children with active upper respiratory infections as it stimulates oral secretions
-Children with psychiatric disorders as it may cause extreme mood alteration
-Children with compromised airways
-No reversal agents
✔✔Ketamine IV - ✔✔-Recommended dosage 0.25-1.0mg/kg
-Dose is based on patient response to the medication
-Infusion should not exceed 50mcg/kg/min
-Onset is immediate
-Peaks in 1 minutes (15-30 seconds)
-Lasts 5 to 10 minutes
,✔✔Ketamine IM - ✔✔-Recommended dosage 1-2 mg/kg
-Onset 3 to 4 minutes
-Peaks 6 to 8 minutes
-Lasts 12 to 25 minutes
✔✔Ketamine Adverse Reactions - ✔✔-Bradypnea, dyspnea, respiratory depression,
apnea, bronchial smooth muscle relaxation, increased trachea-bronchial tree secretions
-Bradycardia, tachycardia, HTN, hypotension, arrhythmias
-Enhanced skeletal tone
-Uncontrolled muscle movements
-Visual illusions
-Vomiting, increased salivary secretions
✔✔Ketamine Special Considerations - ✔✔-Monitor for emergent reactions including
vivid dreams or hallucinations
-Consider premedication with midazolam to reduce potential for adverse reactions.
✔✔Diprivan (Propofol) - ✔✔-Sedative Hypnotic Agent = rapid hypnosis with minimal
excitation
-Onset 40 seconds
-Peak 1 minute
-Lasts 5 to 10 minutes
-Considerations: Strict aseptic technique while handling as it is preservative free and will
thus support bacterial growth
-Prepared for single patient use only, just prior to beginning the procedure
-Discard after opened for 6 hours
-Has antioxidant, immunomodulatory, analgesic, antiemetic, anxiolytic, neuroprotective
effects
✔✔Diprivan Adult Dose - ✔✔-25 to 50mg IV (0.5 to 1 mg /kg) given in 10 mg increments
over several minutes
✔✔Diprivan Pediatric Dose - ✔✔-0.5 to 1.0 mg/kg infused slowly, titrate to desired effect
✔✔Diprivan Adverse Reactions - ✔✔-Respiratory depression, apnea, hiccup,
bronchospasm, laryngospasm
-Hypotension, HTN, arrhythmia, tachycardia, bradycardia
-N/V, abdominal cramps
✔✔Special Considerations Diprivan - ✔✔-Titrated to effect and given slowly
-Reduce dosage in elderly, hypovolemia, high-risk patient
-Potentiation occurs when combined with narcotic analgesics and CNS depressants
-NO REVERSAL AGENT
, ✔✔SEDASYS/CAPS - ✔✔-Computer Assisted Personalized Sedation System
-Approved by FDA on May 3, 2013
-Allows the on-label administration of propofol by nurses as a member of the trained,
physician-led team
✔✔Propofol Adverse Reactions - ✔✔-Respiratory: Depression; apnea; hiccup;
bronchospasm; laryngospasm
-Cardiovascular: Hypotension; arrhythmia; tachycardia; bradycardia; hypertension
-CNS: HA; Dizziness; Euphoria; Myoclonic/clonic movement; seizures; sexual illusions
✔✔Propofol Concerns - ✔✔-Responses unpredictable
-Airway management requirements are extremely demanding
-No reversal agents
✔✔Arguments for RN Giving Propofol - ✔✔-Painless exams
-Amnesia
-Rapid discharge (15-20 minutes)
-Rapid return of patients to work/leisure
-Improved provider efficiency
-Believed to be safer than traditional sedation
✔✔Considerations when Propofol given for Ventilator Support - ✔✔-Should not be
infused for longer than 5 days without providing a drug holiday
-If the patient is at risk for renal impairment, urinalysis and urine sediment rate should
be checked before initiation of sedation and then monitored on alternate days during
sedation
-Diprivan injectable emulsion is formulated in an oil-in-water emulsion, thus elevations in
serum triglycerides may occur when it is administered for extended periods of time
✔✔Chloral Hydrate - ✔✔-Pure sedative hypnotic
-May produce a state of dis-inhibition with an agitated response to noxious stimuli
-NO analgesic properties
-Used as a adjunct for painful therapeutic procedures
-Most effective in <4 years of age
-No antagonist available
✔✔Chloral Hydrate Dose and Route of Administration - ✔✔-Oral
-25 to 100 mg/kg up to 1 gram
-Max of 2 grams in 2 divided doses
-Onset of 15 to 30 minutes
-Peak effect in 30-60 minutes
-Duration of 60 minutes
-Residual sedation may last for 10 or more hours in toddlers, but 20 hours or more in
neonates
