MODERATE SEDATION UPDATED 2026 EXAM SCRIPT
QUESTIONS AND ANSWERS RATED A+
✔✔Pre-Sedation Assessment: Chart Review - ✔✔1. Past medical illnesses
2. Prior Surgical Procedures
3. Allergies
4. Drug reactions and intra-anesthetic complications
5. Lab Studies
6. Current medications
7. Compliance of medication regimen
✔✔Pre-Sedation Assessment: Ancillary Studies - ✔✔1. Recent EKG (<1year)
2. Patients at risk for myocardial injury (anti-hypertensive)
3. Pregnant, must have OB consult
4. <5 years old require a consult with anesthesia
✔✔ASA Physical Status - ✔✔American Society of Anesthesiologists Physical Status
System helps qualify the relative risk to patients sedative medications pose
✔✔ASA 1 - ✔✔-Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
✔✔ASA 2 - ✔✔Mild systemic disease:
-Controlled HTN
-Type II DM
-H/O tobacco use
-Obesity
-Non-metastatic carcinoma
-Well controlled asthma
-Child with underlying cerebral palsy
-Child with well-controlled seizure disorder
✔✔ASA 3 - ✔✔*Severe systemic disease that is not incapacitating:
-Poorly controlled HTN
-Multiple medications for cardiac, respiratory, and/or metabolic disorders
-Metastatic dz with some interference with function
-PNA
*Divided into Stable and Unstable
✔✔ASA 4 - ✔✔*Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
,-Recent MI with continuing symptoms
-Severe HTN with angina
-Sepsis
-Organ insufficiency
✔✔ASA 5 - ✔✔*Moribund patient not expected to survive longer than 24 hours without
surgical intervention
✔✔ASA 6 - ✔✔*Declared brain-dead whose organs are being removed for donor
purposes
✔✔Physical Examination: Cardiac Considerations - ✔✔1. H/O myocardial infarction
-Assess for angina
-Assess for SOB: at rest; w/ exercise/activity; paroxysmal nocturnal dyspnea
-Signs of CHF
-Elective procedures postponed at least 6 months post-MI
2. Will the patient be able to lie flat for procedure?
-Paroxysmal nocturnal dyspnea
3. Subacute Bacterial Endocarditis Prophylaxis before and after procedure necessary
-Valvular heart disease
4. HTN-Controlled? Compliance?
5. Recent Cardiac Sx
6. Dysrhythmias
7. Pacemaker or Automatic Internal Defibrillator?
✔✔Cardiovascular Physical Assessment should include - ✔✔1. Skin color
2. Peripheral pulses
3. Presence of edema or jugular vein distention
4. Baseline heart rate
5. BP
6. Auscultation of heart soudns
✔✔Pulmonary System Physical Assessment - ✔✔1. Does the patient have a current
cough, sputum production, rhinitis, sore throat, dyspnea, hemoptysis, wheezing?
2. Use oxygen at home?
4. Physical characteristics that may indicate potential difficult airway management
✔✔Physical characteristics that can indicate potential for difficult airway management -
✔✔-Obesity
-Short, thick neck
-Limited neck ROM
-Deviated trachea
-Hypognathic (recessed) jaw
-Hypergnathic (Protruding) jaw
-Small mouth opening (<3cm)
,-High arched palate
-Macroglossia (Large tongue)
-Protruding teeth
-Loose teeth or dentures
-Non visible uvula
-Tonsillar hypertrophy
✔✔Extra precautions necessary with asthmatic patients - ✔✔1. Pre-op bronchodilator
2. Steroid-dependent asthmatics are NOT candidates for nursing administration of
sedatives
3. Presence of wheezing despite bronchodilators and steroid therapy should be
consulted by anesthesia
✔✔Extra precaution for chronic bronchitis patients - ✔✔Pre-op inhaler bronchodilator
✔✔Instructions for conscious sedation given for a short term procedure (<1h)
administered to patients with DM that are well controlled on oral hypoglycemics - ✔✔1.
Do not take scheduled AM dose of oral hypoglycemic
2. Fasting blood glucose morning of procedure
3. Post-op finger stick
*Insulin dependent patients require anesthesia consultation*
✔✔Danger for DM under deep sedation - ✔✔Signs of hypoglycemia are masked and
blood sugar can fall dangerously low
✔✔Physical Examination: Neurological Considerations - ✔✔1. H/O TIA, CVA, Seizure
disorder, head trauma, convulsive disorders, epilepsy
2. Assess general affect, behavior, speech pattern alterations, LOC, orientation, gait
3. Determine pre-existing numbness or weakness prior to local anesthesia
✔✔Physical Examination: Hepatic System - ✔✔-Medical h/o hepatitis or cirrhosis
-Impaired liver function can result in either resistance to sedation medications or
increased sensitivity to the medications
✔✔Physical Examination: GI System - ✔✔-Assess for current N/V, diarrhea,
constipation, GI bleeding, GERD
-Any GI surgery
-Histamine blocker or non-particulate antacid considered for those with GERD
✔✔Physical Examination: Renal System - ✔✔-Renal dz impairs excretion of sedation
medications and their metabolites
-Renal dx requires close regulation of fluid status
-Those with renal insufficiency or renal failure may not be a candidate for nurse-
monitored sedation
, -Assess fluid status: Length of NPO status, urine output, skin turgor, mucous membrane
appearances, BP, and HR
✔✔Physical Examination: Musculoskeletal System - ✔✔-H/O arthritis or recent fractures
-Assess level of mobility; ROM; muscle strength, neurovascular status in any affected
area
✔✔Physical Examination: Integumentary System - ✔✔-Assess skin, color, temperature,
turgor, integrity
✔✔Anesthesia and Surgical History Considerations - ✔✔-Any complications with past
anesthesia
-Any patient with h/o airway difficulties should be referred to Anesthesia for their
recommendations
✔✔Airway Assessment - ✔✔Results will indicate the potential ease or difficulty of
positive pressure ventilation. If assessed as having a difficult airway, it is critical that the
patient maintain protective airway reflexes
✔✔Airway Assessment: Patient History - ✔✔1. Problems with anesthesia
2. Stridor, snoring, sleep apnea?
3. Advanced rheumatoid mouth and jaw
✔✔Mallampati Airway Assessment - ✔✔- Accurate predictor of subtle anatomic causes
of
difficult intubation
- Classification is made per visualization of the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class I - ✔✔Visualize the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class II - ✔✔Visualize soft palate, fauces, uvula
✔✔Mallampati Class III - ✔✔-Visualize soft palate and base of uvula
-Need anesthesia consultation
✔✔Mallampati Class IV - ✔✔-The soft palate is not visible at all; only hard palate visible
-Need anesthesia consultation
✔✔Airway Assessment Considerations - ✔✔-Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
QUESTIONS AND ANSWERS RATED A+
✔✔Pre-Sedation Assessment: Chart Review - ✔✔1. Past medical illnesses
2. Prior Surgical Procedures
3. Allergies
4. Drug reactions and intra-anesthetic complications
5. Lab Studies
6. Current medications
7. Compliance of medication regimen
✔✔Pre-Sedation Assessment: Ancillary Studies - ✔✔1. Recent EKG (<1year)
2. Patients at risk for myocardial injury (anti-hypertensive)
3. Pregnant, must have OB consult
4. <5 years old require a consult with anesthesia
✔✔ASA Physical Status - ✔✔American Society of Anesthesiologists Physical Status
System helps qualify the relative risk to patients sedative medications pose
✔✔ASA 1 - ✔✔-Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
✔✔ASA 2 - ✔✔Mild systemic disease:
-Controlled HTN
-Type II DM
-H/O tobacco use
-Obesity
-Non-metastatic carcinoma
-Well controlled asthma
-Child with underlying cerebral palsy
-Child with well-controlled seizure disorder
✔✔ASA 3 - ✔✔*Severe systemic disease that is not incapacitating:
-Poorly controlled HTN
-Multiple medications for cardiac, respiratory, and/or metabolic disorders
-Metastatic dz with some interference with function
-PNA
*Divided into Stable and Unstable
✔✔ASA 4 - ✔✔*Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
,-Recent MI with continuing symptoms
-Severe HTN with angina
-Sepsis
-Organ insufficiency
✔✔ASA 5 - ✔✔*Moribund patient not expected to survive longer than 24 hours without
surgical intervention
✔✔ASA 6 - ✔✔*Declared brain-dead whose organs are being removed for donor
purposes
✔✔Physical Examination: Cardiac Considerations - ✔✔1. H/O myocardial infarction
-Assess for angina
-Assess for SOB: at rest; w/ exercise/activity; paroxysmal nocturnal dyspnea
-Signs of CHF
-Elective procedures postponed at least 6 months post-MI
2. Will the patient be able to lie flat for procedure?
-Paroxysmal nocturnal dyspnea
3. Subacute Bacterial Endocarditis Prophylaxis before and after procedure necessary
-Valvular heart disease
4. HTN-Controlled? Compliance?
5. Recent Cardiac Sx
6. Dysrhythmias
7. Pacemaker or Automatic Internal Defibrillator?
✔✔Cardiovascular Physical Assessment should include - ✔✔1. Skin color
2. Peripheral pulses
3. Presence of edema or jugular vein distention
4. Baseline heart rate
5. BP
6. Auscultation of heart soudns
✔✔Pulmonary System Physical Assessment - ✔✔1. Does the patient have a current
cough, sputum production, rhinitis, sore throat, dyspnea, hemoptysis, wheezing?
2. Use oxygen at home?
4. Physical characteristics that may indicate potential difficult airway management
✔✔Physical characteristics that can indicate potential for difficult airway management -
✔✔-Obesity
-Short, thick neck
-Limited neck ROM
-Deviated trachea
-Hypognathic (recessed) jaw
-Hypergnathic (Protruding) jaw
-Small mouth opening (<3cm)
,-High arched palate
-Macroglossia (Large tongue)
-Protruding teeth
-Loose teeth or dentures
-Non visible uvula
-Tonsillar hypertrophy
✔✔Extra precautions necessary with asthmatic patients - ✔✔1. Pre-op bronchodilator
2. Steroid-dependent asthmatics are NOT candidates for nursing administration of
sedatives
3. Presence of wheezing despite bronchodilators and steroid therapy should be
consulted by anesthesia
✔✔Extra precaution for chronic bronchitis patients - ✔✔Pre-op inhaler bronchodilator
✔✔Instructions for conscious sedation given for a short term procedure (<1h)
administered to patients with DM that are well controlled on oral hypoglycemics - ✔✔1.
Do not take scheduled AM dose of oral hypoglycemic
2. Fasting blood glucose morning of procedure
3. Post-op finger stick
*Insulin dependent patients require anesthesia consultation*
✔✔Danger for DM under deep sedation - ✔✔Signs of hypoglycemia are masked and
blood sugar can fall dangerously low
✔✔Physical Examination: Neurological Considerations - ✔✔1. H/O TIA, CVA, Seizure
disorder, head trauma, convulsive disorders, epilepsy
2. Assess general affect, behavior, speech pattern alterations, LOC, orientation, gait
3. Determine pre-existing numbness or weakness prior to local anesthesia
✔✔Physical Examination: Hepatic System - ✔✔-Medical h/o hepatitis or cirrhosis
-Impaired liver function can result in either resistance to sedation medications or
increased sensitivity to the medications
✔✔Physical Examination: GI System - ✔✔-Assess for current N/V, diarrhea,
constipation, GI bleeding, GERD
-Any GI surgery
-Histamine blocker or non-particulate antacid considered for those with GERD
✔✔Physical Examination: Renal System - ✔✔-Renal dz impairs excretion of sedation
medications and their metabolites
-Renal dx requires close regulation of fluid status
-Those with renal insufficiency or renal failure may not be a candidate for nurse-
monitored sedation
, -Assess fluid status: Length of NPO status, urine output, skin turgor, mucous membrane
appearances, BP, and HR
✔✔Physical Examination: Musculoskeletal System - ✔✔-H/O arthritis or recent fractures
-Assess level of mobility; ROM; muscle strength, neurovascular status in any affected
area
✔✔Physical Examination: Integumentary System - ✔✔-Assess skin, color, temperature,
turgor, integrity
✔✔Anesthesia and Surgical History Considerations - ✔✔-Any complications with past
anesthesia
-Any patient with h/o airway difficulties should be referred to Anesthesia for their
recommendations
✔✔Airway Assessment - ✔✔Results will indicate the potential ease or difficulty of
positive pressure ventilation. If assessed as having a difficult airway, it is critical that the
patient maintain protective airway reflexes
✔✔Airway Assessment: Patient History - ✔✔1. Problems with anesthesia
2. Stridor, snoring, sleep apnea?
3. Advanced rheumatoid mouth and jaw
✔✔Mallampati Airway Assessment - ✔✔- Accurate predictor of subtle anatomic causes
of
difficult intubation
- Classification is made per visualization of the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class I - ✔✔Visualize the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class II - ✔✔Visualize soft palate, fauces, uvula
✔✔Mallampati Class III - ✔✔-Visualize soft palate and base of uvula
-Need anesthesia consultation
✔✔Mallampati Class IV - ✔✔-The soft palate is not visible at all; only hard palate visible
-Need anesthesia consultation
✔✔Airway Assessment Considerations - ✔✔-Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
