APEX Comprehensive Exam 1
Practice Questions And Correct
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1. A 62-year-old patient with severe chronic obstructive pulmonary
disease is scheduled for abdominal surgery under general anesthesia.
During induction, the patient develops progressive wheezing,
increased airway pressures, prolonged expiration, and a falling end-
tidal carbon dioxide waveform with a “shark-fin” appearance. Oxygen
saturation begins to decrease despite an increase in inspired oxygen
concentration. Which of the following is the most appropriate
immediate pharmacologic intervention for the suspected
intraoperative bronchospasm?
A. Administer intravenous metoprolol to decrease sympathetic stimulation
B. Administer intravenous furosemide to reduce pulmonary vascular
congestion
,C. Administer inhaled albuterol through the anesthesia circuit
D. Administer intravenous protamine to reverse heparinization
The clinical findings are characteristic of acute bronchospasm, and inhaled
β2-adrenergic agonists such as albuterol are first-line therapy because
they produce rapid bronchodilation. Increasing airway pressures,
wheezing, prolonged expiration, and a characteristic capnogram support
the diagnosis.
2. A 45-year-old patient undergoes induction of general anesthesia with
propofol, fentanyl, and rocuronium. Shortly afterward, the blood
pressure decreases from 132/78 mm Hg to 72/42 mm Hg, while the
heart rate remains 48 beats/min. The patient has no evidence of
significant hemorrhage or hypoxemia. Which mechanism most directly
explains the cardiovascular response produced by propofol?
A. Increased systemic vascular resistance caused by α1 stimulation
B. Increased myocardial contractility caused by β1 stimulation
C. Decreased systemic vascular resistance with impairment of
compensatory sympathetic responses
D. Increased venous return caused by peripheral vasoconstriction
Propofol commonly produces hypotension through arterial and venous
vasodilation, reduced sympathetic vascular tone, and some myocardial
depression. The resulting decrease in systemic vascular resistance and
,venous return can be especially pronounced in hypovolemic or elderly
patients.
3. A patient with severe aortic stenosis is scheduled for noncardiac
surgery. During anesthetic management, the anesthesia provider
wants to preserve myocardial perfusion and avoid hemodynamic
changes that could precipitate ischemia. Which hemodynamic goal is
most appropriate for this patient?
A. Maintain a low systemic vascular resistance and allow tachycardia
B. Maintain significant decreases in preload to reduce ventricular workload
C. Maintain sinus rhythm, adequate preload, and systemic vascular
resistance while avoiding tachycardia
D. Deliberately reduce arterial pressure to decrease left ventricular afterload
Patients with severe aortic stenosis have a fixed obstruction to left
ventricular outflow and depend on adequate preload, sinus rhythm, and
coronary perfusion pressure. Tachycardia shortens diastolic filling and
coronary perfusion time, while hypotension can markedly compromise
myocardial perfusion.
4. A 28-year-old patient with a history of asthma is undergoing general
anesthesia. After intubation, peak airway pressure increases from 18
to 38 cm H2O. The capnogram demonstrates prolonged expiration,
and diffuse wheezing is heard bilaterally. The endotracheal tube is
, patent and correctly positioned. Which inhaled anesthetic is generally
associated with bronchodilatory properties and may be advantageous
in this patient?
A. Desflurane
B. Sevoflurane
C. Nitrous oxide
D. Methoxyflurane
Sevoflurane produces bronchodilation and is generally well tolerated in
patients with reactive airway disease. Desflurane can irritate the airway
and provoke coughing, laryngospasm, or bronchoconstriction, particularly
when concentrations are rapidly increased.
5. A 70-kg adult receives 2 mg/kg of intravenous lidocaine for a regional
anesthetic procedure. Several minutes later, the patient develops
circumoral numbness, tinnitus, metallic taste, agitation, and
subsequently a generalized seizure. Which treatment is most
appropriate for severe local anesthetic systemic toxicity?
A. Intravenous naloxone
B. Intravenous flumazenil
C. Intravenous lipid emulsion therapy with appropriate supportive
management
D. Intravenous protamine
Practice Questions And Correct
Answers (Verified Answers) Plus
Rationale 2026 Q&A| Instant
Download Pdf
1. A 62-year-old patient with severe chronic obstructive pulmonary
disease is scheduled for abdominal surgery under general anesthesia.
During induction, the patient develops progressive wheezing,
increased airway pressures, prolonged expiration, and a falling end-
tidal carbon dioxide waveform with a “shark-fin” appearance. Oxygen
saturation begins to decrease despite an increase in inspired oxygen
concentration. Which of the following is the most appropriate
immediate pharmacologic intervention for the suspected
intraoperative bronchospasm?
A. Administer intravenous metoprolol to decrease sympathetic stimulation
B. Administer intravenous furosemide to reduce pulmonary vascular
congestion
,C. Administer inhaled albuterol through the anesthesia circuit
D. Administer intravenous protamine to reverse heparinization
The clinical findings are characteristic of acute bronchospasm, and inhaled
β2-adrenergic agonists such as albuterol are first-line therapy because
they produce rapid bronchodilation. Increasing airway pressures,
wheezing, prolonged expiration, and a characteristic capnogram support
the diagnosis.
2. A 45-year-old patient undergoes induction of general anesthesia with
propofol, fentanyl, and rocuronium. Shortly afterward, the blood
pressure decreases from 132/78 mm Hg to 72/42 mm Hg, while the
heart rate remains 48 beats/min. The patient has no evidence of
significant hemorrhage or hypoxemia. Which mechanism most directly
explains the cardiovascular response produced by propofol?
A. Increased systemic vascular resistance caused by α1 stimulation
B. Increased myocardial contractility caused by β1 stimulation
C. Decreased systemic vascular resistance with impairment of
compensatory sympathetic responses
D. Increased venous return caused by peripheral vasoconstriction
Propofol commonly produces hypotension through arterial and venous
vasodilation, reduced sympathetic vascular tone, and some myocardial
depression. The resulting decrease in systemic vascular resistance and
,venous return can be especially pronounced in hypovolemic or elderly
patients.
3. A patient with severe aortic stenosis is scheduled for noncardiac
surgery. During anesthetic management, the anesthesia provider
wants to preserve myocardial perfusion and avoid hemodynamic
changes that could precipitate ischemia. Which hemodynamic goal is
most appropriate for this patient?
A. Maintain a low systemic vascular resistance and allow tachycardia
B. Maintain significant decreases in preload to reduce ventricular workload
C. Maintain sinus rhythm, adequate preload, and systemic vascular
resistance while avoiding tachycardia
D. Deliberately reduce arterial pressure to decrease left ventricular afterload
Patients with severe aortic stenosis have a fixed obstruction to left
ventricular outflow and depend on adequate preload, sinus rhythm, and
coronary perfusion pressure. Tachycardia shortens diastolic filling and
coronary perfusion time, while hypotension can markedly compromise
myocardial perfusion.
4. A 28-year-old patient with a history of asthma is undergoing general
anesthesia. After intubation, peak airway pressure increases from 18
to 38 cm H2O. The capnogram demonstrates prolonged expiration,
and diffuse wheezing is heard bilaterally. The endotracheal tube is
, patent and correctly positioned. Which inhaled anesthetic is generally
associated with bronchodilatory properties and may be advantageous
in this patient?
A. Desflurane
B. Sevoflurane
C. Nitrous oxide
D. Methoxyflurane
Sevoflurane produces bronchodilation and is generally well tolerated in
patients with reactive airway disease. Desflurane can irritate the airway
and provoke coughing, laryngospasm, or bronchoconstriction, particularly
when concentrations are rapidly increased.
5. A 70-kg adult receives 2 mg/kg of intravenous lidocaine for a regional
anesthetic procedure. Several minutes later, the patient develops
circumoral numbness, tinnitus, metallic taste, agitation, and
subsequently a generalized seizure. Which treatment is most
appropriate for severe local anesthetic systemic toxicity?
A. Intravenous naloxone
B. Intravenous flumazenil
C. Intravenous lipid emulsion therapy with appropriate supportive
management
D. Intravenous protamine
