FCCN LEVEL 2 CERTIFICATION
EXAM QUESTIONS WITH CORRECT
ANSWERS
peripheral nerve stimulator - Answer-a battery-operated device used to assess the level
of neuromuscular blockade by causing muscle contractions
neuromuscular blockade - Answer-acute muscle paralysis and apnea, reserved for pts
with severe, refractory, or life threatening hypoxemia who are not responsive to other
sedatives or analgesics
classified as depolarizing or non-depolarizing
goal is to deliver minimum amount of medication to achieve desired effect
NMB agents indications - Answer--facilitate short procedures
-facilitate mechanical ventilation
-reduce muscle oxygen consumption
-prevent respiratory or other movements
-treat increased muscle activity
neuromuscular junction - Answer-point of contact between a motor neuron and a
skeletal muscle cell
-impulse travels down motor axon resulting in influx of calcium
-calcium generates release of ACh
-ACh crosses into synaptic cleft and binds to receptors
-membrane permeability increases, allowing for exchange of Na and K
-this initiates depolarization and an action potential, which produces muscle contraction
depolarizing agents - Answer-mimic ACh
Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular
membrane. paralysis occurs because depolarized membrane can't respond to
subsequent stimuli by ACh
succinylcholine
succinylcholine - Answer-rapid onset 30-60 seconds, ultra short duration, absence of
adverse effects on smooth muscle
metabolized in blood and excreted by kidneys
,side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia
non-depolarizing agents - Answer-competitively block ACh transmission at post-
junctional receptor sites. level of paralysis increases as number of receptor sites
occupied by drug increases
pancuronium, atracurium, cisatracurium, vec, roc
NMB considerations - Answer-NMBs do not have sedative analgesic or amnestic
properties. assure pain and sedation medication given beforehand.
precedex should not be used due to light sedative properties
assessments for effectiveness of NMB - Answer--TOF
-spontaneous breathing or movement
-resistance to turning
-diaphoresis
-vitals
-ETCO2
Train of four monitoring - Answer--series of four twitches at 2 hz, every half second for 2
sec.
-reflects blockade percentage
-TOF based on provider order for pt's clinical goals
4 twitches: 0-75% of receptors blocked
3: 80%
2: 85%
1: 90%
0: 100%
must establish baseline before initiating NMB
NMB risks - Answer--disconnection from ventilator
-failure to cough
-generalized deconditioning
-skin breakdown
-DVT
-awake and paralyzed
NMB nursing care - Answer--alarms on
-monitor ABG and pulse ox
-hemodynamics
-frequent skin care and assessment, turn and rub, specialty bed/mattress
-monitor for physical signs of pain
, -analgesia and sedation
-prophylactic eye care
-VTW prophylaxis
-TOF with assessments
-explain all procedures to pt
NMB reversal - Answer-used to decrease incidence of residual NMB to prevent awake
paralyzed pt. administer acetylcholinesterase inhibitor and anticholinergic meds during
reversal process.
neostigmine - Answer-most common NMB reversal agent, onset 5-10 mins, physician
must be present. atropine is antidote, must have at bedside
give with glycopyrrolate
pyridostigmine - Answer-NMB reversal agent, onset 2-5 mins, give with glycopyrrolate
sugammadex - Answer-NMB reversal agent of roc and vec
preload - Answer-amount of fluid filling the heart, how wet or dry the pt is
since veins hold venous blood returning to heart, dilation and constriction affect preload
CVP - Answer-preload of right heart
PAWP - Answer-preload of the left heart
6-12 is normal
snapshot in time, not a continuous measurement. swan ganz is advanced and balloon is
inflated and pressure is recorded. risk of rupturing vessels, minimize how often we
measure this
Frank-Starling Law - Answer-the greater the stretch, the stronger is the heart's
contraction
giving fluid increases preload, and therefore increases cardiac output
however if you give too much fluid, you will stretch the heart too much and it won't be
able to contract, which will decrease cardiac output
how to fix preload - Answer-if preload is low, give crystalloids, colloids, or blood to
increase volume
if preload is high, give diuretics, vasodilators, or dialysis
EXAM QUESTIONS WITH CORRECT
ANSWERS
peripheral nerve stimulator - Answer-a battery-operated device used to assess the level
of neuromuscular blockade by causing muscle contractions
neuromuscular blockade - Answer-acute muscle paralysis and apnea, reserved for pts
with severe, refractory, or life threatening hypoxemia who are not responsive to other
sedatives or analgesics
classified as depolarizing or non-depolarizing
goal is to deliver minimum amount of medication to achieve desired effect
NMB agents indications - Answer--facilitate short procedures
-facilitate mechanical ventilation
-reduce muscle oxygen consumption
-prevent respiratory or other movements
-treat increased muscle activity
neuromuscular junction - Answer-point of contact between a motor neuron and a
skeletal muscle cell
-impulse travels down motor axon resulting in influx of calcium
-calcium generates release of ACh
-ACh crosses into synaptic cleft and binds to receptors
-membrane permeability increases, allowing for exchange of Na and K
-this initiates depolarization and an action potential, which produces muscle contraction
depolarizing agents - Answer-mimic ACh
Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular
membrane. paralysis occurs because depolarized membrane can't respond to
subsequent stimuli by ACh
succinylcholine
succinylcholine - Answer-rapid onset 30-60 seconds, ultra short duration, absence of
adverse effects on smooth muscle
metabolized in blood and excreted by kidneys
,side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia
non-depolarizing agents - Answer-competitively block ACh transmission at post-
junctional receptor sites. level of paralysis increases as number of receptor sites
occupied by drug increases
pancuronium, atracurium, cisatracurium, vec, roc
NMB considerations - Answer-NMBs do not have sedative analgesic or amnestic
properties. assure pain and sedation medication given beforehand.
precedex should not be used due to light sedative properties
assessments for effectiveness of NMB - Answer--TOF
-spontaneous breathing or movement
-resistance to turning
-diaphoresis
-vitals
-ETCO2
Train of four monitoring - Answer--series of four twitches at 2 hz, every half second for 2
sec.
-reflects blockade percentage
-TOF based on provider order for pt's clinical goals
4 twitches: 0-75% of receptors blocked
3: 80%
2: 85%
1: 90%
0: 100%
must establish baseline before initiating NMB
NMB risks - Answer--disconnection from ventilator
-failure to cough
-generalized deconditioning
-skin breakdown
-DVT
-awake and paralyzed
NMB nursing care - Answer--alarms on
-monitor ABG and pulse ox
-hemodynamics
-frequent skin care and assessment, turn and rub, specialty bed/mattress
-monitor for physical signs of pain
, -analgesia and sedation
-prophylactic eye care
-VTW prophylaxis
-TOF with assessments
-explain all procedures to pt
NMB reversal - Answer-used to decrease incidence of residual NMB to prevent awake
paralyzed pt. administer acetylcholinesterase inhibitor and anticholinergic meds during
reversal process.
neostigmine - Answer-most common NMB reversal agent, onset 5-10 mins, physician
must be present. atropine is antidote, must have at bedside
give with glycopyrrolate
pyridostigmine - Answer-NMB reversal agent, onset 2-5 mins, give with glycopyrrolate
sugammadex - Answer-NMB reversal agent of roc and vec
preload - Answer-amount of fluid filling the heart, how wet or dry the pt is
since veins hold venous blood returning to heart, dilation and constriction affect preload
CVP - Answer-preload of right heart
PAWP - Answer-preload of the left heart
6-12 is normal
snapshot in time, not a continuous measurement. swan ganz is advanced and balloon is
inflated and pressure is recorded. risk of rupturing vessels, minimize how often we
measure this
Frank-Starling Law - Answer-the greater the stretch, the stronger is the heart's
contraction
giving fluid increases preload, and therefore increases cardiac output
however if you give too much fluid, you will stretch the heart too much and it won't be
able to contract, which will decrease cardiac output
how to fix preload - Answer-if preload is low, give crystalloids, colloids, or blood to
increase volume
if preload is high, give diuretics, vasodilators, or dialysis
