ICA exam 1 UPDATED ACTUAL Questions and CORRECT Answers
Question: ASA standards
Correct Answer: provide rules and minimum requirements of clinical practice. modified only under
unusual circumstances minimal requirements during every anesthetic - negligent if don't follow - only
extreme circumstances ( imminent death - can start without a certain monitor but must try to call and get the
monitor and document that its not working and have made attempts to get it
Question: ASA guidelines
Correct Answer: recommendations, hospital policy supersedes
Question: ASA statements
Correct Answer: opinions, beliefs on a topic
Question: ASA standard 1
Correct Answer: *Qualified anesthesia personnel shall be present in the room throughout all general and
regional anesthetics and MAC
Question: ASA standard 2
Correct Answer: Oxygenation, ventilation, circulation, and temperature shall be continually evaluated
Question: continual
Correct Answer: repeated regularly and frequently in steady rapid succession BP at least every 5 minutes,
temperature and circulation
Question: continuous
Correct Answer: prolonged without any interruption at any time ECG , ETCO2, oxygenation, ventilation,
circulation
Question: basic standards for anesthetic monitoring
Correct Answer: -Qualified Anesthesia Personnel must remain continuously present throughout the
anesthetic -Patient Monitoring Requirements: -Continuous assessment of oxygenation, ventilation, and
circulation (ECG and HR). -Blood pressure, temperature, and circulation must be evaluated and
documented at least every 5 minutes. -Electrocardiogram (ECG): continuously monitored from before
induction until the patient exits the OR -Oxygen Analyzer: Use of an oxygen analyzer to ensure adequate
inspired oxygen during general anesthesia. -Low Oxygen Alarm: use of an audible alarm to alert for
hypoxic gas mixtures. -Temperature Monitoring: Use of a reliable method to assess body temperature must
be readily available and used when significant changes are anticipated (general anesthesia, long procedures,
pediatric patients). -Temperature should be documented at least every 5 minutes in such cases
Question: oxygenation
Correct Answer: adequate oxygen in both inspired gas and patients blood 2 ways--> inspired gas with
oxygen analyzer with low oxygen concentration alarm and quantitative pulse ox with variable pitch tone
and low SPO2 alarm - do not silence alarm but are allowed 20-30sec silence bc turns itself back on
Question: ventilation - general anesthesia
Correct Answer: qualitative such as chest excursion, reservoir breathing bag, auscultation breath sounds
Continual monitoring for the presence of expired carbon dioxide shall be performed unless invalidated by
,the nature of the patient, procedure or equipment. ( cardiac bypass CO2 not measured because leaves via
bypass machine and not the lungs) Quantitative monitoring of the volume of expired gas is strongly
encouraged= ETCO2
Question: Advanced airway/ ET tube or LMA ventilation
Correct Answer: -When an advanced airway is placed, correct placement must be confirmed by clinical
assessment and detection of exhaled carbon dioxide. -Continuous end-tidal CO■ monitoring must be used
from airway placement until extubation/removal or transfer to PACU. -Acceptable methods include
capnography, capnometry, or mass spectroscopy. -An audible CO■ alarm must be active if capnography or
capnometry is used.
Question: mechanical ventilation
Correct Answer: Devices must have disconnect detection and provide an audible alarm if threshold limits
are exceeded.
Question: regional/ MAC
Correct Answer: Ventilation must be evaluated by continuous observation of clinical signs and/or
monitoring for exhaled CO■. -If breathing on own without an ETT/ LMA- still document presence of
+ETCO2 even though value not always correct to show they are ventilating ( chest rise, fogging of mouth,
RR< breath sounds, + ETCO2)= qualitative presence of ETCO2( nasal canula)
Question: circulation standard
Correct Answer: ECG beginning of anesthesia before induction until leave OR - arterial BP and HR every
5 min - at least one additional palpation of a pulse, auscultation of heart sounds, monitoring of a tracing of
intra-arterial pressure, ultrasound peripheral pulse monitoring, or pulse plethysmography or oximetry -
ECG can look normal but patient have no pulse ( pulseless electrical activity)
Question: body temperature standard
Correct Answer: when clinically significant changes in body temperature are intended, anticipated, or
suspected- general anesthesia impacts temp > 1 hour MAC
Question: core temperature sites
Correct Answer: pulmonary artery, nasopharynx, tympanic membrane, distal esophagus
Question: transitional temperature sites
Correct Answer: axillary, rectum, bladder
Question: peripheral temperature sites
Correct Answer: skin
Question: ASA standard monitors
Correct Answer: pulse ox ECG NIBP gas analysis (ETCO2) temperature
Question: pulse ox
Correct Answer: shine red and infrared light through the tissue. The blood, tissue, and bone at the
application site absorb much of the light. However, some light passes through the extremity. A
light-sensitive detector opposite the light source receives the non absorbed light; and using a proprietary
algorithm processes the data to display an blood oxygen saturation value. •The amount of arterial blood at
the sensor changes over short periods of time due to pulsation with cardiac output. The amount of other
, light absorbing components (tissue and bone) is constant. This allows light absorption by blood to be
isolated from the other components. -Oxygenated and Deoxygenated hemoglobin absorb light at different
wavelengths (940nm and 660nm respectively). Oxygenated hemoglobin (oxyhemoglobin or HbO2) absorbs
more infrared light than red light. Deoxygenated hemoglobin (Hb) absorbs more red light than infrared
light. -By comparing the amounts of red (660nm) and infrared (940nm) light received, the instrument can
extrapolate the percentage of oxygenated blood and provide a SpO2 reading.
Question: factors that influence pulse ox
Correct Answer: low blood flow conditions ( PVD, cold) patient movement ambient light
carboxyhemoglobin methemoglobin methylene blue shift in oxyhemoglobin curve artificial nails ( blue
absorbs red light which underestimates pulse ox)
Question: methemoglobin
Correct Answer: drives SPO2 towards 85% regardless of true saturation - use ABG for accurate
assessment - hemoglobin with iron in the Ferric state so can't carry oxygen , absorbs red and infrared
equally which confuses the pulse ox
Question: carboxyhemoglobin
Correct Answer: CO poisoning reads falsely normal 98% left shift on oxyhemoglobin dissociation curve
pulse ox doesn't distinguish it from oxyhemoglobin so reads normal or high
Question: left shift of oxyhemoglobin curve
Correct Answer: alkalosis ( dec H+) dec BPG dec temp inc HbF inc CO inc MetHB
Question: right shift of hemoglobin curve
Correct Answer: acidosis ( inc H+) inc BPG inc temp inc altitude
Question: 2,3 BPG
Correct Answer: stabilizes taut form of Hb ( dec O2 affinity) , O2 moves from Hb into plasma and into
tissue by diffusion - regulator of the allosteric properties- when bound to hemoglobin stabilizes in T state (
low affinity for oxygen so shift to right) - high levels shift curve to right
Question: Left shift of oxygen dissociation curve
Correct Answer: increased affinity ( holds O2 tightly) so less oxygen is delivered to the tissues
Question: right shift oxyhemoglobin curve
Correct Answer: dec affinity for O2/ releases O2 easily so more oxygen delivered to the tissues right =
release - enhances tissue oxygenation
Question: invasive BP
Correct Answer: cannula directly and continuously measure arterial BP arterial or Aline placed when
collateral blood flow is present ( distal areas still receive blood)
Question: non invasive
Correct Answer: indirectly measures BP sphygmomanometer- mmHG occlude artery against bone then
slowly released - ossifications appear ( systolic) and disappear ( diastolic)
Question: pulse pressure
Correct Answer: difference between systolic and diastolic
Question: ASA standards
Correct Answer: provide rules and minimum requirements of clinical practice. modified only under
unusual circumstances minimal requirements during every anesthetic - negligent if don't follow - only
extreme circumstances ( imminent death - can start without a certain monitor but must try to call and get the
monitor and document that its not working and have made attempts to get it
Question: ASA guidelines
Correct Answer: recommendations, hospital policy supersedes
Question: ASA statements
Correct Answer: opinions, beliefs on a topic
Question: ASA standard 1
Correct Answer: *Qualified anesthesia personnel shall be present in the room throughout all general and
regional anesthetics and MAC
Question: ASA standard 2
Correct Answer: Oxygenation, ventilation, circulation, and temperature shall be continually evaluated
Question: continual
Correct Answer: repeated regularly and frequently in steady rapid succession BP at least every 5 minutes,
temperature and circulation
Question: continuous
Correct Answer: prolonged without any interruption at any time ECG , ETCO2, oxygenation, ventilation,
circulation
Question: basic standards for anesthetic monitoring
Correct Answer: -Qualified Anesthesia Personnel must remain continuously present throughout the
anesthetic -Patient Monitoring Requirements: -Continuous assessment of oxygenation, ventilation, and
circulation (ECG and HR). -Blood pressure, temperature, and circulation must be evaluated and
documented at least every 5 minutes. -Electrocardiogram (ECG): continuously monitored from before
induction until the patient exits the OR -Oxygen Analyzer: Use of an oxygen analyzer to ensure adequate
inspired oxygen during general anesthesia. -Low Oxygen Alarm: use of an audible alarm to alert for
hypoxic gas mixtures. -Temperature Monitoring: Use of a reliable method to assess body temperature must
be readily available and used when significant changes are anticipated (general anesthesia, long procedures,
pediatric patients). -Temperature should be documented at least every 5 minutes in such cases
Question: oxygenation
Correct Answer: adequate oxygen in both inspired gas and patients blood 2 ways--> inspired gas with
oxygen analyzer with low oxygen concentration alarm and quantitative pulse ox with variable pitch tone
and low SPO2 alarm - do not silence alarm but are allowed 20-30sec silence bc turns itself back on
Question: ventilation - general anesthesia
Correct Answer: qualitative such as chest excursion, reservoir breathing bag, auscultation breath sounds
Continual monitoring for the presence of expired carbon dioxide shall be performed unless invalidated by
,the nature of the patient, procedure or equipment. ( cardiac bypass CO2 not measured because leaves via
bypass machine and not the lungs) Quantitative monitoring of the volume of expired gas is strongly
encouraged= ETCO2
Question: Advanced airway/ ET tube or LMA ventilation
Correct Answer: -When an advanced airway is placed, correct placement must be confirmed by clinical
assessment and detection of exhaled carbon dioxide. -Continuous end-tidal CO■ monitoring must be used
from airway placement until extubation/removal or transfer to PACU. -Acceptable methods include
capnography, capnometry, or mass spectroscopy. -An audible CO■ alarm must be active if capnography or
capnometry is used.
Question: mechanical ventilation
Correct Answer: Devices must have disconnect detection and provide an audible alarm if threshold limits
are exceeded.
Question: regional/ MAC
Correct Answer: Ventilation must be evaluated by continuous observation of clinical signs and/or
monitoring for exhaled CO■. -If breathing on own without an ETT/ LMA- still document presence of
+ETCO2 even though value not always correct to show they are ventilating ( chest rise, fogging of mouth,
RR< breath sounds, + ETCO2)= qualitative presence of ETCO2( nasal canula)
Question: circulation standard
Correct Answer: ECG beginning of anesthesia before induction until leave OR - arterial BP and HR every
5 min - at least one additional palpation of a pulse, auscultation of heart sounds, monitoring of a tracing of
intra-arterial pressure, ultrasound peripheral pulse monitoring, or pulse plethysmography or oximetry -
ECG can look normal but patient have no pulse ( pulseless electrical activity)
Question: body temperature standard
Correct Answer: when clinically significant changes in body temperature are intended, anticipated, or
suspected- general anesthesia impacts temp > 1 hour MAC
Question: core temperature sites
Correct Answer: pulmonary artery, nasopharynx, tympanic membrane, distal esophagus
Question: transitional temperature sites
Correct Answer: axillary, rectum, bladder
Question: peripheral temperature sites
Correct Answer: skin
Question: ASA standard monitors
Correct Answer: pulse ox ECG NIBP gas analysis (ETCO2) temperature
Question: pulse ox
Correct Answer: shine red and infrared light through the tissue. The blood, tissue, and bone at the
application site absorb much of the light. However, some light passes through the extremity. A
light-sensitive detector opposite the light source receives the non absorbed light; and using a proprietary
algorithm processes the data to display an blood oxygen saturation value. •The amount of arterial blood at
the sensor changes over short periods of time due to pulsation with cardiac output. The amount of other
, light absorbing components (tissue and bone) is constant. This allows light absorption by blood to be
isolated from the other components. -Oxygenated and Deoxygenated hemoglobin absorb light at different
wavelengths (940nm and 660nm respectively). Oxygenated hemoglobin (oxyhemoglobin or HbO2) absorbs
more infrared light than red light. Deoxygenated hemoglobin (Hb) absorbs more red light than infrared
light. -By comparing the amounts of red (660nm) and infrared (940nm) light received, the instrument can
extrapolate the percentage of oxygenated blood and provide a SpO2 reading.
Question: factors that influence pulse ox
Correct Answer: low blood flow conditions ( PVD, cold) patient movement ambient light
carboxyhemoglobin methemoglobin methylene blue shift in oxyhemoglobin curve artificial nails ( blue
absorbs red light which underestimates pulse ox)
Question: methemoglobin
Correct Answer: drives SPO2 towards 85% regardless of true saturation - use ABG for accurate
assessment - hemoglobin with iron in the Ferric state so can't carry oxygen , absorbs red and infrared
equally which confuses the pulse ox
Question: carboxyhemoglobin
Correct Answer: CO poisoning reads falsely normal 98% left shift on oxyhemoglobin dissociation curve
pulse ox doesn't distinguish it from oxyhemoglobin so reads normal or high
Question: left shift of oxyhemoglobin curve
Correct Answer: alkalosis ( dec H+) dec BPG dec temp inc HbF inc CO inc MetHB
Question: right shift of hemoglobin curve
Correct Answer: acidosis ( inc H+) inc BPG inc temp inc altitude
Question: 2,3 BPG
Correct Answer: stabilizes taut form of Hb ( dec O2 affinity) , O2 moves from Hb into plasma and into
tissue by diffusion - regulator of the allosteric properties- when bound to hemoglobin stabilizes in T state (
low affinity for oxygen so shift to right) - high levels shift curve to right
Question: Left shift of oxygen dissociation curve
Correct Answer: increased affinity ( holds O2 tightly) so less oxygen is delivered to the tissues
Question: right shift oxyhemoglobin curve
Correct Answer: dec affinity for O2/ releases O2 easily so more oxygen delivered to the tissues right =
release - enhances tissue oxygenation
Question: invasive BP
Correct Answer: cannula directly and continuously measure arterial BP arterial or Aline placed when
collateral blood flow is present ( distal areas still receive blood)
Question: non invasive
Correct Answer: indirectly measures BP sphygmomanometer- mmHG occlude artery against bone then
slowly released - ossifications appear ( systolic) and disappear ( diastolic)
Question: pulse pressure
Correct Answer: difference between systolic and diastolic
