Moderate Sedation Certification 2025
update|comprehensive questions and
verified answers (complete solutions) A+
GRADE!!
Actions if vomiting occurs in the obtunded patient - ✔✔- ANSWER: -Place on side
-Clear airway of vomitus
-Place in trendelenburg to allow gravity to drain emesis away from trachea
Adverse events of Conscious Sedation may involve - ✔✔- ANSWER: -Multiple drugs
-Drug errors
-Inadequate evaluation
-Inadequate monitoring
-Inadequate practitioner skills
-Lack of vigilance
-Premature discharge
Age-Specific Considerations: Geriatric - ✔✔- ANSWER: *65 years*
-Functional age more important than chronological
-Careful titration and reduced doses of medications are required to avoid the development of
deep sedation states, prolonged recovery, and cardiovascular depression
Airway Adjuncts for Anesthesia - ✔✔- ANSWER: -ETT (absolute control of airway)
-Laryngeal mask airway
Airway Adjuncts for Sedation - ✔✔- ANSWER: -Nasal Airway
-Oral Airway
Airway Assessment - ✔✔- ANSWER: 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 Considerations - ✔✔- ANSWER: -Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
Airway Assessment: Patient History - ✔✔- ANSWER: 1. Problems with anesthesia
2. Stridor, snoring, sleep apnea?
3. Advanced rheumatoid mouth and jaw
Airway Obstruction: Complete Obstruction - ✔✔- ANSWER: -Silent, exaggerated attempts at
inspiration
-If not corrected = respiratory and cardiac arrest and death
Airway Obstruction: Evidence of poor air movement or partial obstruction - ✔✔- ANSWER:
-Increasing ventilatory effort
-Sternal retractions
-Inspiratory Stridor, snoring, gasping breath sounds
-Faint/absent breath sounds
-Accessory respiratory muscle use is evidence of increased respiratory effort
,Alpha-2 Receptors Agonists - ✔✔- ANSWER: -Clonidine (Catapres)
-Dexamedetomidine (Precedex)
-Decreases sympathetic nervous system activity (decreased BP and HR)
Anesthesia and Surgical History Considerations - ✔✔- ANSWER: -Any complications with past
anesthesia
-Any patient with h/o airway difficulties should be referred to Anesthesia for their
recommendations
Anesthesia Class Medications - ✔✔- ANSWER: -Ketamine
-Propofol
-Thiopental
-Brevital
Anti-emetics - ✔✔- ANSWER: -Droperidol
-Prochlorperazine (Compazine)
-Promethazine (Phenergan)
-Ondansetron Hydrochloride (Zofran)
Arguments for RN Giving Propofol - ✔✔- ANSWER: -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
ASA 1 - ✔✔- ANSWER: -Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
ASA 2 - ✔✔- ANSWER: 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 - ✔✔- ANSWER: *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 - ✔✔- ANSWER: *Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
, ASA 5 - ✔✔- ANSWER: *Moribund patient not expected to survive longer than 24 hours
without surgical intervention
ASA 6 - ✔✔- ANSWER: *Declared brain-dead whose organs are being removed for donor
purposes
ASA Fasting Recommendations - ✔✔- ANSWER: -Clear liquids: 2h
-Breast milk: 4h
-Infant formula: 6h
-Nonhuman milk: 6h
-Light meal: 6h
-Full meal/Fat: Up to 8h
ASA Physical Status - ✔✔- ANSWER: American Society of Anesthesiologists Physical Status
System helps qualify the relative risk to patients sedative medications pose
Atropine - ✔✔- ANSWER: -Increases HR by blocking vagal nerve stimulation
-IV bolus 0.4-1.0 mg
Benzodiazepines cause what effects - ✔✔- ANSWER: 1. Anxiolysis
2. Amnesiac...antero-grade amnesia
3. Anti-convulsive
4. Skeletal muscle relaxation
5. Sedative-hypnotic in large doses
6. When used alone, will cause little respiratory or cardiovascular depression, but synergistic
effects seen when combined with other CNS depressants
**NO analgesic properties**
Bronchospasm - ✔✔- ANSWER: -Narrowing of the lower airways due to increased tone in the
circular smooth muscle in the bronchi or bronchioles
Bronchospasm Symptoms - ✔✔- ANSWER: -High pitched wheezing and coarse crackles
-Flaring nostrils
-Increased respiratory rate and restlessness
Bronchospasm Treatment - ✔✔- ANSWER: -Positioning and calm environment
-Have the patient cough deeply with oxygen administration
-Both inhaled and parenteral bronchodilating drugs
Bronchospasm: Prevention - ✔✔- ANSWER: -Accurate hx to ID risk
-Pre-treat with a bronchodilator
-Avoid irritation of the tracheobronchial tree
-Decrease anxiety and stress
Capnogram - ✔✔- ANSWER: The waveform of carbon dioxide over a period of time
Capnography - ✔✔- ANSWER: -The combination of a waveform and numerical value of
ETCO2
-Measures the amount of carbon dioxide in respiratory gases
-Monitors ventilation, defined as the adequacy of respiration (how adequately the patient is
inhaling O2 and eliminating CO2)
-Provides breath-to-breath feedback so that changes in breathing are reflected immediately
-Provides information about end-tidal carbon dioxide values, defined as maximal concentration
update|comprehensive questions and
verified answers (complete solutions) A+
GRADE!!
Actions if vomiting occurs in the obtunded patient - ✔✔- ANSWER: -Place on side
-Clear airway of vomitus
-Place in trendelenburg to allow gravity to drain emesis away from trachea
Adverse events of Conscious Sedation may involve - ✔✔- ANSWER: -Multiple drugs
-Drug errors
-Inadequate evaluation
-Inadequate monitoring
-Inadequate practitioner skills
-Lack of vigilance
-Premature discharge
Age-Specific Considerations: Geriatric - ✔✔- ANSWER: *65 years*
-Functional age more important than chronological
-Careful titration and reduced doses of medications are required to avoid the development of
deep sedation states, prolonged recovery, and cardiovascular depression
Airway Adjuncts for Anesthesia - ✔✔- ANSWER: -ETT (absolute control of airway)
-Laryngeal mask airway
Airway Adjuncts for Sedation - ✔✔- ANSWER: -Nasal Airway
-Oral Airway
Airway Assessment - ✔✔- ANSWER: 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 Considerations - ✔✔- ANSWER: -Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
Airway Assessment: Patient History - ✔✔- ANSWER: 1. Problems with anesthesia
2. Stridor, snoring, sleep apnea?
3. Advanced rheumatoid mouth and jaw
Airway Obstruction: Complete Obstruction - ✔✔- ANSWER: -Silent, exaggerated attempts at
inspiration
-If not corrected = respiratory and cardiac arrest and death
Airway Obstruction: Evidence of poor air movement or partial obstruction - ✔✔- ANSWER:
-Increasing ventilatory effort
-Sternal retractions
-Inspiratory Stridor, snoring, gasping breath sounds
-Faint/absent breath sounds
-Accessory respiratory muscle use is evidence of increased respiratory effort
,Alpha-2 Receptors Agonists - ✔✔- ANSWER: -Clonidine (Catapres)
-Dexamedetomidine (Precedex)
-Decreases sympathetic nervous system activity (decreased BP and HR)
Anesthesia and Surgical History Considerations - ✔✔- ANSWER: -Any complications with past
anesthesia
-Any patient with h/o airway difficulties should be referred to Anesthesia for their
recommendations
Anesthesia Class Medications - ✔✔- ANSWER: -Ketamine
-Propofol
-Thiopental
-Brevital
Anti-emetics - ✔✔- ANSWER: -Droperidol
-Prochlorperazine (Compazine)
-Promethazine (Phenergan)
-Ondansetron Hydrochloride (Zofran)
Arguments for RN Giving Propofol - ✔✔- ANSWER: -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
ASA 1 - ✔✔- ANSWER: -Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
ASA 2 - ✔✔- ANSWER: 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 - ✔✔- ANSWER: *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 - ✔✔- ANSWER: *Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
, ASA 5 - ✔✔- ANSWER: *Moribund patient not expected to survive longer than 24 hours
without surgical intervention
ASA 6 - ✔✔- ANSWER: *Declared brain-dead whose organs are being removed for donor
purposes
ASA Fasting Recommendations - ✔✔- ANSWER: -Clear liquids: 2h
-Breast milk: 4h
-Infant formula: 6h
-Nonhuman milk: 6h
-Light meal: 6h
-Full meal/Fat: Up to 8h
ASA Physical Status - ✔✔- ANSWER: American Society of Anesthesiologists Physical Status
System helps qualify the relative risk to patients sedative medications pose
Atropine - ✔✔- ANSWER: -Increases HR by blocking vagal nerve stimulation
-IV bolus 0.4-1.0 mg
Benzodiazepines cause what effects - ✔✔- ANSWER: 1. Anxiolysis
2. Amnesiac...antero-grade amnesia
3. Anti-convulsive
4. Skeletal muscle relaxation
5. Sedative-hypnotic in large doses
6. When used alone, will cause little respiratory or cardiovascular depression, but synergistic
effects seen when combined with other CNS depressants
**NO analgesic properties**
Bronchospasm - ✔✔- ANSWER: -Narrowing of the lower airways due to increased tone in the
circular smooth muscle in the bronchi or bronchioles
Bronchospasm Symptoms - ✔✔- ANSWER: -High pitched wheezing and coarse crackles
-Flaring nostrils
-Increased respiratory rate and restlessness
Bronchospasm Treatment - ✔✔- ANSWER: -Positioning and calm environment
-Have the patient cough deeply with oxygen administration
-Both inhaled and parenteral bronchodilating drugs
Bronchospasm: Prevention - ✔✔- ANSWER: -Accurate hx to ID risk
-Pre-treat with a bronchodilator
-Avoid irritation of the tracheobronchial tree
-Decrease anxiety and stress
Capnogram - ✔✔- ANSWER: The waveform of carbon dioxide over a period of time
Capnography - ✔✔- ANSWER: -The combination of a waveform and numerical value of
ETCO2
-Measures the amount of carbon dioxide in respiratory gases
-Monitors ventilation, defined as the adequacy of respiration (how adequately the patient is
inhaling O2 and eliminating CO2)
-Provides breath-to-breath feedback so that changes in breathing are reflected immediately
-Provides information about end-tidal carbon dioxide values, defined as maximal concentration
