Preparation for Procedure
Not all patients are candidates for moderate sedation provided by nursing. Patients classified as ASA I, ASA II, and medically stable ASA III are commonly considered appropriate for registered nurse–administered moderate sedation. Which of these patients would NOT be appropriate for nurse administered moderate sedation.
a.Normal healthy patient
b.Patient with mild systemic disease
c.Patient with severe systemic disease that is a constant threat to life.
d. Medically stable patient with severe systemic disease.
Patient with severe systemic disease that is a constant threat to life.
What is the reversal agent for Versed (Midazolam), Ativan (Lorazepam), and Valium (Diazepam)?
a.Naloxone (Narcan)
b.Flumazenil (Romazicon)
c.Acetylcysteine (N-acetylcysteine [NAC])
d.Calcium Gluconate
b.Flumazenil (Romazicon)
During the Moderate Sedation procedure, how often should vital signs be documented?
a.Every 2 minutes
b.Every 5 minutes
c.Every 15 minutes
d.Every 1 hour
b.Every 5 minutes
How often are vital signs to be documented post procedure?
a.Immediately post procedure and minimum of every 15 minutes as clinical condition requires.
b.Every 15 minutes x 2 then every 30 minutes until discharge.
c.Every 30 minutes until sedation wears off.
d.As long as you are monitoring the vital signs, you do not need to document them.
a.Immediately post procedure and minimum of every 15 minutes as clinical condition requires.
You are preparing to provide moderate sedation to your ED patient for an orthopedic reduction. In preparation you have the patient on the cardiac monitor with continuous pulse oximetry and etCO2 monitoring, suction is set up, IV is patent, oxygen is available, medication and reversal agents are identified and available, you have a second person to help with the procedure so you can focus on providing sedation and monitoring the patient. What else should be prepared/available?
a.Emergency cart with emergency medications and airway supplies
b.Continuous temperature monitoring
c.Urinary catheter insertion
d.Type and crossmatch complete
a.Emergency cart with emergency medications and airway supplies
What is the reversal medication for opiate medications?
a.Naloxone (Narcan)
b.Flumazenil (Romazicon)
c.Acetylcysteine (N-acetylcysteine [NAC])
d.Calcium Gluconate
a.Naloxone (Narcan)
If a reversal agent is administered, which of the following actions should be taken?
a.Discontinue monitoring after reversal medication is given as the patient is no longer sedated
b.Discharge the patient immediately after reversal medication is given
c.Monitor patient for a sufficient time interval after reversal was given to ensure re-sedation does not occur
d.Monitor patient for 15 minutes before disconnecting from telemetry and monitor
c.Monitor patient for a sufficient time interval after reversal was given to ensure re-sedation does not occur
Which of the following vital signs should be continuously monitored and documented post moderate sedation procedure?
a.Blood pressure
b.Heart rate and rhythm
c.ETCO2 via capnography or continuous pulse oximetry if capnography not available
d.Level of consciousness
e.Respiratory rate
f.Consider monitoring temperature when clinically significant
g.All of these should be monitored post procedure
g.All of these should be monitored post procedure
Prior to moderate sedation the team reviewed the following information: Information related to chief complaint and planned procedure, pregnancy status, physical assessment, medications, allergies, informed consent, height and weight, and pain score. What was missed?
a.Swallowing evaluation
b.NPO status and Modified Aldrete Score
c.NPO status and Type and Crossmatch
d.Blood consent and Type and Crossmatch
b.NPO status and Modified Aldrete Score
What medications are universally most commonly used for Moderate Sedation?
a.Versed and Fentanyl
b.Ketamine and Fentanyl
c.Propofol and Valium
d.Precedex and Dilaudid
a.Versed and Fentanyl
How is the patient's LOC monitored during moderate sedation?
a.Assessed by checking verbal response to commands
b.Assessed by checking the patient’s vitals
c.Assessed by checking if patient’s eyes are open or not
d.LOC does not need to be monitored during moderate sedation
a.Assessed by checking verbal response to commands
Which of the following is not a potential post procedure adverse drug reaction or complication of sedation?
a.Hypotension
b.Cardiac arrhythmia
c.Respiratory depression
d.Desaturation
e.Hypertension
f.Constipation
f.Constipation
The Modified Aldrete score is used to compare baseline and post sedation assessments. Parameters assessed with the Modified Aldrete score include:
a.Blood pressure, heart rate, and respiratory rate
b.Glasgow Coma Score, pulse ox, and heart rate
c.Activity, respiratory rate, circulation, level of consciousness, and oxygen saturation
d.Activity, respiratory rate and ETCO2 measurement
c.Activity, respiratory rate, circulation, level of consciousness, and oxygen saturation
The RN administering moderate sedation and monitoring the patient should have no other responsibilities during the procedure.
a.True
b.False
a.True
Which of the following does NOT need to be monitored during moderate sedation?
a.Heart Rate
b.Respiratory Rate
c.Pulse Oximetry
d.Blood Pressure
e.Bowel Sounds
e.Bowel Sounds
A patient who received moderate sedation followed by a reversal agent post procedure develops bradypnea with elevated ETCO2 and is difficult to arouse. What nursing actions should you prioritize?
a.Stimulate patient, administer oxygen, support ventilation, and consider repeating reversal agent.
b.Simulate patient and keep them awake until sedation wears off
c.Increase vital sign monitoring to every 5 minutes, notify provider, and wait for further orders
d.Administer oxygen to keep oxygen saturation above 90%, because oxygen saturation is more accurate than ETCO2 for determining effectiveness of ventilation.
a.Stimulate patient, administer oxygen, support ventilation, and consider repeating reversal agent.
Which patient would you have heightened concerns about the risk of complications with moderate sedation?
a.A 50-year-old male with history of peripheral vascular disease and prior right below the knee amputation who will receive moderate sedation for a cardiac catheterization.
b.A 25-year-old female weighs 380 pounds and uses CPAP at home who is scheduled for moderate sedation for an implanted infusion port insertion.
c.A 65-year-old male with stage 3 prostate cancer scheduled to receive moderate sedation for a colonoscopy
d.A patient with a history of diabetes and new onset atrial fibrillation who is receiving moderate sedation for cardioversion.
b.A 25-year-old female weighs 380 pounds and uses CPAP at home who is scheduled for moderate sedation for an implanted infusion port insertion.
According to our nursing scope of practice, the nurse assisting with moderate sedation does not need to have ACLS training as long as the physician is present.
a.True
b.False
b.False
If capnography is not available, what action should be taken?
a.Connect patient to nonrebreather mask and turn up oxygen flow
b.Attach patient to cardiac monitor to continuously monitor heart rate and use pulse oximetry to monitor oxygenation, respiratory rate, and adequacy of ventilation
c.Discontinue the moderate sedation procedure
d.Estimate the patient’s ETCO2 value based on visual assessment
b.Attach patient to cardiac monitor to continuously monitor heart rate and use pulse oximetry to monitor oxygenation, respiratory rate, and adequacy of ventilation
A patient receiving moderate sedation is allowed to drive themself home after being monitored for an appropriate amount of time and passing the discharge criteria.
a.True
b.False
b.False