Clinical Monitoring (Ericksen) Exam 1 Flashcards by Kimberly Diane Hill

Which of the following are included in the Oxygenation monitoring standards?

a.) Electrocardiogram
b.) Clinical observation
c.) Pulse oximetry
d.) ABG’s as indicated

b.) Clinical observation
c.) Pulse oximetry
d.) ABG’s as indicated

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According to the Ventilation monitoring standards, what should be monitored every 5 minutes?

a.) Respiratory rate (RR)
b.) Blood pressure (BP)
c.) Heart rate (HR)
d.) Temperature

a.) Respiratory rate (RR)

2,3

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Which of the following are part of the Cardiovascular monitoring standards?

a.) Electrocardiogram
b.) Auscultation as needed
c.) BP and HR every 5 minutes
d.) Chest excursion

a.) Electrocardiogram
b.) Auscultation as needed
c.) BP and HR every 5 minutes

2,3

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What method is used for monitoring Oxygenation as per AANA standards?

a) Electrocardiogram
b) Pulse oximetry
c) Blood pressure monitoring
d) Capnography

b) Pulse oximetry

2,3

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In the context of Ventilation monitoring, ETCO₂ refers to:

a) End Tidal Carbon Monoxide
b) End Tidal Carbon Dioxide
c) End Tidal Oxygen
d) End Tidal Nitrogen

b) End Tidal Carbon Dioxide

2,3

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Additional means of monitoring depend on the needs of the _______, surgical technique, or procedure.

patient

2,3

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Omission with reason must be _______.

charted

2,3

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When neuromuscular blocking agents are administered, _______ monitoring is required

neuromuscular

2,3

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T/F
Thermoregulation monitoring is only necessary when clinically significant changes in body temperature are anticipated or suspected.

True

2,3

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Which of the following conditions are associated with a left shift in the oxygen-hemoglobin dissociation curve?

a.) Alkalosis
b.) Hypocarbia
c.) Hypothermia
d.) Acidosis
e.) Hypercarbia
f.) Hyperthermia

a.) Alkalosis
b.) Hypocarbia
c.) Hypothermia

4-7

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Factors that cause a right shift in the oxygen-hemoglobin dissociation curve include:

a.) Hypocarbia
b.) Acidosis
c.) Hypercarbia
d.) Hyperthermia
e.) Hypothermia
f.) Increased 2,3-DPG

b.) Acidosis
c.) Hypercarbia
d.) Hyperthermia
f.) Increased 2,3-DPG

4-7

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According to the oxygen-hemoglobin dissociation curve, a PO₂ of 60 mm Hg corresponds to an O₂ saturation of approximately:

a) 100%
b) 75%
c) 90%
d) 50%

c) 90%

4-7

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The Beer-Lambert law relates the transmission of light through a solution to:

a) The color of the solution
b) The concentration of the solute in the solution
c) The pH of the solution
d) The temperature of the solution

b) The concentration of the solute in the solution

4-7

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Light can be _______, absorbed, or reflected as it passes through matter.

transmitted

4-7

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According to the Beer-Lambert law, light absorption must be measured at wavelengths that are proportional to the number of _______.

solutes

4-7

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Which of the following types of hemoglobin are present in adult blood?

a.) Oxyhemoglobin (O₂Hb)
b.) Reduced Hb (Deoxyhemoglobin, deO₂Hb)
c.) Methemoglobin (metHb)
d.) Carboxyhemoglobin (COHb)

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Co-oximetry is considered the gold standard for measuring which of the following?

a.) Blood glucose
b.) Oxyhemoglobin (O₂Hb)
c.) Carboxyhemoglobin (COHb)
d.) Methemoglobin (metHb)
e.) Serum electrolytes

b.) Oxyhemoglobin (O₂Hb)
c.) Carboxyhemoglobin (COHb)
d.) Methemoglobin (metHb

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What wavelength of light is primarily absorbed by deoxyhemoglobin (deO₂Hb)?

a) 660 nm (red)
b) 940 nm (infrared)
c) 600 nm (orange)
d) 700 nm (near infrared)

a) 660 nm (red)

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Which type of hemoglobin absorbs more infrared light than deoxyhemoglobin?

a) Carboxyhemoglobin
b) Methemoglobin
c) Oxyhemoglobin (O₂Hb)
d) Fetal hemoglobin

c) Oxyhemoglobin (O₂Hb)

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The pulsatility of arterial blood flow is used to estimate _______.

SaO₂ (arterial oxygen saturation)

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The ratio of AC to DC light absorption is used to calculate the _______ of hemoglobin.

oxygen saturation

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The following types of hemoglobin can be distinguished using co-oximetry:

a.) Oxyhemoglobin (O₂Hb)
b.) Deoxyhemoglobin (deO₂Hb)
c.) Carboxyhemoglobin (COHb)
d.) Methemoglobin (metHb)
e.) Fetal hemoglobin (HbF)

a.) Oxyhemoglobin (O₂Hb)
b.) Deoxyhemoglobin (deO₂Hb)
c.) Carboxyhemoglobin (COHb)
d.) Methemoglobin (metHb)

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What is the gold standard method if oximetry is inaccurate?

a) Capnography
b) Arterial blood gas (ABG)
c) Co-oximetry
d) Spirometry

c) Co-oximetry

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Which components affect light absorption in pulse oximetry?

a.) Skin
b.) Soft tissue
c.) Venous blood
d.) Arterial blood
e.) Capillary blood

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Carboxyhemoglobin (COHb) absorbs light in the 660 nm range similarly to which type of hemoglobin? a) Deoxyhemoglobin b) Methemoglobin c) Oxyhemoglobin d) Fetal hemoglobin

c) Oxyhemoglobin | 11

What effect does an increase in Carboxyhemoglobin (COHb) have on SpO₂ readings? a) It decreases SpO₂ readings b) It has no effect on SpO₂ readings c) It falsely elevates SpO₂ readings d) It decreases accuracy of SpO₂ readings but doesn't change the value

c) It falsely elevates SpO₂ readings | 11

Each 1% increase of COHb will increase SpO₂ by _______.

1% | 11

Many smokers have more than _______% COHb in their blood.

6% | 11

How can ambient light interference in pulse oximetry usually be resolved? a.) By alternating red/infrared light b.) By using ultraviolet light c.) By increasing the light intensity d.) By using blue light

a.) By alternating red/infrared light | 12

Which issue is specifically related to low perfusion in pulse oximetry? a) Falsely elevated SpO₂ readings b) Reduced signal amplitude c) Increased signal noise d) Overestimation of venous oxygen saturation

b) Reduced signal amplitude | 12

Detection of which type of hemoglobin saturation due to venous blood pulsations results in a reduction of presumed arterial SpO₂? a) Carboxyhemoglobin b) Methemoglobin c) Deoxyhemoglobin d) Oxyhemoglobin

d) Oxyhemoglobin | 11

Venous blood pulsations can cause the detection of venous O₂Hb saturation, resulting in a reduction of presumed arterial _______.

SpO2 | 11

Very new pulse oximeters use up to _______ wavelengths to address additional light absorbers.

12 | 12

Which patient conditions will make pressure waveform analysis inaccurate? (Select all that apply - 3) A. Atrial fibrillation (Afib) B. Normal intra-abdominal pressure C. Trendelenburg positioning D. Closed chest cavity E. Open chest cavity

A. Atrial fibrillation (Afib) C. Trendelenburg positioning E. Open chest cavity | *slide 44*

Optical interference, such as from _______ and _______ can affect the accuracy of pulse oximetry readings.

* nail polish * covering | 14

Which of the following analyzers are used for gas mixture analysis? (Select all that apply - 4) A. Side-stream analyzer B. Mainstream analyzer C. Diverting analyzer D. Non-diverting analyzer E. Carbon dioxide analyzer

A. Side-stream analyzer B. Mainstream analyzer C. Diverting analyzer D. Non-diverting analyzer **side stream - diverting** **main stream - non-diverting** | *slide 48*

Which of the following are reasons why pulse oximetry is considered economical? a.) It uses reusable probes b.) It requires frequent calibration c.) It is battery-operated d.) It is noninvasive, reducing the need for additional supplies e.) It involves high initial setup costs

a.) It uses reusable probes c.) It is battery-operated d.) It is noninvasive, reducing the need for additional supplies | 14

In which type of analyzer is gas brought to the analyzer rather than the analyzer being brought to the gas? A. Mainstream analyzer B. Non-diverting analyzer C. Side-stream analyzer D. Direct analyzer

C. Side-stream analyzer | *slide 48*

# 14 Which of the following is an advantage of pulse oximetry in monitoring patients during surgery? a) Delayed detection of hypoxic events b) Non-continuous monitoring c) Affected by anesthetic vapors d) Provides continuous and real-time monitoring

d) Provides continuous and real-time monitoring | 14

Which type of analyzer is positioned directly in the airway for gas mixture analysis? A. Side-stream analyzer B. Mainstream analyzer C. Diverting analyzer D. Indirect analyzer

B. Mainstream analyzer | *slide 48*

In what situation might pulse oximetry give inaccurate readings due to motion artifact? a) Patient is lying still b) Patient has stable perfusion c) Patient is shivering or moving d) Patient is sedated

c) Patient is shivering or moving | 14

A fuel cell oxygen analyzer is an example of which type of analyzer? A. Side-stream analyzer B. Diverting analyzer C. Mainstream analyzer D. Indirect analyzer

C. Mainstream analyzer | *slide 48*

The use of tone modulation in pulse oximetry helps in quickly assessing a patient's _______ status.

oxygenation | 14

T/F One disadvantage of pulse oximetry is that it functions poorly in conditions of low perfusion.

True | 14

What is the accuracy range of pulse oximetry when measured against arterial blood gases (ABGs) with a saturation greater than 70%? a) +/- 1% b) +/- 2% c) +/- 3% d) +/- 5%

b) +/- 2% | 13

Which of the following characteristics change as the pressure wave moves to the periphery, away from the heart? Select all that apply (2) A) Arterial upstroke becomes steeper B) Systolic peak becomes lower C) Dicrotic notch appears earlier D) End-diastolic pressure becomes lower E) Arterial upstroke becomes slower

A) Arterial Upstroke becomes steeper D) End-diastolic pressure becomes lower **systolic peak becomes higher & Dicrotic notch appears later** | *slide 31*

Which of the following statements about the creation of waveforms are true? Select all that apply. A) Waveforms are created by the summation of sine waves B) Only the fundamental wave is needed for a typical arterial pressure wave C) Fourier analysis helps in the analysis of summation of multiple sine waves D) Typically, 6 to 10 harmonics are required for most arterial pressure waveforms E) The projection of waveforms on screens is due to Fourier analysis

A) Waveforms are created by the summation of sine waves C) Fourier analysis helps in the analysis of summation of multiple sine waves D) Typicall, 6-10 harmonics are required for most arterial pressure waveforms E) The projection of waveforms on screens is due to Fourier Analysis | *slide 32*

The typical arterial pressure wave is a result of the combination of which types of waves? A) Longitudinal and transverse waves B) Fundamental wave and harmonic waves C) Standing wave and traveling wave D) Electromagnetic waves

B) Fundamental wave and harmonic waves | *slide 32*

What does the presence of several bounces after a fast flush indicate about the arterial line setup? A) It is correct and functioning properly B) It is overdamped C) It is underdamped D) It is not connected

C) It is underdamped | *slide 33*

The square wave test involves performing a fast flush. What is this test used to evaluate? A) The patient's blood pressure B) The integrity of the arterial line setup C) The heart rate D) The oxygen saturation level

B) The integrity of the arterial line setup | *slide 33*

During a square wave test, what is the maximum number of oscillations that should be observed after a fast flush? A) 1 B) 3 C) 4 D) 2

D) 2 | *slide 33*

Which of the following are characteristics of an underdamped arterial line system? Select all that apply (3) A) Elevated systolic pressure B) Decreased systolic pressure C) Several dicrotic notches D) Multiple oscillations after the fast flush E) Loss of detail in the waveform

A) Elevated Systolic Pressure C) Several Dicrotic notches D) Multiple oscillations after the fast flush | *slide 34*

Which of the following are characteristics of an overdamped arterial line system? Select all that apply (3) A) Elevated systolic pressure B) Decreased systolic pressure C) Absent dicrotic notch D) Multiple oscillations after the fast flush E) Falsely narrowed pulse pressure

B) Decreased systolic pressure C) Absent Dicrotic Notch E) Falsely narrowed pulse pressure | *slide 34*

Select all conditions that can lead to changes in the pressure gradient within blood vessels: select 3 A) Atherosclerosis B) Hypothermia C) Increased vessel distensibility D) Septic shock

A) Atherosclerosis, B) Hypothermia D) Septic shock | *slide 35*

Which of the following are consequences of decreased vessel compliance due to aging? (Select all that apply) A) Increased systolic blood pressure B) Increased distensibility C) Decreased diastolic blood pressure D) Lower peripheral vascular resistance

A) Increased systolic blood pressure C) Decreased diastolic blood pressure | *slide 35*

A) Distal ischemia B) Local infection C) Increased flow to the limb D) Arterial embolization

A) Distal ischemia B) Local infection D) Arterial embolization **also hemorrhage/hematoma & peripheral neuropathy** | *slide 36*

Select all conditions that may cause peripheral neuropathy from an arterial line: select 2 A. Hemorrhage B. Catheter being left in too long C. Decreased flow D. Sepsis

B) Catheter being left in too long C) Decreased flow | *slide 36*

One of the most common complications of arterial lines is __________ and __________.

hemorrhage, hematoma | *slide 36*

What can pressure waveform analysis help identify in patients? A. Presence of residual preload reserve B. Cardiac output levels C. Oxygen saturation levels D. Blood glucose levels

A. Presence of residual preload reserve | *slide 37*

Pressure waveform analysis is used to determine if a patient can tolerate a: A. Blood transfusion B. Fluid bolus/challenge C. Medication adjustment D. Ventilator setting change

B. Fluid bolus/challenge | *slide 37*

Cyclic arterial blood pressure variations due to respiratory-induced changes in intrathoracic pressure can be observed during: A. Iron Lung Therapy B. Spontaneous breathing C. Positive pressure ventilation (PPV) D. Use of a Mapleson circuit

C. Positive pressure ventilation (PPV) | *slide 37*

Pressure waveform analysis can be used to assess which of the following in patients? (Select all that apply - 3) A. Hemodynamic stability B. Hydration status (Are they dry?) C. Pulmonary function D. Residual preload reserve

A. Hemodynamic stability B. Hydration status (Are they dry?) D. Residual preload reserve | *slide 37*

Select all effects of increasing intra-thoracic pressure during the inspiratory phase: select 5 A) Decreased LV preload B) Decreased systemic venous return C) Increased RV afterload D) Increased total lung volume E) Decreased RV preload F) Decreased LV stroke volume G) Decreased systemic arterial pressure H) Increased pulmonary vascular resistance (PVR)

B. Decreased systemic venous return C. Increased RV afterload D. Increased total lung volume E. Decreased RV preload H. Increased pulmonary vascular resistance (PVR) | *slide 38*

During the inspiratory phase, what happens to intra-thoracic pressure and LV afterload? A. Both increase B. Intra-thoracic pressure increases and LV afterload decreases C. Both decrease D. Intra-thoracic pressure decreases and LV afterload increases

B. Intra-thoracic pressure increases and LV afterload decreases | *slide 38*

What effect does increased total lung volume during the inspiratory phase have on LV preload? A. It decreases LV preload B. It has no effect on LV preload C. It increases LV preload D. It stabilizes LV preload

C. It increases LV preload | *slide 38*

Which of the following occurs as a result of increased LV preload and decreased LV afterload? A. Decreased LV stroke volume B. Decreased cardiac output (CO) C. No change in systemic arterial pressure D. Increased LV stroke volume, CO, and systemic arterial pressure

D) Increased LV stroke volume, CO, and systemic arterial pressure | *slide 38*

What happens to systemic venous return and RV preload as intra-thoracic pressure increases? A. Both increase B. Both decrease C. Systemic venous return increases, RV preload decreases D. Systemic venous return decreases, RV preload increases

B. Both decrease | *slide 38*

Select all effects of the expiratory phase on the cardiovascular system: select 3. A. Decreased RV stroke volume B. Increased LV stroke volume C. Reduced LV filling D. Decreased systemic arterial blood pressure E. Increased pulmonary blood flow

A) Decreased RV stroke volume C) Reduced LV filling D) Decreased systemic arterial blood pressure | *slide 40*

Which of the following statements are true regarding blood pressure changes during the respiratory cycle? (Select all that apply - 2) A) BP goes up on inspiration B) BP remains unchanged during the respiratory cycle C) BP decreases on inspiration and increases on expiration D) BP goes down on expiration

A) BP goes up on inspiration D) BP goes down on expiration | *slide 40*

What is the effect of the decreased RV stroke volume during expiration on the left ventricle? A) Increased LV filling B) Increased LV stroke volume C) Reduced LV filling D) Increased systemic arterial BP

C) Reduced LV filling | *slide 40*

What is the normal range of systolic pressure variation (SPV) in mechanically ventilated patients? A)7-10 mm Hg B) 3-5 mm Hg C) 10-15 mm Hg D) 15-20 mm Hg

A) 7-10 mm Hg | *slide 41*

What is the normal range for the Δ Up component of SPV in mechanically ventilated patients? A)1-2 mm Hg B) 2-4 mm Hg C) 4-6 mm Hg D) 6-8 mm Hg

B) 2-4 mm Hg | *slide 41*

What does an increased SPV indicate in mechanically ventilated patients? A) They are volume overloaded B) They have normal volume status C) They are at risk for hypertension D) They are volume responsive or have residual preload reserve

D) They are volume responsive or have residual preload reserve | *slide 41*

Which of the following statements are true regarding pulse pressure variation (PPV)? (Select all that apply - 5) A) PPV utilizes maximum and minimum pulse pressures over the entire respiratory cycle B) Normal PPV is less than 13-17% C) PPV greater than 13-17% indicates a positive response to volume expansion D) PPV readings are not affected by mechanical ventilation E) PPV greater than 13-17% can be an early indicator of hypovolemia F) PPV values are irrelevant for assessing volume status G) PPV is used to assess fluid status in patients Feel free to adjust or expand these answer choices as needed!

A) PPV utilizes maximum and minimum pulse pressures over the entire respiratory cycle B) Normal PPV is less than 13-17% C) PPV greater than 13-17% indicates a positive response to volume expansion E) PPV greater than 13-17% can be an early indicator of hypovolemia G) PPV is used to assess fluid status in patients | *slide 42*

In which scenarios would you expect a positive response to volume expansion based on PPV readings? (Select all that apply - 2) A. PPV of 10% B. PPV of 14% C. PPV of 18% D. PPV of 12%

B) PPV of 14% C) PPV of 18% | *slide 42*

When a patient has a PPV reading of 14%, the appropriate action is to: A) Give volume B) Administer a diuretic C) Monitor without intervention D) Reduce fluid intake

A) Give volume | *slide 42*

Which conditions or factors can lead to an SVV greater than 10-13%? (Select all that apply - 3) A. Hypovolemia B. Volume responsiveness C. Hypervolemia D. Residual preload reserve E. Pulmonary hypertension

A. Hypovolemia B. Volume responsiveness D. Residual preload reserve | *slide 43*

What is the normal range for stroke volume variation (SVV)? A. 5-8% B. 10-13% C. 14-17% D. 18-20%

B. 10-13% | *slide 43*

Which of the following statements is true? A. SPV can be used interchangeably with SVV. B. SVV is calculated using pulse pressure variation. C. SPV and SVV are both used to assess fluid responsiveness but are not interchangeable. D. SVV does not involve arterial pulse pressure waveform analysis.

C. SPV and SVV are both used to assess fluid responsiveness but are not interchangeable. | *slide 43*

Which of the following conditions are necessary for predicting accurate results in BP variation? (Select all that apply - 5) A. Mechanical ventilation with tidal volume of 8 to 10 mL/kg B. Positive end-expiratory pressure (PEEP) ≥ 5 mm Hg C. Irregular cardiac rhythm D. Normal intra-abdominal pressure E. An open chest cavity F. Regular cardiac rhythm G. Supine positioning

A. Mechanical ventilation with tidal volume of 8 to 10 mL/kg B. Positive end-expiratory pressure (PEEP) ≥ 5 mm Hg D. Normal intra-abdominal pressure F. Regular cardiac rhythm G. Supine Positioning | *slide 44*

Which factors affect the transit time in a side-stream analyzer? (Select all that apply - 3) A. Inner diameter of the sampling tubing B. Length of the sampling tubing C. Patient's heart rate D. Analyzing machine's power E. Gas sampling rate

A. Inner diameter of the sampling tubing B. Length of the sampling tubing E. Gas sampling rate | *slide 48*

Which statements are true about rise time in a gas analyzer? (Select all that apply - 3) A. It is the time taken by the analyzer to react to changes in gas concentration. B. It is instantaneous in a side-stream analyzer. C. It can fluctuate when reading ETCO2. D. It depends on how much gas is being read and drawn out by the sampling line. E. It remains constant regardless of patient exhalation.

A. It is the time taken by the analyzer to react to changes in gas concentration C. It can fluctuate when reading ETCO2 D. It depends on how much gas is being read and drawn out by the sampling line | *slide 48*

What does transit time refer to in the context of gas sampling? A. The time taken by the patient to exhale completely B. The time lag for the gas sample to reach the analyzer C. The time taken by the analyzer to react to changes in gas concentration D. The time taken to switch between different gas samples

B. The time lag for the gas sample to reach the analyzer | *slide 48*

What is rise time in the context of gas analysis? A. The time lag for the gas sample to reach the analyzer B. The time taken by the analyzer to react to changes in gas concentration C. The time taken for the gas analyzer to warm up D. The time taken by the patient to inhale

B. The time taken by the analyzer to react to changes in gas concentration | *slide 48*

What will happen to the rise time and transit time if a patient is not exhaling properly? A. Both rise time and transit time will increase B. Both rise time and transit time will decrease C. Rise time will increase and transit time will decrease D. Rise time will decrease and transit time will increase

A. Both rise time and transit time will increase | *slide 48*

Which of the following are potential issues with mainstream ETCO2 sampling? Select all that apply: 3 A) Water vapor condensation in airway tubing B) Faster breath-by-breath analysis C) Secretions clogging the sampling line D) Additional interfaces for disconnections E) Reduced chance of condensation in sampling line

A) Water vapor condensation in airway tubing C) Secretions clogging the sampling line D) Additional interfaces for disconnections | *slide 49*

What is one of the benefits of mainstream ETCO2 sampling sites? A) Reduced condensation in the sampling line B) Faster breath-by-breath analysis C) Fewer disconnections D) Easier to manage secretions

B) Faster breath-by-breath analysis | *slide 49*

Select All That Apply Which of the following connections can contribute to disconnections in mainstream ETCO2 monitoring? A) Sampling line to the vapor analyzer B) Elbow to the y-piece C) Mainstream analyzer to the monitor D) Endotracheal tube to the ventilator

B) Elbow to the y-piece | *slide 49*

Which of the following are potential issues with side-stream ETCO2 sampling? Select all that apply: 4 A) Kinking of sampling tubing B) Water vapor condensation C) Faster response time D) Failure of sampling pump E) Leaks in the line

A) Kinking of sampling tubing B) Water vapor condensation D) Failure of sampling pump E) Leaks in the line | *slide 49*

Which of the following factors can lead to leaks in the side-stream ETCO2 sampling line? Select all that apply: 3 A) Overtightening the connection B) Reusing the line multiple times C) Faster breath-by-breath analysis D) Water vapor condensation E) Kinking of sampling tubing

A) Overtightening the connection B) Reusing the line multiple times E) Kinking of sampling tubing | *slide 49*

What is a common problem when the sampling pump fails in side-stream ETCO2 monitoring? A) Slow response time B) No waveform at all C) Enhanced accuracy of ETCO2 measurements D) Increased waveform amplitude

B) No waveform at all | *slide 49*

What is a disadvantage of side-stream ETCO2 monitoring compared to mainstream? A) Increased likelihood of condensation B) Faster response time C) Fewer interfaces for disconnections D) Slow response time

D) Slow response time

According to Dalton's Law, which of the following statements are true? A) The total pressure exerted by a mixture of gases is less than the sum of the partial pressures of each gas. B) The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas. C) Each gas in a mixture exerts its own pressure independently. D) At sea level, the total pressure of all anesthetic gases in the system is 760 mm Hg. E) The partial pressure of a gas is always expressed in volumes %.

B) The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas | *slide 50*

How can gases be expressed in measurement units? Select all that apply: 2 A) Partial pressure (mm Hg) B) Density (g/L) C) Volumes % D) Molarity (mol/L) E) Weight percent

A) Partial pressure (mm Hg) C) Volumes % | *slide 50*

If the partial pressure of oxygen (O2) in room air is 160 mm Hg, what is its volume percent? A) 16% B) 21% C) 25% D) 50%

B) 21% | *slide 50*

Which of the following statements about mass spectrometry are true? Select all that apply: 3 A) Concentration is determined according to the mass/charge ratio. B) It measures the volume percent of gases directly. C) Abundance of ions at specific mass/charge ratios is related to the fractional composition of the gas mixture. D) It can identify and calculate up to eight different gases in a sample. E) It is currently the primary method used, replacing infrared technology.

A) Concentration is determined according to the mass/charge ratio. C) Abundance of ions at specific mass/charge ratios is related to the fractional composition of the gas mixture. D) It can identify and calculate up to eight different gases in a sample. | *slide 51*

Which of the following are characteristics of Raman Spectroscopy? Select all that apply: 2 A) It uses a highly powered argon laser. B) It measures gas concentrations using infrared technology. C) Scattered photons are measured in a spectrum to identify each gas. D) It determines concentration based on mass/charge ratios. E) It is used to identify gases like Sevo, O2, and Nitrous.

A) It uses a highly powered argon laser. C) Scattered photons are measured in a spectrum to identify each gas. | *slide 51*

What does mass spectrometry measure to determine the concentration of gases? A) Volume percent B) Mass/charge ratio C) Scattered photons D) Infrared absorption

B) Mass/charge ratio | *slide 51*

What technology is now commonly used instead of mass spectrometry for analyzing gas samples? A) Raman Spectroscopy B) Mass/charge spectrometry C) Infrared technology D) Electron microscopy

C) Infrared technology | *slide 52*

Which of the following statements about non-dispersive infrared analyzers are true? Select all that apply: 3 A) They measure the concentration of gases by absorbing energy from a narrow band of IR wavelengths. B) They can measure the concentration of O2. C) They are used to measure CO2, nitrous oxide, water, and volatile anesthetic gases. D) O2 does not absorb IR radiation and cannot be measured by this method. E) They use a wide-band pass filter to transmit IR light.

A) They measure the concentration of gases by absorbing energy from a narrow band of IR wavelengths. C) They are used to measure CO2, nitrous oxide, water, and volatile anesthetic gases. D) O2 does not absorb IR radiation and cannot be measured by this method. | *slide 52 & 53*

Why can't non-dispersive infrared analyzers measure oxygen (O2)? A) O2 absorbs IR radiation too strongly. B) O2 does not absorb IR radiation. C) O2 molecules are symmetric and do not have an IR absorption band. D) O2 is a polyatomic molecule and absorbs IR light at multiple wavelengths.

B) O2 does not absorb IR radiation | *slide 52*

What is the relationship between the amount of IR light that reaches the detector and the concentration of the gas being measured in non-dispersive infrared analyzers? A) Directly proportional B) Not related C) Logarithmically related D) Inversely proportional

B) Inversely proportional | *slide 53*

Which of the following statements about water vapor and gas analyzers are true? Select all that apply: A) Side-stream analyzers report results as ATPD values. B) Analyzers should report results at BTPS values. C) Saturated H2O vapor pressure is 47 mm Hg. D) BTPS values do not account for water vapor. E) When calculating partial pressures, water vapor should always be accounted for.

A) Side-stream analyzers report results as ATPD values. B) Analyzers should report results at BTPS values. C) Saturated H2O vapor pressure is 47 mm Hg. | *slide 54*

What is the partial pressure of oxygen (O2) at 30% when considering water vapor saturation? A) 214 mm Hg B) 228 mm Hg C) 205 mm Hg D) 200 mm Hg

A) 214 mmHg **(760mmHg - 47mmHg) x (0.3)** | *slide 54*

Which of the following statements about the fuel or galvanic cell used in breathing tubes are correct? Select all that apply (3) A. Measures the current produced when nitrogen diffuses across a membrane. B. The current is proportional to the partial pressure of the oxygen in the fuel cell. C. Has a long life span lasting several years. D. It is best to monitor O2 concentration in the inspiratory limb. E. The oxygen battery has a slow response time of approximately 30 seconds. F. The infrared analyzer is able to read O2 because of the fuel cell.

B. The current is proportional to the partial pressure of the oxygen in the fuel cell. D. It is best to monitor O2 concentration in the inspiratory limb. E. The oxygen battery has a slow response time of approximately 30 seconds. | *slide 55*

What actions can prolong the life of the oxygen fuel cell? Select all that apply (2) A. Turn off O2 at the end of the case. B. Increase oxygen exposure. C. Keep O2 always on. D. Use lower oxygen flows.

A. Turn off O2 at the end of the case. D. Use lower oxygen flows. | *slide 55*

Where is the best location to monitor O2 concentration using a fuel cell in the breathing tube? A. In the inspiratory limb, to know the concentration of O2 going to the patient. B. In the expiratory limb, to measure what the patient is exhaling. C. Outside the breathing tube, to avoid exposure to oxygen. D. At the end of the breathing tube, to get a cumulative reading.

A. In the inspiratory limb, to know the concentration of O2 going to the patient. | *slide 55*

Which of the following statements about the paramagnetic properties of oxygen are correct? Select all that apply: (3) A. Oxygen is highly paramagnetic due to the magnetic energy of unpaired electrons in their outer shell orbits. B. Paramagnetic oxygen detection measures the change in sample line pressure resulting from the attraction of oxygen by switched magnetic fields. C. Paramagnetic detection is used in mainstream gas analyzers. D. Paramagnetic detectors have a slow response time compared to fuel cells. E. Paramagnetic detectors provide rapid, breath-by-breath monitoring.

A. Oxygen is highly paramagnetic due to the magnetic energy of unpaired electrons in their outer shell orbits. B. Paramagnetic oxygen detection measures the change in sample line pressure resulting from the attraction of oxygen by switched magnetic fields. E. Paramagnetic detectors provide rapid, breath-by-breath monitoring. **main advantage over the fuel cell** | *slide 55*

What are the main advantages of using paramagnetic detection over fuel cells in multi-gas analyzers? Select all that apply: (3) A. Slow response time. B. Rapid, breath-by-breath monitoring. C. Correlates signal changes with O2 concentration. D. Used in mainstream sampling analyzers. E. Provides early indication for necessary changes in gas/FiO2 levels.

B. Rapid, breath-by-breath monitoring. C. Correlates signal changes with O2 concentration. E. Provides early indication for necessary changes in gas/FiO2 levels. | *slide 55*

Which of the following statements about oxygen monitoring are correct? Select all that apply: (4) A. Oxygen monitoring is arguably the least important of all monitors. B. The O2 analyzer in the inspiratory limb ensures oxygen delivery to the patient. C. Oxygen monitoring can analyze hypoxic mixtures. D. ET O2 above 90% is considered inadequate. E. Oxygen monitoring is not possible with all masks and cannulas. F. High O2 concentrations are a concern for patients on chemotherapeutic drugs like bleomycin.

B. The O2 analyzer in the inspiratory limb ensures oxygen delivery to the patient. C. Oxygen monitoring can analyze hypoxic mixtures. E. Oxygen monitoring is not possible with all masks and cannulas. F. High O2 concentrations are a concern for patients on chemotherapeutic drugs like bleomycin. | *slide 56*

What can trigger a low O2 alarm? A. Pipeline crossover B. Correctly filled tanks C. Failure of a proportioning system D. Incorrectly filled tanks E. All masks and cannulas monitoring O2 concentration accurately

A. Pipeline crossover C. Failure of a proportioning system D. Incorrectly filled tanks | *slide 56*

Which patients are at risk from high oxygen concentrations? A. Premature infants B. Patients on chemotherapeutic drugs like bleomycin C. Patients with lung comorbidities D. All of the above

D. All of the above | *slide 56*

Where is the best location to sample oxygen for ensuring complete preoxygenation and denitrogenation? A. Inside the inspiratory limb B. Outside the breathing circuit C. Inside the expiratory limb D. At the auxiliary sites

C. Inside the expiratory limb | *slide 56*

Which of the following are true about airway pressure monitoring? (Select all that apply - 3) A. It is a key component in measuring ventilation. B. It is always invasive. C. It helps detect circuit disconnections and ETT occlusions. D. It relies solely on alarm systems for monitoring. E. It assesses mechanical or spontaneous ventilation.

A. It is a key component in measuring ventilation C. It helps detect circuit disconnections and ETT occlusions E. It assesses mechanical or spontaneous ventilation | *slide 58*

What issues can airway pressure monitoring detect? (Select all that apply - 4) A. Fresh gas hose kink or disconnection B. Collection of water vapor in the circuit C. Electrical failures in ventilators D. Low scavenging system pressures E. High scavenging system pressures

A. Fresh gas hose kink or disconnection B. Collection of water vapor in the circuit D. Low scavenging system pressures E. High scavenging system pressures | *slide 58*

Which of the following are characteristics of mechanical pressure gauges? (Select all that apply - 4) A. Requires no power B. Always on and highly reliable C. Records data for future reference D. Has no alarm system E. Must be continually scanned

A. Requires no power B. Always on and highly reliable D. Has no alarm system E. Must be continually scanned | *slide 58*

Electronic pressure gauges are built within which devices? A. Mechanical pressure gauges B. Manual resuscitators C. Ventilators or anesthesia machines D. Oxygen tanks

C. Ventilators or anesthesia machines | *slide 58*

Which of the following statements about the breathing circuit low pressure alarm are true? (Select all that apply - 3) A. It is required by AANA/ASA standards. B. It is a fail-safe mechanism for all types of disconnections. C. Its primary purpose is the identification of circuit disconnections or leaks. D. It can detect all partial disconnections and misconnections. E. It may need a new setup during the case.

A. It is required by AANA/ASA standards C. Its primary purpose is the identification of circuit disconnections or leaks E. It may need a new setup during the case. | *sldie 59*

Where do 70% of circuit disconnections typically occur? A. At the ventilator connection B. At the gas supply hose C. At the Y-piece D. At the scavenging system

C. At the Y-piece | *slide 59*

What should the low-pressure limit be set to? A. Above the normal peak airway pressure B. At the same level as the normal peak airway pressure C. Just below the normal peak airway pressure D. Below the minimum airway pressure

C. Just below the normal peak airway pressure | *slide 59*

What is a limitation of the breathing circuit low pressure alarm? A. It may not detect misconnections or obstructions B. It always detects partial disconnections C. It never needs a new setup during the case D. It does not require monitoring airway or circuit pressure

A. It may not detect misconnections or obstructions | *slide 59*

Which of the following are functions of the sub-atmospheric pressure alarm? (Select all that apply - 2) A. Measures and alerts negative circuit pressure B. Detects high circuit pressure C. Alerts potential for reverse flow of gas D. Monitors patient heart rate E. Measures oxygen levels in the blood

A. Measures and alerts negative circuit pressure, C. Alerts potential for reverse flow of gas | *slide 60*

What are the potential consequences of negative circuit pressure? (Select all that apply - 3) A. Pulmonary edema B. Atelectasis C. Hypoxia D. Hypertension E. Bradycardia

A. Pulmonary edema B. Atelectasis C. Hypoxia | *slide 60*

What are possible causes of sub-atmospheric pressure in the breathing circuit? (Select all that apply - 3) A. Active (suction) scavenging system malfunctions B. High fresh gas flow C. Patient inspiratory effort against a blocked circuit D. Dry CO2 absorbent E. Suction to misplaced NGT/OGT

A. Active (suction) scavenging system malfunctions C. Patient inspiratory effort against a blocked circuit E. Suction to misplaced NGT/OGT **also inadequate FGF & moisture in CO2 absorbent** | *slide 60*

Which of the following statements about high-pressure alarms are true? (Select all that apply - 3) A. Activated if the pressure exceeds a certain limit B. Cannot be adjusted by the user C. Particularly valuable in pediatrics D. Only important for adult patients E. Can be user-adjustable or automated

A. Activated if the pressure exceeds a certain limit C. Particularly valuable in pediatrics E. Can be user-adjustable or automated | *slide 61*

What are possible causes of high-pressure alarms? (Select all that apply - 4) A. Obstructions in the circuit B. Increased patient compliance C. Coughing or straining D. Kinked endotracheal tube (ETT) E. Endobronchial intubation

A. Obstructions in the circuit C. Coughing or straining D. Kinked endotracheal tube (ETT) E. Endobronchial intubation **reduced compliance also** | *slide 61*

What are potential causes of continuing pressure alarms? (Select all that apply - 3) A. Scavenging system occlusion B. Activation of oxygen flush system C. Proper functioning of the adjustable pressure relief valve D. Malfunctioning PEEP E. High fresh gas flow rate

A. Scavenging system occlusion B. Activation of oxygen flush system D. Malfunctioning PEEP **other cause: malfunctioning APL** | *slide 61*

When is a continuing pressure alarm triggered? A. When circuit pressure drops below 10 cm H2O for 15 seconds B. When circuit pressure exceeds 10 cm H2O for more than 15 seconds C. When there is no fresh gas flow D. When the patient’s heart rate increases

B. When circuit pressure exceeds 10 cm H2O for more than 15 seconds | *slide 61*

What must be done to resolve a continuing pressure alarm when the vent is turned off and flipped to APL valve? A. Increase fresh gas flow B. Squeeze the bag to move the flow through the scavenging system C. Turn off the oxygen supply D. Disconnect the patient from the ventilator

B. Squeeze the bag to move the flow through the scavenging system | *slide 61*

Which of the following are characteristics of electrical nerve stimulation in peripheral nerve monitoring? (Select 2) a) Most commonly used b) Less painful c) Requires physical contact d) No TOF stimulation

a) Most commonly used c) Requires physical contact ## Footnote Slide 63

Which characteristics are associated with magnetic nerve stimulation? a) Less painful b) No physical contact required c) Bulky and heavy e) Difficult to achieve supramaximal stimulation

All of the above *No TOF capability* *Not used in clinical practice anymore* ## Footnote Slide 63

What is the reaction pattern of a single muscle fiber to a supramaximal stimulus? a) Gradual increase b) All-or-none c) Variable response d) Decreasing response

b) All-or-none *Electrical Nerve Stimulator* ## Footnote Slide 63

The effectiveness of whole muscle response to electrical stimulation depends on the activation of how many ________ fibers. a) Nerve b) Muscle c) Bone d) Skin

b) Muscle ## Footnote Slide 63

Which nerve is considered the gold standard for peripheral nerve stimulation? a) Median nerve b) Ulnar nerve c) Posterior tibial nerve d) Facial nerve

b) Ulnar nerve ## Footnote Slide 64

What are the advantages of using easily accessible sites for nerve stimulation? (Select 2) a) Allow quantitative monitoring b) Avoid direct muscle stimulation c) Increase the need for muscle relaxants d) Reduce the effectiveness of nerve stimulation

- a) Allow quantitative monitoring - b) Avoid direct muscle stimulation ## Footnote Slide 64

What is true about using the ulnar nerve-adductor pollicis muscle for nerve stimulation? a) Highest risk of direct muscle stimulation and lowest risk of direct muscle stimulation b) Easily accessible and lowest risk of direct muscle stimulation c) Not accessible d) Highest recovery rate

b) Easily accessible and lowest risk of direct muscle stimulation ## Footnote Slide 64

Which muscles can be accessed for nerve stimulation when the arms are unavailable? Select 2 a) Adductor pollicis b) Biceps c) Orbicularis oculi d) Corrugator supercilii e) Quadriceps

c) Orbicularis oculi d) Corrugator supercilii *Both part of the facial nerve* ## Footnote Slide 64

Which muscle is most resistant to depolarizing and nondepolarizing neuromuscular blocking drugs (NMBDs)? a) Adductor pollicis b) Diaphragm c) Corrugator supercilii d) Orbicularis oculi

b) Diaphragm *Shorter onset than adductor pollicis, recovers quicker than peripheral muscles * ## Footnote Slide 64

The corrugator supercilii muscle is better than the adductor pollicis muscle at reflecting the extent of neuromuscular block of which muscles? Select 2 a) Arm muscles b) Laryngeal adductor c) Leg muscles d) Facial muscles e) Abdominal muscles

b) Laryngeal adductor e) Abdominal muscles ## Footnote Slide 64

At what frequency can single stimuli be applied in single twitch stimulation? a) 1.0 Hz (every second) to 0.1 Hz (every 10 seconds) b) 2.0 Hz (every second) to 0.2 Hz (every 10 seconds) c) 0.5 Hz (every second) to 0.05 Hz (every 10 seconds) d) 5.0 Hz (every second) to 1.0 Hz (every 10 seconds)

a) 1.0 Hz (every second) to 0.1 Hz (every 10 seconds) *Single twitch is the earliest and simpliest pattern* ## Footnote Slide 65

Why is a reference value mandatory prior to administering NMBDs when using a single twitch nerve stimulator? a) To adjust anesthesia depth b) To determine baseline c) To monitor heart rate d) To measure blood pressure

b) To determine baseline muscle response ## Footnote Slide 65

What is required to perform single twitch nerve stimulation? a) An intravenous line b) A monitoring device c) A catheter d) An oxygen mask

b) A monitoring device ## Footnote Slide 65

What does the TOF ratio compare? a) The first response to the second response b) The first response to the fourth response c) The second response to the third response d) The third response to the fourth response

b) The first response to the fourth response *TOF ratio – 4th response/1st response* ## Footnote Slide 66

What is the primary advantage of using the Train of Four (TOF) method for neuromuscular blockade monitoring? a) Requires no setup b) Provides reliable information c) Needs constant recalibration d) Only works in the initial phase of blockade

b) Provides reliable information *throughout all phases of blockade **without a monitoring device*** *Reliable assessment of onset and moderate blockade* ## Footnote Slide 66

How often are the supramaximal stimuli applied in the TOF method? a) Every second b) Every 2 seconds c) Every 0.5 seconds d) Every minute

c) Every 0.5 seconds *evaluate TOF count or fade in the muscle response* ## Footnote Slide 66

In a partial nondepolarizing block, what happens to the TOF ratio? a) It increases b) It remains constant c) It decreases d) It fluctuates

c) It decreases *(fade)* ## Footnote Slide 66

In a partial depolarizing block, what does the TOF ratio typically indicate? a) There is fade b) The ratio is 1.0 c) The ratio is 0.5 d) The response is absent

b) The ratio is 1.0 *No fade, ratio is 1.0 If fade, phase II block developed* ## Footnote Slide 66

Double Burst Stimulation (DBS) uses ________ bursts of ________ Hz tetanic stimulation. a) One, 20 b) Two, 50 c) Three, 40 d) Four, 30

b) Two, 50 *Two short muscle contractions with fade in the 2nd burst, 1st is the comparison * *Not used in clinical practice anymore* ## Footnote Slide 67

The separation between the two bursts in DBS is ________ ms and the duration of each square wave impulse in the burst is ________ ms. a) 500, 0.1 b) 750, 0.2 c) 1000, 0.3 d) 1250, 0.4

b) 750ms, 0.2ms ## Footnote Slide 67

What are the modes of DBS and their respective impulse configurations? (Select 2) - a) DBS3,3 mode: 3 impulses in each burst - b) DBS3,2 mode: 3 impulses in first burst, 2 impulses in second burst - c) DBS2,3 mode: 2 impulses in each burst - d) DBS4,2 mode: 4 impulses in first burst, 2 impulses in second burst - e) DBS3,4 mode: 3 impulses in each burst

- a) DBS3,3 mode: 3 impulses in each burst - b) DBS3,2 mode: 3 impulses in first burst, 2 impulses in second burst ## Footnote Slide 67

In the case of non-depolarizers, tetanic stimulation results in one strong sustained muscle contraction with ________ after stimulation. a) No response b) Immediate relaxation c) Fade d) Prolonged contraction

c) Fade ## Footnote Slide 68

Tetanic stimulation is given at ________ Hz for ________ seconds. a) 20, 2 b) 30, 3 c) 40, 4 d) 50, 5

d) 50, 5 *Not used as frequently* ## Footnote Slide 68

Depolarizers cause a strong sustained muscle contraction ________ fade during tetanic stimulation. a) With b) Without c) Followed by d) Preceded by

b) Without *Phase II block – fade occurs * ## Footnote Slide 68

Why is tetanic stimulation limited in value for assessing recovery? a) It is not reliable b) It is very painful c) It requires special equipment d) It is too short

b) It is very painful ## Footnote Slide 68

What is the composite stimulation pattern used in post-tetanic stimulation? a) 20 Hz for 2 seconds followed by 5 single twitches b) 30 Hz for 3 seconds followed by 7 single twitches c) 50 Hz for 5 seconds followed by 10 to 15 single twitches d) 50 Hz for 6 seconds followed by 10 to 20 single twitches

c) 50 Hz for 5 seconds followed by 10 to 15 single twitches *(1 Hz after 3 sec post tetanic stimulation)* ## Footnote Slide 69

Which factors influence the response to post-tetanic stimulation? (Select 3) a) Degree of blockade b) Frequency and duration of tetanic stimulation c) The patient's age d) Length of time between the end of tetanic stimulation and the first post-tetanic stimulus e) Length of time between the end of post-tetanic stimulation and the first tetanic stimulus f) The patient's weight

a) Degree of blockade b) Frequency and duration of tetanic stimulation d) Length of time between the end of tetanic stimulation and the first post-tetanic stimulus ## Footnote Slide 69

What are additional factors that affect the response to post-tetanic stimulation? (Select 2) a) Frequency of the single-twitch stimulation b) Duration of single-twitch stimulation before tetanic stimulation c) Duration of double-twitch stimulation before tetanic stimulation d) Frequency of the double-twitch stimulation

a) Frequency of the single-twitch stimulation b) Duration of single-twitch stimulation before tetanic stimulation ## Footnote Slide 69

# True or False Post-tetanic stimulation is used for deep and surgical blockade assessment.

True ## Footnote Slide 69

How long after the intubating dose of a non-depolarizing NMBD does the **intense** blockade period last? a) 1-3 minutes b) 3-6 minutes c) 6-9 minutes d) 9-12 minutes

b) 3-6 minutes *period of no response* ## Footnote Slide 70

What is the recommended dose of sugammadex for reversing **intense** blockade for a non-depolarizer? a) 2 mg/kg b) 4 mg/kg c) 8 mg/kg d) 16 mg/kg

d) 16 mg/kg *Neostigmine reversal impossible; high dose of sugammadex (16 mg/kg) for reversal* ## Footnote slide 70

During the **deep** blockade period for non-depolarizers, what is typically absent? a) TOF response b) Muscle relaxation c) Pain sensation d) Post-tetanic count

a) TOF response *presence of at least one response to post-tetanic count stimulation* ## Footnote slide 70

What dose of sugammadex is used for reversing **deep** non-depolarizing blockade? a) 2 mg/kg b) 4 mg/kg c) 8 mg/kg d) 16 mg/kg

b) 4 mg/kg *Neostigmine reversal usually impossible; dose of sugammadex (4 mg/kg) for reversal*

What dose of sugammadex is recommended for reversing **moderate** blockade for non-depolarizers? a) 2 mg/kg b) 4 mg/kg c) 8 mg/kg d) 16 mg/kg

a) 2 mg/kg *Neostigmine reversal after 4/4 TOF; dose of sugammadex (2 mg/kg) for reversal* ## Footnote slide70

What characterizes Phase I of depolarizing blockade? a) Presence of fade during tetanic stimulation b) All 4 responses are equal, reduced and disappear simultaneously in TOF c) All 4 responses are equal, taller and disappear simultaneously in TOF d) Occurrence of post-tetanic facilitation

b) All 4 responses are reduced and disappear simultaneously in TOF ## Footnote Slide 71

In Phase II of depolarizing blockade, what occurs in response to TOF and tetanic stimulation? a) No fade b) All responses are equal c) Fade d) Normal plasma cholinesterase activity

c) Fade *Fade present in response to TOF and tetanic stimulation* ## Footnote Slide 71

Which phase of depolarizing blockade shows **abnormal** plasma cholinesterase activity? a) Phase I b) Phase II c) Both Phase I and Phase II d) Phase III

b) Phase II *Normal Plasma Cholinesterase activity is seen in Phase 1* ## Footnote Slide 71

How does the response in Phase II of depolarizing blockade compare to non-depolarizing blockade? a) It is different b) It is similar c) It is less intense d) It is more intense

b) It is similar ## Footnote Slide 71

# True or False Occurrence of post-tetanic facilitation happens in Phase II of depolarizing blockade

True ## Footnote Slide 71

Why is it important to keep the patient warm during peripheral nerve monitoring? a) To cause shivering b) To prevent delaying nerve conduction c) To decrease blood flow d) To maintain muscle strength

b) To prevent delaying nerve conduction ## Footnote Slide 72

What are the steps involved in the use of peripheral nerve monitoring in clinical practice? (Select 2) a) Attach electrodes prior to induction, turn on after patient is unconscious b) Check for neuromuscular recovery prior to extubation c) Maintain a moderate level of blockade with 1 or 2 responses to TOF d) Reverse when all 4 responses are present to TOF

a) Attach electrodes prior to induction, turn on after patient is unconscious d) Reverse when all 4 responses are present to TOF ## Footnote slide 72

Which reliable clinical signs indicate neuromuscular recovery post-reversal? (Select all that apply) a) Sustained head lift for 5 seconds b) Sustained leg lift for 5 seconds c) Sustained handgrip for 5 seconds d) Sustained 'tongue depressor test' e) Maximum inspiratory pressure

a) Sustained head lift for 5 seconds b) Sustained leg lift for 5 seconds c) Sustained handgrip for 5 seconds *Sustained** ‘tongue depressor test’** Maximum inspiratory pressure * ## Footnote Slide 72

Which actions should be taken to ensure effective peripheral nerve monitoring during surgery? (Select 2) a) Keep the patient cool to prevent delaying nerve conduction b) Check for neuromuscular recovery prior to extubation post-reversal c) Administer reversal agents only when 2/4 responses to TOF are present d) Maintain a deep level of blockade throughout the surgery e) Use moderate blockade with 1 or 2 responses to TOF

b) Check for neuromuscular recovery prior to extubation post-reversal e) Use moderate blockade with 1 or 2 responses to TOF ## Footnote Slide 72

EEG measures the summation of which types of potentials in the cerebral cortex? a) Excitatory b) Inhibitory c) Both excitatory and inhibitory d) Neither excitatory nor inhibitory

c) Both excitatory and inhibitory ## Footnote Slide 74

How many channels of information are used in a standard EEG? a) At least 8 b) At least 12 c) At least 16 d) At least 20

c) At least 16 *Electrodes placed so that surface anatomy relates to cortical regions* ## Footnote Slide 74

EEG can identify which of the following conditions? a) Consciousness and Unconsciousness b) Seizure activity c) Stages of sleep d) Coma e) All of the above

d) All of the above ## Footnote Slide 74

# True or False EEG's can identify indequate oxygen delivery to the brain (hypoxemia or ischemia)

True ## Footnote Slide 74

What is the term for the number of times per second the EEG signal oscillates or crosses the 0-voltage line? a) Amplitude b) Frequency c) Time d) Voltage

b) Frequency ## Footnote Slide 74

Which of the following describes the amplitude in an EEG signal? a) Size or voltage of the recorded signal b) Number of times per second the signal oscillates c) Duration of the sampling of the signal d) Location of electrode placement

a) Size or voltage of the recorded signal ## Footnote Slide 74

What are the components of signal description in EEG? (Select 3) a) Amplitude b) Frequency c) Time d) Electrode placement e) Signal duration

a) Amplitude b) Frequency c) Time - *duration of the sampling of the signal * ## Footnote Slide 74

Which of the following is a peri-operative use of EEG? a) Identifying inadequate blood flow to the cerebral cortex b) Monitoring orbital blood flow c) Measuring blood pressure in carotid artery d) Assessing inadequate blood flow to frontal lobe

a) Identifying inadequate blood flow to the cerebral cortex ## Footnote Slide 75

What are the peri-operative uses of EEG? (Select 3) a) Identifies tumors in the cerebral cortex b) Guides an anesthetic-induced reduction of cerebral metabolism c) Predicts neurologic outcome after a brain insult d) Gauges the depth of the hypnotic state of patients under general anesthesia e) Monitors heart rate during surgery

b) Guides an anesthetic-induced reduction of cerebral metabolism c) Predicts neurologic outcome after a brain insult d) Gauges the depth of the hypnotic state of patients under general anesthesia ## Footnote Slide 75

What frequency range is associated with Beta waves in EEG? a) 8 - 13 Hz b) 4 - 7 Hz c) Greater than 13 Hz d) Less than 4 Hz

c) Greater than 13 Hz *Considered Awake - Alert attentive brain * ## Footnote Slide 76

Alpha waves, with a frequency range of 8 - 13 Hz, are typically observed when the patient has their: a) Eyes open b) Eyes closed c) Mouth open d) Mouth closed

b) Eyes closed ## Footnote Slide 76

Which EEG waves are associated with anesthetic effects? a) Beta waves b) Alpha waves c) Theta waves d) Delta waves

b) Alpha waves ## Footnote Slide 76

Theta waves (4 - 7 Hz) and Delta waves (< 4 Hz) are indicative of what state? a) Alertness b) Anesthetic effects c) Depression d) High activity

c) Depression ## Footnote Slide 76

Processed EEG contains artifact along with the desired EEG signal. How many channels of information does it use? a) 2 channels b) 4 channels c) Less than 4 channels d) More than 4 channels

c) Less than 4 channels *2 channels per hemisphere* ## Footnote Slide 77

Why is it necessary for processed EEG to display the activity of both hemispheres? a) To delineate bilateral changes b) To delineate unilateral from bilateral changes c) To increase signal strength d) To delineate unilateral changes

b) To delineate unilateral from bilateral changes *Ex: Regional ischemia d/t carotid clamping (unilateral), EEG depression from anesthetic drug bolus (bilateral)* ## Footnote Slide 77

Which of the following statements is true regarding studies comparing EEG (gold standard) vs. processed EEG? a) There is an adequate number of studies b) There is not an adequate number of studies c) Processed EEG is more accurate than standard EEG d) Processed EEG uses more channels than standard EEG

b) There is not an adequate number of studies ## Footnote Slide 77

What does the Bispectral Index (BIS) process to estimate anesthetic depth? a) Heart rate b) Blood pressure c) EEG signal d) Oxygen saturation

c) EEG signal *Uses a computer-generated algorithm/weighting system* ## Footnote Slide 78

BIS is proposed as a method to prevent which of the following during surgery? a) Intraoperative Pain b) Intraoperative Awareness c) Intraoperative Nausea d) Intraoperative Infection

b) Intraoperative awareness *Has not demonstrated to be superior to end-tidal agent concentration monitoring * ## Footnote Slide 78

What is the most common type of evoked potentials monitored intra-operatively? a) Motor-evoked potentials b) Auditory-evoked potentials c) Visual-evoked potentials d) Sensory-evoked potentials

d) Sensory-evoked potentials ## Footnote Slide 79

Sensory-evoked responses are electric CNS responses to which types of stimuli? a) Electric stimuli b) Auditory stimuli c) Visual stimuli d) All of the above

d) All of the above ## Footnote Slide 79

Sensory system stimulus have responses recorded at various sites along the sensory pathway to the cerebral cortex. At what sites are responses recorded? a) Cortical only b) Subcortical only c) Cortical or subcortical d) Peripheral

c) Cortical or subcortical ## Footnote Slide 79

Sensory-evoked responses are described in terms of which two parameters? a) Duration and frequency b) Latency and amplitude c) Speed and accuracy d) Voltage and current

b) Latency and amplitude *Latency – time measured from the application of the stimulus to the onset or peak of the response Amplitude – size or voltage of recorded signal * ## Footnote Slide 79

What is necessary to ensure the reliability of sensory-evoked response monitoring? a) High sensitivity equipment b) Experienced technician c) Reproducible tracings d) Advanced algorithms

c) Reproducible tracings *Need baseline reproducible, reliable tracings * ## Footnote Slide 79

Which types of sensory-evoked potentials are included in intra-operative monitoring? (Select 3) a) Somatosensory-evoked potentials (SSEPs) b) Brainstem auditory-evoked potentials (BAEPs) c) Visual-evoked potentials (VEPs) d) Motor-evoked potentials (MEPs) e) Cortical evoked potentials (CEPs)

a) Somatosensory-evoked potentials (SSEPs) b) Brainstem auditory-evoked potentials (BAEPs) c) Visual-evoked potentials (VEPs) ## Footnote Slide 79

# True or False Somatosensory-Evoked Potentials monitor the responses to stimulation via sensory nerves to the sensorimotor cortex

FALSE Monitor the responses to stimulation of *peripheral mixed nerves (contain motor and sensory nerves)* to the sensorimotor cortex ## Footnote Slide 80

What types of waveforms do SSEPs consist of? a) Short-latency and long-latency b) High-frequency and low-frequency c) High-amplitude and low-amplitude d) Short-latency and short-latency

a) Short-latency and long-latency *Short-latency SSEPs are most commonly recorded intra-op; less influenced by changes in anesthetic drug levels * ## Footnote Slide 80

Which types of factors can alter the appearance of SSEPs? (Select 4) a) Induction b) Neurological disease c) Age d) Use of different recording electrode locations e) Gender f) Emergence

a) Induction b) Neurological disease c) Age d) Use of different recording electrode locations ## Footnote Slide 80

What do Brainstem Auditory-Evoked Potentials (BAEPs) monitor? A. Responses to light-emitting diodes B. Responses to click stimuli delivered via foam ear inserts C. Responses to touch stimuli on the skin D. Responses to visual stimuli through contact lenses

B. Responses to click stimuli delivered via foam ear inserts *Monitors the responses to click stimuli that are delivered via foam ear inserts along the auditory pathway **from the ear to the auditory cortex*** ## Footnote Slide 81

Which monitoring technique uses light-emitting diodes embedded in soft plastic goggles? A. Brainstem Auditory-Evoked Potentials (BAEPs) B. Somatosensory Evoked Potentials (SSEPs) C. Visual-Evoked Potentials (VEPs) D. Motor Evoked Potentials (MEPs)

C. Visual-Evoked Potentials (VEPs) * Monitors the responses to flash stimulation of the retina using light-emitting diodes embedded in soft plastic goggles through closed eyelids or contact lenses Least commonly used monitoring technique intra-op * ## Footnote Slide 81

What do Motor-Evoked Potentials (MEPs) monitor? A. The integrity of the motor tracts along the spinal column, peripheral nerves, and innervated muscle B. The integrity of the auditory pathway along the spinal column, peripheral nerves, and innervated muscle C. The integrity of the visual pathway along the spinal column, peripheral nerves, and innervated muscle D. The integrity of the sensory tracts along the spinal column, peripheral nerves, and innervated muscle

B. The integrity of the motor tracts along the spinal column, peripheral nerves, and innervated muscle ## Footnote Slide 82

Which type of MEP is most common? A. Somatosensory Evoked Potentials (SSEPs) B. Visual-Evoked Potentials (VEPs) C. Brainstem Auditory-Evoked Potentials (BAEPs) D. Transcranial Motor-Evoked Potentials

D. Transcranial Motor-Evoked Potentials *Monitors stimuli along the motor tract via transcranial electrical stimulation overlying the motor cortex * ## Footnote Slide 82

Electromyography (EMG) monitors the responses generated by cranial and peripheral motor nerves to allow early detection of _______ and assessment of the level of nerve function intra-op. A. visual loss B. motor cortex damage C. surgically induced nerve damage D. auditory damage

C. surgically induced nerve damage *Assesses the integrity of cranial or peripheral nerves at risk during surgery* ## Footnote Slide 82

What is the primary thermoregulatory control center in the body? A. Pituitary gland B. Hypothalamus C. Thalamus D. Medulla oblongata

B. Hypothalamus ## Footnote Slide 84

Which type of fibers are responsible for detecting heat and warmth? A. Unmyelinated C fibers B. Alpha-delta fibers C. Beta fibers D. Gamma fibers

A. Unmyelinated C fibers | CHOT ## Footnote Slide 84

Which type of fibers are responsible for detecting cold? A. Unmyelinated C fibers B. Alpha-delta fibers C. Beta fibers D. Gamma fibers

B. Alpha-delta fibers | colD ## Footnote Slide 84

Which factors can influence thermoregulatory responses? (Select 2) A. Circadian rhythm B. Alcohol C. Exercise D. Drugs

B. Alcohol D. Drugs ## Footnote Slide 84

Thermoregulatory response is characterized by _______ (temperature at which a response will occur), _______ (the intensity of the response), and _______ (sweating, vasodilation, vasoconstriction, and shivering). A. threshold, gain, response B. response, gain, threshold C. gain, response, threshold D. threshold, response, gain

A. threshold, gain, response ## Footnote Slide 84

Thermoregulatory responses can be affected by which of the following factors? A. Anesthesia B. Age C. Menstrual cycle D. All of the above

D. All of the above ## Footnote Slide 84

During the **initial phase** of hypothermia under general anesthesia, what is the approximate decrease in temperature? A. 0.1 to 0.5°C B. 0.5 to 1.5°C C. 1.5 to 2.5°C D. 2.5 to 3.5°C

B. 0.5 to 1.5°C *"Anesthesia-induced vasodilation"* ## Footnote Slide 85

During the **slow linear** reduction phase of hypothermia in GA, what is the approximate rate of temperature decrease per hour? A. 0.1°C per hour B. 0.2°C per hour C. 0.3°C per hour D. 0.7°C per hour

C. 0.3°C per hour ## Footnote Slide 85

How long after anesthesia does the **plateau phase** of hypothermia typically occur? A. 1-2 hours B. 2-3 hours C. 3-4 hours D. 4-5 hours

C. 3-4 hours ## Footnote Slide 85

Which factors contribute to the **slow linear reduction** phase of hypothermia in GA? (Select 2) A. Decrease in metabolic rate by 20-30% B. Heat loss exceeding production C. Thermal steady state D. Vasoconstriction preventing loss of heat from the core

A. Decrease in metabolic rate by 20-30% B. Heat loss exceeding production *Happens 1-2 hours after anesthesia* ## Footnote Slide 85

During the **plateau phase **of hypothermia in GA, heat loss equals heat production, resulting in a _______. Answer Choices: A. rapid decrease in temperature B. thermal steady state C. decrease in metabolic rate D. increase in heat production

B. thermal steady state *Vasoconstriction prevents loss of heat from core, but peripheral heat continues to be lost* ## Footnote Slide 85

Why do patients under neuraxial anesthesia typically not complain of feeling cold? A. They are given warming blankets. B. Hypothermia does not cause much thermal discomfort. C. They receive medications to prevent cold sensation. D. The operating room is kept warm.

B. Hypothermia does not cause much thermal discomfort. ## Footnote Slide 86

How does neuraxial anesthesia affect central thermoregulatory control? A. It enhances thermoregulatory control. B. It has no effect on thermoregulatory control. C. It inhibits thermoregulatory control. D. It only affects peripheral thermoregulation.

C. It inhibits thermoregulatory control. ## Footnote Slide 86

What are the autonomic thermoregulatory defenses that are impaired by neuraxial anesthesia? Select 2 A. Shivering and sweating only B. Vasodilation, sweating C. Sweating and vasoconstriction only D. Vasodilation and shivering only E. Vasoconstriction and shivering

B. Vasodilation, sweating E. Vasoconstriction and Shivering ## Footnote Slide 86

What causes the initial decrease in core temperature during neuraxial anesthesia? A. Increased metabolic rate B. Neuraxial blockade-induced vasodilation C. Decreased metabolic rate D. Increased heat production

B. Neuraxial blockade-induced vasodilation *May not plateau d/t inhibition of peripheral vasoconstriction threshold being altered* ## Footnote Slide 86

Which method of heat transfer accounts for approximately 40% of heat loss in a patient? A. Convection B. Radiation C. Evaporation D. Conduction

B. Radiation ## Footnote Slide 87

Which statements are true regarding **radiation** as a method of heat transfer? (Select 2) A. Accounts for approximately 80% of heat loss in patients. B. Body Surface Area is exposed to environment C. Infants are particularly vulnerable due to a high BSA/body mass ratio. D. Involves direct contact between the skin and a cooler material.

B. Body Surface Area is exposed to environment C. Infants are particularly vulnerable due to a high BSA/body mass ratio. ## Footnote Slide 87

What percentage of heat loss in a patient is typically due to **convection**? A. 20% B. 25% C. 30% D. 35%

C. 30% *Clothing or drapes decrease heat loss Greater in rooms with laminar air flow * ## Footnote Slide 87

Which method of heat loss is mainly through sweating and accounts for approximately 8-10% of heat loss? A. Radiation B. Convection C. Evaporation D. Conduction

C. Evaporation *Latent heat of vaporization of water from open body cavities and respiratory tract, approx. 8-10% * ## Footnote Slide 87

# True or False Heat loss due to direct contact of body tissues or fluids with a colder material is known as _______ and is considered negligible. A. Radiation B. Convection C. Evaporation D. Conduction

D. Conduction *Ex: contact between skin and OR table; intravascular compartment and an infusion of cold fluid * ## Footnote Slide 87

What effect does hypothermia have on platelet aggregation and the activity of enzymes involved in the coagulation cascade? A. Enhances platelet aggregation and enzyme activity B. Impairs platelet aggregation and enzyme activity C. Has no effect on platelet aggregation and enzyme activity D. Doubles the activity of enzymes involved in the coagulation cascade

B. Impairs platelet aggregation and enzyme activity ## Footnote Slide 88

By what percentage does hypothermia increase the need for transfusion? A. 10% B. 15% C. 22% D. 28%

C. 22% *Increases Blood loss by 16%* ## Footnote slide 88

Which of the following is a result of decreased oxygen delivery to tissues caused by hypothermia? A. Increased risk of wound infection B. Enhanced tissue healing C. Reduced need for transfusion D. Decreased cardiac outcomes

A. Increased risk of wound infection ## Footnote Slide 88

Hypothermia increases the incidence of morbid cardiac outcomes by three times. Which of the following is **NOT** a related effect? A. Increased blood pressure (BP) B. Decreased heart rate (HR) C. Increased plasma catecholamine levels D. Increased oxygen demand due to shivering

B. Decreased heart rate (HR) ## Footnote Slide 88

Which of the following are effects of shivering caused by hypothermia? (Select 2) A. Decreases oxygen demand B. Decreased drug metabolism C. Decreases plasma catecholamine levels D. Increases post-operative thermal discomfort

B. Decreased drug metabolism - *Increased duration of NMB* D. Increases post-operative thermal discomfort ## Footnote slide 88

Which of the following is a benefit of hypothermia in the context of cerebral ischemia? A. Increases metabolic rate B. Decreases oxygen delivery to tissues C. Protects against cerebral ischemia D. Impairs platelet aggregation

C. Protects against cerebral ischemia *Hypothermia during neurosurgery when brain tissue ischemia is expected* ## Footnote Slide 89

By how much does hypothermia reduce metabolism per degree Celsius? A. 5% B. 6% C. 8% D. 10%

C. 8% ## Footnote Slide 89

Which of the following are benefits of hypothermia? (Select 2) A. Increases cerebral ischemia B. Increases metabolic rate C. Improved outcome during recovery from cardiac arrest D. More difficult to trigger malignant hyperthermia (MH)

C. Improved outcome during recovery from cardiac arrest D. More difficult to trigger malignant hyperthermia (MH) ## Footnote Slide 89

Which patient population benefits more from airway heating and humidification? A. Adults B. Infants and children C. Elderly D. Children E. Adolescents

B. Infants D. children ## Footnote Slide 90

What is the purpose of warming IV fluids and blood during surgery? A. To increase metabolic rate B. To decrease metabolic rate C. To prevent cooling D. To increase body temperature

C. To prevent cooling

Which of the following are methods of cutaneous warming? (Select 3) A. Increase room temperature B. Insulation C. Forced air warming D. Hot water mattresses E. Lava rocks

A. Increase room temperature -*Ex: liver transplants, major trauma, pediatrics * B. Insulation - *Single blanket reduces loss by 30%. **Doesn’t increase body temperature *** D. Hot water mattresses -*More effective and safer placed on top of pts * ## Footnote Slide 90

What are the benefits of forced air warming during surgery? (Select 2) A. Prevents heat loss from radiation B. Uses convection to transfer heat to the patient C. Increases metabolic rate D. Reduces oxygen demand

A. Prevents heat loss from radiation B. Uses convection to transfer heat to the patient ## Footnote Slide 90

What is the most common method used for peri-operative temperature management to prevent heat loss from** radiation**? A. Airway heating B. Warm IV fluids C. Forced air warming D. Hot water mattresses

C. Forced air warming *Uses convection to transfer heat to patient* ## Footnote Slide 90

Which site is considered the gold standard for temperature monitoring? A. Tympanic membrane B. Esophagus C. Nasopharyngeal D. Pulmonary artery

D. Pulmonary artery *Correlates well with tympanic membrane, distal esophageal, and nasopharyngeal temperatures* ## Footnote Slide 91

What is a risk associated with placing a temperature probe in the tympanic membrane? A. Epistaxis B. Perforation C. Artifact resistance D. Poor correlation with brain temperature

B. Perforation *Approximates temp at the hypothalamus* ## Footnote Slide 91

Which monitoring site reflects brain temperature but is more prone to error? A. Pulmonary artery B. Tympanic membrane C. Nasopharyngeal D. Esophagus

C. Nasopharyngeal *Risk of epistaxis* ## Footnote Slide 91

Which site for temperature monitoring is described as safe, easily accessible, artifact-resistant, and accurate? A. Pulmonary artery B. Tympanic membrane C. Nasopharyngeal D. Esophagus

D. Esophagus *Placement in distal esophagus, lower 1/3 to ¼ of esophagus * ## Footnote Slide 91

An OR temperature of 70 degrees Fahrenheit is equivalent to _______ degrees Celsius. Answer Choices: A. 18 B. 19 C. 20 D. 21

D. 21 ## Footnote Slide 92

An OR temperature of 65 degrees Fahrenheit is equivalent to _______ degrees Celsius. Answer Choices: A. 17 B. 18 C. 19 D. 20

B. 18 ## Footnote Slide 92