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Equipment/Monitoring Flashcards

1
Q

A 34-year-old female is undergoing laparoscopic tubal ligation. Her vital signs are: BP - 110/74 mmHg, P - 70/min, R - 10/min. Her mean arterial pressure is approximately:

A

86 mmHg

Because the time spent in diastole is approximately twice the time spent in systole, a time-weighted average is used to calculate mean arterial pressure (MAP). The formula for MAP is:

MAP = (SBP) + 2(DBP)
3

pg. 87
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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2
Q

According to the American Society for Testing and Materials F1850-00 standard, an anesthesia machine must have:

  • a carbon dioxide absorber
  • an exhaled volume or ventilatory carbon dioxide monitor
  • unidirectional flow valves
  • an active scavenging system
A

an exhaled volume or ventilatory carbon dioxide monitor

The ASTM F1850-00 standard requires monitoring of breathing system pressures, exhaled tidal volume, ventilatory carbon dioxide, anesthetic vapor concentration, inspired oxygen concentration, oxygen supply pressure, arterial saturation, arterial blood pressure and electrocardiogram. In addition, the anesthesia workstation must have a 3-tiered prioritized alarm system.

pg. 244
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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3
Q

In the central venous pressure tracing below, ventricular contraction corresponds to:

A

B

The pressure increase seen at point B is the result of bulging of the tricuspid valve during ventricular contraction.

pp. 299-300
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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4
Q

The risk of occupational exposure to inhaled anesthetic agents is higher with:

  • an open scavenger
  • a closed scavenger
  • passive scavenging
  • active scavenging
A

an open scavenger

Unless used correctly, the risk of occupational exposure is higher with an open interface. Open scavenging systems require an active disposal system for effective scavenging.

pg. 281
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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5
Q

When calculating the cardiac output using the Fick principle:

  • systemic vascular resistance must be determined
  • mixed venous oxygen content must be determined
  • stroke volume must be determined
  • aortic root velocity must be determined
A

mixed venous oxygen content must be determined

The Fick principle states that the amount of oxygen consumed equals the difference between arterial and mixed venous oxygen content multiplied by the cardiac output. Therefore cardiac output is equal to:

    Oxygen consumption          A-V oxygen content difference

pg. 114
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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6
Q

When using a circle system, readings from the oxygen analyzer may overestimate the actual inspired oxygen concentration if the sensor is placed in the:

  • expiratory limb
  • inspiratory limb
  • Y-piece
  • fresh gas line
A

fresh gas line

The concentration of oxygen inspired by the patient is determined by the mixture of fresh gas and expired gas. As a result of oxygen consumption, placement of the oxygen analyzer sensor in the fresh gas line may overestimate the actual inspired oxygen concentration - especially if low flows are used.

pg. 67
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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7
Q

In adults, the distance from the ventricular port to the tip of a pulmonary artery catheter is:

  • 10 cm
  • 20 cm
  • 30 cm
  • 40 cm
A

20 cm

The ventricular port on a PA catheter is 20 cm from the tip; the distance of the proximal port is 30 cm.

pg. 106
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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8
Q

Ventricular arrhythmias are not induced by electrosurgical units as a result of the:

  • small amount of current applied
  • frequency of the current applied
  • low voltage of the current applied
  • large dispersive pad used
A

frequency of the current applied

In contrast to the current from the line power (60 Hz), electrosurgical units (ESUs) use ultrahigh frequencies (0.1 - 3 MHz) to avoid the induction of arrhythmias. Also, ESUs use a large return pad for the dispersal of exiting electrical current to avoid burns at the exit site.

pg. 19
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

pp. 204-205
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

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9
Q

Inspired and expired gases that can be measured using infrared absorption analysis include: (Select 2)

  • carbon dioxide
  • desflurane
  • oxygen
  • nitrogen
A

carbon dioxide, desflurane

Most anesthetic gases and carbon dioxide are now measured by infrared absorption analysis. Nonpolar gases such as oxygen and nitrogen do not absorb infrared light and must be measured by other means.

pg. 233
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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10
Q

A list of definitions is shown (Click here to display definitions). By dragging & reordering the selections in yellow, match the term with the associated definition.

  • Sterilization
  • Sanitation
  • Disinfection
  • Decontamination

1) Process capable of removing or destroying all viable forms of microbial life, including bacterial spores, to an acceptable assurance level.
2) Process of reducing the number of microbial contaminants to a relatively safe level.
3) Process capable of destroying most microorganisms but, as ordinarily used, not bacterial spores.
4) Process that renders inanimate items safe for handling by personnel who are not wearing protective attire.

A

Sterilization 1) Process capable of removing or destroying all viable forms of microbial life, including bacterial spores, to an acceptable assurance level.

Sanitization 2) Process of reducing the number of microbial contaminants to a relatively safe level.

Disinfection 3) Process capable of destroying most microorganisms but, as ordinarily used, not bacterial spores.

Decontamination 4) Process that renders inanimate items safe for handling by personnel who are not wearing protective attire.

Cleaning and Sterilization Terms
pp. 628-631
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

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11
Q

The normal gradient between PaCO2 and ETCO2 is approximately:

  • 2 to 5 mmHg
  • 7 to 10 mmHg
  • 10 to 13 mmHg
  • 15 to 17 mmHg
A

2 - 5 mmHg

The normal gradient between PaCO2 and ETCO2 is 2 - 5 mmHg and reflects alveolar dead space. Any significant reduction in lung perfusion increases alveolar dead space, diluting expired CO2 and increasing the gradient.

pg. 127
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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12
Q

During the delivery of an anesthetic in the CT scanning suite, oxygen from the E-cylinder is being used. The patient is intubated and spontaneously ventilating with 94% oxygen and 6% desflurane. Sixty minutes into the case the pressure of the E-cylinder has fallen from 2000 psi to 1100 psi. From this information, the fresh gas flow is estimated to be:

A

4.8 - 5.2 L/min

The content of oxygen in an E-cylinder is about 660 L when full, at a pressure of 2000 psi. As oxygen is expended, the cylinder’s pressure falls in proportion to the content. As a result, a fall in pressure from 2000 to 1100 results in:

content = (1100/2000) x 660 = 363 L remaining in cylinder
660 L - 363L = 297L consumed in during case
297 L / 60 minutes = 4.95 L/minute

pg. 249
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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13
Q

In the flow-volume loops below, endotracheal tube kinking is best represented by:

A

C

Loop C demonstrates reduced flow during both inspiration and exhalation without changes in lung volume.

pg. 468
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

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14
Q

The effect of methemoglobinemia on the pulse oximetry reading is to:

  • cause a reading of 85% regardless of the actual saturation
  • cause a reading that is 10% less then the actual saturation
  • have only minimal effect on the saturation reading
  • maintain a reading of 99% regardless of the actual saturation
A

cause a reading of 85% regardless of the actual saturation

Methemoglobin has the same absorption coefficient at both red and infrared wavelengths causing a reading of 85% regardless of the actual hemoglobin saturation.

pg. 125
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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15
Q

For accurate blood pressure measurement, the width of the blood pressure cuff should be:

  • 10 to 15% > than the diameter of the extremity
  • 20 to 50% > than the diameter of the extremity
  • equal to the circumference of the extremity
  • 20 to 50% > than the circumference of the extremity
A

20 - 50% greater than the diameter of the extremity

The accuracy of any method of blood pressure measurement depends on proper cuff size. The cuff’s bladder should extend at least halfway around the extremity and the width of the cuff should be 20 - 50% greater than the diameter of the extremity.

pg. 91
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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16
Q

Interchanging the position of the APL valve and the fresh gas inlet transforms a Mapleson A circuit into a:

  • Mapleson B circuit
  • Mapleson C circuit
  • Mapleson D circuit
  • Mapleson E circuit
A

Mapleson D circuit

Interchanging the position of the APL and fresh gas inlet on a Mapleson A circuit results in the creation of the Mapleson D circuit, which is better suited for controlled ventilation.

pp 33, 35-36
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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17
Q

The capnogram below is indicative of:

A

exhausted carbon dioxide absorbent

Elevation of the baseline of the capnogram indicates rebreathing. This could be the result of an incompetent expiratory valve or an exhausted carbon dioxide absorber.

pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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18
Q

At or below which of the following pressures is it recommended that the E-cylinder of oxygen be changed?

  • 250 psi
  • 500 psi
  • 750 psi
  • 1000 psi
A

1000 psi

Current anesthesia apparatus checkout recommendations state that the E-cylinder of oxygen should be at least half full corresponding to a pressure of 1000 psi.

pg. 84
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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19
Q

During the administration of general anesthesia for a laparoscopic herniorrhaphy using a circle system, the capnogram below was obtained. This capnogram is consistent with:

A

an incompetent inspiratory valve

An incompetent inspiratory valve causes part of the expired gas to flow back into the inspiratory limb and allows these exhaled gases to be inspired with the next breath. This results in a delay in the initiation of Phase IV of the capnogram.

pg. 433
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

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20
Q

Concerning the use of lasers, as wavelength increases:

  • tissue penetration increases
  • the area of coagulation increases
  • absorption by water increases
  • the risk of retinal damage increases
A

absorption by water increases

As wavelength increases the energy of the laser light decreases. There is increased absorption by water and decreased tissue penetration and coagulation. Corneal damage is more likely with longer wavelength lasers (CO2 laser) and retinal damage is more likely with shorter wavelength lasers (YAG laser).

pg. 776
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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21
Q

Advantages of nondiverting (flowthrough) capnographs include:

  • light weight
  • no traction placed on the ETT
  • no aspiration of gas from the circuit
  • direct delivery of aspirated gas to the scavenger
A

no aspiration of gas from the circuit

Nondiverting capnographs measure carbon dioxide passing through an adaptor placed in the breathing circuit. The weight of the sensor can cause traction on the tracheal tube. However, since the sensor is in the gas stream, no aspiration of gas is required.

pg. 126
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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22
Q

In order for leakage current to be perceptible to touch, the current must exceed:

  • 0.5 mA
  • 1.0 mA
  • 20 mA
  • 100 mA
A

1.0 mA

Most current leaks are imperceptible. In order to be felt, leakage current must exceed 1.0 mA. Leakage current of 100 mA or greater is capable of causing ventricular fibrillation.

pg. 231
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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23
Q

A 78-year-old female is scheduled to undergo a right knee replacement. Prior to induction, the rhythm strip below is obtained. At this time the most appropriate course of action is:

A

postpone the case and obtain a cardiology consultation

This rhythm strip shows a regular atrial rhythm and a regular ventricular rhythm, but no relationship between the P wave and the QRS complex. This rhythm constitutes a complete heart block, also known as a 3rd degree block. Immediate treatment is required if cardiac output is reduced and consideration should be given to insertion of a pacemaker.

pg. 1703
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

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24
Q

Small circuit leaks will have little effect on minute ventilation when using a:

  • time-cycled ventilator
  • pressure-cycled ventilator
  • volume-cycled ventilator
  • hanging-bellows ventilator
A

pressure-cycled ventilator

With pressure-cycled ventilators, small leaks will not cause a change in tidal volume, and secondarily minute ventilation, because cycling will be delayed until the pressure limit is met. Hanging-bellows ventilators are no longer approved for use in the anesthesia circuit.

pp. 273-274
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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25
Q

Some patients are at increased risk for hand ischemia secondary to radial artery catheterization because of an incomplete palmar arch. The approximate percentage of patients with incomplete palmar arch is:

  • 1%
  • 5%
  • 10%
  • 15%
A

5%

About five percent of patients have incomplete palmar arches and lack adequate collateral blood flow.

pg. 92
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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26
Q

As compared to non-rebreathing circuits, disadvantages of the circle system include:

  • higher fresh gas flow rates are needed
  • decreased humidity of inspired gases as compared to the Mapleson D circuit
  • higher system resistance
  • higher inspiratory carbon dioxide levels
A

higher system resistance

Disadvantages of the circle system include: greater size, decreased portability, increased complexity, increased risk of disconnection, increased system resistance and difficulty in predicting inspired gas concentrations during low fresh gas flows. With a properly functioning carbon dioxide absorber, inspired carbon dioxide levels should approach zero in the circle system.

pp. 265-268
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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27
Q

The tracing below is noted during the insertion of a pulmonary artery catheter. As the catheter is advanced further:

A

the diastolic pressure will increase

This trace is demonstrating a right ventricular pressure trace. As the catheter is further advanced it will cross the pulmonic valve and the diastolic pressure will increase.

pp. 299-300
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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28
Q

Determinants of bobbin position in the flowmeter include: (Select 2)

  • gas density at low-flow rates
  • gas viscosity at high-flow rates
  • gas molecular weight at high-flow rates
  • changes in atmospheric pressure
  • the introduction of volatile anesthetic agent
  • the use of nitrous oxide in the gas mixture
A

gas molecular weight at high-flow rates, changes in atmospheric pressure

At low (laminar) flow rates the bobbin height is determined by gas viscosity. At high (turbulent) flow rates the bobbin height is determined by gas density. Since gas density is directly proportional to the molecular weight of the gas, bobbin height during high flows is determined also by molecular weight.

pp. 68-69
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

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29
Q

Problems inherent with the dye-dilution technique of measuring cardiac output include:

  • the need for specialized pulmonary artery catheters
  • mixed venous sampling is required
  • background indicator buildup
  • intrapulmonary shunting may cause measurement inaccuracy
A

background indicator buildup

The dye-dilution technique introduces the problems of indicator recirculation, arterial blood sampling and background indicator buildup.

pp. 112-113
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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30
Q

The need for a return electrode to the electrocautery can be eliminated if:

  • bipolar electrodes are used
  • the patient is properly grounded
  • an isolation transformer is used
  • ultrahigh electrical frequencies are used
A

bipolar electrodes are used

Bipolar electrodes confine current propagation to a few millimeters, eliminating the need for a return electrode.

pg. 232
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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31
Q

Pulse oximetry changes seen in carbon monoxide poisoning include a(n):

  • decreased SpO2 levels
  • falsely increased SpO2 levels
  • SpO2 of 85% regardless of the actual SpO2
  • augmentation of the pulsatile waveform
A

falsely increased SpO2 levels

Because carboxyhemoglobin and oxyhemoglobin absorb light at 660 nm identically, pulse oximeters will register a falsely high reading in patients with carbon monoxide poisoning.

pp. 320, 604
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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32
Q

A 53-year-old man is undergoing a laparoscopic cholecystectomy. He is currently receiving 6% desflurane and oxygen at 3 L/min. A ventilator lacking fresh-gas-flow compensation is set to: TV = 700, Rate = 9, I:E = 1:2. This patient’s minute ventilation is:

A

7.3 L/min

Because the ventilator’s spill valve is closed during inspiration, fresh gas flow contributes to the minute ventilation (MV). With I:E = 1:2, fresh gas flow contributes to the MV 33% of the time. This results in an increase of minute ventilation of 1 L/min. The patients total MV is therefore (0.7 L)(9 breaths/min) + 1 L = 7.3 L.

pp. 275-276
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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33
Q

Central venous pressure measurements should be made at the beginning or the end of exhalation:

  • exhalation
  • inspiration
  • at the end of exhalation
  • at the end of inspiration
A

at the end of exhalation

Measurement of CVP is made with a water column or transducer. The pressure should be measured during end expiration.

pg. 100
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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34
Q

During exhalation, sticking of the spill valve of the ventilator can result in:

  • inadequate patient ventilation
  • the application of PEEP
  • elevated carbon dioxide levels
  • the application of negative airway pressure during exhalation
A

the application of positive end-expiratory pressure

The ventilator has its own pressure-relief valve, called the spill valve, which is closed during inspiration and open at the end of exhalation. Sticking of this valve results in abnormally elevated airway pressure during exhalation.

pg. 279
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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35
Q

The decline in core temperature during the first hour of general anesthesia is largely due to:

  • heat loss from conduction
  • heat loss from convection
  • heat loss from radiation
  • redistrubiton of heat to cooler peripheral tissues
A

redistribution of heat to cooler peripheral tissues

Temperature decreases during general anesthesia can be grouped into 3 phases. Phase I is usually a decrease of 1 - 2o C that occurs during the first hour and is the result of redistribution of heat to cooler peripheral tissues. Phase II occurs over the next 3 - 4 hours and is a result of heat loss to the environment. During Phase III, a steady-state equilibrium is established between heat production and loss to the environment with little change in core temperature.

pg. 1184
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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36
Q

The purpose of the bimetallic strip, commonly found in variable-bypass vaporizers, is to compensate for:

  • changes in temperature
  • changes in atmospheric pressure
  • changes in fresh gas flow
  • vaporizer output changes that occur with the introduction of nitrous oxide
A

changes in temperature

In the variable-bypass vaporizer, temperature compensation is achieved by a strip composed of two different metals welded together. The metal strips expand and contract differently in response to temperature changes and are used to alter the flows in the vaporizer.

pg. 61
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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37
Q

Immediately after intubation, the capnogram below was obtained. This capnogram is consistent with:

A

bronchospasm

The sloping of Phase II and III of the capnogram indicates increased airway resistance and is consistent with bronchospasm or endotracheal tube kinking.

pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

pg. 436
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

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38
Q

When using the desflurane Tec 6 vaporizer at high elevations:

  • the concentration of the agent is decreased
  • the delivered partial pressure of the agent is decreased
  • the concentration of the agent is increased
  • the delivered partial pressure of the agent is increased
A

the delivered partial pressure of the agent is decreased

At high elevations, the Tec 6 vaporizer continues to deliver the set concentration. However, because of the decrease in the ambient pressure, the partial pressure of desflurane is decreased.

pg. 63
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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39
Q

During the administration of general anesthesia for a strabismus repair in a 4-year-old using a Mapelson D circuit, the capnogram below was obtained. This capnogram is consistent with:

A

inadequate fresh gas flow

Carbon dioxide elimination is entirely dependent on fresh gas flow in the Mapleson circuits. This capnogram demonstrates rebreathing, with a baseline that does not approach zero and is the result of inadequate fresh gas flow.

pg. 317
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

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40
Q

The intergranular air space of the carbon dioxide absorber is approximately:

  • 10% of the total volume
  • 25% of the total volume
  • 50% of the total volume
  • 75% of the total volume
A

50% of the total volume

To guarantee complete absorption, a patient’s tidal volume should not exceed the air space between absorbent granules. To ensure this, the carbon dioxide absorber has an intergranular air space of roughly 50% of the total volume, or approximately 1000 mL of air space.

pg. 39
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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41
Q

Burst suppression patterns become evident when the Bispectral Index:

  • is between 80 and 90
  • is between 60 and 80
  • is between 40 and 60
  • is below 40
A

is below 40

At BIS values below 40, cortical suppression becomes discernible in an EEG as a burst suppression pattern.

pp. 130-134
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

42
Q

At sea-level, the capacity of a full E cylinder of air is:

  • 500L
  • 625L
  • 660L
  • 1590L
A

625 L

The E cylinder of air has slightly lower total contents, measured in liters, as compared to the oxygen E cylinder (625 L vs. 660 L). However, like the oxygen E cylinder, the pressure of the air E cylinder declines in a linear fashion with use.

pg. 247
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

43
Q

The pulse oximeter corrects for the absorption of light by nonpulsating venous blood and tissues by the use of:

  • using two separate wavelengths of light emitting diodes
  • calculating a ratio of red and infrared light absorption
  • detecting thermal changes from the sensor diodes
  • identifying arterial pulsations with plethysmography
A

identifying arterial pulsations with plethysmography

To eliminate the effects of light absorption from tissues and venous blood, arterial pulsations are identified by plethysmograph.

pg. 124
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

44
Q

During the delivery of an anesthetic in the endoscopy suite, E-cylinders are being used as the gas supply. The anesthetic being delivered is sevoflurane 2% in a 3:2 L/min mixture of nitrous oxide and oxygen. If fresh E-cylinders were present at the start of the case, after 3 hours of anesthetic delivery the expected pressure of the nitrous oxide E-cylinder is:
(Enter numerical answer in box below. Click ‘Next’ when completed.)

A

745 psig

Unlike the oxygen E-cylinder, the nitrous oxide E-cylinder is 90-95% filled with liquid nitrous oxide when full. The tank pressure of 745 psi represents the vapor pressure of liquid nitrous oxide. The cylinder gauge will remain at 745 psig until all of the liquid is gone and at this point the tank is less than 25% full. Since the nitrous oxide E-cylinder contains 1590 L of nitrous oxide, the consumption of 180 L during the described case will not cause any change in the tank pressure.

pp. 247, 249
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

45
Q

An echocardiogram is shown (Click here to display definitions). By dragging & reordering the selections in yellow, match the letter with the associated anatomic structure.

-Right Atrium
-Right Ventricle
-Left Atrium
Left Ventricle

A

A-Right atrium
B-Left atrium
C-Left ventricle
D-Right ventricle

pg. 434
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York: McGraw Hill, 2012.

46
Q

The nitrous cut-off valve, formerly know as the fail-safe valve:

  • reduces pressure of nitrous oxide to the flow meter to below that of oxygen
  • prevents barotrauma from high-flow delivery of nitrous oxide
  • alarms if the oxygen supply pressure falls below 20 psi
  • discontines nitrous oxide flow if the pressure of oxygen to the machine drops below psi
A

discontinues nitrous oxide flow if the pressure of oxygen to the machine drops below 20 psig

If the pressure from the oxygen supply declines, usually below 20 psig, the shut-off valve will discontinue the flow nitrous oxide to prevent the accidental delivery of a hypoxic mixture as a result of oxygen supply failure.

pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

47
Q

Using transesophageal echocadiography (TEE) and the pulsed doppler, cardiac output can be determined by:

  • measuring aortic flow velocity and cross-sectional area
  • measuring distention of the aorta during ventricular contraction
  • measuring diastolic and systolic ventricular dimensions
  • measuring ventricular ejection fraction
A

measuring aortic flow velocity and cross-sectional area

A two-dimensional image from TEE can assess LV filling, ejection fraction, wall motion abnormalities, contractility and valve areas. When used with pulsed doppler to measure aortic blood velocity, an accurate cardiac output can be determined.

pg. 113
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

48
Q

The FDA Universal negative pressure leak test:

  • must be done with the machine on
  • tests both low pressure and high pressure circuitry
  • should be repeated with each vaporizer individually turned on
  • can detect leaks of as little as 10 mL/min
A

should be repeated with each vaporizer individually turned on

The FDA Universal negative pressure leak test should be done with the machine, flow control valves and vaporizers turned off. Individually, the vaporizers are turned on to look for leaks in the vaporizers themselves. The test only checks the low pressure system of the anesthesia machine and can detect leaks of as little as 30 mL/min.

pg. 286
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

49
Q

When using a modified V5 (CS5) lead, the proper lead selection on the monitor is lead:

  • I
  • II
  • III
  • V5
A

I

When using a 3-lead ECG monitor and positioning the electrodes in a modified V5 placement, the appropriate lead selection for monitoring is lead I.

pg. 298f
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

50
Q

What does the line isolation monitor:

  • measures the potential for line current flow to the ground
  • measures the current flow through the ground line of equipment
  • measures total current flow into and out of the operating room
  • measures the potential for isolation transformer current flow to the ground
A

measures the potential for isolation transformer current flow to the ground

The line isolation monitor measures the potential for current flow from the isolated power supply to ground.

pg. 232
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

51
Q

Electrosurgical units use high-frequency alternating current. This high frequency causes an increase in circuit:

  • inductance
  • impedence
  • resistance
  • voltage
A

inductance

Increasing frequency in an AC circuit decreases both capacitance and impedance in the circuit. Inductance, however, is increased with increased frequency. Electrosurgical units, such as the Bovie, use frequencies in excess of 500,000 Hz. This can cause current inductance in other electrical equipment in the OR and explains the excessive electrical interference seen with the use of these devices.

pg. 232
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

pp. 19-22
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

52
Q

The addition of tubing and stopcocks to a transducer measuring arterial blood pressure:

  • increases the natural frequency of the system
  • decreases the natural frequency of the system
  • causes underdamping
  • causes overestimation of the systolic blood pressure
A

decreases the natural frequency of the system

The addition of tubing, stopcocks and air in the line all decrease the natural frequency of the system. If the frequency response is too low, the system will be overdamped and will not faithfully reproduce the arterial waveform, underestimating the systolic pressure.

pg. 95
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

53
Q

The carbon dioxide absorption capacity of 100 grams of soda lime is approximately:

A

15 - 26 liters

The chemical reaction of soda lime with carbon dioxide would allow the absorption of 26 L of carbon dioxide per 100 grams of absorbent under ideal conditions. In practice, the absorption capacity of 100 grams of soda lime is about 15 - 23 L of CO2.

pg. 37
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

pg. 641
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York: McGraw Hill, 2012.

54
Q

In determining the cardiac output from the thermodilution curve, the cardiac output monitor calculates the output by:

  • determining the slop at the peak of the curve
  • determining the duration of the temperature change
  • determining the slope of the curve immediately after injection
  • determining the area under the curve
A

determining the area under the curve

Plotting the temperature change as a function of time produces a thermodilution curve. Cardiac output is determined by the integration of the area under the curve which is inversely proportional to the cardiac output.

pp. 304-305
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

55
Q

In 1963, Eger et al. showed that the proper placement of the flowmeters could help prevent the delivery of a hypoxic mixture if a leak in a flowmeter occurred. The proper flowmeter sequence is:
(Make your selection by clicking on the appropriate part of the figure)

A

Flowmeter leaks are a substantial hazard because the flowmeters are located downstream from all machine safety devices except the oxygen analyzer. Eger et al. demonstrated that, in the presence of a flowmeter leak, a hypoxic mixture is less likely to occur if the oxygen flowmeter is located downstream from all other flowmeters.

pg. 657
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

56
Q

Visual detection of cyanosis usually occurs when the SpO2 falls below:

  • 60%
  • 70%
  • 80%
  • 90%
A

80%

In contrast to the pulse oximeter, which can detect very small changes in saturation, visual detection of cyanosis occurs only when more than 5 g of hemoglobin is desaturated or at about a SpO2 of 80%.

pg. 125
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

57
Q

Components of the low-pressure circuit in the anesthesia machine include the: (Select 2)

  • oxygen supply failure alarm
  • oxygen failure cut off valve
  • flowmeters
  • vaporizers
  • second stage oxygen pressure regulator
  • oxygen flush valve
A

vaporizers, flowmeters

Components of the low-pressure circuit in the anesthesia machine are found distal to the flow valves. The vaporizers and flowmeters are placed after the flow valves. The oxygen flush valve, oxygen failure cutoff (fail-safe) valve, oxygen supply failure alarm and pressure regulators are all proximal to the flow valves in the anesthesia machine.

pg. 54
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

58
Q

The vacuum control on an active scavenging system should be adjusted to allow the evacuation of:

  • 5 to 10 L/min
  • 10 to 15 L/min
  • 25 to 30 L/min
  • > 30 L/min
A

10 - 15 L/min

The vacuum control valve should be adjusted to allow the evacuation of 10 - 15 L/min of waste gas per minute. This rate is adequate for periods of high fresh gas flow and yet minimizes the risk of transmitting negative pressure to the breathing circuit.

pg. 81
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

59
Q

In the transesophageal echogardiogram 4-chamber view shown below, the mitral valve is best represented by:
(Make your selection by clicking on the appropriate part of the figure)

Correct Flowmeter Positioning

A

pp. 444-449

Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York: McGraw Hill, 2012.

60
Q

Automated blood pressure monitors electronically measure blood pressure by:

  • using an acoustic monitor to detect blood flow
  • using a doppler monitor to detect blood flow
  • using pressure transducers over the artery to sense compression changes
  • using oscillation in cuff pressure
A

using oscillations in cuff pressure

Automated blood pressure monitors measure the pressures at which oscillation amplitudes change. From this, a microprocessor derives systolic, mean and diastolic pressures.

pg. 307
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

61
Q

Airway pressure curves from the same patient, one hour apart, are shown below. Likely causes for the change from curve A to curve B include:

A

increased tidal volume

An increase in both peak inspiratory pressure and plateau pressure, with the difference between the two remaining constant, indicates a change in tidal volume or a change in compliance. Increases in peak inspiratory pressure with large difference in plateau pressure indicates an increase in inspiratory flow or an increase in airway resistance.

pg. 80
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

62
Q

The largest P wave voltages are seen in lead:

  • I
  • II
  • III
  • V5
A

II

The electrical axis of lead II is approximately 60o from the right arm to the left leg, which is parallel to the electrical axis of the atria, resulting in the largest P wave voltages of any surface lead.

pg. 98
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

63
Q

On the normal capnogram, exhalation of pure dead space gas is seen during phase:

  • I
  • 2
  • 3
  • 4
A

1

The expiratory portion of the capnogram can be divided into 3 phases. Phase 1 is the exhalation of dead space gases. Phase 2, sometimes called the transition phase, is the introduction of carbon dioxide as the dead space gases are washed away. Phase 3 is the alveolar gas plateau. Phase 3 often has an upward slope as alveolar units with lower V/Q ratios empty. Inhalation can be seen on the capnogram as Phase 4.

pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

64
Q

The advantage of motor evoked potential as opposed to sensory evoked potentials for spinal cord monitoring is that motor evoked potentials:

  • monitor the ventral spinal cord
  • are unaffected by volatile anesthetic agents
  • are unaffected by intraoperative hyperthermia
  • are unaffected by high-dose opioid anesthetics
A

monitor the ventral spinal cord

In contrast to SEP’s, MEP’s monitor the ventral aspect of the spinal cord and can predict postop motor deficit. MEP’s are affected by volatile agents, benzodiazepines, opioids and moderate hypothermia.

pg. 331
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

pg. 135
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

65
Q

The oxygen supply from E-cylinders:

  • uses a diameter-index safety system
  • should be left on in case of pipeline oxygen failure
  • is regulated to a pressure exceeding that of the pipeline
  • has a check valve to prevent cross filling of tanks
A

has a check valve to prevent cross filling of tanks

The E-cylinder and yoke assembly use a pin-index safety system to eliminate tank interchange. The pressure from the E-cylinders is regulated to a pressure below the pipeline pressure to ensure preferential use of the pipeline gases if the tank is open. E-cylinders should be closed when not in use. The yoke assembly contains a check valve to prevent cross filling of tanks and to allow tank exchange while a second tank is in use.

pg. 248
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

66
Q

A 25-year-old female is undergoing a right knee arthroscopy. Prior to induction, the rhythm strip below is obtained. This rhythm strip is consistent with:

A

a pre-excitation syndrome

This rhythm strip shows a short PR interval with an initial up-sloping of the QRS complex, also known as a delta wave. This strip is consistent with the pre-excitation syndrome known as Wolff-Parkinson-White (WPW) syndrome. Digoxin should be avoided in patients with WPW syndrome.

pp. 243, 401
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

pp. 193, 200
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

67
Q

Known as the pumping effect, the concentration delivered by some vaporizers during controlled or assisted ventilation is higher than when the vaporizer is used with free flow to the atmosphere. This change is most pronounced when: (Select 2)

  • the carrier gas flow is high
  • there is less agent in the vaporizing chamber
  • peak inspiratory pressures are low
  • there is a rapid ventilatory rate
  • the dial setting is high
A

there is less agent in the vaporizing chamber, there is a rapid ventilatory rate

The pumping effect is most pronounced when there is less agent in the vaporizing chamber, when carrier gas flow is low, when the pressure fluctuations are high and frequent and when the dial setting is low.

pg. 664
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

68
Q

Enhancement of flow direction of the pulmonary artery catheter can be achieved by:

  • asking the patient to forcibly exhale
  • positioning the patient in a head down position
  • placing the patient in a left lateral tilt position
  • injecting iced saline thorough the catheter
A

injecting iced saline thorough the catheter

Flow directed flotation of the pulmonary artery catheter can be enhanced by maneuvers that increase cardiac output, increase venous return or elevate the position of the pulmonary artery. As a result, deep inspiration, head-up position and right lateral tilt all improve flow direction. In addition, the injection of iced saline stiffens the catheter catheter and reduces coiling thereby improving flow direction.

pp. 107-108
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

69
Q

In the circuit diagram below, the patient can receive an electric shock if contact is made with:

A

line 2

Despite the presence of an isolation transformer, the circuit will be completed and electrical shock will occur if contact is made with line 2.

pg. 231
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

70
Q

A 58-year-old male is undergoing a craniotomy in a semi-sitting position. The patient’s head is 30 cm above the radial artery where his blood pressure is being measured. If the patient’s mean arterial pressure at the radial artery is found to be 100 mmHg it can be estimated that the mean pressure at the cranial vault is:

A

78 mmHg

Because of mercury’s high density (13.7 g/cc), the height of elevation must be multiplied by a conversion factor (1 cmH2O = 0.74 mmHg) Therefore:

30 cm H2O (0.74 mmHg/cm H2O) = 22 mmHg
100 mmHg - 22 mmHg = 78 mmHg

pg. 89
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

71
Q

Output from a variable-bypass sevoflurane vaporizer is shown below. Possible causes for the transient reduction in vaporizer output seen at point A include:

A

introduction of nitrous oxide to the fresh gas flow

Changing the gas composition from 100% oxygen to 70% nitrous oxide may transiently decrease the anesthetic concentration due to the greater solubility of nitrous oxide in the volatile agent. Changes in temperature and fresh gas flow, within clinical ranges, have little effect on vaporizer output.

pg. 665
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

72
Q

When using an arterial catheter to measure blood pressure, the optimum damping coefficient is:

  • 0.1 to 0.2
  • 0.4 to 0.5
  • 0.6 - 0.7
  • greater than 1
A

0.6 - 0.7

Catheter-tubing-transducer systems must prevent both overdamping and underdamping if an accurate waveform is to be displayed. A damping coefficient of 0.6 - 0.7 is optimal. The damping coefficient can be determined by the high-pressure flush test.

pg. 95
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

73
Q

Advantages of paramagnetic oxygen analyzers include:

  • lower initial cost
  • self-calibration
  • easily replaceable consumable parts
  • requires no electric input for operation
A

self-calibration

Although the initial cost of paramagnetic sensors is higher, the devices are self-calibrating and have no consumable parts. In addition, their response time is fast enough to differentiate between inspired and expired oxygen concentrations.

pg. 67
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

74
Q

The accuracy of the pulse oximeter is:

  • greatest at saturations over 70%
  • greatest at saturations under 60%
  • the same for all measurable saturations
  • bimodal, with the greatest accuracies between 50 - 60% and 9 - 99%
A

greatest at saturations over 70%

Pulse oximeters have their greatest accuracy (+/- 2 to 3%) in the range of 70 - 100 %.

pg. 703
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

75
Q

Signs of a leak in the bellows-in-box ventilator include:

  • decreased inspired anesthetic concentration
  • increased end-tidal carbon dioxide level
  • decreased tidal volume
  • decreased peak airway pressure
A

decreased inspired anesthetic concentration

With a leak in the bellows assembly, ventilator driving gas will enter the bellows. This will result in the dilution of anesthetic agent, increased tidal volume, decreased carbon dioxide levels and increased peak inspiratory pressures.

pg. 680
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

76
Q

Duration of the twitch stimuli from a peripheral nerve stimulator is approximately:

  • 50us
  • 200us
  • 50ms
  • 200ms
A

200 μs

All stimuli from the peripheral nerve stimulator are 200 μs in duration, of square-wave pattern and of equal intensity.

pg. 160
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

pg. 525
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

77
Q

To prevent rebreathing of carbon dioxide in the classic circle system: (Select 2)

  • unidirectional valves must separate the patient and reservoir bag
  • fresh gas flow must enter the circuit between the expiratory valve and patient
  • the carbon dioxide absorber must be between the patient and reservoir bag
  • the APL valve cannot be located between the patient and inspiratory valve
  • the inspiratory valve must separate the patient from the fresh gas flow
  • output to the scavenging system must be located between the patient and expiratory valve
A

unidirectional valves must separate the patient and reservoir bag, the APL valve cannot be located between the patient and inspiratory valve

To prevent rebreathing in a classic circle system, three rules must be followed: (1) a unidirectional valve must be located between the patient and the reservoir bag on both the inspiratory and expiratory limbs of the circuit, (2) the fresh gas inflow cannot enter the circuit between the expiratory valve and the patient and (3) the APL valve cannot be located between the patient and the inspiratory valve.

pg. 674
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

78
Q

Falsely low blood pressure measurements can occur when:

  • the cuff is applied too loosely
  • the extremity is below the heart
  • the cuff is too large
  • cuff deflation is slow
A

the cuff is too large

Falsely low blood pressure measurements result when cuffs are too large, the extremity is above the heart level or after quick deflations. Falsely elevated measurements result when cuffs are too small, applied too loosely or the extremity is below the heart level.

pg. 709
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

79
Q

Resuscitation bags are unlike Mapleson non-rebreathing circuits in that resuscitation bags:

  • incorporate carbon dioxide absorption
  • can use very low oxygen flows and still deliver a high FiO2
  • incorporate a non-recreating valve
  • has an adjustable pressure-limited expiratory valve
A

incorporate a non-rebreathing valve

A resuscitator is unlike a Mapleson circuit because it contains a non-rebreathing valve. High flows of oxygen are required to deliver a high FiO2 since resuscitator bags entrain room air.

pp. 40-41
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

80
Q

When using a doppler probe and a blood pressure cuff to measure blood pressure:

  • only systolic pressure can be reliably determined
  • only diastolic pressure can be reliably determined
  • both systolic and diastolic pressures can be reliably determined
  • the mean arterial pressure is most accurately determined
A

only systolic pressure can be reliably determined

Although the doppler probe offers more sensitivity than palpation of the artery, only systolic pressure can be reliably determined by this method.

pg. 89
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

81
Q

Chemicals found in freshly opened soda lime include:

  • calcium carbonate
  • sodium carbonate
  • water
  • carbonic acid
A

water

The chemical composition of soda lime is calcium hydroxide, sodium hydroxide, potassium hydroxide, ethyl violet, silica and water. Commercial soda lime has a water content of 10 - 20%.

pg. 269
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

82
Q

When using a pulmonary artery catheter to measure pulmonary artery pressure, system dynamics can be improved by:

  • using tubing at least 1 meter long
  • using as few stopcocks as possible
  • using high compliance tubing
  • achieving a damping coefficient greater than 1.5
A

using as few stopcocks as possible

Catheter-tubing-transducer system dynamics are improved by minimizing tubing length, eliminating unnecessary stopcocks, removing air bubbles and using low-compliance tubing.

pp. 708-708
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

83
Q

According to the American National Standards Institute, essential features of the anesthesia machine include:

  • vaporizers that increase concentration with clockwise rotation
  • an unshielded and easily accessible oxygen flush control
  • an exhaled volume monitor
  • a separate low-flow oxygen control valve
A

an exhaled volume monitor

Newly manufactured workstations must have monitors that measure the following parameters: continuous breathing system pressure, exhaled tidal volume, ventilatory CO2 concentration, anesthetic vapor concentration, inspired oxygen concentration, oxygen supply pressure, arterial hemoglobin oxygen saturation, arterial blood pressure, and continuous electrocardiogram.

pg. 644
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

84
Q

The galvanic cell measures inspired oxygen concentration by examining the:

  • electrical frequency of the cell
  • the voltage and current produced by the cell
  • capacitance changes in the cell
  • change in gas flow when a magnetic field is applied
A

the voltage and current produced by the cell

The galvanic cell (fuel cell) produces voltage and electrical current that is proportional to the amount of oxygen being measured.

pg. 235
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

85
Q

When using a circle system, where is dead space in the circuit?

  • distal to the Y-piece
  • distal to the inspiratory valve
  • physiologic dead space plus the volume of the circuit hoses
  • physiologic dead space plus the volume of the circuit hoses and reservoir bag
A

distal to the Y-piece

In the circle system, dead space occurs only in areas of bidirectional gas flow. If the unidirectional valves are working properly, dead space will only be distal to the Y-piece.

pg. 268
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

86
Q

When using a peripheral nerve stimulator, the most sensitive test of neuromuscular function is:

  • the train-of-four
  • double burst stimulation
  • a 5 second tetanic stimulus at 50 Hz
  • a 5 second tetanic stimulus at 100 Hz
A

a 5-second tetanic stimulus at 100 Hz

Tetany at 50 or 100 Hz is a sensitive test of neuromuscular function. Sustained contraction for 5 seconds indicates adequate reversal. As stimulus frequency increases, fade is more pronounced. As a result, a 100 Hz stimulus is more likely to produce fade than a 50 Hz stimulus.

pg. 543
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

pg. 161
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

87
Q

Compliance for standard adult breathing circuits is about:

  • 2 mL/cm H2O
  • 5 mL/cm H2O
  • 8 mL/cm H2O
  • 12 mL/cm H2O
A

5 mL/cm H2O

The compliance for standard adult breathing circuits is about 5 mL/cm H2O. Thus, at a peak inspiratory pressure of 20 cm H2O, about 100 mL of set tidal volume is lost to expanding the circuit.

pp. 79-80
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

88
Q

One hour after a rapid-sequence induction with propofol and succinylcholine for an appendectomy the train-of-four stimulation below was obtained. These results are consistent with: This train-of-four pattern demonstrates no fade

Picture shows 4 equal lines at about 50%

  • normal recovery from depolarizing neuromuscular block
  • normal recovery from non depolarizing neuromuscular block
  • a Phase II block
  • a pseudocholinesterase deficiency
A

This train-of-four pattern demonstrates no fade, which is consistent with depolarizing blockade. However, after 1 hour the patient has persistence of the block, which would suggest reduced metabolism of succinylcholine as is seen with a pseudocholinesterase deficiency.

pp. 166-171
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

89
Q

To obtain the best accuracy in determining the patient’s tidal volume, the spirometer should be placed:

  • -at the Y piece
  • just distal to the inspiratory valve
  • -just proximal to the expiratory valve
  • distal to the expiratory valve, but proximal to the inspiratory valve
A

at the Y-piece

Because of compliance of the breathing circuits, gas compression losses, ventilator-fresh gas flow coupling and leaks, substantial differences between set tidal volume and delivered tidal volume may exist. The effects of these factors in measuring tidal volume can be minimized by placing the spirometer at the Y-piece.

pg. 68
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

90
Q

A 28-year-old female is undergoing a left shoulder arthroscopy. Ninety minutes after induction the rhythm strip below is obtained. This rhythm strip is consistent with:

A

a premature atrial contraction

PACs cause an irregular heart beat. The premature beat is preceded by a P wave, however this may be obscured by the preceding T wave. The QRS complex appears normal.

pg. 1716
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

91
Q

The National Institute for Occupational Safety and Health (NIOSH) recommends limiting the operating room concentrations of anesthetic agents to:

  • N2O < 50 ppm, halogenated agents < 2 ppm
  • N2O < 25 ppm, halogenated agent < 5 ppm
  • N2O < 50 ppm, halogenated agent < 0.5 ppm
  • N2O < 25 ppm, halogenated agent < 0.5 ppm
A

N2O < 25 ppm, halogenated agent < 0.5 ppm

92
Q

With proper placement of a central venous catheter, the catheter tip lies:

  • in the right atrium
  • in the right ventricle
  • in the inferior vena cava
  • at the junction of the superior vena cava and right atrium
A

at the junction of the superior vena cava and right atrium

The central venous catheter tip should lie just above or at the junction of the superior vena cava and the right atrium.

pg. 299
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

93
Q

An open scavenging interface:

  • has a negative pressure relief valve
  • has a positive pressure relief valve
  • should only be used with an active disposal system
  • does not require a reservoir
A

should only be used with an active disposal system

An open scavenging interface is open to the outside atmosphere and requires no pressure relief valves. Atmospheric pollution may occur if the reservoir does not have sufficient volume to contain the boluses of waste gases. Open scavenging interfaces require active removal to be effective.

pg. 281
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

94
Q

Desirable characteristics of a peripheral nerve stimulator, used to assess the level of neuromuscular blockade, include:

  • the stimulator should have a fixed voltage output
  • the stimulator should vary its output to adjust for changing skin resistance
  • the stimulator should be able to deliver a biphasic wave pattern
  • the duration of stimulation should exceed 0.5 sec
A

the stimulator should vary its output to adjust for changing skin resistance

Current, not voltage, is the determining factor in nerve stimulation. Because skin resistance may change, only a stimulator that adjusts its output to maintain constant direct current can ensure unchanging stimulation. The stimulus waveform should be rectangular and monophasic. Biphasic waves may produce repetitive stimulation. The duration of the stimulus should be 0.3 msec or less or a second action potential may be triggered.

pg. 501
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

95
Q

Spongiform encephalopathies, such as Creutzfeldt-Jakob disease, are caused by prions, which demonstrate resistance to sterilization. Effective methods of prion inactivation include:

  • normal autoclave cycles
  • glutaraldehyde sterilization
  • ethylene oxide gas sterilization
  • 1:10 hypochlorite sterilization
A

1:10 hypochlorite sterilization

Prions are notoriously hardy and demonstrate resistance to routine methods of sterilization. Effective inactivation methods include: incineration, prolonged steam sterilization (1320 C for 1 - 4 hours), high-temperature prevacuum sterilization, sodium hydroxide solution, sodium hypochlorite solution and proprietary phenolics.

pg. 660
Dorsch, JA, Dorsch, SE. A Practical Approach to Anesthesia Equipment. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.

96
Q

One hour after induction of general anesthesia in a 3-year-old for cleft palate repair the capnogram below was obtained. This capnogram is consistent with:

A

inadequate minute ventilation

Capnogram

This capnogram shows elevated end-tidal carbon dioxide levels and the patient overriding mechanical ventilation.

pg. 317
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

97
Q

At 20o C the pressure of the nitrous oxide E-cylinder should not exceed:

A

745 psig

The pressure gauge of a nitrous oxide cylinder should not exceed 745 psig at 20o C. A higher reading implies gauge malfunction, tank overfill, or a cylinder containing the wrong gas.

pp. 247-249
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

98
Q

During general anesthesia for a total hip replacement, periods of asystole are noted during times of electrocautery use (see rhythm strip below). At this time the most appropriate therapy is:

  • to administer atropine
  • to administer carotid massage
  • placement of a temporary transvenous pacemaker
  • to switch to a bipolar electrocautery
A

to switch to a bipolar electrocautery

ECG

This rhythm strip shows a paced ventricular rhythm. The pacemaker is interpreting the electrocautery interference as ventricular activity and is being inhibited. Bipolar electrocautery devices better localize current flow and cause less pacemaker interference. Alternatively, the pacemaker could be programmed at a fixed rate until the end of surgery.

pg. 1719
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.

pg. 358
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

99
Q

The oxygen flush valve delivers:

A

35 - 70 L/min

The oxygen flush valve delivers oxygen at 45 - 55 psi and a rate of 35 - 70 L/min.

pg. 256
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2013.

100
Q

Comparing blood pressure measurements made from the radial artery to measurements made from the dorsalis pedis artery, the dorsalis pedis artery measurements have:

  • an elevated systolic pressure and lower pulse pressure
  • an elevated systolic pressure and elevated pulse pressure
  • a depressed systolic pressure and elevated pulse pressure
  • a depressed systolic pressure and depressed pulse pressure
A

an elevated systolic pressure and elevated pulse pressure

Arterial blood pressure is greatly affected by where the pressure is measured. As a pulse moves peripherally, wave reflection distorts the pressure waveform, leading to an exaggeration of systolic and pulse pressures.

pp. 87-88
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail’s Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2013.

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