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Arizona CVT practice questions

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Question 1Pharmacy and Pharmacology

Which medication is a direct thrombin inhibitor commonly used as an alternative anticoagulant in patients with heparin-induced thrombocytopenia?

  1. Warfarin
  2. Argatroban Correct answer.
  3. Clopidogrel
  4. Heparin

Explanation

Argatroban binds directly to thrombin and inhibits both clot-bound and free thrombin without requiring antithrombin, so it remains effective when heparin-induced thrombocytopenia makes heparin unsafe. Heparin depends on antithrombin and can worsen HIT, warfarin takes days to act and can cause transient hypercoagulability, and clopidogrel is an antiplatelet agent rather than an anticoagulant.

Question 2Pharmacy and Pharmacology

A patient on a continuous heparin infusion has a platelet count that has fallen by more than 50 percent from baseline. Which laboratory test is most appropriate to confirm heparin-induced thrombocytopenia?

  1. Serum troponin
  2. Platelet factor 4 antibody assay Correct answer.
  3. Activated partial thromboplastin time
  4. International normalized ratio

Explanation

HIT is mediated by antibodies against platelet factor 4-heparin complexes, so a PF4 antibody assay (often with a functional confirmation such as serotonin release) supports the diagnosis. The INR and aPTT reflect clotting times, not the antibody, and troponin assesses myocardial injury.

Question 3Pharmacy and Pharmacology

Which agent is a vitamin K antagonist that requires monitoring with the international normalized ratio?

  1. Apixaban
  2. Enoxaparin
  3. Fondaparinux
  4. Warfarin Correct answer.

Explanation

Warfarin inhibits vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX, and X, and its effect is monitored with the INR. Enoxaparin and fondaparinux act through antithrombin and are monitored differently, while apixaban is a direct factor Xa inhibitor that generally does not require routine INR monitoring.

Question 4Pharmacy and Pharmacology

A patient taking warfarin has an INR of 8.5 with no active bleeding. Which intervention is most appropriate?

  1. Continue the current warfarin dose
  2. Transfuse platelets
  3. Hold warfarin and give oral vitamin K Correct answer.
  4. Give a therapeutic dose of heparin

Explanation

For a markedly elevated INR without bleeding, warfarin should be withheld and oral vitamin K given to reverse the anticoagulant effect while avoiding unnecessary procoagulant risk. Continuing the same dose risks bleeding, heparin would add anticoagulation rather than reverse it, and platelets do not correct a coagulation factor deficiency.

Question 5Pharmacy and Pharmacology

Which laboratory parameter is used to monitor the anticoagulant effect of unfractionated heparin?

  1. Prothrombin time
  2. D-dimer
  3. Bleeding time
  4. Activated partial thromboplastin time Correct answer.

Explanation

Unfractionated heparin potentiates antithrombin and predominantly inhibits thrombin and factor Xa, prolonging the activated partial thromboplastin time, which is used for dose titration. The prothrombin time reflects the extrinsic pathway, bleeding time assesses primary hemostasis, and D-dimer indicates fibrin degradation.

Question 6Pharmacy and Pharmacology

Which antiplatelet drug irreversibly inhibits the platelet P2Y12 ADP receptor?

  1. Clopidogrel Correct answer.
  2. Abciximab
  3. Dipyridamole
  4. Aspirin

Explanation

Clopidogrel is a prodrug whose active metabolite irreversibly blocks the P2Y12 ADP receptor, inhibiting platelet activation. Aspirin blocks cyclooxygenase, abciximab blocks glycoprotein IIb/IIIa, and dipyridamole inhibits phosphodiesterase and adenosine uptake.

Question 7Pharmacy and Pharmacology

A patient with a history of aspirin-exacerbated respiratory disease needs antiplatelet therapy after stent placement. Which drug is most appropriate?

  1. Aspirin
  2. Clopidogrel Correct answer.
  3. Ketorolac
  4. Ibuprofen

Explanation

Clopidogrel is not a cyclooxygenase inhibitor and therefore does not trigger the leukotriene-mediated bronchospasm seen with aspirin and other NSAIDs in aspirin-exacerbated respiratory disease. Aspirin, ibuprofen, and ketorolac all inhibit cyclooxygenase and can precipitate severe bronchospasm in these patients.

Question 8Pharmacy and Pharmacology

Which medication is a glycoprotein IIb/IIIa receptor inhibitor given intravenously during percutaneous coronary intervention?

  1. Ticagrelor
  2. Eptifibatide Correct answer.
  3. Heparin
  4. Alteplase

Explanation

Eptifibatide blocks the platelet glycoprotein IIb/IIIa receptor, the final common pathway of platelet aggregation, and is given intravenously during PCI. Ticagrelor is an oral P2Y12 inhibitor, heparin is an anticoagulant, and alteplase is a fibrinolytic.

Question 9Pharmacy and Pharmacology

Which drug is a synthetic indirect factor Xa inhibitor that requires dose adjustment in renal impairment and has no specific reversal agent other than factor concentrates?

  1. Warfarin
  2. Fondaparinux Correct answer.
  3. Bivalirudin
  4. Argatroban

Explanation

Fondaparinux binds antithrombin and selectively inhibits factor Xa, is renally cleared, and accumulates in kidney disease, so dosing must be adjusted. Argatroban and bivalirudin are direct thrombin inhibitors, and warfarin is a vitamin K antagonist.

Question 10Pharmacy and Pharmacology

A patient on apixaban requires emergency surgery. Which product is most appropriate for reversing the anticoagulant effect?

  1. Idarucizumab
  2. Andexanet alfa Correct answer.
  3. Protamine sulfate
  4. Vitamin K

Explanation

Andexanet alfa is a recombinant modified factor Xa decoy that binds and neutralizes direct factor Xa inhibitors such as apixaban. Protamine reverses heparin, vitamin K reverses warfarin, and idarucizumab is specific for dabigatran.

Question 11Pharmacy and Pharmacology

Which oral anticoagulant is a direct thrombin inhibitor that can be reversed with idarucizumab?

  1. Rivaroxaban
  2. Dabigatran Correct answer.
  3. Apixaban
  4. Edoxaban

Explanation

Dabigatran is a direct oral thrombin inhibitor, and idarucizumab is a monoclonal antibody fragment that binds dabigatran and reverses its anticoagulant effect. Rivaroxaban, edoxaban, and apixaban are direct factor Xa inhibitors reversed by andexanet alfa or factor concentrates.

Question 12Pharmacy and Pharmacology

Which agent is a fibrinolytic that converts plasminogen to plasmin and is used in acute ischemic stroke within the appropriate time window?

  1. Vitamin K
  2. Alteplase Correct answer.
  3. Aminocaproic acid
  4. Protamine sulfate

Explanation

Alteplase is a recombinant tissue plasminogen activator that converts plasminogen to plasmin, degrading the fibrin clot in acute ischemic stroke. Aminocaproic acid is an antifibrinolytic, vitamin K supports clotting factor synthesis, and protamine reverses heparin.

Question 13Pharmacy and Pharmacology

A trauma patient receiving alteplase develops severe bleeding. Which medication is most appropriate to inhibit fibrinolysis?

  1. Aspirin
  2. Heparin
  3. Tranexamic acid Correct answer.
  4. Clopidogrel

Explanation

Tranexamic acid is an antifibrinolytic that blocks lysine binding sites on plasminogen, preventing plasmin-mediated clot breakdown after a thrombolytic. Heparin, aspirin, and clopidogrel all further impair hemostasis and would worsen bleeding.

Question 14Pharmacy and Pharmacology

Which drug is a low-molecular-weight heparin that is primarily cleared renally and should be dose-reduced in severe kidney impairment?

  1. Enoxaparin Correct answer.
  2. Warfarin
  3. Argatroban
  4. Aspirin

Explanation

Enoxaparin is a low-molecular-weight heparin cleared largely by the kidneys, so it accumulates in renal impairment and requires dose reduction or anti-Xa monitoring. Warfarin is hepatically metabolized, argatroban is hepatically cleared, and aspirin is an antiplatelet drug.

Question 15Pharmacy and Pharmacology

Which medication is a nitrate that relieves angina by dilating veins and reducing preload?

  1. Nitroglycerin Correct answer.
  2. Digoxin
  3. Metoprolol
  4. Amlodipine

Explanation

Nitroglycerin releases nitric oxide, relaxing vascular smooth muscle with predominant venodilation that lowers preload and myocardial oxygen demand. Metoprolol is a beta blocker, amlodipine is a dihydropyridine calcium channel blocker, and digoxin increases contractility.

Question 16Pharmacy and Pharmacology

A patient taking nitroglycerin for angina asks about combining it with sildenafil. What is the most important concern?

  1. Severe hyperkalemia
  2. Loss of antianginal effect
  3. Profound hypotension from additive vasodilation Correct answer.
  4. Increased risk of thrombosis

Explanation

Both nitrates and phosphodiesterase-5 inhibitors such as sildenafil increase cyclic GMP-mediated vasodilation, and combining them can cause life-threatening hypotension. The interaction does not reduce antianginal effect, promote thrombosis, or cause hyperkalemia.

Question 17Pharmacy and Pharmacology

Which beta blocker is cardioselective at usual doses and is preferred in a patient with reactive airway disease who needs rate control?

  1. Carvedilol
  2. Nadolol
  3. Propranolol
  4. Metoprolol Correct answer.

Explanation

Metoprolol is beta-1 selective at usual doses, so it is less likely to cause bronchospasm than nonselective agents. Propranolol, nadolol, and carvedilol all block beta-2 receptors as well and carry greater risk of bronchoconstriction.

Question 18Pharmacy and Pharmacology

Which medication is a dihydropyridine calcium channel blocker that primarily causes peripheral arterial vasodilation?

  1. Diltiazem
  2. Atenolol
  3. Amlodipine Correct answer.
  4. Verapamil

Explanation

Amlodipine is a dihydropyridine calcium channel blocker with predominant arteriolar vasodilating effects and little cardiac conduction effect. Verapamil and diltiazem are nondihydropyridines with greater cardiac effects, and atenolol is a beta blocker.

Question 19Pharmacy and Pharmacology

A patient develops peripheral edema after starting amlodipine. Which mechanism best explains this adverse effect?

  1. Direct sodium retention by the kidney
  2. Reduced myocardial contractility
  3. Increased vascular permeability from histamine release
  4. Arteriolar dilation increasing capillary hydrostatic pressure Correct answer.

Explanation

Dihydropyridine calcium channel blockers dilate arterioles more than venules, raising capillary hydrostatic pressure and favoring fluid movement into the interstitium, which produces dose-related ankle edema. The effect is not caused by direct renal sodium retention, reduced contractility, or histamine-mediated permeability.

Question 20Pharmacy and Pharmacology

Which drug is an angiotensin-converting enzyme inhibitor that should be avoided in pregnancy because of fetal toxicity?

  1. Hydralazine
  2. Lisinopril Correct answer.
  3. Methyldopa
  4. Amlodipine

Explanation

ACE inhibitors such as lisinopril cause fetal renal damage, oligohydramnios, and skull hypoplasia and are contraindicated in pregnancy. Amlodipine, hydralazine, and methyldopa are among the agents used for hypertension in pregnancy.

Question 21Pharmacy and Pharmacology

A patient taking lisinopril develops angioedema of the tongue and lips. Which action is most appropriate?

  1. Add an antihistamine and continue the same dose
  2. Discontinue the drug, secure the airway, and avoid ACE inhibitors permanently Correct answer.
  3. Switch to enalapril at a lower dose
  4. Reduce the dose and observe

Explanation

ACE inhibitor angioedema is bradykinin-mediated and can progress to airway obstruction, so the drug must be stopped permanently, the airway assessed, and all ACE inhibitors avoided thereafter. Dose reduction, antihistamines, or switching to another ACE inhibitor does not address the bradykinin mechanism.

Question 22Pharmacy and Pharmacology

Which combination is most likely to cause hyperkalemia in a patient with chronic kidney disease?

  1. Lisinopril plus spironolactone Correct answer.
  2. Metoprolol plus nitroglycerin
  3. Aspirin plus clopidogrel
  4. Amlodipine plus hydrochlorothiazide

Explanation

ACE inhibitors reduce aldosterone production and potassium excretion, and spironolactone blocks aldosterone receptors directly, so combining them in chronic kidney disease markedly raises serum potassium. The other pairs do not combine two potassium-retaining mechanisms.

Question 23Pharmacy and Pharmacology

Which medication is a loop diuretic that acts on the thick ascending limb of the loop of Henle?

  1. Hydrochlorothiazide
  2. Furosemide Correct answer.
  3. Mannitol
  4. Spironolactone

Explanation

Furosemide inhibits the sodium-potassium-2chloride cotransporter in the thick ascending limb, producing potent diuresis. Spironolactone blocks aldosterone in the collecting duct, hydrochlorothiazide acts on the distal convoluted tubule, and mannitol is an osmotic diuretic.

Question 24Pharmacy and Pharmacology

A patient on furosemide has a potassium of 2.9 mEq/L and reports muscle weakness. Which explanation best accounts for this finding?

  1. Reduced gastrointestinal potassium absorption
  2. Direct inhibition of aldosterone synthesis
  3. Increased distal sodium delivery promotes potassium excretion Correct answer.
  4. Enhanced renal potassium reabsorption

Explanation

Loop diuretics increase sodium delivery to the distal nephron, where sodium reabsorption through the epithelial sodium channel drives potassium secretion into the lumen, causing hypokalemia. They do not inhibit aldosterone synthesis, enhance potassium reabsorption, or primarily impair gastrointestinal absorption.

Question 25Surgical Nursing and Anesthesia

Which monitoring value most directly reflects the adequacy of systemic oxygen delivery during cardiopulmonary bypass?

  1. Nasopharyngeal temperature
  2. Mixed venous oxygen saturation Correct answer.
  3. Central venous pressure trend
  4. Arterial line waveform amplitude

Explanation

Mixed venous oxygen saturation reflects the balance between oxygen delivery and oxygen consumption, so a falling value signals inadequate flow, anemia, or increased metabolic demand. It is the standard perfusion adequacy marker used during bypass.

Question 26Surgical Nursing and Anesthesia

During cardiopulmonary bypass, which parameter is typically maintained to guide adequate anticoagulation?

  1. Fibrinogen level
  2. Activated clotting time Correct answer.
  3. International normalized ratio
  4. Platelet count

Explanation

Activated clotting time is measured on bypass because it responds rapidly to heparin and is used to keep anticoagulation in the target range. INR and fibrinogen change too slowly to guide minute-to-minute heparin dosing.

Question 27Surgical Nursing and Anesthesia

A patient becomes hypotensive and tachycardic immediately after protamine administration following bypass. Which cause should be suspected first?

  1. Local anesthetic toxicity
  2. Tension pneumothorax
  3. Protamine reaction Correct answer.
  4. Malignant hyperthermia

Explanation

Rapid protamine infusion can cause histamine-mediated vasodilation, anaphylaxis, or pulmonary vasoconstriction, producing sudden hypotension and tachycardia. Slowing the infusion and supporting hemodynamics are the immediate priorities.

Question 28Surgical Nursing and Anesthesia

Which induction agent is most appropriate for an unstable patient with severely depressed ventricular function?

  1. Sodium thiopental
  2. Etomidate Correct answer.
  3. Propofol
  4. Dexmedetomidine

Explanation

Etomidate provides hypnosis with minimal myocardial depression and minimal blood pressure change, making it suitable for patients with poor ventricular function. Propofol and thiopental cause significant vasodilation and myocardial depression.

Question 29Surgical Nursing and Anesthesia

Which volatile anesthetic is most often avoided in patients at risk for coronary steal because of its vasodilating properties?

  1. Isoflurane Correct answer.
  2. Desflurane
  3. Nitrous oxide
  4. Sevoflurane

Explanation

Isoflurane produces more coronary vasodilation than sevoflurane or desflurane and has historically been linked to coronary steal in susceptible patients. Sevoflurane and desflurane are generally preferred when this concern exists.

Question 30Surgical Nursing and Anesthesia

Which finding best indicates that a patient has adequate neuromuscular recovery before extubation?

  1. Sustained tetanus without fade and a train-of-four ratio above 0.9 Correct answer.
  2. Ability to follow verbal commands
  3. Return of spontaneous eye opening
  4. Presence of two twitches on train-of-four

Explanation

A train-of-four ratio above 0.9 with sustained tetanus and no fade is the objective standard for adequate neuromuscular recovery. Clinical signs such as eye opening or command following can be present despite residual blockade.

Question 31Surgical Nursing and Anesthesia

Which agent is the specific reversal for residual rocuronium blockade?

  1. Neostigmine
  2. Sugammadex Correct answer.
  3. Naloxone
  4. Flumazenil

Explanation

Sugammadex encapsulates rocuronium and vecuronium, rapidly reversing even deep blockade. Neostigmine only reverses partial blockade and works through acetylcholinesterase inhibition.

Question 32Surgical Nursing and Anesthesia

Which position is used to improve surgical exposure for a posterolateral thoracotomy?

  1. Trendelenburg
  2. Prone
  3. Supine
  4. Lateral decubitus Correct answer.

Explanation

The lateral decubitus position places the operative side up and spreads the ribs for posterolateral thoracotomy access. It requires careful padding and attention to dependent-lung ventilation.

Question 33Surgical Nursing and Anesthesia

One-lung ventilation during thoracic surgery most commonly requires which adjustment to reduce the risk of volutrauma to the ventilated lung?

  1. Increasing tidal volume to 12 mL/kg
  2. Increasing respiratory rate to 30 breaths per minute
  3. Applying zero positive end-expiratory pressure
  4. Reducing tidal volume to about 4 to 6 mL/kg predicted body weight Correct answer.

Explanation

The entire tidal volume enters one lung during one-lung ventilation, so lower tidal volumes of roughly 4 to 6 mL/kg predicted body weight limit barotrauma. Moderate PEEP and permissive hypercapnia are often used alongside this strategy.

Question 34Surgical Nursing and Anesthesia

During one-lung ventilation, which strategy best reduces hypoxemia from intrapulmonary shunt?

  1. Reducing positive end-expiratory pressure on the ventilated lung to zero
  2. Increasing the fraction of inspired oxygen on the ventilated lung alone
  3. Increasing the tidal volume on the ventilated lung
  4. Applying continuous positive airway pressure to the non-ventilated lung Correct answer.

Explanation

Applying modest continuous positive airway pressure to the non-dependent, non-ventilated lung reduces shunt by maintaining some oxygenation in that lung. This complements PEEP on the dependent lung.

Question 35Surgical Nursing and Anesthesia

Which finding during surgery most suggests malignant hyperthermia?

  1. Unexplained rising end-tidal carbon dioxide with muscle rigidity Correct answer.
  2. Gradual temperature rise after four hours of anesthesia
  3. Isolated hypertension with tachycardia
  4. Decreased end-tidal carbon dioxide with shallow breathing

Explanation

Malignant hyperthermia classically presents with unexplained hypercarbia and rigidity that precede or accompany temperature rise. The first-line treatment is dantrolene with discontinuation of triggering agents.

Question 36Surgical Nursing and Anesthesia

Which drug is the specific treatment for malignant hyperthermia?

  1. Dantrolene Correct answer.
  2. Atropine
  3. Sodium bicarbonate
  4. Procainamide

Explanation

Dantrolene inhibits calcium release from the sarcoplasmic reticulum and is the definitive treatment for malignant hyperthermia. Supportive measures address hyperkalemia, acidosis, and hyperthermia concurrently.

Question 37Surgical Nursing and Anesthesia

During cardiopulmonary bypass, mean arterial pressure is typically targeted within which range to support organ perfusion while limiting bleeding risk?

  1. 50 to 80 mm Hg Correct answer.
  2. 20 to 30 mm Hg
  3. 130 to 150 mm Hg
  4. 100 to 120 mm Hg

Explanation

Perfusionists commonly target a mean arterial pressure of roughly 50 to 80 mm Hg during bypass, balancing organ perfusion against bleeding and embolic risk. Targets are individualized for patients with cerebrovascular or renal disease.

Question 38Surgical Nursing and Anesthesia

Which fluid is generally avoided as a pump prime in cardiopulmonary bypass because of its effect on coagulation and renal function?

  1. Hydroxyethyl starch Correct answer.
  2. Balanced crystalloid
  3. Ringer's lactate
  4. Albumin

Explanation

Hydroxyethyl starch impairs platelet function and coagulation and has been associated with renal injury, so it is avoided in bypass priming. Crystalloid and albumin are commonly used alternatives.

Question 39Surgical Nursing and Anesthesia

A patient with severe aortic stenosis is undergoing noncardiac surgery. Which hemodynamic goal is most important to maintain?

  1. Permitting hypotension to reduce myocardial work
  2. Inducing tachycardia to increase cardiac output
  3. Reducing systemic vascular resistance with vasodilators
  4. Preserving sinus rhythm, preload, and systemic vascular resistance Correct answer.

Explanation

In aortic stenosis, a fixed outflow obstruction makes cardiac output dependent on preload, atrial kick, and adequate afterload. Tachycardia, vasodilation, and hypotension can cause severe ischemia and collapse.

Question 40Surgical Nursing and Anesthesia

Which monitoring is most useful for detecting myocardial ischemia intraoperatively in a patient with coronary disease?

  1. Pulse oximetry trend
  2. Central venous pressure
  3. Capnography waveform
  4. Continuous ST-segment analysis on the electrocardiogram Correct answer.

Explanation

Continuous ST-segment monitoring detects ischemic changes earlier than vital sign changes alone. It is combined with hemodynamic monitoring to guide therapy in patients with coronary disease.

Question 41Surgical Nursing and Anesthesia

Which agent is preferred for rapid sequence induction in a patient with a full stomach and hemodynamic instability?

  1. Etomidate with succinylcholine Correct answer.
  2. Propofol with rocuronium
  3. Midazolam with fentanyl
  4. Ketamine with vecuronium

Explanation

Etomidate preserves hemodynamics, and succinylcholine provides the fastest onset for rapid airway control. The combination suits an unstable patient at aspiration risk.

Question 42Surgical Nursing and Anesthesia

Which measure best prevents aspiration during induction in a patient with a full stomach?

  1. Using a laryngeal mask airway
  2. Applying cricoid pressure with rapid sequence induction Correct answer.
  3. Placing the patient in deep Trendelenburg
  4. Preoxygenating for ten minutes only

Explanation

Rapid sequence induction with cricoid pressure limits gastric insufflation and regurgitation during the interval before the airway is secured. Suction must be immediately available.

Question 43Surgical Nursing and Anesthesia

Which statement about the effect of positive end-expiratory pressure on cardiac output is most accurate?

  1. It can reduce venous return and cardiac output by raising intrathoracic pressure Correct answer.
  2. It increases cardiac output by reducing afterload
  3. It always increases cardiac output by improving oxygenation
  4. It has no effect on preload

Explanation

High intrathoracic pressure from PEEP impedes venous return to the right heart, which can lower preload and cardiac output. The effect is most pronounced in volume-depleted patients.

Question 44Surgical Nursing and Anesthesia

Which finding most suggests an esophageal intubation?

  1. Rising oxygen saturation
  2. Chest rise with ventilation
  3. Absent sustained waveform on capnography Correct answer.
  4. Bilateral breath sounds

Explanation

An esophageal tube produces no sustained carbon dioxide waveform, which is the most reliable confirmation of tracheal placement. Breath sounds and chest rise can be misleading.

Question 45Surgical Nursing and Anesthesia

During cerebral aneurysm clipping, which strategy is used to reduce transmural pressure and the risk of rupture during dissection?

  1. Induced hypertension
  2. Rapid volume loading
  3. Controlled hypotension or temporary clipping Correct answer.
  4. Hyperventilation to a very low carbon dioxide level

Explanation

Controlled hypotension or temporary clip application lowers transmural pressure across the aneurysm wall during dissection. The goal is balanced against the risk of cerebral ischemia.

Question 46Surgical Nursing and Anesthesia

Which maneuver best reduces the risk of venous air embolism during sitting-position neurosurgery?

  1. Avoiding end-tidal carbon dioxide monitoring
  2. Maintaining a patent airway with positive pressure and using a precordial Doppler Correct answer.
  3. Permitting spontaneous ventilation at low volumes
  4. Deliberately lowering central venous pressure

Explanation

Positive pressure ventilation with a sealed airway and a precordial Doppler for early detection reduce the risk and impact of venous air embolism. A patent foramen ovale increases risk and should be considered.

Question 47Surgical Nursing and Anesthesia

Which is the most appropriate initial management of a sudden drop in end-tidal carbon dioxide with hypotension during a sitting craniotomy?

  1. Increase the volatile anesthetic concentration
  2. Administer a bolus of vasodilator
  3. Flood the field with saline and aspirate the right atrial catheter while supporting hemodynamics Correct answer.
  4. Deepen the neuromuscular blockade

Explanation

A sudden fall in end-tidal carbon dioxide with hypotension suggests venous air embolism; the field should be flooded, air aspirated from a right atrial catheter, and hemodynamics supported. Nitrous oxide should be discontinued.

Question 48Surgical Nursing and Anesthesia

Which measure best reduces the risk of pressure injury during prolonged surgery in the lateral position?

  1. Padding the dependent shoulder, hip, and ear and repositioning periodically Correct answer.
  2. Applying tight straps across the dependent arm
  3. Elevating the head of the bed 60 degrees
  4. Removing all padding to allow direct monitoring

Explanation

Padding pressure points over the dependent shoulder, hip, and ear and periodic repositioning limit prolonged pressure and nerve injury. The dependent arm must be supported and free of compression.

Question 49Surgical Nursing and Anesthesia

Which statement about the effect of hypothermia during cardiopulmonary bypass is most accurate?

  1. It eliminates the need for anticoagulation
  2. It has no effect on coagulation
  3. It lowers cerebral metabolic demand and permits lower pump flows Correct answer.
  4. It increases cerebral oxygen consumption

Explanation

Hypothermia reduces cerebral and systemic metabolic demand, allowing lower flow rates during circulatory support. It also impairs coagulation and platelet function, so rewarming is needed before separation from bypass.

Question 50Surgical Nursing and Anesthesia

During surgery, the anesthesia team is concerned about a patient developing malignant hyperthermia. Which medication is the specific treatment for this condition?

  1. Atropine
  2. Furosemide
  3. Sodium bicarbonate
  4. Dantrolene Correct answer.

Explanation

Dantrolene is the specific antidote for malignant hyperthermia because it inhibits calcium release from the sarcoplasmic reticulum of skeletal muscle, halting the uncontrolled muscle contraction that drives hyperthermia and hypermetabolism. Treatment should be given promptly at the recommended dose and repeated until symptoms resolve, along with supportive cooling and management of hyperkalemia and acidosis.