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CPAN practice questions

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Question 1Perianesthesia patient assessment and evaluation

During Phase I postanesthesia care, at what minimum interval should the patient's vital signs and assessment be documented?

  1. Every 30 minutes
  2. Every 15 minutes Correct answer.
  3. Every 5 minutes
  4. Every 60 minutes

Explanation

ASPAN standards require Phase I assessments on admission and at least every 15 minutes thereafter, with more frequent monitoring based on patient condition. Intervals longer than 15 minutes are not adequate for Phase I.

Question 2Perianesthesia patient assessment and evaluation

Which parameter is included in the Aldrete scoring system for postanesthesia recovery?

  1. Pain intensity score
  2. Oxygen saturation Correct answer.
  3. Urine output volume
  4. Core body temperature

Explanation

The Aldrete score assesses activity, respiration, circulation, consciousness, and oxygen saturation. Urine output, temperature, and pain are not components of the Aldrete score.

Question 3Perianesthesia patient assessment and evaluation

A patient in Phase I has a modified Aldrete score of 9 with stable vital signs. What does this score generally indicate?

  1. Requires immediate reintubation
  2. Meets criteria for Phase II transfer Correct answer.
  3. Has a contraindication to discharge
  4. Must remain in Phase I for 2 more hours

Explanation

A modified Aldrete score of 9 to 10 out of 10 generally meets the score criterion for transfer from Phase I to Phase II, provided other discharge criteria are satisfied. A score below this usually prompts continued observation and reassessment.

Question 4Perianesthesia patient assessment and evaluation

Which factor is part of the Apfel simplified risk score for postoperative nausea and vomiting?

  1. Age older than 70 years
  2. Female sex Correct answer.
  3. Surgery lasting less than 1 hour
  4. Use of regional anesthesia

Explanation

The Apfel score includes female sex, nonsmoking status, history of PONV or motion sickness, and postoperative opioid use. Age, surgery duration, and anesthetic technique are not components of the simplified score.

Question 5Perianesthesia patient assessment and evaluation

Which finding is an early sign of malignant hyperthermia during anesthesia?

  1. Hypothermia
  2. Masseter muscle rigidity Correct answer.
  3. Bradycardia
  4. Decreased end-tidal carbon dioxide

Explanation

Early malignant hyperthermia often presents with masseter muscle rigidity, rising end-tidal carbon dioxide, tachycardia, and hypercarbia before a measurable temperature increase. Prompt recognition and treatment are critical.

Question 6Perianesthesia patient assessment and evaluation

A Mallampati class III airway assessment indicates which finding?

  1. Uvula and soft palate completely hidden
  2. Hard palate only visible
  3. Full view of tonsillar pillars and uvula
  4. Only soft palate and uvular base visible Correct answer.

Explanation

Mallampati class III shows only the soft palate and base of the uvula, with the tonsillar pillars and full uvula obscured. This finding suggests a potentially difficult intubation.

Question 7Perianesthesia patient assessment and evaluation

Which set of variables is included in the STOP-BANG questionnaire for obstructive sleep apnea?

  1. Age, weight, height, waist circumference
  2. Allergies, medications, surgical history, family history
  3. Pain score, oxygen saturation, heart rate, temperature
  4. Snoring, tiredness, observed apnea, blood pressure Correct answer.

Explanation

STOP-BANG stands for Snoring, Tiredness, Observed apnea, Pressure (hypertension), BMI, Age, Neck circumference, and Gender. It is a screening tool, not a diagnostic test.

Question 8Perianesthesia patient assessment and evaluation

A patient rates postoperative pain as 7 on a 0-to-10 numeric rating scale. How should the nurse interpret this score?

  1. No pain is present
  2. Severe pain Correct answer.
  3. Moderate pain
  4. Mild pain

Explanation

On a 0-to-10 numeric rating scale, 0 indicates no pain, 1 to 3 indicates mild pain, 4 to 6 indicates moderate pain, and 7 to 10 indicates severe pain. A score of 7 warrants prompt intervention and reassessment.

Question 9Perianesthesia patient assessment and evaluation

Using the Richmond Agitation-Sedation Scale, how is a patient scored who briefly opens the eyes to voice but does not maintain eye contact?

  1. -1
  2. 0
  3. -2 Correct answer.
  4. +1

Explanation

RASS -2 describes light sedation in which the patient briefly awakens with eye contact to voice for less than 10 seconds. RASS -1 describes a patient who sustains awakening to voice for longer than 10 seconds.

Question 10Perianesthesia patient assessment and evaluation

Which patient has the highest risk for opioid-induced respiratory depression in the PACU?

  1. A 72-year-old with obstructive sleep apnea receiving IV opioids Correct answer.
  2. A 28-year-old healthy patient after arthroscopy receiving no opioids
  3. A 45-year-old receiving only a peripheral nerve block
  4. A 35-year-old with no comorbidities receiving NSAIDs only

Explanation

Risk for opioid-induced respiratory depression increases with older age, obstructive sleep apnea, and systemic opioid administration. Patients receiving no opioids or only NSAIDs are at much lower risk.

Question 11Perianesthesia patient assessment and evaluation

Which parameter is included in the Post Anesthesia Discharge Scoring System (PADSS)?

  1. Surgical bleeding Correct answer.
  2. Serum creatinine
  3. White blood cell count
  4. Liver function tests

Explanation

PADSS evaluates vital signs, activity level, nausea and vomiting, pain, and surgical bleeding. Laboratory values such as creatinine, white blood cell count, and liver function tests are not part of the score.

Question 12Perianesthesia patient assessment and evaluation

Which monitoring modality detects opioid-induced respiratory depression earliest in a spontaneously breathing PACU patient?

  1. Pulse oximetry
  2. Capnography Correct answer.
  3. Noninvasive blood pressure
  4. Manual respiratory rate counting every 15 minutes

Explanation

Capnography detects hypoventilation and apnea through changes in exhaled carbon dioxide before oxygen saturation falls. Pulse oximetry can lag behind because of oxygen reserve and may not detect hypoventilation promptly.

Question 13Perianesthesia patient assessment and evaluation

An end-tidal carbon dioxide reading of 55 mm Hg in a spontaneously breathing postoperative patient most likely indicates which condition?

  1. Hyperventilation
  2. Hypoventilation Correct answer.
  3. Metabolic alkalosis
  4. Normal ventilation

Explanation

Normal end-tidal carbon dioxide is approximately 35 to 45 mm Hg. A value of 55 mm Hg suggests hypoventilation and retained carbon dioxide.

Question 14Perianesthesia patient assessment and evaluation

A train-of-four ratio of 0.7 in the PACU indicates which condition?

  1. Normal baseline neuromuscular function
  2. Overdose of reversal agent
  3. Adequate recovery from neuromuscular blockade
  4. Residual neuromuscular blockade Correct answer.

Explanation

A train-of-four ratio of at least 0.9 is generally required to indicate adequate recovery from neuromuscular blockade. A ratio of 0.7 indicates residual blockade with increased risk of weakness and airway compromise.

Question 15Perianesthesia patient assessment and evaluation

Which core temperature defines perioperative hypothermia?

  1. Below 35.0°C
  2. Below 37.0°C
  3. Below 36.0°C Correct answer.
  4. Below 37.5°C

Explanation

Perioperative hypothermia is generally defined as a core temperature below 36.0°C. Even mild hypothermia can impair coagulation, increase shivering, and prolong recovery.

Question 16Perianesthesia patient assessment and evaluation

A PACU patient has blood pressure 82/50 mm Hg, heart rate 122 beats/min, and cool clammy skin. Which cause is most likely?

  1. Hypovolemia Correct answer.
  2. Anaphylaxis
  3. Opioid overdose
  4. Malignant hyperthermia

Explanation

Hypotension with tachycardia and cool, clammy skin suggests hypovolemia or hemorrhage. Malignant hyperthermia causes hyperthermia and rigidity, opioid overdose causes bradycardia, and anaphylaxis often causes warm flushed skin and urticaria.

Question 17Perianesthesia patient assessment and evaluation

Which urine output value indicates adequate renal perfusion in an adult PACU patient?

  1. 2.0 mL/kg/hr
  2. 0.1 mL/kg/hr
  3. 0.3 mL/kg/hr
  4. 0.6 mL/kg/hr Correct answer.

Explanation

Adequate urine output in adults is generally at least 0.5 mL/kg/hr. Values below this may indicate hypovolemia or impaired renal perfusion.

Question 18Perianesthesia patient assessment and evaluation

A 6-year-old child is agitated, inconsolable, and disoriented 20 minutes after sevoflurane anesthesia. Which condition is most consistent with this presentation?

  1. Opioid-induced respiratory depression
  2. Malignant hyperthermia
  3. Emergence delirium Correct answer.
  4. Postoperative delirium related to dementia

Explanation

Emergence delirium is an acute confusional state during recovery, commonly seen in children after volatile anesthetics. It is characterized by agitation, inconsolability, and disorientation.

Question 19Perianesthesia patient assessment and evaluation

Which pain assessment tool is most appropriate for a 2-year-old postoperative patient?

  1. Numeric rating scale
  2. FLACC scale Correct answer.
  3. Verbal descriptor scale
  4. Visual analog scale

Explanation

The FLACC scale is an observational tool for children who cannot self-report pain, including young children and toddlers. Numeric, visual analog, and verbal descriptor scales require the patient to understand and report pain.

Question 20Perianesthesia patient assessment and evaluation

Which factor most strongly increases the risk of postoperative delirium in an older adult?

  1. Male sex
  2. Use of regional anesthesia technique
  3. Younger age at the time of surgery
  4. Baseline cognitive impairment Correct answer.

Explanation

Preexisting cognitive impairment or dementia is a major risk factor for postoperative delirium in older adults. Age, sensory impairment, and polypharmacy also contribute.

Question 21Perianesthesia patient assessment and evaluation

A patient in the PACU reports nausea and has repeated retching. How should the nurse document this finding?

  1. Normal gastric emptying
  2. Regurgitation without nausea
  3. Dysphagia
  4. PONV Correct answer.

Explanation

Nausea with retching or vomiting is documented as postoperative nausea and vomiting (PONV). Retching is a component of vomiting and should be treated and documented accordingly.

Question 22Perianesthesia patient assessment and evaluation

After a thyroidectomy, a patient has 200 mL of bright red blood in the drain over 1 hour and reports neck tightness. What is the priority nursing action?

  1. Increase the drain suction
  2. Assess airway and call surgeon Correct answer.
  3. Document and reassess in 2 hours
  4. Give the scheduled analgesic

Explanation

Neck hematoma after thyroidectomy can rapidly compress the airway and cause respiratory compromise. The priority is to assess airway patency and notify the surgeon immediately.

Question 23Perianesthesia patient assessment and evaluation

A patient develops seizures and cardiovascular collapse shortly after an interscalene brachial plexus block. Which complication is most likely?

  1. Local anesthetic toxicity Correct answer.
  2. Vasovagal syncope
  3. Anaphylaxis to bupivacaine
  4. Malignant hyperthermia

Explanation

Local anesthetic systemic toxicity can present with neurologic symptoms such as seizures followed by cardiovascular collapse after local anesthetic injection. Prompt recognition and lipid emulsion therapy may be required.

Question 24Perianesthesia patient assessment and evaluation

A patient has not voided for 6 hours after surgery and reports suprapubic discomfort. What is the most appropriate initial assessment?

  1. Perform a bladder scan Correct answer.
  2. Administer a diuretic
  3. Encourage oral fluids and reassess in 4 hours
  4. Immediate straight catheterization

Explanation

A bladder scan noninvasively quantifies urine volume and confirms urinary retention before catheterization is performed. Catheterization should be reserved for confirmed retention or clinical need.

Question 25Perianesthesia patient assessment and evaluation

Which communication tool is recommended for structured handoff of a postanesthesia patient?

  1. DAR
  2. SBAR Correct answer.
  3. SOAP
  4. PIE

Explanation

SBAR (Situation, Background, Assessment, Recommendation) is a structured handoff tool that improves communication during transitions of care. SOAP, PIE, and DAR are documentation formats rather than handoff tools.

Question 26Perianesthesia patient assessment and evaluation

Which ASA physical status class describes a patient with severe systemic disease that is a constant threat to life?

  1. ASA II
  2. ASA V
  3. ASA III
  4. ASA IV Correct answer.

Explanation

The ASA physical status scale runs from I (healthy) to VI (brain-dead organ donor), with each class defined by the degree of systemic disease and functional limitation. Class IV denotes severe systemic disease that is a constant threat to life, distinct from class III, which is severe disease without a constant threat.

Question 27Perianesthesia patient assessment and evaluation

For a healthy adult having elective surgery, ingestion of clear liquids should be stopped how long before induction of anesthesia?

  1. 8 hours
  2. 2 hours Correct answer.
  3. 6 hours
  4. 4 hours

Explanation

Clear liquids empty from the stomach rapidly, so current ASA fasting guidance requires at least a 2-hour fast for clear liquids, 6 hours after a light meal, and 8 hours after fatty or fried food. The time of the last intake should be verified and documented during the preanesthesia assessment.

Question 28Perianesthesia patient assessment and evaluation

Shortly after extubation, a patient develops a harsh, high-pitched inspiratory sound with suprasternal retractions and decreasing oxygen saturation. Which condition do these findings most suggest?

  1. Laryngospasm Correct answer.
  2. Bronchospasm
  3. Pulmonary edema
  4. Atelectasis

Explanation

Partial upper airway closure at the level of the vocal cords produces inspiratory stridor with accessory muscle use and retractions. Immediate management focuses on opening the airway with continuous positive airway pressure, jaw thrust, and suctioning while calling for anesthesia assistance.

Question 29Perianesthesia patient assessment and evaluation

Which set of factors makes up the simplified Apfel score used to estimate postoperative nausea and vomiting risk?

  1. Male sex, current smoking, and insulin-dependent diabetes
  2. Female sex, nonsmoking, PONV history, and postoperative opioids Correct answer.
  3. Use of nitrous oxide and emergency surgical status
  4. Age above 70 years and surgery lasting more than 3 hours

Explanation

The simplified Apfel score assigns one point each for female sex, nonsmoker status, a history of PONV or motion sickness, and anticipated postoperative opioid use. Each additional point corresponds to a stepwise increase in the predicted incidence of postoperative nausea and vomiting.

Question 30Perianesthesia patient assessment and evaluation

Which preoperative history finding most warrants planning for malignant hyperthermia precautions?

  1. Severe nausea and vomiting after a prior anesthetic
  2. First-degree relative with a documented MH crisis Correct answer.
  3. Childhood asthma treated with inhaled albuterol
  4. Documented penicillin allergy with urticaria

Explanation

Susceptibility to malignant hyperthermia is inherited, so a personal or family history of an MH crisis, unexplained intraoperative hyperthermia, or masseter muscle rigidity warrants a trigger-free anesthetic and dantrolene availability. Other prior anesthetic reactions do not predict MH.

Question 31Perianesthesia patient assessment and evaluation

Which set of vital sign changes meets the definition of orthostatic hypotension in an adult?

  1. A fall of 10 mm Hg systolic or 5 mm Hg diastolic
  2. A fall of 5 mm Hg systolic or 5 mm Hg diastolic
  3. A fall of 20 mm Hg systolic or 10 mm Hg diastolic Correct answer.
  4. A rise of 20 mm Hg systolic with standing

Explanation

Orthostatic hypotension is defined as a drop of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of assuming an upright position. In the perianesthesia setting it suggests hypovolemia, residual sympathetic blockade, or medication effect and should be correlated with symptoms.

Question 32Perianesthesia patient assessment and evaluation

An adult scheduled for elective outpatient surgery reports a productive cough, a temperature of 38.3 degrees C, and wheezing that began 4 days ago. What is the most appropriate action?

  1. Proceed with surgery and add postoperative antibiotics
  2. Notify the anesthesia provider and expect the case to be postponed Correct answer.
  3. Obtain a chest radiograph and proceed if it is normal
  4. Cancel the case permanently and refer to a pulmonologist

Explanation

An active febrile respiratory infection increases the risk of bronchospasm, laryngospasm, hypoxemia, and postoperative pulmonary complications, so elective procedures are typically delayed until symptoms resolve. The nurse's role is to document the findings and escalate them promptly so the anesthesia provider can decide on timing.

Question 33Perianesthesia patient assessment and evaluation

Eight hours after spinal anesthesia, a patient reports new severe back pain and has progressive lower extremity weakness with urinary retention. Which complication should be suspected first?

  1. Postdural puncture headache
  2. Transient neurologic symptoms
  3. Residual motor blockade
  4. Spinal epidural hematoma Correct answer.

Explanation

Severe back pain with progressive motor and sensory deficits plus bowel or bladder dysfunction after neuraxial anesthesia suggests an expanding epidural hematoma or abscess, which requires urgent imaging and decompression. Residual block should be stable or improving, making deterioration an alarming finding.

Question 34Perianesthesia patient assessment and evaluation

Three days after intramedullary nailing of a femoral shaft fracture, a patient becomes confused and has a petechial rash over the chest and axillae with an oxygen saturation of 88% on room air. Which complication is most likely?

  1. Sepsis from surgical site infection
  2. Pulmonary thromboembolism
  3. Fat embolism syndrome Correct answer.
  4. Malignant hyperthermia

Explanation

The combination of hypoxemia, neurologic change, and a petechial rash appearing 24 to 72 hours after a long bone fracture is the classic triad of fat embolism syndrome. Management is supportive, with oxygen, hemodynamic support, and monitoring for respiratory failure.

Question 35Anesthesia and analgesia management

Which statement best defines the minimum alveolar concentration (MAC) of an inhalant anesthetic?

  1. The vaporizer setting that keeps the majority of patients at a surgical plane of anesthesia
  2. The blood concentration at which 95% of patients become unconscious and lose airway reflexes
  3. The lowest end-tidal concentration that abolishes the palpebral reflex in 50% of patients
  4. The alveolar concentration that blocks movement in half of patients given a noxious stimulus Correct answer.

Explanation

MAC is the alveolar concentration, expressed as volume percent, at which 50% of patients fail to move purposefully in response to a supramaximal noxious stimulus. It is a population median, so individual patients may require more or less, and surgical planes are usually maintained near 1.3 to 1.5 MAC.

Question 36Anesthesia and analgesia management

Which cardiovascular effect is primarily associated with acepromazine administration?

  1. Increased cardiac contractility
  2. Bradycardia from direct vagal stimulation
  3. Hypertension from beta-2 receptor stimulation
  4. Hypotension from alpha-1 adrenergic blockade Correct answer.

Explanation

Acepromazine is a phenothiazine that blocks alpha-1 adrenergic receptors, producing peripheral vasodilation and dose-dependent hypotension. It also blocks dopamine receptors, which contributes to sedation and extrapyramidal effects, and it provides no analgesia.

Question 37Anesthesia and analgesia management

A pulse oximeter on an anesthetized dog breathing room air reads 88%. How should this be interpreted?

  1. It most likely reflects hyperventilation rather than a true oxygenation problem
  2. It is within normal limits for an anesthetized patient breathing room air
  3. It indicates hypoxemia and warrants prompt assessment and oxygen support Correct answer.
  4. It suggests a faulty probe because values below 90% do not occur in practice

Explanation

An SpO2 below 90% corresponds roughly to a PaO2 below 60 mmHg and represents clinically important hypoxemia. The airway, circuit, probe placement, and oxygen supply should be checked immediately while supplemental oxygen is provided.

Question 38Anesthesia and analgesia management

Which drug is used to reverse the sedative effects of dexmedetomidine?

  1. Naloxone
  2. Atropine
  3. Flumazenil
  4. Atipamezole Correct answer.

Explanation

Atipamezole is a selective alpha-2 adrenergic antagonist that reverses medetomidine and dexmedetomidine. It is given intramuscularly, often at several times the volume of the administered alpha-2 agonist, and can produce transient tachycardia and arousal.

Question 39Anesthesia and analgesia management

Which measure most effectively limits intraoperative heat loss in a small anesthetized dog?

  1. Active warming with forced-air and circulating-water blankets Correct answer.
  2. Delaying intravenous fluid therapy until after recovery
  3. Using a high fresh gas flow to warm the breathing circuit
  4. Withholding premedication to prevent vasodilation

Explanation

Anesthetized patients lose heat by radiation, conduction, convection, and evaporation, and small patients lose it fastest because of their high surface area to body weight ratio. Active external warming, warmed fluids, humidified low-flow circuits, and insulation together limit the drop in core temperature.

Question 40Anesthesia and analgesia management

Which property best describes propofol when used for induction of anesthesia?

  1. It is a dissociative agent that preserves laryngeal reflexes
  2. It provides smooth, rapid induction and recovery after a single dose Correct answer.
  3. It produces prolonged recovery because of accumulation in fat
  4. It requires dilution in sterile water before intravenous use

Explanation

Propofol is highly lipid soluble, so it crosses the blood-brain barrier quickly and produces rapid induction; recovery after a single induction dose follows rapid redistribution. It causes dose-dependent apnea and hypotension and is given undiluted intravenously.

Question 41Anesthesia and analgesia management

During isoflurane anesthesia a dog shows a strong palpebral reflex, increased jaw tone, and a rising heart rate. What is the best interpretation?

  1. Anesthesia is light; deepen or provide additional analgesia before proceeding Correct answer.
  2. The patient is at a suitable surgical plane and no adjustment is needed
  3. The palpebral reflex indicates a neurologic problem unrelated to depth
  4. Anesthesia is excessive and the vaporizer should be turned down immediately

Explanation

A brisk palpebral reflex, increased jaw tone, and rising heart rate and blood pressure are signs of a light plane of anesthesia. Deepening the anesthetic or adding analgesia before continuing surgery prevents awareness and sympathetic stimulation.

Question 42Anesthesia and analgesia management

A Doppler ultrasonic flow detector placed over a peripheral artery estimates which pressure?

  1. Mean arterial pressure
  2. Central venous pressure
  3. Systolic pressure Correct answer.
  4. Diastolic pressure

Explanation

The Doppler probe detects the return of arterial flow as the cuff deflates, which corresponds most closely to systolic pressure. Oscillometric devices instead report systolic, diastolic, and mean arterial pressures directly.

Question 43Anesthesia and analgesia management

Capnography shows an end-tidal CO2 of 62 mmHg in a spontaneously breathing anesthetized dog. What does this indicate?

  1. A normal value for a dog maintained on isoflurane
  2. Hyperventilation caused by inadequate anesthetic depth
  3. Hypoventilation that requires ventilatory support Correct answer.
  4. A circuit leak diluting the sampled gas with room air

Explanation

End-tidal CO2 is normally about 35 to 45 mmHg, so a value above roughly 55 to 60 mmHg indicates alveolar hypoventilation. Common causes include anesthetic-induced respiratory depression, airway obstruction, and rebreathing, and assisted ventilation is indicated.

Question 44Anesthesia and analgesia management

Which finding is the clearest indication to begin intermittent positive pressure ventilation?

  1. A systolic blood pressure of 100 mmHg
  2. End-tidal CO2 of 38 mmHg with a respiratory rate of 12 breaths per minute
  3. Apnea lasting longer than 60 seconds after induction Correct answer.
  4. An SpO2 of 97% while breathing 100% oxygen

Explanation

Positive pressure ventilation is indicated for apnea, hypoventilation with end-tidal CO2 above roughly 60 mmHg, and when ventilation must be controlled, such as during thoracotomy or to manage intracranial pressure. Normal ventilation and oxygenation values do not require intervention.

Question 45Anesthesia and analgesia management

Ketamine produces anesthesia primarily through which mechanism?

  1. Activation of mu opioid receptors
  2. Antagonism of NMDA glutamate receptors Correct answer.
  3. Blockade of voltage-gated sodium channels
  4. Potentiation of GABA-A receptor activity

Explanation

Ketamine is a dissociative anesthetic that antagonizes NMDA-type glutamate receptors, producing analgesia and amnesia while tending to preserve airway reflexes and sympathetic tone. Subanesthetic doses are used as constant rate infusions for somatic analgesia.

Question 46Anesthesia and analgesia management

A 10 kg dog is to receive lidocaine without epinephrine. Using a maximum dose of 4 mg/kg, what total dose should not be exceeded?

  1. 20 mg
  2. 30 mg
  3. 40 mg Correct answer.
  4. 10 mg

Explanation

Multiplying 4 mg/kg by 10 kg gives 40 mg, which is the recommended ceiling for lidocaine without epinephrine in dogs. Exceeding it risks dose-related central nervous system excitation, seizures, and cardiovascular collapse, so doses are reduced for cats and for concurrent epinephrine use.

Question 47Anesthesia and analgesia management

Which condition is an absolute contraindication to lumbosacral epidural injection?

  1. A history of chronic otitis externa
  2. Mild dehydration in an otherwise healthy dog
  3. Coagulopathy or infection at the injection site Correct answer.
  4. A closed fracture of the tibia

Explanation

Epidural puncture in a patient with coagulopathy risks epidural hematoma, and local infection risks introducing bacteria into the epidural space. Relative contraindications also include hypovolemia, which can worsen hypotension from sympathetic blockade.

Question 48Anesthesia and analgesia management

Which statement about meloxicam in cats is correct?

  1. It is COX-2 preferential and has a long half-life in cats Correct answer.
  2. It is dosed at the same mg/kg in cats as in dogs for long-term use
  3. It is a selective COX-1 inhibitor with minimal gastrointestinal risk
  4. It may be combined with another NSAID to improve analgesia

Explanation

Meloxicam preferentially inhibits COX-2 and has a markedly longer half-life in cats, which have limited glucuronidation capacity. Chronic dosing therefore uses a low maintenance dose given at extended intervals, and NSAIDs must not be combined with each other or with corticosteroids.

Question 49Anesthesia and analgesia management

Which benzodiazepine is preferred for sedation in a patient with severe hepatic dysfunction?

  1. Midazolam, because it is water soluble and undergoes extrahepatic metabolism Correct answer.
  2. Diazepam, because it also provides visceral analgesia in hepatic disease
  3. Diazepam, because it has the shortest duration of action of the benzodiazepines
  4. Flurazepam, because it is excreted unchanged in the urine and bile

Explanation

Midazolam is water soluble, can be given intramuscularly or intravenously, and is partly metabolized by extrahepatic pathways, making it the safer choice when hepatic function is poor. Diazepam relies on hepatic metabolism and its propylene glycol vehicle can accumulate.

Question 50Anesthesia and analgesia management

Compared with isoflurane, sevoflurane has which property?

  1. Greater sensitization of the myocardium to circulating catecholamines
  2. A pungent odor that makes mask induction difficult in cats
  3. Lower blood-gas solubility, so induction and recovery are faster Correct answer.
  4. A higher blood-gas solubility coefficient and slower equilibration

Explanation

Sevoflurane has a lower blood-gas solubility coefficient than isoflurane, so alveolar and brain concentrations equilibrate rapidly and depth changes quickly. It is also less pungent, which makes it suitable for mask induction.