GKA CPC Exam Study Guide - Questions, Answers and Rationales Where is the proper placement of Magill forceps on the endotracheal tube for nasal
... [Show More] intubation? On the connector On the cuff Distal to the cuff Proximal to the cuff Rationale The Magill forceps should be placed proximal to the cuff to prevent tearing of the cuff and aid in the placement of the endotracheal tube. A 0.5-mL dose of a 1:1,000 solution of epinephrine contains how many milligrams of epinephrine? 0.1 0.5 1 5 Rationale In a 1:1,000 solution, there is 1 g in 1,000 mL of solution; 1 g is 1,000 mg; therefore, 1,000 mg in 1,000 mL is 1 mg per 1 mL, or 0.5 mg of epinephrine in 0.5 mL of a 1:1,000 solution. A 65-year-old man is admitted for altered mental status, pulse oximeter desaturations to the low 90s, blood in the airway, and increased work of breathing. Past medical history includes recent chemotherapy and radiation exposure for head and neck carcinoma. Intubation by anesthesia personnel is requested secondary to severe mucositis. Which is the MOST important consideration for airway management? Cervical spine laxity Loss of skeletal muscle tone Reduced need for sedatives Increased risk for aspiration Rationale Mucositis is a painful inflammation and ulceration of the mucous membranes of the digestive tract. Oral mucositis is a relatively common adverse effect of high-dose chemotherapy and radiation to the head and neck. Oral lesions begin as mucosal whitening followed by the development of erythema and tissue friability. Narcotics are frequently required to achieve adequate analgesia. In its most severe form, pseudomembrane formation, edema, and bleeding may cause airway compromise or risk of aspiration. Which inhaled agent forms a haloalkene compound that is toxic to the kidneys? Nitrous oxide Isoflurane (Forane) Desflurane (Suprane) Sevoflurane (Ultane) Rationale Sevoflurane forms a haloalkene compound known as compound A, which is a known nephrotoxin. Sensation to the airway below the epiglottis is provided by which cranial nerve? Glossopharyngeal Vagus Facial Trigeminal Rationale The vagus nerve provides sensation to the airway below the epiglottis. The facial nerve provides sensations of taste. The glossopharyngeal nerve provides sensation to the posterior third of the tongue, roof of the pharynx, tonsils, and undersurface of the soft palate. The trigeminal nerve provides innvervation to the mucous membranes of the nose, and other branches of the trigeminal nerve provide sensation to the hard and soft palates and anterior two-thirds of the tongue. Which side effect would be expected from a nonspecific beta-receptor antagonist? Bronchoconstriction Increased heart rate Uterine relaxation Increased cardiac output Rationale Effects of nonspecific beta-receptor antagonists include bronchoconstriction, bradycardia, and decreased myocardial contractility resulting in decreased cardiac output. A patient with emergent stroke comes for an embolization procedure. The patient is allergic to morphine and sulfonamides. He has a history of gout, hypertension, gastrointestinal bleeding, and reflux. Which medication should be avoided in the postoperative orders? Ketorolac (Toradol) Hydromorphone (Dilaudid) Fentanyl (Sublimaze) Acetaminophen Rationale Ketorolac is a nonselective inhibitor of prostaglandin synthesis. It is contraindicated in patients with a history of peptic ulcer disease and gastrointestinal bleeding. Which anesthesia machine component is NOT monitored via an oxygen analyzer? Auxiliary oxygen flowmeter Circle system Ventilator Reservoir bag Rationale Oxygen analyzers measure the fraction of inspired oxygen delivered by the anesthesia gas machine. The auxiliary oxygen flowmeter obtains oxygen from the high-pressure oxygen system or from a wall source and has no oxygen analyzer for monitoring the administered content of oxygen. Which criteria are recommended for awake extubation? (Select 2.) Bucking against the ventilator Attempted spontaneous respiration Following commands Sustained head lift >5 seconds Rationale Criteria for awake extubation include T1/T4 ratio >0.7, following commands, sustained head lift >5 seconds, intact gag reflex, and tidal volume >6 mL/kg. What is a late clinical sign of carbon dioxide absorbent exhaustion? Hyperventilation Flushed appearance Dysrhythmia Respiratory alkalosis Rationale Carbon dioxide is a cardiac stimulant that initially increases blood pressure, heart rate, and respiration and causes a flushed appearance. Eventually cardiac irregularities develop as a late sign of carbon dioxide absorbent exhaustion. A patient undergoing central line placement under general anesthesia develops an increase in heart rate from 98/min to 185/min associated with a regular, narrow QRS complex and lack of normal P wave during guidewire insertion. The arrhythmia persists after guidewire removal and BP is 70/40 mm Hg. The MOST appropriate action is to: prepare to defibrillate. commence chest compressions. administer adenosine. obtain a transesophageal echocardiogram. Rationale A rapid, regular rhythm, often between 130/min and 270/min, usually with a narrow QRS complex and lacking the normal sinoatrial node P wave, characterizes paroxysmal supraventricular tachycardia (PSVT). Adenosine (6-12 mg by IV bolus) has been used to slow the rate by transiently enhancing the normal degree of atrioventricular block, or to terminate the arrhythmia. Esophageal leads may also be helpful to better define atrial activity; however, transesophageal chocardiography will not terminate the arrhythmia in this unstable patient (ie, hypotension). Chest compressions are not warranted. PSVT may also be treated with synchronized cardioversion and does not require defibrillation. What is the BEST action to prevent prerenal acute kidney injury during the perioperative period? Optimize fluid volume status. Avoid renally excreted agents. Reduce blood pressure. Administer diuretic agent. Rationale Prerenal acute kidney injury occurs due to reduced perfusion to the kidney. The injury occurs due to hypoxic ischemia and debris released into the tubules. It is most often caused by low-volume states. Which drug would be MOST appropriate to maintain hemodynamic stability during induction of anesthesia? Propofol (Diprivan) Dexmedetomidine (Precedex) Methohexital (Brevital) Etomidate (Amidate) Rationale Etomidate has the least effect on heart rate and blood pressure compared to other listed induction agents, thus maintaining stable hemodynamics during induction. Which nerve is MOST likely to be injured in the anesthetized patient who is in the sitting position? Obturator Sciatic [Show Less]