Deck 15: Sedatives, Analgesics, and Paralytics

Question 1

The paralytic agent associated with precipitation of malignant hyperthermia is which of the following?

A) Vecuronium
B) Cisatracurium
C) Pancuronium
D) Succinylcholine

Answer 1

D
Succinylcholine can precipitate malignant hyperthermia in susceptible individuals.Malignant hyperthermia is a rare but potentially fatal disorder characterized by sustained skeletal muscle depolarization.It occurs in 1 in 50,000 adults and 1 in 15,000 pediatric patients.

Question 2

Caution should be used when administering propofol for longer than 48 hours in pediatric patients because of what adverse effect?

A) Lethargy
B) Lactic acidosis
C) Cardiac dysrhythmias
D) Reduced cerebral blood flow

Answer 2

B
Prolonged use of propofol (longer than 48 hours)in pediatric patients has been associated with the development of lactic acidosis.

Question 3

A patient with hypovolemic shock secondary to widespread second- and third-degree burns is being mechanically ventilated.The patient appears agitated,and the respiratory therapist is unable to synchronize the ventilator to the patient.Which drug can the respiratory therapist suggest to the ICU team to sedate this patient and synchronize ventilation?

A) Fentanyl
B) Morphine
C) Propofol
D) Succinylcholine

Answer 3

A
Fentanyl has minimal effects on the cardiovascular system and does not cause histamine release,as does morphine.It also has minimal effects on the renal system compared with other opioids.Therefore,fentanyl is the opioid of choice for patients with unstable hemodynamic status and renal insufficiency.Morphine and propofol have hemodynamic effects that may worsen this patient's hypovolemia.Succinylcholine is a paralyzing agent.Paralyzing agents should not be given without sedatives.

Question 4

The train-of-four response is used to assess a patient's level of paralysis during high-frequency oscillatory ventilation,and the patient's foot twitches four times.The most appropriate evaluation of this circumstance is which of the following?

A) Nothing need be done; paralysis is adequate.
B) The paralyzing agent is moderately effective.
C) The paralyzing agent needs to be readministered.
D) Propofol needs to be added to enhance the effect.

Question 5

The drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours is which of the following?

A) Lorazepam (Ativan)
B) Midazolam (Versed)
C) Diazepam (Valium)
D) Propofol (Diprivan)

Question 6

A patient with head trauma and an elevated ICP is being ventilated postoperatively and shows signs of asynchrony with the mechanical ventilator.The most appropriate medication to sedate this patient is which of the following?

A) Morphine
B) Propofol
C) Propofol and morphine
D) Fentanyl

Question 7

The group of drugs that interact with GABA receptor complex on neurons in the brain is which of the following?

A) Opioids
B) Paralytics
C) Benzodiazepines
D) Depolarizing agents

Question 8

Which of the following is the sedation scale that uses a graduated single category?

A) Comfort Scale
B) Motor Activity Assessment Scale
C) Ramsay Sedation Scale
D) Sedation-Agitation Scale

Question 9

Which of the following drugs has the potential for causing bronchospasm in patients with asthma and hypersensitive airways?

A) Fentanyl
B) Propofol
C) Diazepam
D) Morphine

Question 10

The neuromuscular blocking agent that resembles acetylcholine in chemical structure is which of the following?

A) Succinylcholine
B) Pancuronium
C) Vecuronium
D) Cisatracurium

Question 11

Permissive hypercapnia is needed to protect patients with ARDS from atelectrauma.Which of the following medications is appropriate to facilitate this?

A) Propofol
B) Fentanyl
C) Midazolam
D) Cisatracurium

Question 12

What range of scores on the Ramsay Sedation Scale indicates adequate sedation?

A) 1-3
B) 2-4
C) 3-5
D) 5-6

Question 13

Which of the following describes moderate sedation?

A) The patient can respond to verbal commands, although cognitive function may be impaired.
B) The patient is not easily aroused but can respond to painful stimulation.
C) The patient can perform purposeful response following repeated or painful stimulation.
D) The patient cannot be aroused, even by painful stimulation.

Question 14

A patient who is receiving mechanical ventilation in the ICU is found to be wildly agitated.The most appropriate drug to control this delirium is which of the following?

A) Propofol
B) Fentanyl
C) Haloperidol
D) Lorazepam

Question 15

What drug reverses the sedative effects of benzodiazepines?

A) Naloxone
B) Flumazenil
C) Fentanyl
D) Vecuronium

Question 16

A mechanically ventilated patient is being assessed for her level of sedation.The patient is semiasleep and responds to verbal commands.What score on the Ramsay Sedation Scale should be assigned to this patient?

A) 2
B) 3
C) 4
D) 5

Question 17

Neuromuscular blocking agents are commonly used in mechanically ventilated patients when which of the following occurs?

A) The patient is in severe pain.
B) Cardiac arrhythmias are present.
C) The patient develops anxiety as a result of ICU psychosis.
D) Patient-ventilator dyssynchrony cannot be corrected.