1. A patient undergoing procedural sedation and analgesia (PSA) is at risk for respiratory depression. Which of the following is the most appropriate intervention?
• A. Administer naloxone.
• B. Place the patient in a prone position.
• C. Increase the sedation dose.
• D. Encourage deep ...
NCLEX-Style Questions for Chapter 20: Procedural Sedation and Analgesia
1. A patient undergoing procedural sedation and analgesia (PSA) is at risk for respiratory
depression. Which of the following is the most appropriate intervention?
• A. Administer naloxone.
• B. Place the patient in a prone position.
• C. Increase the sedation dose.
• D. Encourage deep breathing exercises.
Answer: A
Rationale: Naloxone is an opioid antagonist that reverses respiratory depression caused by
opioid use during procedural sedation. Increasing the sedation dose would worsen respiratory
depression, and the prone position would not improve ventilation.
2. Which of the following medications is most commonly used for moderate procedural
sedation due to its short half-life and minimal cardiovascular effects?
• A. Propofol
• B. Midazolam
• C. Fentanyl
• D. Ketamine
Answer: B
Rationale: Midazolam, a benzodiazepine, is frequently used for moderate sedation because of its
amnestic and anxiolytic properties. Propofol is typically used for deeper sedation or general
anesthesia, while fentanyl is used for pain relief and ketamine for dissociative sedation.
3. What is the priority nursing intervention when a patient is experiencing apnea during
procedural sedation?
• A. Increase oxygen flow rate.
• B. Administer a muscle relaxant.
• C. Begin bag-valve-mask ventilation.
• D. Administer flumazenil.
Answer: C
Rationale: When apnea occurs, the priority is to assist ventilation immediately, typically with a
bag-valve-mask, to prevent hypoxia. Administering flumazenil or oxygen may be necessary
later, but ventilation support is the priority.
,4. The nurse is monitoring a patient receiving procedural sedation. The patient’s blood
pressure drops suddenly. Which of the following medications is most likely to cause this
effect?
• A. Ketamine
• B. Propofol
• C. Midazolam
• D. Fentanyl
Answer: B
Rationale: Propofol can cause significant hypotension due to vasodilation. Ketamine tends to
increase blood pressure, while midazolam and fentanyl typically have minimal cardiovascular
effects unless used in high doses.
5. What is the primary reason for obtaining informed consent before administering
procedural sedation and analgesia?
• A. To protect the healthcare provider from liability.
• B. To inform the patient about the risks, benefits, and alternatives to sedation.
• C. To ensure the patient understands the importance of fasting before the procedure.
• D. To confirm the patient's knowledge about postoperative care.
Answer: B
Rationale: Informed consent is primarily obtained to ensure the patient understands the risks,
benefits, and alternatives to the sedation, as well as the procedure itself. It’s a key aspect of
patient autonomy and legal protection.
6. Which of the following is a typical side effect of fentanyl during procedural sedation?
• A. Hypertension
• B. Respiratory depression
• C. Hallucinations
• D. Tachycardia
Answer: B
Rationale: Fentanyl, a potent opioid, can cause respiratory depression, especially in high doses.
Tachycardia is not a common side effect of fentanyl, while hypotension and bradycardia may
occur in some cases.
, 7. A nurse administers flumazenil to a patient who received excessive midazolam during
procedural sedation. What is the primary purpose of flumazenil in this situation?
• A. To reduce sedation
• B. To reverse benzodiazepine effects
• C. To prevent hypotension
• D. To prevent nausea
Answer: B
Rationale: Flumazenil is a benzodiazepine antagonist that reverses the sedative effects of
midazolam. Its primary function is to restore consciousness and prevent respiratory depression
caused by excessive benzodiazepine use.
8. During procedural sedation, the nurse should frequently monitor which of the following
parameters?
• A. Blood glucose levels
• B. Oxygen saturation, heart rate, and blood pressure
• C. Capillary refill time
• D. Electrolyte levels
Answer: B
Rationale: Continuous monitoring of oxygen saturation, heart rate, and blood pressure is crucial
during sedation to detect early signs of hypoxia or cardiovascular instability.
9. A patient receiving ketamine for procedural sedation reports vivid dreams after waking
up. What should the nurse document this as?
• A. A normal side effect of ketamine
• B. An allergic reaction
• C. A sign of inadequate sedation
• D. An adverse reaction to the procedure
Answer: A
Rationale: Vivid dreams or hallucinations are common side effects of ketamine. It’s not an
allergic or adverse reaction but a known dissociative effect of the drug.
10. What is the most significant complication to monitor for in a patient receiving
procedural sedation with propofol?
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