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A [blank_start]Standard of Care[blank_end] is the highest mandate for clinical behavior.
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Select the standard of nursing practice that most applies to CRNAs.
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Standard III
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Standard IV
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Standard V
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Standard VI
Frage 3
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Fill in the blanks for the AANA Standards for Nurse Anesthesia Practice:
Standard V
A. Monitor [blank_start]ventilation[blank_end] continuously.
B. Monitor [blank_start]oxygenation[blank_end] continuously.
C. Monitor [blank_start]cardiovascular[blank_end] status continuously.
D. Monitor [blank_start]body temperature[blank_end] continuously.
E. Monitor [blank_start]neuromuscular function[blank_end] and status.
F. Monitor and assess the [blank_start]patient positioning[blank_end].
Antworten
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ventilation
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oxygenation
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cardiovascular
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body temperature
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neuromuscular function
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patient positioning
Frage 4
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One of the key components to patient safety is to: [blank_start]Avoid turning your back on the patient[blank_end] and surgical procedure for long periods of time.
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[blank_start]Monitors[blank_end] are placed first and removed last.
Frage 6
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Name two ways (in alpha order) that CRNAs monitor the respiratory system:
1. [blank_start]Capnography[blank_end]
2. [blank_start]Pulse oximetry[blank_end]
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Capnography
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Pulse oximetry
Frage 7
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What is the standard of care for monitoring of oxygenation?
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Arterial blood gas
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Capnography
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Pulse oximetry
Frage 8
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The Beer-Lambert Law is a method for measuring what?
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Capnography
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Arterial blood gas
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Pulse oximetry
Frage 9
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Drag and drop the spectrum of light to the appropriate type.
Red: [blank_start]660[blank_end] nm
Infrared: [blank_start]940[blank_end] nm
Frage 10
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The Beer-Lambert Law and pulse oximetry measures the difference between absorbed light by [blank_start]oxyhemoglobin[blank_end] relative to [blank_start]deoxyhemoglobin[blank_end] in a pulsatile ([blank_start]arterial[blank_end]) bed.
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oxyhemoglobin
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deoxyhemoglobin
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arterial
Frage 11
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[blank_start]Oxyhemoglobin Dissociation Curve[blank_end]: The percentage of hemoglobin saturation with oxygen at different partial pressures of oxygen in blood is described by this S-shaped curve.
Frage 12
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Insert the appropriate corresponding numbers for the oxygen-hemoglobin dissociation curve.
At an 02 reading of 97 percent, the Pa02 is likely [blank_start]100[blank_end].
At an 02 reading of [blank_start]90[blank_end] percent, the Pa02 is usually 60.
At an 02 reading of 83 percent, the Pa02 is usually [blank_start]50[blank_end].
Frage 13
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Your patient's pulse oximeter isn't reading well. What are some potential causes?
Low flow conditions
• [blank_start]Hypotension[blank_end]→vasoconstrictionoftheperiphery
– Motion artifact
– Nail polish
– Ambient light interference – [blank_start]Dysfunctional hemoglobin[blank_end]
• Fetal hemoglobin
• Hemoglobin S
– Carboxyhemoglobinemia
• 240timestheaffinityforhgbvs.O2. – Methemoglobinemia
– Methylene blue, indigo carmine
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Hypotension
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Dysfunctional hemoglobin
Frage 14
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Name the three ways we verify intubation:
1. [blank_start]Auscultation[blank_end]
2. [blank_start]Chest excursion[blank_end]
3. Confirmation of [blank_start]CO2 in expired gases[blank_end].
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Auscultation
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Chest excursion
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CO2 in expired gases
Frage 15
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What is an early indicator of esophageal intubation and airway disconnect?
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Arterial blood gas
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Capnography
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Pulse oximetry
Frage 16
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[blank_start]Capnography[blank_end] continuously monitors all of the following:
– Alveolar ventilation
– Pulmonary perfusion
– Respiratory patterns
– Correct placement of endotracheal tube
Frage 17
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Match the type of capnography with its description:
[blank_start]Main-Stream Capnographs[blank_end] (non-diverting or flow-through):
CO2 sensor located between endotracheal tube and breathing circuit
[blank_start]Side-Stream Capnographs[blank_end]: (Diverting or aspiration):
Sensor is located in the main unit and CO2 is aspirated via a sampling tube connected to a T-piece adapter located between endotracheal tube and breathing circuit.
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Main-Stream Capnographs
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Side-Stream Capnographs
Frage 18
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Name two potentially fatal conditions that may first be indicated by capnographic changes:
[blank_start]Pulmonary embolism[blank_end]
[blank_start]Malignant hyperthermia[blank_end]
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Pulmonary embolism
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Malignant hyperthermia
Frage 19
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Use of [blank_start]capnography[blank_end] has markedly decreased incidence of unrecognized esophageal intubation and their associated brain injuries and deaths
Frage 20
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Label the following image with the appropriate portions of the expiratory segment.
Frage 21
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Label the appropriate angle segments of the expiration of capnography.
Frage 22
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Which of the following options describes Phase I of the expiratory segment?
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Exhalation of gas from the alveolar capillary bed mixing with dead space gas
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Positive slope due to continuous excretion of CO2 into alveoli
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Gas exchange that is free of CO2
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Used to assess extent of breathing
Frage 23
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In capnography, what is part of the expiratory segment?
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Phase 0
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Phase I
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Phase II
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Phase III
Frage 24
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In capnography, the [blank_start]alpha[blank_end] angle is between Phases II and III.
The [blank_start]alpha[blank_end] angle is an indirect indication of the V/Q status of the lung.
The [blank_start]beta[blank_end] angle is between Phase III and descending limb of inspiratory segment.
The [blank_start]beta[blank_end] angle is used to assess the extent of rebreathing.
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alpha
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beta
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alpha
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beta
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alpha
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beta
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alpha
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beta
Frage 25
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Fill in the blanks for the five characteristics of capnogram that should be evaluated:
-Frequency
-Rhythm
-[blank_start]Height[blank_end]
-Baseline
-[blank_start]Shape[blank_end]
Frage 26
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Your patient has low or no ETCO2 -- what are two of the major causes?
[blank_start]Decreased CO2 production/delivery[blank_end].
Causes: Hypothermia
[blank_start]Decreased pulmonary perfusion[blank_end].
Causes: Hypovolemia
Hypotension
Pulmonary embolism
Decreased cardiac output (arrest)
Frage 27
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Select some causes of low ETCO2.
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Altered alveolar ventilation
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Increase CO2 production/delivery
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Increased pulmonary perfusion
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Technical errors/machine faults
Frage 28
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Match the causes of low ETCO2 to the examples (in alpha order)
Altered Alveolar Ventilation
[blank_start]Apnea (accidental extubation)[blank_end]
[blank_start]Hyperventilation[blank_end]
[blank_start]Increase in dead space ventilation[blank_end]
[blank_start]Partial/total airways obstruction[blank_end]
Technical Errors/Machine Faults
[blank_start]Esophageal intubation[blank_end][blank_start]Sampling line leak[blank_end]
[blank_start]Ventilator malfunction[blank_end]
Antworten
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Apnea (accidental extubation)
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Hyperventilation
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Increase in dead space ventilation
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Partial/total airways obstruction
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Esophageal intubation
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Sampling line leak
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Ventilator malfunction
Frage 29
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Name the two chief causes of elevated CO2.
[blank_start]Increased CO2 production/delivery[blank_end].
[blank_start]Increased pulmonary perfusion[blank_end]
Frage 30
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Drag and drop the cause of the elevated ETCO2 with its cause:
Increased CO2 production/delivery.
[blank_start]Fever[blank_end]
[blank_start]Hyperthyroid storm[blank_end]
[blank_start]Laparoscopic surgeries[blank_end]
[blank_start]Malignant hyperthermia[blank_end]
[blank_start]Right-to-Left Shunts[blank_end]
[blank_start]Sepsis[blank_end]
[blank_start]Shivering[blank_end]
[blank_start]Sodium bicarbonate[blank_end]
[blank_start]Tourniquet[blank_end]
Increased pulmonary perfusion
[blank_start]Increased blood pressure[blank_end]
[blank_start]Increased cardiac output[blank_end]
Antworten
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Fever
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Hyperthyroid storm
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Laparoscopic surgeries
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Malignant hyperthermia
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Right-to-Left Shunts
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Sepsis
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Shivering
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Sodium bicarbonate
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Tourniquet
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Increased blood pressure
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Increased cardiac output
Frage 31
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Select some examples of elevated CO2 causes.
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Hyperventilation
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Hypoventilation
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Bronchial intubation
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Exhausted CO2 absorber
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Apnea/circuit disconnect
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Malignant hyperthermia
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Sepsis
Frage 32
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You notice your patient is experiencing small breaths at various points in the ETCO2 waveform. What is NOT a potential cause of this?
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Inadequate muscle paralysis
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Improper ventilator settings
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Excessive oxygenation
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Pressure on the patient's chest
Frage 33
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Cardiac oscillations are most prominent in what patient population?
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Adult
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Elderly
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Pediatric
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Pregnant
Frage 34
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[blank_start]Cardiac oscillations[blank_end] are small gas movements produced by pulsations of the aorta and heart.
Frage 35
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This image is an example of what on a capnograph?
Frage 36
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Other considerations/things that may mimic [blank_start]cardiac oscillations[blank_end]
– negative intrathoracic pressure
– low respiratory rate
– low I:E ratio
– Waning muscle relaxation
Frage 37
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Phase II and III are prolonged or slanted when a patient experiences a [blank_start]prolonged expiratory upstroke[blank_end].
Frage 38
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You are administering anesthesia when you suddenly notice your patient's baseline is elevated. You immediately:
Frage 39
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You see the capnograph below during your case. You know this is a sign of:
Frage 40
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An [blank_start]expiratory valve[blank_end] defect allows exhaled CO2-rich gases to be rebreathed with each inspiration.
Frage 41
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ETC02 is indicative of [blank_start]alveolar[blank_end] CO2.
Frage 42
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You have two CO2 readings: 38 and 43. Which one is the arterial concentration or PACO2?
Frage 43
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The [blank_start]facial[blank_end] nerve is the better site to monitor for onset of block because the larynx also mimics the response of the diaphragm.
Frage 44
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The [blank_start]ulnar[blank_end] nerve is the best nerve to monitor for recovery.
Frage 45
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Match the pattern of stimulation to its stimulus.
[blank_start]Single stimulus:[blank_end] The simplest mode of stimulation; consists of a single supramaximal electrical stimulus that is delivered from every 1 to 10 seconds (1‐0.1 Hz)
[blank_start]Train of Four:[blank_end] Four successive 200 μs stimuli at 2Hz delivered every 0.5 seconds for 2 seconds
[blank_start]Double Burst Stimulation:[blank_end] delivers two bursts (at 50Hz) of three electrical stimulations separated by 750 sec followed later by two such impulses
[blank_start]Tetanus:[blank_end] Repetitive, high-frequency stimulation at frequencies of 50 Hz or greater for five seconds
Frage 46
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Which form of peripheral nerve monitoring is based on the concept that acetylcholine is depleted by successive stimulation?
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Single stimulus
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Train of four
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Double-burst stimulation
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Tetanus
Frage 47
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In Train of Four stimulation, no twitches equals what kind of blockage?
Frage 48
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Clinical relaxation usually require what percentage of neuromuscular blockage?
Antworten
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50 to 60 percent
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60 to 70 percent
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75 to 95 percent
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100 percent
Frage 49
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What PNM improves accuracy over the T4/T1 ratio by delivering a stronger stimulation and eliminating the second and third twitches?
Antworten
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Double burst stimulation
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Single burst stimulation
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Tetanus
Frage 50
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Which PNM option may provide an indication of the time until return of the first response in the TOF and subsequent readiness for reversal of neuromuscular blockage?
Frage 51
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Which of the following muscle groups are most sensitive to neuromuscular blocking agents?
Antworten
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Diaphragm and Masseter
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Extra ocular and adductor pollicis
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Diaphragm and Orbicularis oculi
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Adductor pollicis and Orbicularis oculi