Moderate Sedation – Provider Portal

Welcome to the Moderate Sedation quiz this must be completed on initial & for re-credentialing.

First & Last Name

Moderate sedation is defined as:

A depressed level of consciousness, retaining the ability to independently and continuously maintain a patient airway and respond purposefully to verbal and tactile stimulation.

Any depressed level of consciousness

A depressed level of consciousness, retaining the ability to independently and continuously maintain a patient airway while not responding to physical stimulation.

d. A controlled state of depressed consciousness from which the patient is not easily aroused, and is unable to respond purposefully to physical stimulation or verbal command.

Medications used for moderate sedation routinely include:

Narcotics and propofol

Narcotics and nitrous oxide

Benzodiazepines and narcotics

Nitrous oxide and pentothal

Benzodiazepines, narcotics, and barbituates

Desired effects of moderate sedation include:

1 = relaxation
2 = cooperation
3= deep, unarousable sleep
4 = elevation of pain threshold

1 and 2

1 and 3

1, 2 and 3

1, 2 and 4

1,2,3 and 4

Desired effects of Benzodiazepines:

1 = provide anterograde amnesia
2 = provide analgesia
3 = are antagonized with flumazenil

1 and 2

1 and 3

2 and 3

1, 2, and 3

Desired effects of Narcotics:

1 = provide analgesia
2= provide anterograde amnesia
3 = are antagonized with naloxone

1 and 2

1 and 3

2 and 3

1, 2, and 3

In a medical evaluation prior to administration of moderate sedation, the history and physical examination should include:

1 = A focused examination of the airway, heart and lungs
2 = Assessment of ASA physical status classification
3 = A determination of the last PO intake
4 = Past history of problems with anesthesia

1 and 2

3 and 4

1, 2, and 3

1, 2, and 4

1, 2, 3 and 4

A 42-year-old man scheduled for a colonoscopy has a history of non-insulin dependent diabetes and hypertension that is well controlled. His history is otherwise unremarkable. He would be best classified as:

ASA 2

ASA 3

ASA 1

ASA 4

ASA 5

When performing a procedure with moderate sedation:

1 = The provider and monitor must be present
2 = Monitoring includes ECG (when indicated) and non-invasive blood pressure
3 = Vital signs need to be recorded only at the beginning and end of the procedure
4 = The procedure room should have a pulse oximeter available for emergency
5 = A pulse oximeter should be in use throughout the procedure

1 and 2

1, 2 and 3

2, 3 and 5

1, 2 and 5

Documentation during a procedure with moderate sedation should include:

1 = Dose, route, administration time and effects of drugs used
2 = Type / amount of IV fluid given
3 = Vital signs/respiratory function every 10 minutes
4 = Comments about the procedure

1, 3 and 5

1, 2 and 3

1, 2, and 4

1, 2, 3, and 4

Discharge criteria after a procedure with moderate sedation include:

1 = Patient’s level of consciousness is no more than a 2 on the Ramsey scale and no less than a level 8 on the Aldrete scale
2 = Patient is able to swallow or has a gag reflex
3 = Is able to ambulate with assistance or is at pre-procedure norm
4 = Feels well and is ready to drive himself home
5 = Has instructions regarding diet, activity, and medications

1 and 2

1, 2 and 3

1, 2, and 4

1, 2, 3 and 5

1, 2, 3, 4 and 5

Pulse oximetry:

1 = Provides the same information about arterial oxygenation as a blood gas
2 = Is not necessary if blood gases are monitored during the procedure
3 = Measures the absorbances of light at 660 and 940 nm
4 = Provide a non-invasive method of estimating partial pressure of oxygen in arterial blood
5 = May be affected by ambient light, low perfusion, motion artifacts and dye injection

1, 2 and 3

1, 2 and 4

1, 2, and 5

1, 3 and 4

3, 4 and 5

Which of the following describes flumazenil:

1 = IV dosing of 0.2 mg repeated at 1 minute intervals to a total dose of 1 mg
2 = Onset of action usually within 2 minutes
3 = Acute withdrawal can occur with chronic benzodiazepine use
4 = Respiratory depression is reliably antagonized.

1 and 4

2, 3 and 4

1, 2 and 3

1 and 2

Providers that are to be credentialed to provide moderate sedation:

Can also provide deep sedation

Must demonstrate competency in provision of moderate sedation for 1 event

Must demonstrate competency in provision of moderate sedation for 5 events

Which of the following describes the provider’s responsibilities regarding documentation of a moderate sedation event:

The provider is responsible for completing the “Sedation and Analgesia Record” at the end of the procedure.

A progress note listing the names and dosages of medications administered by the provider must be written.

Each provider may use documentation forms developed for his or her personal use, as long as all the critical elements are included in those forms, either before the procedure begins or immediately at the end of the procedure.

The provider must either generate, or verify the accuracy of an existing, history and physical examination (done by a partner, resident, fellow or extender working with the provider) including heart, lung, and airway assessment plus ASA physical status classification.

After receiving morphine and Valium for sedation and analgesia for a procedure, the patient loses consciousness and becomes dusky in appearance as the oxygen saturation decreases rapidly from 95% to 75%. Reasonable initial responses include:

1 = Administration of oxygen via an ambu bag to improve oxygen saturation
2 = Giving naloxone and flumazenil IV
3 = Increase the oxygen flow through the nasal cannula
4 = Begin the procedure as planned (which will stimulate respirations)

1 and 4

2 and 3

1 and 2

4 only

1, 2 and 4

Capnography is the:

1= Measurement of exhaled carbon dioxide
2=Used to confirm ET tube placement
3=Is used to monitor the ventilatory status of a non-intubated patient

1 and 3

2 and 3

1 and 2

1, 2 and 3

Capnography is measuring end tidal carbon dioxide levels. Which correlation below is correct?

Hypoventilation will decrease end tidal CO2 and therefore capnography readings will have low values or smaller wave forms.

Hyperventialtion will decrease end tidal CO2 and therefore capnography readings will have low values or smaller wave forms.

Changes in end tidal CO2 monitoring via capnography can be reliable indicators in:

1=metabolic changes related to sedation
2=decreased circulation
3=Increased cardiac output

1 and 3

2 and 3

1 and 2

1, 2 and 3