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WorksheetsIntroduction to NORA and Patient Advocacy
Total questions: 30
Worksheet time: 15mins
Which statement best defines NORA in the context of anesthesia practice?
Non-Operating Room Anesthesia for procedures outside the operating room but within a hospital
Normal Operating Room Anesthesia performed only in the main OR suite
Nasal Oxygen and Respiratory Assessment used during surgery
Neonatal Operating Room Anesthesia for pediatric cases
Which location is MOST appropriately categorized as a NORA site?
Main operating room suite
Gastrointestinal endoscopy suite
Post-anesthesia care unit (PACU) within the OR complex
Hospital cafeteria
An anesthesiologist planning care for a patient scheduled for a CT-guided procedure should anticipate which general consideration about NORA locations?
They are inherently challenging compared with the OR suite
They have identical resources and workflows as the main OR
They never require patient advocacy
They eliminate the need for standard monitoring
Which patient is the best candidate for office-based anesthesia in a NORA setting?
ASA physical status 1–2 without significant comorbidities
History of malignant hyperthermia with prolonged emergence
Decompensated congestive heart failure with frequent angina
Severe obstructive sleep apnea with known difficult airway
According to AANA Standard IX, which parameter must be documented at least every five minutes for all anesthetics?
Urine output
Blood pressure, heart rate, and respiration
Core temperature only
Neuromuscular twitch count
Which statement aligns with patient candidacy guidance for office-based anesthesia?
ASA III patients are excluded regardless of disease control
Procedures should allow for expeditious recovery
Prior PONV automatically disqualifies a patient
Any severe comorbidity is acceptable if brief anesthesia is planned
During preprocedural assessment for NORA, assigning an ASA physical status occurs after which of the following activities have been completed?
Only the physical exam
Review of medical/surgical history, medications, labs, diagnostics, and questioning about prior anesthesia problems
Postoperative recovery evaluation
Intraoperative monitoring setup
Insurance preauthorization
According to AANA Standard IX (Thermoregulation), when malignant hyperthermia (MH) triggering agents are used, what actions are specifically required?
Avoid temperature monitoring to prevent artifact
Monitor temperature and recognize signs and symptoms to immediately initiate appropriate treatment and management of MH
Use passive warming only and delay MH treatment until post-op
Administer neuromuscular blockers prophylactically to prevent MH
Discontinue all monitoring once normothermia is reached
In AANA Standard IX, which statement best describes the expectation for temperature management when clinically significant changes in body temperature are intended, anticipated, or suspected?
Temperature monitoring is optional unless hypothermia occurs
Monitor body temperature and use active measures to facilitate normothermia
Only monitor skin temperature without intervention
Deliberately induce hypothermia for all NORA cases
Rely on patient self-reporting of thermal comfort
Per AANA Standard IX (Neuromuscular), when neuromuscular blocking agents are administered during NORA procedures, what should be monitored?
Respiratory rate only
End-tidal CO2 only
Neuromuscular response to assess depth of blockade and degree of recovery
Core temperature exclusively
Blood glucose levels
Which trend has contributed to the rapid increase in NORA numbers and acuity over the last two decades?
Decreasing patient age and improved overall health
New technology and treatments
Reduction in outpatient procedures
Lower availability of anesthesia providers
Elimination of imaging-guided procedures
Which statement best describes a current trend in Non-Operating Room Anesthesia (NORA)?
NORA cases are declining due to limited procedural options.
NORA cases are increasing, and patients often present with higher acuity.
NORA is limited to pediatric populations only.
NORA is primarily reserved for elective cosmetic procedures.
Which patient factor most directly justifies anesthesia to facilitate immobility during a scan?
Controlled hypertension
Severe phobia or movement disorder
History of mild seasonal allergies
Recent dental cleaning
Which of the following is listed as a typical non-operating room location or procedure for anesthesia services?
Open cholecystectomy
Electrophysiology lab
Total hip arthroplasty
Thoracotomy
In the sedation continuum table, at which level does airway intervention often become required and spontaneous ventilation is often inadequate?
Minimal sedation
Moderate sedation
Deep sedation
General anesthesia
You are preparing a NORA suite. Which action aligns with environmental requirements before starting the anesthetic?
Begin as soon as the surgeon arrives
Confirm all equipment and monitoring are functioning properly
Skip checking emergency drugs if oxygen is available
Rely on hallway staff if an emergency arises
During a NORA emergency, which behavior best reflects effective communication and delegation in a setting where some staff are less familiar with emergencies?
Delay care until everyone understands the plan
Firmly but professionally explain the importance of airway or blood pressure and assign tasks such as squeezing the bag
Avoid training bystanders to prevent confusion
Focus solely on your task and avoid delegating
In a NORA setting, what is the primary reason an anesthesia machine must be available nearby, even if not inside the procedure room?
To provide continuous nebulization for all patients
To enable rapid conversion to general anesthesia if needed
To serve as a backup ventilator for PACU
To calibrate monitoring equipment before cases
During NORA, if an anesthesia machine is not immediately available for conversion, which immediate action is emphasized?
Initiate high-flow nasal cannula and discontinue sedation
Bag the endotracheal tube and continue IV sedation drip or wake the patient
Place a central venous catheter and start vasopressors
Transition to regional anesthesia with local infiltration
Which monitoring statement aligns with the recommendations for NORA environments?
Capnography is optional if pulse oximetry is normal
An arterial line may be indicated in certain cases such as EP lab or interventional radiology TIPS
Noninvasive blood pressure monitoring should be avoided during MAC
End-tidal CO2 monitoring is unnecessary during sedation
According to ASA closed claims related to NORA, which risk pattern is highlighted for remote locations compared with the OR?
Lower proportion of claims for death and fewer respiratory events
Higher proportion of claims for death and more respiratory events involving inadequate oxygenation/ventilation
Similar claim patterns with most due to equipment malfunction
Most claims involved regional anesthesia rather than MAC
Which room/equipment layout challenge is commonly encountered during NORA procedures and can necessitate extensions for breathing circuits and IV lines?
Limited space for equipment and supplies
Excessively warm ambient temperature
Ready access to the patient’s head
Fixed placement of the C-arm away from the anesthesia machine
According to the National Council on Radiation Protection and Measurements in the US, what is the recommended occupational limit for radiation exposure in any one year?
10 mSv
20 mSv
50 mSv
100 mSv
During a severe contrast hypersensitivity reaction in a NORA setting, which drug is identified as the primary escalation agent when symptoms persist despite initial measures?
Diphenhydramine 25 mg IV once
Famotidine 20 mg IV
Epinephrine in 10 mcg boluses titrated until improvement
Albuterol 1–2 puffs once
Which statement best defines contrast-induced nephropathy (CIN) in the context of NORA?
An allergic-type reaction to iodinated contrast with urticaria and bronchospasm
An acute decline in renal function after exposure to contrast media, typically evidenced by a rise in serum creatinine
A chronic kidney disease caused by repeated exposure to gadolinium
A hemodynamic instability caused by blood loss during interventional procedures
A patient undergoing an interventional radiology procedure develops flushing, urticaria, and wheezing immediately after iodinated contrast injection. What is the most appropriate first-line management?
Administer protamine sulfate and stop the procedure
Give intramuscular epinephrine and support airway, breathing, and circulation
Start hemodialysis to remove contrast
Administer vitamin K to reverse anticoagulation
In NORA cases with mandatory anticoagulation for the procedure, which strategy best balances bleeding risk and procedural necessity?
Proceed without any plan because bleeding can always be controlled later
Coordinate timing of anticoagulant dosing and reversal agents with the procedural team, ensure availability of blood products, and establish clear thresholds for transfusion or reversal
Delay all procedures until anticoagulation can be completely stopped for a week
Use only regional anesthesia to avoid bleeding
Which statement best defines esophagogastroduodenoscopy (EGD) in the context of NORA procedures?
A diagnostic and therapeutic endoscopic examination of the esophagus, stomach, and duodenum
A radiologic study of the entire colon using contrast
A surgical resection of the stomach performed laparoscopically
A noninvasive ultrasound of the esophagus and stomach
For an upper endoscopy, which patient risk is most directly related to gastric contents entering the airway during instrumentation?
Laryngospasm
Aspiration
Perforation
Airway obstruction from edema
During EGD under anesthesia, which technique most effectively minimizes coughing and facilitates scope passage when airway stimulation is expected?
Light sedation without airway adjuncts
General anesthesia with muscle relaxation
Inhalational-only anesthesia via facemask
Regional neuraxial anesthesia
