Certified Ambulatory Perianesthesia Nurse (CAPA) Practice Exam

If a patient is unresponsive after receiving excessive midazolam, what medication should the perianesthesia nurse anticipate an order for?

1. Flumazenil 0.01 mg IV

2. Naloxone 0.04 mg IV

3. Naloxone 0.4 mg IV

4. Flumazenil 0.1 mg IV

The correct answer is: Flumazenil 0.1 mg IV

In the case of a patient who is unresponsive due to excessive midazolam, the appropriate medication to anticipate would be Flumazenil. Flumazenil is a specific benzodiazepine antagonist that works to reverse the effects of benzodiazepines, including midazolam. When administered intravenously, Flumazenil can help restore consciousness and normal respiratory function in patients who have experienced sedation or respiratory depression due to benzodiazepine overdose. The usual starting dose of Flumazenil is often around 0.1 mg IV, with the possibility of repeated doses if the desired effect is not achieved. This medication’s specific role in countering the sedative effects of benzodiazepines makes it the appropriate choice in this scenario as opposed to Naloxone, which is primarily used as an opioid antagonist and is not effective for benzodiazepine-related respiratory depression or sedation. It's essential to note that Flumazenil should be used with caution, particularly in patients who may be dependent on benzodiazepines, as it can precipitate seizures in such cases. This understanding of the pharmacological actions and appropriate uses of Flumazenil is crucial for the care of patients experiencing excessive sedation.