Chapter 11: General and Local AnestheticsTest Bank

MULTIPLE CHOICE

1.During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?a.No anesthesiab.Topical benzocaine spray on the areac.Topical prilocaine (EMLA) cream around the sited.Infiltration of the puncture wound with lidocaine

ANS:DInfiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of no anesthesia is incorrect.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 175TOP:NURSING PROCESS: PlanningMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2.A patient is to receive local anesthesia for removal of a lymph node from his armpit. The physician asks for a solution of premixed lidocaine and epinephrine. The nurse knows that the epinephrine is used for which reason?a.It prevents an anaphylactic reaction from occurring.b.The anesthetic enhances the effect of the epinephrine.c.Epinephrine contributes to a balanced anesthetic state.d.It keeps the anesthetic at its local site of action and decreases incisional bleeding.

ANS:DVasoconstrictors such as epinephrine are coadministered with local anesthetics to keep the anesthetic at its local site of action and to prevent systemic absorption. The other options are not correct rationales for using this medication.

DIF:COGNITIVE LEVEL: Understanding (Comprehension)REF:p. 176TOP:NURSING PROCESS: ImplementationMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3.During the immediate postoperative recovery period, what is the nurses priority assessment?a.Pupil responsesb.Return to sensationc.Level of consciousnessd.Airway, breathing, and circulation

ANS:DAfter surgery and the termination of general anesthesia, the priority assessment is the patients airway, breathing, and circulation status. The other assessments are important but are not the immediate concern.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 180TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Safe and Effective Care Environment: Management of Care

4.While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?a.Tachyphylaxisb.Postoperative infectionc.Malignant hypertensiond.Malignant hyperthermia

ANS:DA sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 172TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Safe and Effective Care Environment: Management of Care

5.When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?a.The 30-year-old patient who has never had surgery beforeb.The 45-year-old patient who stopped smoking 10 years agoc.The 21-year-old patient who is to have a kidney stone removedd.The 78-year-old patient who is to have gallbladder removal

ANS:DThe elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 172TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Physiological Integrity: Reduction of Risk Potential

6.A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?a.Anxiety related to the use of an anestheticb.Risk for injury related to increased sensorium from general anesthesiac.Decreased cardiac output related to systemic effects of local anesthesiad.Impaired gas exchange related to central nervous system depression produced by general anesthesia

ANS:DThe nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 182TOP:NURSING PROCESS: Nursing DiagnosisMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7.When administering a neuromuscular blocking drug such as pancuronium (Pavulon), the nurse needs to remember which principle?a.It is used instead of general anesthesia during surgery.b.Only skeletal muscles are paralyzed; respiratory muscles remain functional.c.It causes sedation and pain relief while allowing for lower doses of anesthetics.d.Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

ANS:DPatients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 177TOP:NURSING PROCESS: ImplementationMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8.A patient has been given succinylcholine (Anectine) after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine?a.valium (Diazepam)b.caffeinec.neostigmine (Prostigmin)d.vecuronium (Norcuron)

ANS:CThe antidote for neuromuscular blocking drugs is an anticholinesterase drug, such as neostigmine. Neostigmine reverses the effects of neuromuscular blocking drugs. The other drugs listed are not antidotes for neuromuscular blocking drugs.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 179TOP:NURSING PROCESS: PlanningMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9.A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation?a.Local anesthesiab.Moderate sedationc.Topical anesthesiad.Spinal anesthesia

ANS:BModerate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patients ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect.

DIF:COGNITIVE LEVEL: Understanding (Comprehension)REF:p. 173TOP:NURSING PROCESS: ImplementationMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10.During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103 F (39.4 C). The nurse will prepare for what immediate treatment?a.naltrexone hydrochloride (Narcan) injection, an opioid reversal drugb.dantrolene (Dantrium) injection, a skeletal muscle relaxantc.An anticholinesterase drug, such as neostigmined.Cardiopulmonary resuscitation (CPR) and intubation

ANS:BTachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 172TOP:NURSING PROCESS: ImplementationMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1.The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.)a.Procedural sedationb.Surgeries of short durationc.Surgeries of long durationd.Postoperative anxietye.Sedation of mechanically ventilated patients

ANS:A, B, EDexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. 173TOP:NURSING PROCESS: PlanningMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MATCHING

When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the drug effects in the correct order, using the choices A through C listed below.a.Cessation of respirations due to paralysis of diaphragm and intercostal musclesb.Total flaccid paralysisc.Weakness

1.Occurs first

2.Occurs second

3.Occurs last

1.ANS:CDIF:COGNITIVE LEVEL: Applying (Application)REF:p. 177TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral TherapiesNOT:The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.

2.ANS:BDIF:COGNITIVE LEVEL: Applying (Application)REF:p. 177TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral TherapiesNOT:The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.

3.ANS:ADIF:COGNITIVE LEVEL: Applying (Application)REF:p. 177TOP:NURSING PROCESS: AssessmentMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral TherapiesNOT:The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.

OTHER

1.A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is available in a strength of 5 mg/mL. How many milliliters of medication will the nurse draw up into the syringe for this dose?

ANS:0.4 mL5 mg : 1 mL :: 2 mg : x mL(5 x) = (1 2); 5x = 2; x = 0.4

DIF:COGNITIVE LEVEL: Applying (Application)REF:p. N/ATOP:NURSING PROCESS: ImplementationMSC:NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies