Ch.11 General and Local Anesthetics (Exam 1)

The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the:

A. Administration of minimal doses of multiple anesthetic drugs.

B. Administration of inhaled anesthetics.

C. Intravenous (IV) administration of anesthetics.

D. Administration of anesthetics to cause muscle relaxation.

A. Administration of minimal doses of multiple anesthetic drugs.

When assessing a patient under general anesthesia, which change to organ systems does the nurse expect?

A. Vasodilation

B. Skeletal muscle contraction

C. Hypertension

D. Decreased intracranial pressure

A. Vasodilation

During surgery, the anesthetist notes that the patient's heart rate is gradually increasing and becoming more irregular, the patient's blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately?

A. Pupillary reactions

B. Respiratory effort

C. Temperature

D. Urinary output

C. Temperature

Which statement regarding conscious sedation does the nurse identify as being accurate?

A. The IV route of drug administration is commonly used in pediatric patients to provide conscious sedation.

B. Mild amnesia is a common effect of midazolam.

C. Patients receiving conscious sedation must be intubated with an endotracheal tube.

D. Effects of propofol include relief of anxiety and pain.

B. Mild amnesia is a common effect of midazolam.

When teaching a patient about spinal headaches, which statement will the nurse include?

A. "Spinal headaches can be prevented with bed rest after the epidural procedure."

B. "Patients who have a spinal headache should have very limited fluid intake."

C. "A graft of skin from the patient's hand can be used to seal the leaking area causing the headache."

D. "High Fowler's positioning should be used for patients who have a spinal headache."

A. "Spinal headaches can be prevented with bed rest after the epidural procedure."

A patient in the ICU will be receiving an NMBD. Which piece of equipment is essential to have nearby when the nurse initiates this therapy?

A. Defibrillator

B. Sphygmomanometer

C. Mechanical ventilator

D. Oxygen source

C. Mechanical ventilator

Which subarachnoid space is injected when using spinal anesthesia?

A. Below L1 in adults

B. Below C2 in adults

C. Below L5 in children

D. Below C4 in children

A. Below L1 in adults

Which type of anesthesia is quickly absorbed systemically, has a rapid action, and is eliminated quickly?

A. Local anesthetics

B. Topical anesthetics

C. Inhalation anesthetics

D. Infiltration anesthetics

C. Inhalation anesthetics

Which route should be used for the induction stage of general anesthesia?

A. Local

B. Topical

C. Spinal

D. Intravenous (IV)

D. Intravenous (IV)

How long will the health care provider need to wait before suturing a wound when administering lidocaine as a local anesthetic?

A. 0 seconds (no wait time)

B. 2 minutes

C. 5 minutes

D. 1 hour

B. 2 minutes

Which statement correctly describes the action of lidocaine as a local anesthetic?

A. Nerve conduction is stopped by blocking sodium channels.

B. Nerve conduction is stopped by stimulating calcium channels.

C. Nerve conduction is stopped by blocking potassium channels.

D. Nerve conduction is stopped by stimulating potassium channels.

A. Nerve conduction is stopped by blocking sodium channels

Ms. Vega is receiving an epidural with lidocaine. Her baseline vital signs are BP 130/80, P 88, R 16, Temp 98.9°F, and O2 saturation of 99% on room air. The nurse assesses Ms. Vega and finds that she has decreased sensory and motor function of her bilateral lower extremities. Ms. Vega is having her first baby, and her husband is at the bedside. The patient states, "I feel so sleepy, and I feel like I can't get a full breath." The husband asks the nurse, "What is going on?"

The nurse reassesses vital signs, and they are BP 118/60, P 64, R 10, Temp 98.9°F, and O2 saturation of 92% on room air.

A. "Your wife is experiencing normal side effects from her epidural."

B. "The epidural is decreasing your wife's blood pressure, making her sleepy."

C. "Your wife may be having respiratory adverse effects from the epidural."

D. "These symptoms may be related to an allergic reaction to the epidural."

C. "Your wife may be having respiratory adverse effects from the epidural."

A nurse is preparing to administer lidocaine to a patient who is also receiving St. John's wort for depression. Which statement is correct?

A. The concentration of lidocaine may be decreased.

B. The concentration of lidocaine may be increased.

C. The effect of St. John's wort may be increased.

D. The effect of St. John's wort may be decreased.

A. The concentration of lidocaine may be decreased.

A patient has been prescribed lidocaine for oral mucous membrane anesthesia. Which information will the nurse include in the teaching plan for this patient?

A. "The effects of this drug will last for 4 hours."

B. "Brush your teeth after gargling with this drug."

C. "If you experience dry mouth, suck on hard candy."

D. "Do not drink fluids or eat after gargling with this medicine."

D. "Do not drink fluids or eat after gargling with this medicine."

Which information will the nurse include in the teaching for a patient who received lidocaine for an epidural block?

A. "Until your numbness goes away, do not ambulate without assistance."

B. "You will not be able to drink anything until your numbness goes away."

C. "You will not be able to eat anything until your numbness goes away."

D. "It will most likely take at least 8 hours for your numbness to subside."

A. "Until your numbness goes away, do not ambulate without assistance."

Which statement correctly describes the difference between the action of a spinal anesthesia and epidural anesthesia?

A. Spinal anesthesia involves injection through the sacral hiatus, and epidural anesthesia involves injection into the epidural space.

B. Spinal anesthesia involves the injection into the subarachnoid space, and epidural anesthesia involves injection into the epidural space.

C. Spinal anesthesia involves injection into the subdural space, and epidural anesthesia involves injection into the cerebrospinal fluid (CSF).

D. Spinal anesthesia involves injection into the lower end of the spinal cord, and epidural anesthesia involves injection into the epidural space.

B. Spinal anesthesia involves the injection into the subarachnoid space, and epidural anesthesia involves injection into the epidural space.

A patient is undergoing surgery and receiving a neuromuscular blocking agent, a short-acting barbiturate, and nitrous oxide. To achieve balanced anesthesia, which drug would be added to this drug regimen?

A. An opioid

B. An additional dose of propofol

C. An additional dose of nitrous oxide

D. A benzodiazepine

A. An opioid

Which drug diffuses rapidly in the arterial vascular system and crosses the blood-brain barrier to produce amnesia, skeletal muscle relaxation, and hypnosis?

A. Propofol

B. Diazepam

C. Isoflurane

D. Thiopental sodium

C. Isoflurane (an inhaled anesthetic)

The rate of absorption for topical lidocaine is determined by which factor?

A. Amount of lidocaine applied

B. Blood flow to the area

C. Frequency of lidocaine applied

D. Tissue surrounding area of application

B. Blood flow to the area

A nurse is getting ready to start a peripheral IV on a pediatric patient. Which form of lidocaine would be appropriate?

A. Oral sedative

B. Topical preparation

C. Subcutaneous injection

D. Intramuscular injection

B. Topical preparation

The health care provider has administered an appropriate dose of lidocaine for a local anesthetic. The patient still has sensation and mobility. Which statement describes what is happening?

A. The drug is being absorbed rapidly.

B. The drug is not being metabolized.

C. The drug is being absorbed more slowly than it is being metabolized.

D. The drug is being absorbed much more rapidly than it is being metabolized.

C. The drug is being absorbed more slowly than it is being metabolized

A patient with poor perfusion to the right lower extremity is receiving topical lidocaine for a wound debridement. Which statement regarding the absorption of lidocaine in this patient is accurate?

A. Absorption will be slower than normal.

B. Absorption will be faster than normal.

C. Absorption rate is unknown and is dependent upon dosage.

D. Absorption rate is unknown and is dependent upon frequency.

A. Absorption will be slower than normal

The nurse is caring for four patients who have all received lidocaine. Which patient symptom would the nurse assess first?

A. Nausea

B. Diarrhea

C. Rash and itching all over

D. Pain increasing with movement

C. Rash and itching all over

Epinephrine is mixed with lidocaine for which purpose?

A. Prolong anesthesia

B. Provide additional pain relief

C. Prevent thrombosis at injection site

D. Decrease swelling at injection site

A. Prolong anesthesia

Which clinical manifestation indicates that a patient is exhibiting cardiac toxicity to lidocaine?

A. Seizure

B. Bradycardia

C. Bradypnea

D. Tachypnea

B. Bradycardia

A patient who is about to undergo surgery states, “My parents tell me I had a horrible response to anesthesia as a child.” Which action would the nurse most likely anticipate?

A. The surgery will be cancelled.

B. A chest x-ray will be ordered.

C. Nothing will be done because the patient does not know what actually happened.

D. The health care provider would discuss family history with the patient to get more information.

D. The health care provider would discuss family history with the patient to get more information

Which clinical manifestation indicates that a patient is exhibiting central nervous system (CNS) toxicity to lidocaine?

A. Seizure

B. Heart block

C. Tachypnea

D. Hypertension

A. Seizure

The nurse would educate the patient that which symptoms may occur with topical lidocaine?

Select all that apply.

A. Redness

B. Burning

C. Stinging

D. Swelling

E. Tenderness

B. Burning

C. Stinging

E. Tenderness

Which statement is correct for patient teaching in preoperative preparation of receiving lidocaine for an epidural block?

A. "You will temporarily lose feeling and the ability to move below the waist."

B. "You will temporarily lose feeling below the waist, but you'll still be able to move your legs."

C. "We will only need to take vital signs to start but won't have to bother you once the epidural is in place."

D. "We will need to take vital signs every 5 minutes while the epidural is in place."

A. "You will temporarily lose feeling and the ability to move below the waist"

The nurse teaches a patient prescribed a lidocaine patch that which symptom needs to be reported to the health care provider?

A. Drowsiness

B. Hypertension

C. Increased urine output

D. Decreased sensation

A. Drowsiness

While completing preoperative patient teaching, which information would the nurse include for a surgery with a general anesthetic?

A. It produces muscle relaxation and loss of consciousness.

B. It provides moderate sedation that allows you to relax.

C. It affects a specific region of the body to block pain sensation.

D. It uses only one type of medication to produce sedation.

A. It produces muscle relaxation and loss of consciousness.

A patient verbalizes concern to the nurse regarding postoperative nausea and vomiting from the anesthesia. Which is the nurse's best response?

A. "Don't worry because you'll be heavily or completely sedated if that occurs."

B. "I understand your concern but intermittent vomiting often occurs after surgery."

C. "You will need to notify the charge nurse and health care provider if you feel nauseated after surgery."

D. "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anesthesia."

D. "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anesthesia."

An intubated, mechanically ventilated patient in the intensive care unit (ICU) is becoming increasingly restless and anxious. The nurse expects to administer which intravenous (IV) anesthetic drug?

A. Propofol

B. Isoflurane

C. Halothane

D. Nitrous oxide

A. Propofol

Which postoperative nursing action will help the patient avoid serious respiratory complications from general anesthesia?

A. Monitor input and output closely.

B. Provide a quiet, calm environment.

C. Place in a semi-Fowler's position.

D. Teach to turn, cough, and deep breathe.

D. Teach to turn, cough, and deep breathe.

Immediate postoperative assessment of a patient reveals a body temperature of 102°F. What is the appropriate nursing intervention?

A. Notify the health care provider.

B. Apply a cooling blanket per protocol.

C. Assess for signs and symptoms of infection related to the surgical wound.

D. Administer acetaminophen as prescribed and recheck temperature in 1 hour.

A. Notify the health care provider.

A student questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug used in the emergency department for someone who is coding." Which is the nurse's best response?

A. "Epinephrine is used with lidocaine to prevent adverse effects."

B. "The systemic absorption of lidocaine is maximized by the epinephrine, and the anesthetic effect is reached more quickly."

C. "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site."

D. "Epinephrine is metabolized more quickly than lidocaine so that the anesthetic effect wears off more quickly after the laceration is sutured."

C. "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site."

A mechanically ventilated patient receiving a neuromuscular-blocking drug has tearing in the eyes and increased heart rate and blood pressure. How does the nurse interpret this clinical finding?

A. The patient's level of sedation is inadequate.

B. The patient's response to the drug is appropriate.

C. The patient is having an adverse reaction to the medication.

D. The patient's dose of the neuromuscular-blocking drug is insufficient.

A. The patient's level of sedation is inadequate.

While taking a patient's history before surgery for a cardiac problem, the patient tells the nurse, "I am addicted to cocaine." The nurse notifies the anesthesiologist of this finding because use of cocaine can cause which effect when a patient is under anesthesia?

A. Blood-clotting problems

B. Complications during recovery

C. Immediate withdrawal symptoms

D. Anesthetic-induced complications

D. Anesthetic-induced complications

The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the

A.administration of minimal doses of multiple anesthetic drugs.

B.administration of inhaled anesthetics.

C.intravenous (IV) administration of anesthetics.

D.administration of anesthetics to cause muscle relaxation.

A.administration of minimal doses of multiple anesthetic drugs.

When assessing a patient under general anesthesia, which change to organ systems does the nurse expect?

A.Vasodilation

B.Skeletal muscle contraction

C.Hypertension

D.Decreased intracranial pressure

A.Vasodilation

During surgery, the anesthetist notes that the patient's heart rate is gradually increasing and becoming more irregular, the patient's blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately?

A.Pupillary reactions

B.Respiratory effort

C.Temperature

D.Urinary output

C.Temperature

Which statement regarding conscious sedation does the nurse identify as being accurate?

A.The IV route of drug administration is commonly used in pediatric patients to provide conscious sedation.

B.Mild amnesia is a common effect of midazolam.

C.Patients receiving conscious sedation must be intubated with an endotracheal tube.

D.Effects of propofol include relief of anxiety and pain.

B.Mild amnesia is a common effect of midazolam.

When teaching a patient about spinal headaches, which statement will the nurse include?

A."Spinal headaches can be prevented with bed rest after the epidural procedure."

B."Patients who have a spinal headache should have very limited fluid intake."

C."A graft of skin from the patient's hand can be used to seal the leaking area causing the headache."

D."High Fowler's positioning should be used for patients who have a spinal headache."

A."Spinal headaches can be prevented with bed rest after the epidural procedure."

A patient is to receive a NMBD while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be

A.sedated.

B.resisting the ventilator.

C.awake but unable to move.

D.pain free.

C.awake but unable to move.

A patient in the ICU will be receiving an NMBD. Which piece of equipment is essential to have nearby when the nurse initiates this therapy?

A.Defibrillator

B.Sphygmomanometer

C.Mechanical ventilator

D.Oxygen source

C.Mechanical ventilator

Which statement best describes general anesthetics?

A. They alter pain perception without loss of consciousness

B. They selectively block peripheral nerve transmission

C. They produce complete loss of consciousness and depress respiratory drive

D. They provide muscle relaxation only

C. They produce complete loss of consciousness and depress respiratory drive

How do general anesthetics reduce pain and sensation?

A. By blocking opioid receptors in the CNS

B. By altering CNS nerve impulses throughout the entire body

C. By increasing serotonin levels

D. By blocking peripheral nerve endings only

B. By altering CNS nerve impulses throughout the entire body

Which statement best describes the Overton-Meyer theory?

A. Water-soluble anesthetics are more potent

B. Potency increases as protein binding increases

C. Fat-soluble anesthetics are more potent because they cross the blood-brain barrier easily

D. Anesthetic potency depends on renal clearance

C. Fat-soluble anesthetics are more potent because they cross the blood-brain barrier easily

Which condition is a contraindication for many general anesthetics?

A. Hypertension

B. Diabetes mellitus

C. Known history of malignant hyperthermia

D. Asthma

C. Known history of malignant hyperthermia

Which respiratory effect is associated with inhaled and IV general anesthetics?

A. Bronchodilation with improved oxygenation

B. Increased respiratory rate

C. Depressed airway-protective mechanisms

D. Increased lung compliance

C. Depressed airway-protective mechanisms

Malignant hyperthermia is most commonly associated with which agents?

A. Local anesthetics

B. Opioids

C. Volatile inhaled anesthetics and succinylcholine

D. Benzodiazepines

C. Volatile inhaled anesthetics and succinylcholine

What medication is used to treat malignant hyperthermia?

A. Naloxone

B. Flumazenil

C. Dantrolene

D. Atropine

C. Dantrolene

Which statement best describes moderate sedation?

A. Causes complete loss of consciousness

B. Commonly causes respiratory arrest

C. Allows the patient to remain responsive

D. Requires inhaled anesthetics

C. Allows the patient to remain responsive

Moderate sedation commonly includes which medication combination?

A. Opioid and antihistamine

B. Benzodiazepine or propofol with an opioid

C. NMBD and anesthetic gas

D. Barbiturate only

B. Benzodiazepine or propofol with an opioid

Which statement best describes local anesthetics?

A. They cause unconsciousness

B. They alter nerve transmission without affecting consciousness

C. They depress respiratory drive

D. They act primarily on the CNS

B. They alter nerve transmission without affecting consciousness

Which suffix is common to local anesthetic medications?

A. -ol

B. -ine

C. -caine

D. -one

C. -caine

In what order do local anesthetics cause loss of function?

A. Motor → sensory → autonomic

B. Sensory → motor → autonomic

C. Autonomic → sensory → motor

D. Autonomic → motor → sensory

C. Autonomic → sensory → motor

A spinal headache following spinal anesthesia is best treated initially with:

A. IV antibiotics

B. Bedrest, analgesics, and caffeine

C. Emergency surgery

D. Naloxone

B. Bedrest, analgesics, and caffeine

What is the purpose of balanced anesthesia?

A. To eliminate the need for inhaled agents

B. To combine drugs for smooth induction, analgesia, and muscle relaxation

C. To reduce surgery time

D. To avoid opioid use

B. To combine drugs for smooth induction, analgesia, and muscle relaxation

Which drug class is used for muscle relaxation in balanced anesthesia?

A. Opioids

B. Benzodiazepines

C. Neuromuscular blocking agents

D. Local anesthetics

C. Neuromuscular blocking agents

What is the primary effect of neuromuscular blocking drugs?

A. Sedation

B. Analgesia

C. Muscle paralysis

D. Anxiolysis

C. Muscle paralysis

Why must emergency ventilation equipment be available when administering NMBDs?

A. They cause severe hypotension

B. They paralyze respiratory muscles

C. They cause seizures

D. They depress cardiac output

B. They paralyze respiratory muscles

Nondepolarizing NMBDs work by:

A. Mimicking acetylcholine

B. Blocking acetylcholine at the neuromuscular junction

C. Enhancing calcium release

D. Increasing muscle contraction

B. Blocking acetylcholine at the neuromuscular junction

What medication class is used as an antidote for nondepolarizing NMBDs?

A. Opioid antagonists

B. Anticholinesterases

C. Benzodiazepine antagonists

D. Beta blockers

B. Anticholinesterases