ANA 877 Pharm II Comp Final

Exam 1

Which of the following local anesthetics is the MOST lipid soluble?

  

A.    Bupivacaine

B. Procaine  

C. Lidocaine

D. Mepivacaine

A.    Bupivacaine

True/False: Local anesthetics become less ionized as the pH INCREASES.

True

Match the local anesthetic adjunct with its contribution to a nerve block.

Clonidine:              

Bicarbonate:        

Dexamethasone:              

Hyaluronidase:          

Clonidine: Supplemental analgesia             

Bicarbonate: Speeds onset             

Dexamethasone:  Prolongs duration             

Hyaluronidase:  Enhances tissue spread     

Which of the following is INCORRECT about C fibers?

 

A. They carry diffuse and persistent burning, aching, and throbbing pain

B. They carry “slow” pain or “second” pain

C. They have cell bodies located in dorsal root ganglion

D. They are myelinated

D. They are myelinated

Which of the following descriptions of local anesthetics is INCORRECT?

A. They contain either an amide or ester linkage

B. They have a benzene ring

C. The ionized form conveys the lipid solubility

D. They are weak bases  

E. They exert their effects on the intracellular side of the sodium channel

C. The ionized form conveys the lipid solubility

Which structure is characterized as an interruption of the myelin sheath that is essential for the propagation of neuron electrical signals?

  

A. Nodes of Ranvier

B. Cytoplasm

C. Fibroblasts

D. Schwann cells

A. Nodes of Ranvier

What initial arrhythmia would you most likely see in a patient experiencing cardiovascular toxicity from a local anesthetic?

  

A. Sinus tachycardia

B. Atrial flutter

C. Ventricular tachycardia

D. Bradycardia

D. Bradycardia

The typical tertiary amine local anesthetic needs to be _____ to enter an axon and _____ to exert its effect once inside the neuron.

  

A. Non-ionized, ionized

B. Ionized, ionized

C. Ionized, non-ionized

D. Non-ionized, non-ionized

A. Non-ionized, ionized

Which of the following statements about local anesthetic adjuncts is INCORRECT?

  

A. When epinephrine is added to bupivacaine and ropivacaine, there appears to be a prolongation of the block.

B. Preservative-free morphine can only be injected into the subarachnoid space.

C. Sodium bicarbonate increases the pH of the local anesthetic, which increases the proportion of the drug in the non-ionized state.

D. Clonidine can be used to improve the analgesic effects of local anesthetics.

B. Preservative-free morphine can only be injected into the subarachnoid space.

The SRNA is selecting a local anesthetic for a labor epidural. Knowing that the goal of an epidural is to provide sensory blockade and not necessarily motor blockade, which of the following would be the MOST appropriate local anesthetic?

  

A. Ropivacaine 0.5%

B. Bupivacaine 0.75%

C. Lidocaine 5%

D. Lidocaine 2%

A. Ropivicaine 0.5%

A weak acid becomes greater than 50% non-ionized following intravenous injection (blood pH = 7.4).  The pKa of this weak acid could feasibly be:

  

A. 7.2

B. 1.5

C. 7.6

D. 7.4

C. 7.6

How many mg of bupivacaine is found in 10 mL of 0.25% solution?

  

A. 2.5 mg

B. 12.5 mg

C. 20 mg

D. 25 mg

D. 25 mg

Which characteristic(s) MOST correlate with the onset of action of a local anesthetic? (choose 2)

  

A. pKa

B. Protein binding

C. Lipid solubility

D. Concentration

A. pKa

C. Lipid solubility

The rate of systemic absorption and toxicity is reflected from highest to lowest in which of the following?

  

A. Epidural>Sciatic>Spinal> Intercostal> Intravenous> Tracheal

B. None of these answers are correct

C. Subcutaneous>Sciatic>Epidural>Spinal>Intercostal>Intravenous

D. All of these answers are correct

E. Intercostal>Caudal>Epidural>Brachial Plexus>Subcutaneous

F. Intravenous>Intercostal> Epidural>Sciatic>Brachial Plexusd

E. Intercostal>Caudal>Epidural>Brachial Plexus>Subcutaneous

Selective cardiotoxicity is primarily attributed to which local anesthetic?

  

A. Lidocaine

B. Bupivacaine

C. Ropivacaine

D. Tetracaine

B. Bupivacaine

Which of the following local anesthetics is associated with transient neurologic syndrome?

  

A. Epidural ropivacaine 0.1%

B. Epidural lidocaine 2%

C. Intrathecal bupivacaine 0.5%

D. Intrathecal bupivacaine 0.75% w/ dextrose

E. Intrathecal lidocaine 5%

 

E. Intrathecal lidocaine 5%

Which of the following statements regarding pKa is FALSE?

  

A. The onset of a local anesthetic is slowed by increasing the pKa

B. pKa is the pH at which 50% of a drug exists ionized and 50% unionized

C. Increasing the pKa of a local anesthetic increases its lipid soluble form

D. pKa is the dissociation constant

E. pKa of a local anesthetic is useful in predicting the relative potency

C. Increasing the pKa of a local anesthetic increases its lipid soluble form

The max dose of lidocaine with epinephrine 1:200,000 is:

  

A. 3.5 mg/kg

B. 2 mg/kg

C. 7 mg/kg

D. 3 mg/kg

E. 35 mg/kg

C. 7 mg/kg

Which of the following does NOT help mitigate the CNS effects exhibited with LAST?

  

A. Hypokalemia

B. Versed

C. Acidosis

D. Propofol

C. Acidosis

Which local anesthetic is most rapidly metabolized by cholinesterase?

  

A. Chloroprocaine

B. Lidocaine

C. Tetracaine

D. Procaine

A. Chloroprocaine

The unionized fraction of weak acids becomes _____ when pH decreases and _____ when pH increases.

  

A. less; more

B. more; less

C. more; more

D. less; less

B. more; less

Which of the following local anesthetics has the highest ionized fraction and highest percentage of protein binding at physiologic pH (7.4)?

  

A. Chloroprocaine

B. Bupivacaine

C. Mepivacaine

D. Lidocaine

B. Bupivacaine

What is the MAXIMUM dose of EMLA cream for a 9-month-old infant weighing 8 kg?

  

A. 10 g

B. 2 g

C. 4 g

D. 1 g

B. 2 g

What is the maximum dose of mepivacaine?

  

A. 400 mg

B. 200 mg

C. 800 mg

D. 100 mg

A. 400 mg

The biggest controllable factor affecting block height in neuraxial anesthetics is/are: (select 2)

  

A. CSF volume and baricity

B. Drug concentration

C. CSF baricity

D. Drug volume

E. CSF volume

B. Drug concentration

D. Drug volume

Cardiovascular effects of spinal anesthesia are primarily attributable due to:

  

A. Blockade of sympathetic efferents

B. High vagal tone in younger patient

C. Block height

D. Block height and high vagal tone in younger patients

E. Block height and blockade of sympathetic efferents

E. Block height and blockade of sympathetic efferents

Local anesthetics: (select 2)

  

A. Increase resting membrane potential

B. Decrease threshold potential

C. Have no effect on resting membrane potential

D. Decrease resting membrane potential

E. Increase threshold potential

F. Have no effect on threshold potential

C. Have no effect on resting membrane potential

F. Have no effect on threshold potential

All of the following additives prolong the duration of local anesthetics EXCEPT:

  

A. Epinephrine

B. Hyaluronidase

C. Dextran

D. Dexamethasone

B. Hyaluronidase

The primary mechanism of action for local anesthetics is blockade of:

  

A. Voltage-gated sodium sodium channels

B. G-protein coupled sodium channels

C. Metabotropic calcium channels

D. Voltage-gated potassium channels

A. Voltage-gated sodium sodium channels

Saltatory conduction occurs in all of the following nerve types EXCEPT:

  

A. B fibers  

B. A gamma fibers  

C. A delta fibers

D. C fibers

D. C fibers

Based on pKa, the SRNA would expect which of the following local anesthetics to have the fastest onset of action?

  

A. 6.8

B. 7.8

C. 7.6

D. 8.3

A. 6.8

Which of the following is NOT a characteristic of ester local anesthetics?

  

A. Rapid hydrolysis and metabolites excreted in the urine

B. Metabolized via hydroxylation by CYP450

C. Higher occurrence of allergic reactions

D. Metabolized by pseudocholinesterase

B. Metabolized via hydroxylation by CYP450

A patient undergoing a supraclavicular block develops early signs of local anesthetic systemic toxicity. Which physiologic change most directly increases sodium channel susceptibility to local anesthetic binding?

  

A. Hypokalemia causing hyperpolarization

B. Increased protein binding from α₁-glycoprotein

C. Hypocarbia causing cerebral vasoconstriction

 D. Hypercarbia causing acidosis

D. Hypercarbia causing acidosis

Which nerve fiber characteristic MOST strongly explains why B fibers are blocked before C fibers despite being myelinated?

  

A. Lower minimum effective concentration (Cm)

B. Smaller diameter

C. Higher lipid content

D. Central anatomic position

A. Lower minimum effective concentration (Cm)

A local anesthetic with high lipid solubility but significant intrinsic vasodilatory properties will most likely demonstrate which clinical profile?

  

A. Rapid onset, prolonged duration

B. Slow onset, prolonged duration

C. Slow onset, shortened duration

D. Rapid onset, shortened duration

D. Rapid onset, shortened duration

Which property most explains the difficulty in resuscitating bupivacaine-induced cardiac arrest?

  

A. Increased myocardial uptake

B. High protein binding

C. Increased calcium channel blockade

D. Slow dissociation from sodium channels during diastole

D. Slow dissociation from sodium channels during diastole

Which factor MOST explains why the same dose of lidocaine produces higher plasma levels when injected intercostally versus epidurally?

  

A. Reduced protein binding

B. Increased vascular absorption

C. Slower hepatic metabolism

D. Increased tissue lipid content

B. Increased vascular absorption

A patient with G6PD deficiency develops cyanosis after topical anesthetic use. Why is methylene blue ineffective?

  

A. Lack of methemoglobin reductase

B. Inability to bind hemoglobin

C. Inability to obtain IV access

D Competitive inhibition by local anesthetic

A. Lack of methemoglobin reductase

Which clinical feature BEST differentiates methemoglobinemia from hypoxemia?

  

A. Elevated lactate

B. Low SpO2  

C. Cyanosis with normal PaO2

D. Tachycardia

C. Cyanosis with normal PaO2

Why does benzocaine remain effective as a topical anesthetic despite poor tissue penetration?

  

A. Non-ionized at physiologic pH

B. Ester metabolism

C. High protein binding

D. Sodium channel specificity

A. Non-ionized at physiologic pH

Why is epinephrine contraindicated in digital nerve blocks?

  

A. Reduced block quality

B. End-artery vasoconstriction

C. Increased nerve injury risk

D. Increased systemic toxicity

B. End-artery vasoconstriction

Which additive improves block quality primarily by increasing the non-ionized fraction of local anesthetic?

  

A. Sodium bicarbonate

B. Clonidine

C. Epinephrine

D. Dexamethasone

A. Sodium bicarbonate

A local anesthetic with a high pKa relative to physiologic pH is most likely to demonstrate which clinical behavior in infected tissue?

  

A. Delayed onset due to reduced non-ionized fraction

B. Increased potency due to enhanced sodium channel affinity

C. Faster onset due to increased ionization

D. Prolonged duration due to tissue trapping

A. Delayed onset due to reduced non-ionized fraction

A patient receiving an interscalene block becomes unresponsive with seizure activity. Which immediate intervention most directly reduces cerebral local anesthetic delivery?

  

A. Hyperventilation

B. Benzodiazepine administration

C. Epinephrine administration

D. Lipid emulsion bolus

A. Hyperventilation

Why should lidocaine NOT be used as an anti-arrhythmic during LAST?

  

A. Competitive lipid sink interference

B. Reduced myocardial contractility

C. Additive sodium channel blockade

D. Increased seizure risk

C. Additive sodium channel blockade

A patient receives tumescent anesthesia with lidocaine. Why does peak plasma concentration occur several hours later?

  

A. Liposomal encapsulation

B. Gradual systemic absorption from adipose tissue

C. Delayed protein binding

D. Slow hepatic metabolism

B. Gradual systemic absorption from adipose tissue

Why is cocaine uniquely contraindicated with beta-blockers?

  

A. Increased CNS excitation

B. Prolonged sodium channel blockade

C. Reduced hepatic metabolism

D. Unopposed alpha-1 stimulation

D. Unopposed alpha-1 stimulation

Which sequence BEST reflects correct priority in LAST management?

  

A. Lipid bolus → airway → seizure control

B. Airway/oxygen → seizure control → lipid therapy

C. ACLS → lipid therapy → airway

D. Seizure control → lipid bolus → oxygen

B. Airway/oxygen → seizure control → lipid therapy

A clinician wants a faster onset block without changing the drug. Which approach most directly increases the fraction of drug that crosses the nerve membrane?

  

A. Add clonidine to provide A2 analgesia

B. Add hyaluronidase to reduce allergy risk

C. Add epinephrine to reduce uptake

D. Add sodium bicarbonate to raise pH

D. Add sodium bicarbonate to raise pH

Which ranking reflects increasing difficulty of cardiac resuscitation from LA cardiotoxicity?

  

A. Lidocaine > ropivacaine > levobupivacaine > bupivacaine

B. Levobupivacaine > bupivacaine > lidocaine > ropivacaine

C. Bupivacaine > levobupivacaine > ropivacaine > lidocaine

D. Ropivacaine > lidocaine > bupivacaine > levobupivacaine

C. Bupivacaine > levobupivacaine > ropivacaine > lidocaine

A patient with methemoglobinemia receives methylene blue. Which dosing is correct?

  

A. 5 mg/kg bolus, repeat q5 min until resolved

B. 10 mL/kg over 1 min

C. 1–2 mg/kg over 5 min, max 7–8 mg/kg

D. 0.1 mg/kg over 30 min, max 1 mg/kg

C. 1–2 mg/kg over 5 min, max 7–8 mg/kg

Which patient is at increased risk of methemoglobinemia due to relative deficiency of methemoglobin reductase?

  

A. Patient with fetal hemoglobin physiology

B. Beta-blocked patient

C. Hypercarbic patient

D. Chronic kidney disease patient

A. Patient with fetal hemoglobin physiology

A first year resident states “higher concentration always means higher potency.” Which is the best correction?

  

A. Potency is determined by pH of solution only

B. Potency is determined by pKa alone

C. Potency is determined by pseudocholinesterase activity

D. Potency primarily depends on lipid solubility, not concentration

D. Potency primarily depends on lipid solubility, not concentration

A clinician wants to decrease LAST risk during a high-volume block. Which technique is most evidence-aligned?

  

A. Single-shot rapid injection

B. Using vasopressin for hypotension

C. Avoiding all CNS depressants

D. Incremental dosing with aspiration and test dose

D. Incremental dosing with aspiration and test dose

Which choice best represents the correct lipid emulsion initial dosing for LAST?

  

A. 20% bolus 1.5 mL/kg over 1 min, then 0.25 mL/kg/min

B. 10% infusion 1.5 mL/kg bolus, then 0.1 mL/kg/min

C. 20% bolus 10 mL/kg over 30 min only

D. 5% dextrose 1.5 mL/kg bolus, then 0.5 mL/kg/min

A. 20% bolus 1.5 mL/kg over 1 min, then 0.25 mL/kg/min

A patient receives tumescent anesthesia. Which pharmacokinetic profile is expected?

  

A. Peak plasma levels at 1 hr; eliminated by 6 hr

B. Peak plasma levels at 12 hr; eliminated by 36 hr

C. No measurable systemic levels

D. Peak plasma levels at 24 hr; eliminated by 96 hr

B. Peak plasma levels at 12 hr; eliminated by 36 hr

During large-volume tumescent anesthesia (>2–3 L anticipated), what is the key anesthetic planning consideration?

  

A. Secure airway early due to volume physiologic effects

B. Avoid vasopressin

C. Use opioids sparingly

D. Avoid airway devices

A. Secure airway early due to volume physiologic effects

Which statement about allergic potential is TRUE?

  

A. Cross-reactivity is common between ester and amide LAs

B. Amides commonly metabolize to PABA

C. No allergic cross-sensitivity exists between ester and amide classes

D. Allergy is never related to preservatives

C. No allergic cross-sensitivity exists between ester and amide classes

A patient receives a high concentration chloroprocaine v. a lower concentration bupivacaine. The SRNA notes faster onset with chloroprocaine. Besides pKa, what other principle also supports this?

  

A. Increased protein binding always speeds onset

B. Mass effect from higher dose/concentration increases molecules delivered

C. Alpha-2 agonism enhances diffusion

D. Increased vasodilation reduces onset time

B. Mass effect from higher dose/concentration increases molecules delivered

Which pairing correctly identifies the components of EMLA cream?

  

A. Lidocaine + prilocaine

B. Bupivacaine + prilocaine

C. Ropivacaine + lidocaine

D. Lidocaine + benzocaine

A. Lidocaine + prilocaine

A 38-week pregnant mother in active labor becomes hypoxemic quickly during RSI despite adequate preoxygenation. The best physiologic explanation is:

  

A. Decreased minute ventilation

B. Increased ERV and increased RV

C. Decreased FRC with increased VO₂

D. Increased FRC and decreased VO₂

C. Decreased FRC with increased VO₂

The most appropriate ETT size choice for routine intubation in a term parturient is:

  

A. 7.5

B. 8.0

C. 6.0

D. 7.0

C. 6.0

Which change most directly explains increased aspiration risk in pregnancy?

A. Increased gastric emptying before labor

B. Decreased gastrin secretion

C. Increased gastric volume and decreased pH

D. Increased LES tone 

C. Increased gastric volume and decreased pH

The primary driver of increased minute ventilation in pregnancy is:

  

A. Oxytocin

B. Estrogen

C. Progesterone

D. Relaxin

C. Progesterone

A parturient hyperventilates during labor due to pain. Fetal scalp pH subsequently drops. Which mechanism BEST explains this finding?

  

A. Maternal alkalosis shifts oxyhemoglobin curve right → ↑ fetal O₂

B. Maternal hypercarbia increases uterine blood flow

C. Maternal alkalosis shifts curve left, decreasing fetal O₂ offloading

D. Maternal acidosis shifts curve left → ↓ fetal O₂ offloading

C. Maternal alkalosis shifts curve left, decreasing fetal O₂ offloading

The oxyhemoglobin dissociation curve in pregnancy shifts:

  

A. Left due to progesterone-induced alkalosis

B. Right to facilitate fetal oxygen unloading

C. Left to retain maternal oxygen

D. Right only during labor

B. Right to facilitate fetal oxygen unloading

Why does uteroplacental blood flow fall precipitously during maternal hypotension after spinal anesthesia?

  

A. Uterine vessels dilate in response to hypotension

B. Uterine blood flow is pressure-dependent without autoregulation

C. Placental autoregulation preserves flow

D. Fetal shunting compensates for maternal hypotension

B. Uterine blood flow is pressure-dependent without autoregulation

Aortocaval compression reduces uteroplacental perfusion primarily by:

  

A. Reducing preload and cardiac output

B. Increasing afterload via sympathetic activation

C. Compressing uterine arteries only

D. Increasing uterine venous pressure

A. Reducing preload and cardiac output

Best prevention of aortocaval compression is:

  

A. A pillow placed under the right hip

B. Supine with legs elevated

C. Trendelenburg

D. A pillow placed under the left hip

A. A pillow placed under the right hip

Pregnancy hematology is best summarized as:

  

A. Hypocoagulable with increased fibrinolysis

B. No change in coagulation profile

C. Hypercoagulable with increased fibrinolysis

D. Hypocoagulable with impaired fibrinolysis

C. Hypercoagulable with increased fibrinolysis

Which anesthetic implication MOST directly follows decreased serum albumin in pregnancy?

  

A. Reduced efficacy of highly protein-bound drugs

B. Increased total drug clearance

C. Delayed hepatic metabolism

D. Increased free fraction of highly protein-bound drugs

D. Increased free fraction of highly protein-bound drugs

The MAC requirement in a pregnant patient is:

  

A. Increased by 30-40%

B. Decreased by 30-40%

C. Variable only at labor onset

D. Unchanged

B. Decreased by 30-40%

First-stage labor pain pathways primarily involve:

  

A. S2-S4

B. L4-S1

C. T10-L1

D. T1-T4

C. T10-L1

Second-stage labor pain adds afferents from:

  

A. T10-L1 only

B. S2-S4

C. C5-T1

D. T1-T4

B. S2-S4

Why do IV opioids readily transfer to the fetus?

  

A. They are highly ionized in plasma

B. The placenta blocks opioids

C. They are lipid soluble and <500 Da

D. They are large polar molecules

C. They are lipid soluble and <500 Da

The main downside of nitrous oxide for labor analgesia is:

  

A. Profound sedation

B. Severe fetal hypoxemia

C. Increased uterine atony

D. Increased nausea

D. Increased nausea

A patient develops profound hypotension and dyspnea minutes after epidural dosing. Which feature MOST distinguishes total spinal from high sympathetic block?

  

A. Bradycardia

B. Bradycardia

C. Rapid progression to respiratory compromise and LOC

D. Hypotension alone

C. Rapid progression to respiratory compromise and LOC

What factor makess opioids particularly prone to fetal ion trapping?

  

A. Placenta actively concentrates opioids

B. Fetal pH is higher than maternal pH

C. They are weak acids

D. They are weak bases that become ionized in acidic fetal blood

 

D. They are weak bases that become ionized in acidic fetal blood

A parturient who has just undergone neuraxial block placement develops nausea and vomiting. The MOST likely precipitating cause is:

  

A. Hypotension

B. Decreased LES tone

C. Increased vagal tone

D. Opioid administration

A. Hypotension

Which neuraxial opioid is considered the gold standard for postoperative analgesia after C-section?

  

A. Sufentanil

B. Preservative-free morphine

C. Nalbuphine

D. Fentanyl

B. Preservative-free morphine

The primary benefit of combined spinal-epidural (CSE) analgesia is:

  

A. Improved uterine contractility

B. Reduced hypotension

C. Faster onset with ability to extend duration

D. Decreased risk of PDPH

C. Faster onset with ability to extend duration

The antidote for magnesium toxicity is:

  

A. Methylene blue

B. Naloxone

C. Lipid emulsion

D. Calcium gluconate

D. Calcium gluconate

A positive intravascular test dose is suggested by a heart rate increase ≥ ______ bpm.

  

A. 20

B. 15

C. 10

D. 5

C. 10

Ephedrine dosing for neuraxial hypotension is typically:

  

A. 5–10 mg IV bolus

B. 20–40 mg IV bolus

C. 0.5–1 mcg/kg/min infusion

D. 1–2 mg IV bolus

A. 5–10 mg IV bolus

Ondansetron’s mechanism of action is:

  

A. Dopamine antagonist - prokinetic

B. H1 antagonist

C. 5HT3 antagonist blocking serotonin

D. 5HT4 antagonist blocking dopamine

C. 5HT3 antagonist blocking serotonin

Tranexamic acid (TXA) is best categorized as a(n) _____ and has a key caution with administration for _____.

  

A. Tocolytic; bronchospasm

B. Antiemetic; methemoglobinemia

C. Uterotonic; severe hypertension

D. Anti-fibrinolytic; hypotension

D. Anti-fibrinolytic; hypotension

Nitroglycerin use during C-section is highlighted for:

  

A. Increasing uterine tone

B. Aiding placental detachment and hemostasis in the setting of impending hemorrhage

C. Preventing hypotension

D. Increasing uterine tone

B. Aiding placental detachment and hemostasis in the setting of impending hemorrhage

The safest time for the parturient to undergo anesthesia is:

  

A. Third trimester

B. Second trimester

C. There is no safe time during pregnancy for anesthesia

D. First trimester

B. Second trimester

A neonate develops cyanosis with a slate-gray appearance after prolonged topical anesthetic exposure. Pulse oximetry reads 85% despite a normal PaO₂ on arterial blood gas. The mother received a eutectic mixture of local anesthetics prior to delivery. Which mechanism MOST directly explains the neonatal hypoxemia?

  

A. Decreased pulmonary diffusion capacity secondary to anesthetic exposure

B. Oxidation of ferrous iron in hemoglobin by o-toluidine, preventing oxygen binding

C. Competitive displacement of oxygen from hemoglobin by carbon monoxide

D. Inhibition of mitochondrial oxidative phosphorylation by prilocaine

B. Oxidation of ferrous iron in hemoglobin by o-toluidine, preventing oxygen binding

Match each of the following local anesthetics with their maximum dose.

Levobupivacaine

Bupivacaine         

Ropivacaine        

Lidocaine    

Mepivacaine            

Prilocaine 

Levobupivacaine= 2 mg/kg             

Bupivacaine= 2.5 mg/kg             

Ropivacaine= 3 mg/kg             

Lidocaine= 4.5 mg/kg             

Mepivacaine= 7 mg/kg             

Prilocaine= 8 mg/kg    

Match the nerve fiber type with its function.

A alpha              

A beta         

A gamma     

A delta        

B           

C sympathetic         

C dorsal root         

A alpha= Skeletal muscle - motor; proprioception             

A beta= Touch; pressure             

A gamma= Skeletal muscle - tone             

A delta=  Fast pain; temperature; touch             

B= Preganglionic ANS fibers             

C sympathetic=Postganglionic ANS fibers             

C dorsal root= Slow pain; temperature; touch     

Which of the following statements is/are TRUE?

  

A. The gravid uterus receives 500 - 700 mL/min.

B. Cardiac output returns to pre-labor values 24 - 48 H postpartum

C. Uterine blood flow autoregulation.

D. The gravid uterus receives 15% of CO.

E. Cardiac output returns to pre-pregnancy values in ~ 2 weeks.

A. The gravid uterus receives 500 - 700 mL/min.

B. Cardiac output returns to pre-labor values 24 - 48 H postpartum

E. Cardiac output returns to pre-pregnancy values in ~ 2 weeks.

Which of the following statements is/are TRUE?

  

A. Epidural analgesia increases the risk for C-section.

B. Women who request early labor analgesia are less likely to have more pain than those who do not.

C. Epidural analgesia prolongs the first stage of labor.

D. Epidural analgesia may increase the risk for forceps or vacuum-assisted delivery.

D. Epidural analgesia may increase the risk for forceps or vacuum-assisted delivery.

Following placement of an epidural catheter, the provider attaches a 3 mL Luer-lock syringe to the adapter and attempts to aspirate; however, this is negative for CSF. The provider proceeds to administer 3 mL 2% lidocaine with epinephrine 1:200,000. Approximately 15-20 minutes later, the patient experiences a dense sensory and autonomic blockade with difficulty breathing and severe hypotension. Motor ability is grossly preserved. The SRNA suspects which of the following?

A. Intrathecal injection

B. Subdural injection

C. Total (high) spinal

D. Intravascular injection

E. Subarachnoid injection

B. Subdural injection

Following placement of an epidural catheter, the provider attaches a 3 mL Luer-lock syringe to the adapter and attempts to aspirate; this reveals a bubbling fill of scant CSF into the syringe. The provider proceeds to administer 3 mL 2% lidocaine with epinephrine 1:200,000. The patient subsequently experiences immediate, rapid onset of a dense sensory blockade and reports that she is unable to move her legs. The patient experiences difficulty breathing and the tocodynamometer (TOCO) alarms for fetal decelerations. The SRNA suspects which of the following?

  

A. Subcutaneous injection

B. Intravascular injection

C. Subdural injection

D. Minor epidural crossover

E. Subarachnoid injection

E. Subarachnoid injection

The SRNA recognizes that which of the following is the #1 side effect of neuraxial opioids?

  

A. Pruritus

B. Nausea and vomiting

C. Respiratory depression

D. Sedation

A. Pruritus

The SRNA is providing care for a crash C-section. He/She recognizes that the Pitocin infusion should be initiated at which of the following junctures?

  

A. Prior to uterine incision

B. Only once the umbilical cord has been clamped and cut

C. Only once the fetus has cried

D. Upon closure of the uterus

B. Only once the umbilical cord has been clamped and cut

After initiation of Pitocin infusion during an emergent C-section, the surgeon reports that the uterus feels "boggy". The SRNA can anticipate that which of the following may be requested:

  

A. Nifedipine IVP

B. Pitocin IM

C. Methergine IM

D. Pausing the Pitocin infusion

E. Misoprostol IVP

F. Terbutaline IVP

G. Methergine IVP

C. Methergine IM

The SRNA recognizes that the #1 culprit for nausea and/or vomiting during C-section is which of the following?

  

A. Opioid administration

B. Untreated hypotension

C. Hyperemesis gravidarum

D. Pitocin administration

B. Untreated hypotension