General and Local Anesthetic Agents

1.

To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used?
A)
Antihistamines
B)
Antiemetics
C)
Narcotics
D)
Sedative-hypnotics
Ans:
D

Feedback:

Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic and sedative effects.

2.

During what stage of anesthesia would the nurse see the patient’s skeletal muscles relax and return of regular respirations?
A)
Stage 1: Analgesia stage
B)
Stage 2: Excitement stage
C)
Stage 3: Surgical anesthesia stage
D)
Stage 4: Medullary paralysis
Ans:
C

Feedback:

Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.

3.

The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of care for this patient?
A)
Encourage clear fluids.
B)
Increase oxygen.
C)
Reassure the patient that about safety.
D)
Maintain regular repositioning.
Ans:
D

Feedback:

The patient would need to be moved or turned periodically to prevent skin breakdown and the formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from the medications used in general anesthesia would prevent the patient from shifting himself or herself to relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not receive anything by mouth eliminating option A. Reassurance would not be necessary for the unconscious patient.

4.

A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which diagnoses will the nurse include that is directly related to safety?
A)
Deficient knowledge regarding drug therapy
B)
Disturbed sensory perception (kinesthetic, tactile) related to anesthesia
C)
Risk for impaired skin integrity related to immobility
D)
Risk for injury related to central nervous system (CNS) depressive effects of drugs
Ans:
D

Feedback:

The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to express safety concerns and must rely completely on the surgeon and OR staff for protection.

5.

What nursing interventions would help minimize the risk of a headache in a patient recovering from spinal anesthesia?
A)
Administer a triptan intramuscularly.
B)
Administer morphine intravenously.
C)
Maintain patient in recumbent position.
D)
Place patient in Trendelenburg position.
Ans:
C

Feedback:

Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours. Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine would treat the headache but would not prevent it.

6.

An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also complains that his or her head feels “fuzzy” and that the right words will not come to his or her. What is the priority nursing intervention for this patient?
A)
Provide analgesic medication for the discomfort.
B)
Stay with patient as much as possible and provide reassurance.
C)
Provide fluids to increase his or her wakefulness.
D)
Encourage the patient to turn from side to side periodically.
Ans:
B

Feedback:

Most patients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the patient as much as possible and reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery if the patient reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority nursing action at this time. However, the most effective nursing action for anxious postoperative patients is for the nurse to stay with them as much as possible.

7.

The patient appears awake but is unconscious and has no response to painful stimuli. What medication does the nurse suspect this patient has received?
A)
Thiopental (Pentothal)
B)
Midazolam (Generic)
C)
Ketamine (Ketalar)
D)
Propofol (Diprivan)
Ans:
C

Feedback:

Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous. Thiopental is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate anesthetics. None of these medications have this type of effect.

8.

Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac depression?
A)
Droperidol (Inapsine)
B)
Etomidate (Amidate)
C)
Ketamine (Ketalar)
D)
Propofol (Diprivan)
Ans:
C

Feedback:

If ketamine and halothane are used in combination, severe cardiac depression with hypotension and bradycardia may occur. Use of droperidol, etomidate, and propofol with halothane should not be a concern.

9.

The operating room nurse is developing the care plan for a 10-year-old child with asthma who is scheduled for a tonsillectomy and who will receive halothane as the anesthetic agent. Why is this an appropriate drug for this patient?
A)
Halothane is metabolized in the liver.
B)
Halothane dilates the bronchi.
C)
Halothane is excreted unchanged in the urine.
D)
Halothane causes an accumulation of secretions.
Ans:
B

Feedback:

Halothane is of particular benefit to a child with asthma because it dilates bronchi. Halothane is inhaled drug so it is not metabolized in the liver or excreted in the urine. It does not cause an accumulation of secretions.

10.

The nurse should recognize what drug is classified as an amide local anesthetic?
A)
Lidocaine (Xylocaine)
B)
Benzocaine (Dermoplast)
C)
Chloroprocaine (Nesacaine)
D)
Tetracaine (Pontocaine)
Ans:
A

Feedback:

Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester anesthetics.

11.

A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia?
A)
Induction
B)
Maintenance
C)
Recovery
D)
Medullary paralysis
Ans:
D

Feedback:

Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the patient is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C is a distracter.

12.

The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia. While taking the admission history, the patient says she is allergic to lidocaine. What is the nurse’s priority action?
A)
Notify the anesthesiologist.
B)
Cancel the surgery.
C)
Notify the surgeon.
D)
Tell the perioperative nurse.
Ans:
A

Feedback:

The priority action is to inform the anesthesiologist who will administer the anesthetic because local anesthesia often involves use of lidocaine. It is not within the nurse’s scope of practice to cancel surgery. Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.

13.

The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this patient?
A)
Rub the patient’s back.
B)
Monitor vital signs.
C)
Provide eye care.
D)
Reposition the patient.
Ans:
B

Feedback:

Stage 2, the excitement stage, is a period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes). Monitoring vital signs can be lifesaving at this stage. Eye care is important in stages 3 and 4. Rubbing the patient’s back and repositioning the patient are not indicated in this stage of anesthesia.

14.

The patient received midazolam in combination with an inhaled anesthetic and a narcotic during surgery. The postanesthesia care unit (PACU) nurse anticipates this combination of drugs will have what impact on the patient’s stay in the unit?
A)
Increased use of medications to offset adverse effects
B)
Extended time needed in the unit
C)
Decreased nursing support needed
D)
Increased analgesics needed
Ans:
B

Feedback:

Midazolam is associated with increased toxicity and length of recovery when used in combination with inhaled anesthetics, other central nervous system depressants, narcotics, propofol, or thiopental. Because this patient received both narcotics and inhaled anesthetics, the nurse will anticipate this patient’s time in the PACU will be extended. The patient is likely to need fewer analgesics because it will take longer for the patient to wake from anesthesia, which will also mean fewer medications will be used. Until the patient is awake, he or she will need continuous nursing support.

15.

The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be administered by what method?
A)
Topical Administration
B)
Infiltration
C)
Field block
D)
Nerve block
Ans:
B

Feedback:

Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2-inch laceration.

16.

A nurse is caring for a patient who received thiopental as an anesthetic agent during surgery. What adverse effects would the nurse attribute to the medication?
A)
Tachycardia
B)
Urinary retention
C)
Tachypnea
D)
Headache
Ans:
D

Feedback:

Adverse effects of thiopental include emergence delirium, headache, restlessness, anxiety, cardiovascular depression, respiratory depression, apnea, salivation, hiccups, and rashes. Tachycardia, tachypnea, and urinary retention are not usually associated with this drug.

17.

The nurse is caring for a patient who will receive an epidural block. What procedure is this patient likely to be having?
A)
Rhinoplasty
B)
Inguinal hernia repair
C)
Removal of a brain tumor
D)
Closed reduction of the right humerus
Ans:
B

Feedback:

Nerve block is a method of administering local anesthesia by injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Several types of nerve blocks are possible.
Epidural anesthesia is an injection of the drug into the epidural space where the nerves emerge from the spinal cord. As a result, only an inguinal hernia repair would be an appropriate procedure for administering an epidural. Surgery performed about the spinal cord, such as surgery on the nose or brain, could not be anesthetized by injection of medication into the spinal cord. Closed reduction of the right humerus would not be performed using a local anesthetic.

18.

The operating room nurse is taking the patient into the operating room when the patient says his grandmother almost died from a high fever in surgery 15 years ago. The nurse shares this information with the surgical team, recognizing this information indicates the patient is at risk for what?
A)
An allergic reaction to anesthesia
B)
Malignant hyperthermia
C)
Anxiety
D)
Hypothermia
Ans:
B

Feedback:

The nurse assesses for a personal or family history of malignant hyperthermia, which may be triggered by the use of general anesthetics. Identifying patients at risk is imperative because the mortality rate is very high. All of these drugs have the potential to trigger malignant hyperthermia and should be used with caution in any patient at high risk. The patient’s anxiety is to be expected, all patients are at risk for hypothermia because they are often uncovered in a cold room. Allergy to anesthesia must always be considered a possibility but there is no indication of a higher than normal risk in this patient.

19.

The circulating nurse in the day surgery center is caring for a patient who is to receive a local anesthetic. What potential complications will the nurse monitor for? (Select all that apply.)
A)
Malignant hypothermia
B)
Pain
C)
Blurred vision
D)
Peripheral vasodilation
E)
Nausea
Ans:
C, D, E

Feedback:

Adverse effects of local anesthetics are associated with the route of administration and the amount of drug that is absorbed systemically. These effects are related to the blockade of nerve depolarization throughout the system. Effects that may occur include central nervous system effects such as headache (especially with epidural and spinal anesthesia), restlessness, anxiety, dizziness, tremors, blurred vision, and backache; gastrointestinal (GI) effects such as nausea and vomiting; cardiovascular effects such as peripheral vasodilation, myocardial depression, arrhythmias, and blood pressure changes, all of which may lead to fatal cardiac arrest; and respiratory arrest. There is no such problem as malignant hypothermia (the condition is malignant hyperthermia) and pain may be caused by the procedure but not the anesthetic.

20.

What nursing diagnosis would a circulating nurse use on his or her intraoperative patients who receive general anesthesia? (Select all that apply.)
A)
Disturbed sensory perception
B)
Risk for hypovolemia
C)
Risk for latex allergy response
D)
Disturbed body image
E)
Anxiety
Ans:
A, C, E

Feedback:

Nursing care of patients receiving general or local anesthetics should include safety precautions to prevent injury and skin breakdown, support and reassurance to deal with the loss of sensation and mobility, and patient teaching regarding what to expect to decrease stress and anxiety. Risk for hypovolemia and disturbed body image would be applicable to some surgical procedures but would not be related to general anesthesia.

21.

The patient receives lidocaine as a local anesthetic before insertion of a chest tube. After the procedure the patient tells the nurse, “The area is still numb. How long will this last?” What is the nurse’s best response?
A)
15 minutes
B)
1 hour
C)
2 hours
D)
4 hours
Ans:
C

Feedback:

The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours. Options A, B, and D are distracters.

22.

The pharmacology instructor is explaining balanced anesthesia to the students. What agents would the instructor say are involved in balanced anesthesia? (Select all that apply.)
A)
Neuromuscular junction blockers
B)
Narcotics
C)
Anticholinergics
D)
Salicylates
E)
Nonsteriodal anti-inflammatory drugs (NSAIDs)
Ans:
A, B, C

Feedback:

Balanced anesthesia involves giving a variety of drugs with specific effects to achieve analgesia, relax muscles, and invoke unconsciousness and amnesia. Classification of drugs administered includes anticholinergics, rapid intravenous anesthetics, inhaled anesthetics, neuromuscular junction blockers, and narcotics. Balanced anesthesia does not include use of salicylates or nonsteroidal anti-inflammatory drugs.

23.

The nurse is caring for a patient who received halothane as an anesthetic agent. The patient will require additional surgery. When can halothane be used again without risk of halothane’s recovery syndrome?
A)
1 week
B)
2 weeks
C)
3 weeks
D)
4 weeks
Ans:
C

Feedback:

Halothane’s recovery syndrome is characterized by fever, anorexia, nausea, vomiting, and eventual hepatitis, which can progress to fatal hepatic necrosis. Although this syndrome is rare, halothane is not used more frequently than every 3 weeks to reduce patient risk. Other options are incorrect.

24.

A 54-year-old patient with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this patient?
A)
Enflurane
B)
Desflurane
C)
Sevoflurane
D)
Isoflurane
Ans:
B

Feedback:

Desflurane is associated with a collection of respiratory reactions, including cough, increased secretions, and laryngospasm. The other options have far fewer respiratory adverse effects and would be safer for use in this patient.

25.

The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse’s initial priority nursing assessment?
A)
Assess the patient’s anxiety.
B)
Start an IV.
C)
Show the family the waiting area.
D)
Weigh the patient.
Ans:
D

Feedback:

Weighing the patient is an initial priority because his or her weight will be used to determine appropriate dosing of all medications and will establish a baseline used for evaluation of any potential adverse effects. Other options are all actions the nurse will need to perform, but none are of higher priority than weighing the patient.

26.

A very anxious patient asks the nurse what type of anesthesia they will have for a scheduled tooth extraction. The nurse would describe what type of local anesthetic in laymen’s terms?
A)
Topical
B)
Infiltration
C)
Field block
D)
Nerve block
Ans:
C

Feedback:

Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery.

27.

The nurse receives a patient into the postanaesthesia care unit who has had surgery using the anesthetic agent methohexital. The nurse anticipates the patient’s need for what in the postoperative period?
A)
Assistance in maintaining respirations
B)
Assistance in moving lower extremities
C)
Positioning in Semi-Fowler’s position
D)
Analgesia to control the patient’s pain
Ans:
D

Feedback:

Methohexital lacks analgesic properties so the patient may require postoperative analgesics to control pain. The patient who has surgery under methohexital does not generally require assistance in maintaining respirations or assistance in moving their lower extremities. They also do not generally require positioning in a semi-Fowler’s position.

28.

The emergency room nurse is teaching a class for newly hired graduate nurses on the different types of local anesthetic agents. How would the nurse differentiate lidocaine and procaine as a local anesthetic agent?
A)
Lidocaine is an amide that is broken down slowly and this can lead to toxicity.
B)
Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism.
C)
Procaine is an amide that is broken down immediately in the tissues.
D)
Procaine is metabolized by the liver with risk of toxicity and is classified as an ester.
Ans:
A

Feedback:

The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide and procaine is an ester.

29.

A nursing student in a pharmacology class asks the instructor why nitrous oxide is used for dental surgery. What is the instructor’s most accurate response?
A)
Nitrous oxide stays in the body for a long time.
B)
Nitrous oxide does not cause pressure in body compartments.
C)
Nitrous oxide does not cause muscle relaxation.
D)
Nitrous oxide does not need to be administered with oxygen.
Ans:
C

Feedback:

Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Nitrous oxide does need to be given in combination with oxygen to avoid hypoxia in the patient.

30.

The nurse is admitting a patient to the postanesthesia care unit (PACU) who received halothane and ketamine as anesthesia. What is the nurse’s priority assessment?
A)
Blood pressure and pulse
B)
Respirations and airway
C)
Pain and respirations
D)
Temperature and airway
Ans:
A

Feedback:

If halothane and ketamine are used in combination, severe cardiac depression with hypotension and bradycardia may occur. If these agents must be used together, the patient should be monitored closely. Pain, respirations, airway, and temperature are all assessments the nurse will collect on any patient in the PACU, but they are not priority assessments associated with combining ketamine and halothane.

31.

The nurse is assisting while the physician is suturing a wound in the urgent care clinic. The physician asks for lidocaine with epinephrine. The nurse identifies the primary reason for adding epinephrine to the lidocaine is what effect?
A)
It will sting more when it is injected into the tissue.
B)
Risk of systemic absorption is increased.
C)
Local effect is increased.
D)
Bleeding at the wound site is increased.
Ans:
C

Feedback:

There is less risk of systemic absorption and increased local effects if these drugs are combined with epinephrine. Epinephrine causes vasoconstriction, which reduces bleeding, slows absorption, and makes the duration of effect longer. It does sting more when injected, but that is not a reason to use it.

32.

The nurse is caring for a patient scheduled for surgery who is to receive a barbiturate as part of the planned balanced anesthesia. What drugs, if taken by the patient, could result in a clinically important drug–drug interaction with the barbiturate? (Select all that apply.)
A)
Thyroid hormone
B)
Ibuprofen
C)
Oral contraceptive
D)
Theophylline
E)
Anticoagulant
Ans:
C, D, E

Feedback:

Caution must be used when these drugs are used with any other central nervous system suppressants. Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants, beta-blockers, corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and carbamazepine. Combinations of barbiturate anesthetics and narcotics may produce apnea more commonly than occurs with other analgesics. Thyroid hormone and ibuprofen have no known drug interactions with barbiturates.

33.

The nurse is caring for a patient experiencing malignant hyperthermia. What medication will be administered to treat this condition?
A)
Midazolam
B)
Dantrolene
C)
Halothane
D)
Thiopental
Ans:
B

Feedback:

Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily available whenever anesthetics are used that could trigger the syndrome. Midazolam and thiopental are barbiturates whereas halothane is a volatile gas that can trigger malignant hyperthermia.

34.

The nurse is caring for a patient who will undergo cardioversion in the patient’s room this morning. The patient will receive propofol as anesthetic during the procedure. What are the benefits of using propofol for this procedure? (Select all that apply.)
A)
It has a very rapid clearance.
B)
It produces less of a hangover effect.
C)
It allows for quick recovery from anesthesia.
D)
Its onset of action is 5 minutes.
E)
It is painless to inject IV.
Ans:
A, B, C

Feedback:

Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is a very short-acting anesthetic with a rapid onset of action of 30 to 60 seconds. Propofol often causes local burning on injection.

35.

The nurse applies a topical anesthetic to reduce sensation at the site while starting an IV. What age group is at greatest risk for systemic absorption of the topical anesthetic?
A)
Older adult
B)
Infant
C)
Toddler
D)
Adolescent
Ans:
B

Feedback:

When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. Therefore, the other options are incorrect.