Deck 42: The Perianesthesia Patient

Question 1

Which stage of general anesthesia begins with the initiation of an anesthetic agent and ends with loss of consciousness?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Answer 1

Stage I

Question 2

What medication may be used to treat laryngospasm?

A) Racemic epinephrine
B) Succinylcholine
C) Albuterol
D) Morphine

Answer 2

Succinylcholine

Question 3

The sustained maximal inspiration (SMI)maneuver is performed by having the patient take

A) a deep breath and hold it for 3 to 5 seconds before exhaling.
B) a slow deep breath and then forcefully exhaling.
C) a deep breath and, at the peak of inspiration, expanding the chest and taking in a little more air.
D) in a slow deep breath and then exhaling slowly.

Answer 3

a deep breath and hold it for 3 to 5 seconds before exhaling.

Question 4

Which of the following is a consequence of postoperative hypothermia?

A) Decreased blood viscosity
B) Metabolic alkalosis
C) Decreased systemic vascular resistance
D) Decreased metabolic processes

Question 5

Initial management of laryngospasm includes

A) intubating the patient and providing manual ventilation with 100% oxygen.
B) hyperextending the patient's head and administering positive-pressure ventilations on 100% oxygen.
C) administering 10 mg of succinylcholine.
D) administering nebulized racemic epinephrine.

Question 6

Which stage of general anesthesia is known as surgical anesthesia?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 7

The stir-up regimen consists of

A) deep breathing exercises, suctioning, warming, and nausea management.
B) incentive spirometry, abdominal breathing, warming, drinking, and pain management.
C) incentive spirometry, coughing, suctioning, warming, mobilization, and eating.
D) deep breathing exercises, coughing, positioning, mobilization, and pain management.

Question 8

What medication is a first-line therapy in treating bronchospasm?

A) Racemic epinephrine
B) Methylprednisolone
C) Albuterol
D) Morphine

Question 9

Postoperatively,dysrhythmias occur in patients

A) during the first minute.
B) during the first 2 minutes.
C) during the first 5 minutes.
D) at any time.

Question 10

The effects of nitrous oxide include

A) anesthesia, analgesia, and amnesia.
B) vasodilation, analgesia, and myocardial depression.
C) respiratory and cardiovascular depression.
D) bronchodilation, myocardial excitation, and muscle tremors.

Question 11

Snoring,stridor,nostril flaring,and intercostal retractions are clinical manifestations of

A) angina.
B) airway obstruction.
C) pain.
D) sedation.

Question 12

Which of the following benzodiazepines has a slow onset of action and long duration?

A) Diazepam (Valium)
B) Midazolam (Versed)
C) Lorazepam (Ativan)
D) Droperidol (Inapsine)

Question 13

In the postanesthesia care unit,patients should be stimulated to take three to four deep breaths every

A) 1 to 2 minutes.
B) 3 to 5 minutes.
C) 5 to 10 minutes.
D) 30 to 60 minutes.

Question 14

Oral intake is prohibited after anesthesia until

A) the patient is ambulatory.
B) the patient is strong enough to hold a cup of water.
C) all nausea has ceased.
D) laryngeal and pharyngeal reflexes are fully regained.

Question 15

The duration of action of naloxone is

A) 30 minutes to 1 hour.
B) 1 to 4 hours.
C) 4 to 6 hours.
D) 6 to 10 hours.

Question 16

Patients who shiver

A) are always hypothermic.
B) are always hyperthermic.
C) may be normothermic.
D) always shiver because of pain.

Question 17

What is the principal depolarizing skeletal muscle relaxant?

A) Succinylcholine
B) Pancuronium
C) Mivacurium
D) Rocuronium

Question 18

The coughing maneuver in which a patient takes a deep breath and then performs multiple coughs on exhalation of that breath is known as the

A) serial cough.
B) cascade cough.
C) sustained maximal cough.
D) deep cough.

Question 19

Which of the following antagonizes the effects of benzodiazepines?

A) Naloxone
B) Neostigmine
C) Fentanyl
D) Flumazenil

Question 20

What medication may be used to treat laryngeal edema?

A) Racemic epinephrine
B) Succinylcholine
C) Albuterol
D) Morphine

Question 21

Which medication has a direct myocardial depressant effect on the heart?

A) Ketamine
B) Barbiturates
C) Succinylcholine
D) Opioids

Question 22

Nursing management of a postoperative patient who is experiencing prolonged vomiting includes

A) withholding all pain medication until the nausea has subsided.
B) removing the nasogastric tube.
C) inserting an oral airway.
D) increasing intravenous fluids.

Question 23

The most definitive test for detecting malignant hyperthermia (MH)susceptibility is a(n)

A) creatine phosphokinase (CPK) test.
B) ionized calcium test.
C) core temperature reading.
D) skeletal muscle biopsy.

Question 24

When a patient emerges in a very restless state,the nurse must first assess for

A) anxiety.
B) hypoxia.
C) hyponatremia.
D) gastric distention.

Question 25

Which of the following dysrhythmias are common in the postanesthetic period?

A) Ventricular tachycardia
B) Ventricular fibrillation
C) Supraventricular tachydysrhythmias
D) Sinus bradycardia
E) Premature ventricular contractions

Question 26

A patient was transferred to the postanesthesia care unit from the operating room after the induction of halothane anesthesia.The patient has no significant medical history.On admission,the patient appeared comatose and extremely diaphoretic,with severe muscle rigidity and tremors.The patient's vital signs were heart rate,145 beats/min; monitor reveals sinus tachycardia; blood pressure,85/50 mm Hg; respiratory rate,35 breaths/min; and temperature,103.8° F.Arterial blood gases on 100% oxygen by ventilator were PaO?,70%; PaCO?,35 mm Hg; pH,7.21; HCO?,16 mm Hg; and SaO?,90%.Fluid resuscitation and vasoactive therapy were started.Initial abnormal laboratory results were BUN,66 mg/dL; sodium,155 mEq/L; potassium,5.5 mEq/L; glucose,68 mg/dL; creatinine,2.4 mg/dL; and creatine phosphokinase,1896 U/L.The nurse would anticipate a diagnosis of

A) noncardiogenic pulmonary edema.
B) sepsis.
C) malignant hyperthermia.
D) emergency delirium.

Question 27

Management of an airway obstruction begins with immediate recognition and treatment.Place these nursing interventions in the appropriate order for initial care of a postanesthesia patient with airway obstruction.
1)Positive-pressure mask ventilation
2)Head tilt,chin lift maneuver (nonreactive patient)
3)Insertion of oropharyngeal or nasopharyngeal airway
4)Intubation with mechanical intubation
5)Stimulation of the patient

A) 1, 2, 3, 5, 4
B) 5, 2, 3, 1, 4
C) 2, 3, 1, 5, 4
D) 4, 2, 3, 1, 5

Question 28

What is the most common cause of hypoxemia?

A) Laryngeal edema
B) Laryngospasm
C) Bronchospasm
D) Ventilation/perfusion mismatching

Question 29

A patient emerges from general anesthesia screaming,shouting,and thrashing wildly.The nurse identifies this reaction as

A) emergence hallucination.
B) normal.
C) emergence hyperactivity.
D) emergence delirium.

Question 30

The patient's body temperature is 33° C.The patient is shivering and the nurse needs to

A) cover the patient with warm blankets.
B) apply heat lamps.
C) provide fluid and blood warming.
D) apply supplemental oxygen.
E) provide a thermal mattress.

Question 31

An electrolyte disturbance that can cause delayed arousal in a postoperative patient is

A) hypercalcemia.
B) hyponatremia.
C) hyperkalemia.
D) hypermagnesemia.

Question 32

The nurse suspects that a patient has aspirated.The nurse should immediately

A) raise the head of the bed to a 45- to 90-degree angle.
B) lower the bed and turn the head to the side.
C) insert an ETT tube.
D) call for chest radiography to verify aspiration.

Question 33

What is the most effective treatment of postoperative nausea and vomiting?

A) Prevention
B) Droperidol given immediately when nausea is reported
C) Phenergan given immediately when nausea is reported
D) Metoclopramide given immediately when nausea is reported

Question 34

Causes of a postoperative fever include

A) medication reactions.
B) hypotension.
C) blood transfusion reaction.
D) pulmonary emboli.
E) atelectasis.

Question 35

Which of the following is a common cause of postoperative hypertension?

A) Administration of morphine
B) Fluid overload
C) Bladder distention
D) Tachycardia