Deck 19: Drugs for Local and General Anesthesia

Question 1

The student nurse does an operating room rotation and notes that many patients receive succinylcholine (Anectine). The student nurse asks the nursing instructor how the drug works. What is the best response by the nursing instructor?

A) "It causes the patient to rapidly lose consciousness."
B) "It increases cardiac output by raising the heart rate."
C) "It interferes with impulse transmission, resulting in total anesthesia from the pain of surgery."
D) "It reduces the amount of general anesthetic needed for procedures."

Answer 1

"It reduces the amount of general anesthetic needed for procedures."

Question 2

Which statement correctly identifies a sign of general anesthesia?

A) A sleeping state that can be awakened easily
B) An unconscious state, without analgesia
C) A total loss of body movements
D) A conscious but sleepy state of being

Answer 2

A total loss of body movements

Question 3

The 2-year-old child comes to the emergency department with a laceration to the lower leg. The physician plans to use a local anesthetic, but the child screams at the sight of the needle. What is the best action by the nurse?

A) Wrap the child in a blanket to restrain him and ensure safety during suturing.
B) Rub a local anesthetic cream on the skin so the child will not feel the needle.
C) Administer a small dose of a medication such as lorazepam (Ativan).
D) Ask the parents to leave the room so the child will quiet down.

Answer 3

Rub a local anesthetic cream on the skin so the child will not feel the needle.

Question 4

What does the nurse recognize as the most dangerous adverse effect of volatile liquid inhalation anesthesia?

A) Hypertension
B) Ventricular tachycardia
C) Malignant hyperthermia
D) Increased intracranial pressure

Question 5

The patient has a serious laceration to the arm. The patient receives a local anesthetic mixed with epinephrine prior to suturing. What does the nurse recognize as the rationale for the epinephrine?

A) Constricted blood vessels will extend the duration of action of the drug.
B) Constricted blood vessels will decrease the amount of pain experienced.
C) Constricted blood vessels will promote relaxation of the patient.
D) Constricted blood vessels will result in decreased bleeding.

Question 6

Which statement correctly identifies the initial use for an IV in a patient undergoing a lengthy abdominal surgery that requires general anesthesia?

A) To administer agents that will produce rapid unconsciousness
B) To administer reversal agents or other medications used to treat the adverse effects associated with general anesthesia
C) To administer large amounts of colloid solutions following surgical blood loss
D) To administer a volatile liquid that will keep the patient asleep

Question 7

Local anesthetics work by

A) enhancing the influx of calcium into the cell.
B) occupying potassium receptors.
C) increasing nerve impulse transmission.
D) blocking sodium channels.

Question 8

Which patient is most likely to experience an adverse reaction to inhalation anesthesia?

A) A 15-year-old with diabetes mellitus
B) A 6-year-old with no chronic health problems
C) A 79-year-old with arteriosclerosis
D) A 55-year-old with a serious neck injury

Question 9

Which local anesthetic agent would be considered for use first due to its lower rate of adverse effects?

A) Tetracaine (Pontocaine)
B) Procaine (Novocain)
C) Lidocaine (Xylocaine)
D) Chloroprocaine (Nesacaine)

Question 10

The patient has entered Stage 3 of general anesthesia, known as surgical anesthesia. What will the best assessment of the nurse reveal?

A) Heart rate and breathing become irregular.
B) General sensation is lost, but the patient remains conscious.
C) The medulla region of the brain is paralyzed.
D) Relaxation, stable respiration, and slow eye movements

Question 11

The nurse teaches the patient about the correct use of a topical anesthetic for a skin condition. The nurse determines that learning has occurred when the patient makes which statements?

A) "This lotion should only be used on small areas of skin."
B) "I must wear gloves when I apply the lotion."
C) "This lotion works well on cuts too."
D) "I must wash my hands before touching my eyes."
E) "It's all right to use a lotion after the expiration date."

Question 12

The patient has gastroesophageal reflux disease and receives lidocaine viscous prior to an endoscopy. What will be the nurse's priority assessment immediately after the procedure?

A) Assess for a return of the gag reflex.
B) Assess for nausea and vomiting.
C) Assess for any damage to the teeth or gums.
D) Assess for a headache.

Question 13

The patient is scheduled for a surgical procedure. The nurse plans to teach the patient about anesthesia. Which statement would be included in the best plan of the nurse?

A) "An inhaled agent needs to be followed by an intravenous (IV) agent if it is ineffective."
B) "An inhaled agent is used to induce sleep, followed by an intravenous (IV) agent for relaxation."
C) "An intravenous (IV) agent to induce sleep is usually all that is required."
D) "An intravenous (IV) agent will be used first to induce sleep; then, an inhaled agent will be used."

Question 14

Which description correctly identifies a state of general anesthesia desirable for surgery?

A) The patient is unconscious, with arm and leg movement.
B) The patient is not responsive to pain, and has no spontaneous breathing.
C) The patient is unconscious with slow eye movements.
D) The patient loses sensation, but is awake.

Question 15

The nursing instructor teaches the nursing students about the advantages of local anesthetics, such as lidocaine (Xylocaine). What will the best plan of the nursing instructor include?

A) Amides have fewer side effects than esters.
B) Amides block potassium entry into the cell.
C) Amides are similar in structure to cocaine.
D) Amides tend to last longer than esters.
E) Amides block calcium entry into the cell.

Question 16

The patient receives succinylcholine (Anectine). What will be a priority assessment by the nurse?

A) Spontaneous bleeding
B) Respiratory paralysis
C) Anaphylactic shock
D) Delirium

Question 17

A patient with severe cardiac disorder requires closure of a deep laceration. The nurse would advocate for which plan for analgesia?

A) Plain epinephrine
B) Laceration repair without anesthesia
C) Topical application of lidocaine gel
D) Injected lidocaine without epinephrine

Question 18

A pregnant woman has a malignant melanoma on her leg and will need surgery. She is concerned about anesthesia. What is the best response by the nurse?

A) "You will probably have an epidural, and this won't harm your baby."
B) "There are newer general anesthetics available that are safe for your baby."
C) "You will most likely have local anesthesia; this will not affect your baby."
D) "Inhalation anesthetics are safe because they remain in your lungs."

Question 19

The patient is in Stage 2 of general anesthesia. What are the priority nursing interventions at this time?

A) Assist the anesthesiologist in repositioning the patient.
B) Complete the surgical scrub.
C) Keep the environment quiet and calm.
D) Insert the indwelling urinary catheter.

Question 20

Which clinical technique for administering anesthesia is common for pregnant women during labor and delivery?

A) Nerve block
B) Topical
C) Infiltration
D) Epidural

Question 21

Midazolam (Versed) may be administered as part of surgical anesthesia. This drug is recognized as having which effects?

A) Producing effects consistent with those observed in administering other benzodiazepines
B) Reducing anxiety and stress associated with surgery
C) Producing central nervous system depression and skeletal muscle relaxation
D) Maintaining stable cardiac and respiratory activity
E) Preventing cardiac dysrhythmias

Question 22

Balanced anesthesia is the use of a combination of medications to produce general anesthesia. Which drugs may be used in combination?

A) Benzodiazepines
B) Neuromuscular blockers
C) Inhaled anesthetics
D) Proton-pump inhibitors
E) Intravenous anesthetics

Question 23

A patient has multiple lacerations following a motor vehicle accident. The nurse will be certain that lidocaine without epinephrine is used for local anesthesia when lacerations of which areas are repaired?

A) Laceration to the cheek
B) Laceration to the earlobe
C) Laceration to the end of the nose
D) Laceration on the top of the foot
E) Laceration on the fingertip

Question 24

A patient is scheduled for an operative procedure in which isoflurane (Forane) will be used as the anesthetic agent. The nurse would immediately collaborate with the anesthesiologist if the patient makes which statements?

A) "I stopped taking my vitamin C supplement last week because it upset my stomach."
B) "I have been so depressed about having this surgery. I don't think my St. John's wort is helping at all."
C) "I have not eaten anything since before my CT scan yesterday."
D) "My brother ran a high fever and had seizures after his surgery."
E) "My last dose of levodopa was yesterday."

Question 25

A patient who has history of severe arteriosclerosis has sustained a laceration on the forearm that will be repaired in the emergency department. The nurse would plan to obtain a local anesthetic with which properties?

A) With no epinephrine
B) With sodium bicarbonate
C) Without lidocaine
D) With a volatile liquid
E) With proparacaine (Alcaine)

Question 26

Preoperative adjunct medications are used for which reasons?

A) To reduce anxiety and facilitate sedation
B) To facilitate a faster recovery
C) To reduce the risk of aspiration pneumonia
D) To reduce the risk of a postoperative ileus
E) To manage pain

Question 27

The nurse explaining epidural anesthesia to a patient would indicate which area as the placement for this type of anesthesia?

A) A
B) B
C) C
D) D

Question 28

A novice nurse says, "We want to keep our patients in Stage 4 anesthesia during their surgery." How should the supervising nurse interpret this statement?

A) The novice nurse has made an error in this statement.
B) Stage 4 anesthesia is avoided.
C) This is a good description of the goal of anesthesia.
D) The novice nurse should have said Stage 3 anesthesia.
E) A more accurate statement would be that the patient is maintained in anxiolysis anesthesia.

Question 29

A patient undergoing surgery is receiving general anesthesia as well as a neuromuscular blocking agent. Which statement best indicates the primary reason for the neuromuscular blocking agent?

A) To potentiate analgesic effects
B) To prevent adverse effects associated with inhaled gases
C) To cause total skeletal muscle relaxation
D) To induce unconsciousness

Question 30

A patient has inadvertently received two doses of propofol (Diprivan) within 2 minutes of one another. What nursing actions are indicated?

A) Increase intravenous fluid rate.
B) Monitor the patient closely for development of an allergic skin reaction.
C) Monitor the patient closely for respiratory depression.
D) Have serum calcium levels drawn immediately.
E) Administer a benzodiazepine.