Question 1

The client asks the nurse during preoperative teaching why he has to "receive so many drugs for such a simple procedure." How should the nurse explain the goal of using multiple agents to achieve general anesthesia?

A) This method decreases the dosages required for the various anesthetic agents.
B) Temporary amnesia can be produced in order for the client not to remember the procedure.
C) Use of multiple drugs reduces the pain the client feels postoperatively.
D) This method maintains a deep state of anesthesia during the procedure.

This method maintains a deep state of anesthesia during the procedure.

Accepted Answer

Rationale 1: Not all anaesthetic agents will be reduced, multiple medications may allow for less inhaled agents which improves safety for the client.
Rationale 2: While the client will not remember the surgery, this is a secondary goal.
Rationale 3: While the reduction of postoperative pain is important, it is a secondary goal.
Rationale 4: Multiple medications are used to achieve rapid induction of anesthesia, maintain deep anesthesia, and promote muscle relaxation. While the client will not remember the surgery or experience pain, these are secondary goals.

Question 2

A client has received local anesthesia of lidocaine (Xylocaine) with epinephrine for repair of a laceration. The nurse plans care based on the knowledge of which action of the epinephrine?&#10;A) Constrict the blood vessels in the area to dramatically reduce bleeding, thus enhancing the operative field.&#10;B) Constrict the blood vessels to extend the duration of the drug in the operative area.&#10;C) Constrict the blood vessels to make the wound less distressing to the client and to promote relaxation.&#10;D) Constrict the blood vessels in the area to reduce the transmission of pain signals to the central nervous system.&#10;

Accepted Answer

Rationale 1: The amount of vasoconstriction with a local anesthetic will not significantly decrease bleeding from the injury.
Rationale 2: Epinephrine is a common additive to local anesthetics that is used to constrict the blood vessels and to extend the duration of the drug.
Rationale 3: Vasoconstriction will not promote relaxation in the client.
Rationale 4: Vasoconstriction does not decrease the transmission of pain signals.

Question 3

Which clients would the nurse evaluate as unsuitable for the administration of propofol (Diprivan) as anesthesia?&#10;A) A 60 year old with benign prostatic hypertrophy&#10;B) A 17-year-old who sustained a head injury in a motor vehicle accident&#10;C) A woman in her second trimester of pregnancy&#10;D) A 58-year-old with type 2 diabetes mellitus&#10;E) A 70-year-old with a history of ulcerative colitis&#10;

Accepted Answer

Rationale 1: BPH is not a contraindication for the use of propofol.
Rationale 2: Clients who have sustained head injury should not receive propofol.
Rationale 3: propofol should not be given to pregnant women.
Rationale 4: There is no contraindication to propofol administration for this client.
Rationale 5: Ulcerative colitis is not a contraindication for administration of propofol.

Question 4

A client is being prepared for surgery. Which of the following would be a contraindication for using succinylcholine (Quelicin) as an adjunct to general anaesthesia.&#10;A) Hepatic dysfunction&#10;B) Malignant hyperthermia&#10;C) COPD&#10;D) Congestive heart failure&#10;E) Myasthenia gravis&#10;

Accepted Answer

Rationale 1. Succinylcholine is metabolized by the liver, it's use is contraindicated in clients with liver dysfunction
Rationale 2. Malignant hyperthermia is a serious condition which may be brought on by the use of succinylcholine. Patients with a family or personal history of malignant hyperthermia should not be given succinylcholine.
Rationale 3.Succinylcholine is not contraindicated for clients with COPD.
Rationale 4. Succinylcholine is not contraindicated in clients with congestive heart failure.
Rationale 5. Succinylcholine is contraindicated in clients with myasthenia gravis.

Question 5

The nurse is caring for a client who is one day post surgery for an abdominal hysterectomy. The client is requesting morphine sulfate intravenous (IV), which is prescribed. The client rates her pain as 8 out of 10, with 10 being the most intense. The nurse says to another nurse on the unit, "She really doesn't look like she is in pain. Maybe she is an addict." Which is the best response by the other nurse?

A) "Maybe you could tell her to do some distraction techniques first."
B) "You could call the doctor and get an order for an oral medication."
C) "I would give the morphine; pain is subjective, and we don't know her history."
D) "I would hold the medication until she looks like she is in pain."

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Accepted Answer

Rationale 1: Distraction techniques would be a good adjunct to pain medication, but should not replace it.
Rationale 2: Calling the health care provider for an order for an oral medication is inappropriate on the first postop day.
Rationale 3: The response to pain varies among individuals; a client is not an addict just because she "does not look like she is in pain."
Pain is subjective; the client should be believed.
Rationale 4: Holding a pain medication the first postop day is inappropriate, since not all clients express pain in the same manner.

Question 6

The adolescent client is in a drug rehabilitation program. The mother of this client says to the nurse, "The health care provider said my son has a physical addiction to alcohol. What does this mean?" Which response by the nurse is the most appropriate?

A) "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide."
B) "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped."
C) "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it."
D) "He will have an intense craving for alcohol; this is best managed in group therapy."

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Accepted Answer

Rationale 1: Depression can accompany physical withdrawal, but physical signs are what require medical management.
Rationale 2: Over time, the body's cells become accustomed to the presence of the unnatural substance. Specific physical withdrawal symptoms will occur; the client needs to be medically withdrawn from the substance.
Rationale 3: Alcohol does produce euphoria, but a craving for the substance is not a medical issue.
Rationale 4: Psychological dependence, or craving, does not involve physical withdrawal symptoms.

Question 7

The client has smoked a pack of cigarettes per day for 20 years. The client also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include?

A) "You are at a greater risk for emphysema than are nonsmokers."
B) "You are at a greater risk for developing diabetes than are smokers who do not use birth control pills."
C) "You are at a greater risk for a heart attack than are nonsmokers."
D) "The nicotine will decrease the effectiveness of your birth control pills."

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Accepted Answer

Rationale 1: Smokers are at greater risk for emphysema, but this has nothing do with the client's use of oral contraceptives.
Rationale 2: There is no evidence to support a correlation between diabetes, smoking, and oral contraceptives.
Rationale 3: Cardiovascular effects can be particularly serious in clients taking oral contraceptives if they also smoke. The risk of a fatal heart attack is five times greater in smokers who also use oral contraceptives than in nonsmokers.
Rationale 4: There is no evidence to support that nicotine decreases the effectiveness of oral contraceptives.

Question 8

A client is abusing an antianxiety medication. Which assessment by the nurse would confirm a psychological dependence instead of physical dependence?&#10;A) The client's history reveals the long-term use of high doses of an antianxiety medication.&#10;B) The client describes the &#34;need&#34; to use the antianxiety medication despite not feeling anxious.&#10;C) The client describes feeling nauseous with abdominal cramping.&#10;D) The client tells you her family has &#34;disowned&#34; her because of her need for the antianxiety medication.&#10;E) The client complains she has not slept in days, feels anxious, and tired.&#10;

Accepted Answer

Rationale 1: Psychological dependence usually requires the use of relatively high doses of antianxiety medication over a prolonged period of time.
Rationale 2: Psychological dependence is the "need" or desire to continue taking a drug when there is a lack of physical symptoms. In this case, the client does not feel anxious but still has the desire to take the antianxiety medication.
Rationale 3: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence.
Rationale 4: To continue the use of the antianxiety drug at the risk of jeopardizing relationships is indicative of psychological dependence.
Rationale 5: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence.

Deck 11: Pharmacology of Local and General Anaesthesia