Question 1

While hypothermia was historically credited as a therapeutic modality benefitting all surgery patients because it decreases metabolism and reduces oxygen demand,inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes.Which of the following impairments related to hypothermia can contribute to surgical site infections?
A) Altered drug uptake
B) Impaired wound healing
C) Impaired platelet function
D) Cardiac rhythm disturbances

Accepted Answer

Vasoconstriction from hypothermia can interfere with skin perfusion and delay wound healing processes.Unintentional hypothermia can cause patient discomfort,untoward cardiac events,adrenergic stimulation,impaired platelet function,altered drug metabolism,delayed emergence from anesthesia,and impaired wound healing.

Question 2

Pediatric,geriatric,and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia.The perioperative nurse should prepare the OR bed before patient arrival by placing:
A) an infrared warming lamp 18 inches from the OR bed surface.
B) hot bath blankets over the OR bed surface as the patient transport vehicle enters the room.
C) a forced air-warming hose towel clipped under the lifting sheet.
D) a patient-sized forced air-warming blanket on top of the OR bed surface.

Accepted Answer

Forced air-warming devices that blow heated air onto the upper or lower body surface are commonly used to keep patients warm and maintain normothermia.These units are effective in maintaining body temperature even during a long abdominal procedure and can be used later in the postanesthesia care unit (PACU).Forced air-warming devices must be used according to manufacturers' instructions.They must be used with appropriate disposable blanket and should not have the hose inserted under surgical drapes to warm the patient (this directs the heat on the patient,with the risk of a burn,rather than filtering it through the blanket).

Question 3

Ketamine is a short-acting induction and IV or intramuscular (IM)maintenance agent.Patients are able to maintain their airways.It is a suitable agent to use with small children and burn patients.The concern with this agent is that in large doses it may cause:
A) hallucinations.
B) thrombocytopenia.
C) respiratory depression.
D) hallucinations and respiratory depression.

Accepted Answer

Ketamine,in large doses,can cause hallucinations and respiratory depression.The patient needs a darkened,quiet room for recovery.

Question 4

The ideal agent for pediatric anesthesia is one that offers a rapid and smooth induction with good relaxation,followed by rapid emergence.Which of the listed inhalational agents is the best choice for pediatric anesthesia?
A) Isoflurane
B) Nitrous oxide
C) Sevoflurane
D) Halogen

Accepted Answer

Sevoflurane (Ultane)is used for induction and maintenance.It provides rapid induction and emergence and good relaxation; it is desired for rapid and smooth mask induction in children and adults.

Question 5

Anesthetic gases decrease the patient's heart rate depending on the concentration of the agent being used,and each of the anesthetic gases cause vasodilation which decreases the patient's blood pressure.Interventions that perioperative nurses can provide to help ensure a safe anesthetic experience include:
A) positioning areas directly related to respiration (e.g., chest, diaphragm) with firm pressure.
B) monitoring and documenting physiologic parameters on the anesthesia electronic system.
C) maintaining balanced drug levels of hypnotics, analgesia, and muscle relaxants.
D) positioning patients slowly to assess impact on circulation.

Accepted Answer

Cardiac output and blood pressure are affected by positioning,adding another important consideration.When the surgical team positions a patient in a supine or lateral position,there is minimal effect on hemodynamics,but when a patient is positioned in a flexed lateral,sitting,or prone position,cardiac output and blood pressure are often decreased.When placing a patient in a lithotomy or Trendelenburg position,the patient's blood pressure can increase.When placing a patient in these surgical positions,the perioperative team should position the patient slowly to allow the body to compensate for position-induced hemodynamic changes.Areas related to respiration should be positioned without pressure or restriction.

Question 6

MH is a rare,multifaceted syndrome with an increased incidence in individuals with central core diseases such as:
A) spinal cord injury.
B) muscular dystrophy.
C) congenital myopathies.
D) muscular dystrophy and congenital myopathies.

Accepted Answer

The incidence of MH increases in patients with central core disease (a congenital myopathy)and some muscular dystrophies.

Question 7

In the past,MH mortality ranged up to 80%,but the immediate infusion of dantrolene (Dantrium)and proper treatment have reduced the death rate to about 5%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?
A) It is a succinylcholine reversal agent.
B) It is a skeletal muscle relaxant.
C) It is a metabolic antagonist.
D) It has diuretic properties.

Accepted Answer

Dantrolene is a hydantoin skeletal muscle relaxant that also has effects on vascular and heart muscle.

Question 8

Postoperative nausea and vomiting (PONV)is often a side effect of the analgesic ___________.
A) morphine
B) ketamine
C) ketorolac
D) esmolol

Accepted Answer

Nausea and vomiting are side effects of morphine.

Question 9

Multiple studies have found that intraoperative awareness (IOA)occurs in a small percentage of patients undergoing general anesthesia.Which high risk populations have more incidence of IOA?
A) Emergent trauma and obstetric patients
B) Pediatric patients
C) Ambulatory surgery patients
D) Elderly patients

Accepted Answer

In rare cases,during general anesthesia for emergent procedures or trauma,the patient may be paralyzed,aware of what is occurring but unable to tell anyone.IOA is reported with multiple and differing anesthetic techniques.Several factors may contribute to its occurrence.Overall,20,000 to 40,000 patients each year experience awareness during general anesthesia.The incidence of awareness may increase to 1% to 1.5% in higher risk patient populations,such as patients requiring anesthesia for obstetrics,major trauma,and cardiac surgery.

Question 10

Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?
A) Succinylcholine
B) Mivacurium
C) Pancuronium
D) Rocuronium

Accepted Answer

The standard depolarizing agent is succinylcholine (Anectine),which was introduced in 1952.It has a chemical structure similar to that of acetylcholine (ACh)and depolarizes the postjunctional neuromuscular membrane.Administration is followed by a brief period of muscle fasciculations that corresponds to initial membrane depolarization and muscle fiber activation.

Question 11

Which inhalation anesthetic gas can cause retinopathy in premature infants?
A) Oxygen
B) Sevoflurane
C) Desflurane
D) Nitrous oxide

Accepted Answer

There are advantages and disadvantages to the use of any anesthetic gas.Although oxygen is essential for life and is commonly administered in supplemental form during surgical procedures,a drawback is the fact that it can cause retinopathy in premature infants.

Question 12

What is the primary purpose of premedication before anesthesia?
A) Tranquilize the patient and reduce stomach acidity (pH).
B) Sedate the patient and reduce anxiety.
C) Elicit desirable amnesia and prevent awareness under anesthesia.
D) Promote rapid induction and airway management.

Accepted Answer

The primary purpose of premedication before anesthesia is to sedate the patient and reduce anxiety.Medications that may be given preoperatively include sedatives and hypnotics,anxiolytics,amnestics,tranquilizers,narcotics or other analgesics,antiemetics,and anticholinergics.

Question 13

The term balanced anesthesia is described as:
A) a combination of IV medications and inhalation agents.
B) nitrous oxide, air, and oxygen.
C) premedication, induction agents, and reversal agents.
D) induction agent, muscle relaxation, and analgesics.

Accepted Answer

In the past,the term balanced anesthesia was used when various combinations of IV medications were "balanced" to provide complete anesthesia.Today the term is often used to describe a combination of IV medications and inhalation agents used to obtain specific effects tailored to each patient and procedure.

Question 14

A 72-year-old morbidly obese male patient with uncontrolled diabetes is examined by the anesthesia nurse practitioner in the preoperative holding area for physical status and airway assessment prior to surgery.His most likely American Society of Anesthesiology (ASA)physical status is:
A) P1.
B) P2.
C) P3.
D) P4.

Accepted Answer

The ASA defines a P3 status as a patient with a severe systemic disease that limits activity but is not incapacitating.Examples include cardiovascular or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction,angina pectoris,poorly controlled hypertension,or morbid obesity renal failure on dialysis or class 2 congestive heart failure.There is a significant impact on daily activity.These conditions likely have an impact on anesthesia and surgery.

Question 15

Many factors have contributed to the evolution and progressive growth of ambulatory surgery.Select the three anesthetic agents that promote fast induction,rapid emergence,and minimal side effects and have been credited as a significant factor in this trend.
A) Propofol, desflurane, sublimaze
B) Ketamine, sevoflurane, propofol
C) Desflurane, midazolam, halothane
D) Sevoflurane, propofol, desflurane

Accepted Answer

Goals for anesthesia in an ambulatory setting include minimal physiologic changes secondary to the anesthetic,fast induction,rapid emergence while maintaining patient comfort,intraoperative amnesia and analgesia,suitable operating conditions,minimal perioperative side effects,and minimized postoperative side effects,such as nausea.Use of a laryngeal mask airway (LMA),awareness monitoring,and certain anesthetics (such as propofol,sevoflurane,and desflurane)contribute to attaining these goals.

Question 16

During a hypermetabolic MH crisis,the patient will require major modalities of treatment.In addition to dantrolene what is another priority intervention?
A) Giving mannitol
B) Cooling the patient
C) Reversing the malignancy
D) Continuing succinylcholine

Accepted Answer

In addition to dantrolene,the major modalities of treatment include cooling the patient with ice packs and cold IV solutions,administering diuretics,treating cardiac dysrhythmias,correcting acid-base and electrolyte imbalances,and monitoring fluid intake and output and body temperature.Triggering agents such as volatile anesthetics and succinylcholine are discontinued.

Quiz 5: Anesthesia

Pediatric,geriatric,and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia.The perioperative nurse should prepare the OR bed before patient arrival by placing:

Ketamine is a short-acting induction and IV or intramuscular (IM) maintenance agent.Patients are able to maintain their airways.It is a suitable agent to use with small children and burn patients.The concern with this agent is that in large doses it may cause:

The ideal agent for pediatric anesthesia is one that offers a rapid and smooth induction with good relaxation,followed by rapid emergence.Which of the listed inhalational agents is the best choice for pediatric anesthesia?

MH is a rare,multifaceted syndrome with an increased incidence in individuals with central core diseases such as:

In the past,MH mortality ranged up to 80%,but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 5%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

Postoperative nausea and vomiting (PONV) is often a side effect of the analgesic ___________.

Multiple studies have found that intraoperative awareness (IOA) occurs in a small percentage of patients undergoing general anesthesia.Which high risk populations have more incidence of IOA?

Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?

Which inhalation anesthetic gas can cause retinopathy in premature infants?

What is the primary purpose of premedication before anesthesia?

The term balanced anesthesia is described as:

A 72-year-old morbidly obese male patient with uncontrolled diabetes is examined by the anesthesia nurse practitioner in the preoperative holding area for physical status and airway assessment prior to surgery.His most likely American Society of Anesthesiology (ASA) physical status is:

Many factors have contributed to the evolution and progressive growth of ambulatory surgery.Select the three anesthetic agents that promote fast induction,rapid emergence,and minimal side effects and have been credited as a significant factor in this trend.

During a hypermetabolic MH crisis,the patient will require major modalities of treatment.In addition to dantrolene what is another priority intervention?