Question 1

Two anesthetic gases that are included in the balanced inhalation mix during general anesthesia are:

Accepted Answer

While air has no anesthetic qualities,it is useful as maintenance with O₂ and can be used to ventilate during laser surgery in the airway.Room air also does not support combustion like nitrous oxide.Oxygen is added as it is essential for life.

Question 2

As a member of the surgical team,the perioperative nurse advocates for the surgical patient during the surgical experience.Identify the nursing activities,from the list below,that positively influence patient safety and desired patient outcomes.

Accepted Answer

The perioperative nurse collaborates with the anesthesia provider in the collective care of the patient.A patient should never be left alone in the OR suite.When an anesthetized patient is in the OR,a perioperative nurse should always be immediately available to provide assistance if needed.During induction of anesthesia,particularly with urgent and emergency surgical procedures,the patient is presumed to have a "full stomach." The perioperative nurse should be ready to apply cricoid pressure to prevent regurgitation of stomach contents and assist the anesthesia provider in visualizing the vocal cords.Attentiveness to the needs of the patient and team must be maintained throughout the procedure.Thorough hand-off communication to the next level of care will promote continuity of care.

Question 3

Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?

Accepted Answer

Halothane is a potent inhalational (not IV)anesthetic.

Question 4

During a surgical procedure using ketamine as the induction and maintenance agent,the perioperative nurse should:

Accepted Answer

The perioperative nurse should minimize noxious stimuli that might trigger hallucinations or respiratory distress when large doses of ketamine are used.

Question 5

Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip.She was positioned for a spinal injection to induce spinal anesthesia.During the process,the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space,not noticing the error until the entire syringe of lidocaine was emptied into the patient.Miriam immediately experienced rapid onset of hypotension,bradycardia,and apnea.Miriam's unintentional condition is called __ and now must be managed with _.

Accepted Answer

Subarachnoid injection occurs if the needle or catheter is unintentionally inserted into the subarachnoid space.If a large volume of local anesthetic is injected as a bolus,it causes "total spinal" anesthesia.This condition is associated with a rapid onset of hypotension caused by vasodilation and profound bradycardia,as the sympathetic nerves to the heart are blocked,causing a totally paralyzed patient.Treatment includes intubation,control of ventilation,support of blood pressure and the cardiovascular system,and administration of amnestic drugs until the block resolves.

Question 6

Ketamine is a short-acting induction and IV or 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:

Accepted Answer

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

Question 7

Minimizing risk factors and administering antiemetics are important preventive actions against PONV.Antiemetics are designed to interact with the four main neurotransmitters that affect PONV.These four neurotransmitters are:

Accepted Answer

Antiemetics have been designed to interact with the four main neurotransmitters that affect PONV:histamine,acetylcholine,serotonin,and dopamine.

Question 8

Number the correct sequence of events in a well-managed intraoperative MH crisis.
a.Lavage the stomach,bladder,rectum,and open body cavities as feasible.
b.Give dantrolene sodium (Dantrium) 2.5 mg/kg.
c.Discontinue triggering anesthetic agents.
d.Counsel patient and family about MH.
e.Hyperventilate with 100% O₂ at highest flow rate.
f.If the patient is hyperthermic (>39° C),begin active cooling.
g.Monitor the temperature to avoid hypothermia.Stop cooling at 38° C.
h.Transfer to ICU.
i.Monitor and correct for dysrhythmias,hyperkalemia,metabolic acidosis,and urine output.

Accepted Answer

The answer of Number the correct sequence of events in...

Question 9

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.

Accepted Answer

Some 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 an LMA,awareness monitoring,and certain anesthetics (such as propofol,sevoflurane,and desflurane)have contributed to attaining these goals.

Question 10

A desired anesthesia experience for a child is an anesthetic agent 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?

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 11

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

Accepted Answer

Succinylcholine (Anectine)is the only depolarizing muscle relaxant used clinically.Its action is similar to that of acetylcholine,and at the neuromuscular junction it causes depolarization of the postjunctional membrane.Generalized skeletal muscle contractions known as fasciculations result from simultaneous depolarization of all the muscle fibers.

Question 12

Postoperative nausea and vomiting (PONV)is often a side effect of the inhalational anesthetic _ and the analgesic ___.

Accepted Answer

Anesthetic risk factors for PONV include the use of nitrous oxide and/or opioids.

Question 13

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:

Accepted Answer

Units that blow heated air onto the upper or lower body surface are effective in maintaining body temperature even during a long abdominal procedure and can be used subsequently in the PACU.Forced air-warming units must be used according to manufacturers' instructions.They must be used with the appropriate disposable patient warming blankets 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 14

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 7%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

Accepted Answer

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

Question 15

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

Accepted Answer

The incidence of MH is increased in patients with central core disease (e.g.,a congenital myopathy)and some muscular dystrophies.

Question 16

While hypothermia was historically credited as a therapeutic modality benefitting all surgery 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 can contribute to surgical site infections?

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 17

Which statement best explains the mechanism of action of general anesthetic agents?

Accepted Answer

Numerous proposed theories explain the action of general anesthetics.Evidence suggests that synaptic transmission of nerve impulses is reversibly inhibited in several areas of the CNS.Suppression of spinal reflex activity is believed to produce some relaxation of skeletal muscles.

Question 18

Which inhalational anesthetic agent(s)has the fastest onset of induction,emergence,and recovery?

Accepted Answer

Both nitrous oxide and halothane promote a rapid induction and recovery.

Question 19

During a hypermetabolic MH crisis,the patient will eventually assume a state of metabolic acidosis.What is the desired drug used to reverse this trend?

Accepted Answer

Administration of sodium bicarbonate IV to correct the metabolic acidosis.Refer to arterial blood gas (ABG)values to determine the correct dosage.If ABG results are not available,consider administering 1 to 2 mEq/kg IV.

Question 20

Multiple studies have found that intraoperative awareness (IOA)occurs in 0.1% to 0.2% of patients undergoing general anesthesia.These studies also determined that even under seemingly adequate general anesthesia,implicit memory may be retained along with the ability to process auditory stimuli subconsciously.Based on these studies,it was determined that anesthesia techniques that rely solely on receptor-based drugs are a risk factor for IOA.Which classification of drugs should be avoided for patients at risk for IOA?

Accepted Answer

Based on these studies,it seems prudent to avoid anesthetic techniques that rely solely on receptor-based drugs (i.e.,benzodiazepines,opioids,nitrous oxide)and to include volatile anesthetics.

Quiz 4: Anesthesia