Question 1

A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?
A) "Anesthetic effects develop slowly and persist for several hours."
B) "Cocaine is a local anesthetic administered by injection."
C) "Vasoconstrictors should not be used as adjunct agents with this drug."
D) "When abused, cocaine causes physical dependence."

Accepted Answer

Cocaine should not be combined with epinephrine or other vasoconstrictors,because it causes vasoconstriction itself,and the combination could precipitate severe hypertension. Cocaine has a rapid onset of effects,which last about 1 hour. It is used only topically for anesthesia. Although subject to widespread abuse with profound psychologic dependence,it does not cause substantial physical dependence.

Question 2

A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?
A) Ask the provider why an injectable anesthetic is being used for this procedure.
B) Draw up the medication as ordered and prepare the infant for the procedure.
C) Make sure that seizure precautions are in place.
D) Question the use of the epinephrine for this procedure.

Accepted Answer

The physician is preparing to use infiltration anesthesia by injecting the local anesthetic directly into the immediate area of surgery. Epinephrine can be used in some cases but should never be used in areas supplied by end arteries,such as the penis,toes,fingers,nose,or ears,because restriction of blood flow in these areas can result in gangrene. Injectable agents are appropriate for this procedure. The nurse should not draw up the medication as requested,because the combination of agents can harm the patient. Seizure precautions are not necessary.

Question 3

A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute,a respiratory rate of 16 breaths per minute,and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?
A) Contact the anesthetist to request an order for ephedrine.
B) Have the patient sit up to relieve the headache pain.
C) Lower the head of the bed to a 10- to 15-degree head-down position.
D) Obtain an order for a urinary catheter for urinary retention.

Accepted Answer

Spinal anesthetics have several adverse effects,but the most significant is hypotension caused by the venous dilation that occurs from blockade of sympathetic nerves. The result is decreased blood return to the heart,which causes reduced cardiac output and a drop in blood pressure. The first step in treating this is to put the patient in a 10- to 15-degree head-down position to promote venous return to the heart. Ephedrine or phenylephrine is used if the first measure fails. Spinal headaches are common; the intervention for this is to have the patient assume a supine position. Urinary retention can occur secondary to autonomic blockade; it is a concern if the patient has not voided for 8 hours after the procedure,but not in the immediate postoperative period.

Question 4

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?
A) Difficulty moving the fingers of the affected hand
B) Inability to feel pressure at the suture site
C) Nervousness and tachycardia
D) Sensation of pain returning to the wound

Accepted Answer

Absorption of the vasoconstrictor can cause systemic effects,including nervousness and tachycardia. If severe,alpha- and beta-adrenergic antagonists can be given. Local anesthetics are nonselective modifiers of neuronal function and also can block motor neurons,so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is an expected effect. As the local anesthetic wears off,the sensation of pain will return.

Question 5

A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?
A) "Local anesthetics affect large myelinated neurons first."
B) "Local anesthetics affect motor and sensory nerves."
C) "Local anesthetics do not block temperature perception."
D) "Local anesthetics do not cause systemic effects."

Accepted Answer

Local anesthetics are nonselective modifiers of neuronal function. They block actions in motor and sensory nerves. They affect small myelinated neurons first. They block temperature,pressure,and pain sensation. When absorbed into the systemic circulation,they can cause systemic effects.

Question 6

Vasoconstrictors are combined with local anesthetics for which reasons? (Select all that apply.)
A) To enhance absorption
B) To reduce the risk of toxicity
C) To prevent bradycardia
D) To shorten the duration of action
E) To prolong anesthesia

Accepted Answer

Vasoconstrictors,when combined with local anesthetics,reduce the risk of toxicity and prolong the anesthetic effects. Vasoconstrictors,when combined with local anesthetics,do not speed up the absorption process,prevent bradycardia,or shorten the duration of action.

Question 7

Which are important considerations when spinal anesthesia is being administered? (Select all that apply.)
A) Encouraging the patient to remain supine after the procedure
B) Having epinephrine available in case of adverse effects
C) Injecting a local anesthetic into the sacral region
D) Placing the agent into the spinal column outside the dura mater
E) Using an anesthetic solution from a single-dose vial

Accepted Answer

Spinal anesthesia frequently causes headache; these headaches are posture-dependent and can be relieved by having the patient assume a supine position. Epinephrine is used if significant hypotension occurs as an adverse effect of spinal anesthesia and should be kept nearby. All anesthesia used in spinal anesthesia must be preservative free,so it would be drawn up from a single-dose vial. Spinal anesthesia is produced by injecting local anesthetic into the subarachnoid space with injection made in the lumbar region below the termination of the cord. Epidural anesthesia is injected into the spinal column outside the dura mater.

Question 8

A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic,the patient has a pulse of 54 beats per minute,respirations of 18 breaths per minute,and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of:
A) heart block.
B) anaphylaxis.
C) central nervous system excitation.
D) respiratory depression.

Accepted Answer

When absorbed in a sufficient amount,local anesthetics can affect the heart and blood vessels. These drugs suppress excitability in the myocardium and conduction system and can cause hypotension,bradycardia,heart block,and potentially cardiac arrest. Anaphylaxis would be manifested by hypotension,bronchoconstriction,and edema of the glottis. Central nervous system excitation would be manifested by hyperactivity,restlessness,and anxiety and may be followed by convulsions. No evidence indicates respiratory depression; this patient's respirations are within normal limits.

Question 9

A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?
A) "I will apply a thin layer of the medication to a small area of skin."
B) "I will cover the burn with a dressing after applying the medication."
C) "I will make sure to apply the medication to the entire burn area."
D) "I will use the medication only on the most painful, blistered areas."

Accepted Answer

Topical anesthetics can be absorbed in sufficient amounts to cause serious and even life-threatening systemic toxicity,so they should be applied in the smallest amount needed to as small an area as possible. Covering the site increases the skin's temperature,which increases absorption,so this should be avoided. Applying the medication to a large area increases systemic absorption. Applying the medication to broken skin increases systemic absorption.

Question 10

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:
A) allow more systemic absorption to speed up metabolism of the lidocaine.
B) increase the rate of absorption of the lidocaine.
C) improve perfusion by increasing blood flow to the area.
D) prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

Accepted Answer

Epinephrine causes vasoconstriction,which reduces local blood flow and delays systemic absorption of lidocaine,which prolongs local anesthetic effects and reduces the risk of systemic toxicity. Epinephrine slows the rate of absorption. Epinephrine delays systemic absorption of lidocaine,so metabolism is slowed and the effects are prolonged in the periphery. Epinephrine does not increase local blood flow.

Question 11

A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for:
A) bradycardia.
B) hypoglycemia.
C) jitteriness.
D) tachypnea.

Accepted Answer

Local anesthetics can cross the placenta,causing bradycardia and central nervous system (CNS)depression in the infant. They do not affect blood glucose. Jitteriness is a sign of CNS excitation. Increased respirations are not an adverse effect in the newborn.

Quiz 26: Local Anesthetics

A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?

A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?

A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?

Vasoconstrictors are combined with local anesthetics for which reasons? (Select all that apply.)

Which are important considerations when spinal anesthesia is being administered? (Select all that apply.)

A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:

A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for: