General and Local Anesthetic Agents Quiz Part 1

General and Local Anesthetic Agents 1. To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used? A) Antihistamines B) Antiemetics C) Narcotics D) Sedative-hypnotics Ans: D Feedback: Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic and sedative effects. During what stage of anesthesia would the nurse see the patient’s skeletal muscles relax 2. and return of regular respirations? A) Stage 1: Analgesia stage B) Stage 2: Excitement stage C) Stage 3: Surgical anesthesia stage D) Stage 4: Medullary paralysis Ans: C Feedback: Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied. The nurse is developing a plan of care for the patient undergoing general anesthesia. What 3. is a priority of care for this patient? A) Encourage clear fluids. Increase oxygen. B) C) Reassure the patient that about safety. D) Maintain regular repositioning. Ans: D Feedback: The patient would need to be moved or turned periodically to prevent skin breakdown and the formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from the medications used in general anesthesia would prevent the patient from shifting himself or herself to relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not receive anything by mouth eliminating option A. Reassurance would not be necessary for the unconscious patient. 4. A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which diagnoses will the nurse include that is directly related to safety? A) Deficient knowledge regarding drug therapy B) Disturbed sensory perception (kinesthetic, tactile) related to anesthesia C) Risk for impaired skin integrity related to immobility D) Risk for injury related to central nervous system (CNS) depressive effects of drugs Ans: D Feedback: The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to express safety concerns and must rely completely on the surgeon and OR staff for protection. 5. What nursing interventions would help minimize the risk of a headache in a patient recovering from spinal anesthesia? A) Administer a triptan intramuscularly. B) Administer morphine intravenously. C) Maintain patient in recumbent position. D) Place patient in Trendelenburg position. Ans: C Feedback: Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours. Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine would treat the headache but would not prevent it. An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also complains that his or her head feels fuzzy and that the right words will not come to his or her. What is the priority nursing intervention for this 6. patient? A) Provide analgesic medication for the discomfort. B) Stay with patient as much as possible and provide reassurance. C) Provide fluids to increase his or her wakefulness. D) Encourage the patient to turn from side to side periodically. Ans: B Feedback: Most patients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the patient as much as possible and reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery if the patient reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority nursing action at this time. However, the most effective nursing action for anxious postoperative patients is for the nurse to stay with them as much as possible. 7. The patient appears awake but is unconscious and has no response to painful stimuli. What medication does the nurse suspect this patient has received? A) Thiopental (Pentothal) B) Midazolam (Generic) C) Ketamine (Ketalar) D) Propofol (Diprivan) Ans: C Feedback: Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous. Thiopental is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate anesthetics. None of these medications have this type of effect. 8. Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac depression? A) Droperidol (Inapsine) B) Etomidate (Amidate) C) Ketamine (Ketalar) D) Propofol (Diprivan) Ans: C Feedback: If ketamine and halothane are used in combination, severe cardiac depression with hypotension and bradycardia may occur. Use of droperidol, etomidate, and propofol with halothane should not be a concern. The operating room nurse is developing the care plan for a 10-year-old child with asthma who is scheduled for a tonsillectomy and who will receive halothane as the anesthetic 9. agent. Why is this an appropriate drug for this patient? A) Halothane is metabolized in the liver. B) Halothane dilates the bronchi. C) Halothane is excreted unchanged in the urine. D) Halothane causes an accumulation of secretions. Ans: B Feedback: Halothane is of particular benefit to a child with asthma because it dilates bronchi. Halothane is inhaled drug so it is not metabolized in the liver or excreted in the urine. It does not cause an accumulation of secretions. 10. The nurse should recognize what drug is classified as an amide local anesthetic? A) Lidocaine (Xylocaine) B) Benzocaine (Dermoplast) C) Chloroprocaine (Nesacaine) D) Tetracaine (Pontocaine) Ans: A Feedback: Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester anesthetics. A 21-year-old patient is positioned on the operating room table in preparation for knee 11. surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia? A) Induction B) Maintenance C) Recovery D) Medullary paralysis Ans: D Feedback: Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the patient is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C is a distracter.