General and Local Anesthetic Agents Quiz Part 3

24. A 54-year-old patient with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this patient? A) Enflurane B) Desflurane C) Sevoflurane D) Isoflurane Ans: B Feedback: Desflurane is associated with a collection of respiratory reactions, including cough, increased secretions, and laryngospasm. The other options have far fewer respiratory adverse effects and would be safer for use in this patient. The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an 25. elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse’s initial priority nursing assessment? A) Assess the patient’s anxiety. B) Start an IV. C) Show the family the waiting area. D) Weigh the patient. Ans: D Feedback: Weighing the patient is an initial priority because his or her weight will be used to determine appropriate dosing of all medications and will establish a baseline used for evaluation of any potential adverse effects. Other options are all actions the nurse will need to perform, but none are of higher priority than weighing the patient. A very anxious patient asks the nurse what type of anesthesia they will have for a 26. scheduled tooth extraction. The nurse would describe what type of local anesthetic in laymen’s terms? A) Topical Infiltration B) C) Field block D) Nerve block Ans: C Feedback: Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery. The nurse receives a patient into the postanaesthesia care unit who has had surgery using 27. the anesthetic agent methohexital. The nurse anticipates the patient’s need for what in the postoperative period? A) Assistance in maintaining respirations B) Assistance in moving lower extremities Positioning in Semi-Fowler’s position C) D) Analgesia to control the patient’s pain Ans: D Feedback: Methohexital lacks analgesic properties so the patient may require postoperative analgesics to control pain. The patient who has surgery under methohexital does not generally require assistance in maintaining respirations or assistance in moving their lower extremities. They also do not generally require positioning in a semi-Fowler’s position. The emergency room nurse is teaching a class for newly hired graduate nurses on the 28. different types of local anesthetic agents. How would the nurse differentiate lidocaine and procaine as a local anesthetic agent? A) Lidocaine is an amide that is broken down slowly and this can lead to toxicity. B) Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism. C) Procaine is an amide that is broken down immediately in the tissues. D) Procaine is metabolized by the liver with risk of toxicity and is classified as an ester. Ans: A Feedback: The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide and procaine is an ester. A nursing student in a pharmacology class asks the instructor why nitrous oxide is used 29. for dental surgery. What is the instructor’s most accurate response? A) Nitrous oxide stays in the body for a long time. B) Nitrous oxide does not cause pressure in body compartments. C) Nitrous oxide does not cause muscle relaxation. D) Nitrous oxide does not need to be administered with oxygen. Ans: C Feedback: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Nitrous oxide does need to be given in combination with oxygen to avoid hypoxia in the patient. 30. The nurse is admitting a patient to the postanesthesia care unit (PACU) who received halothane and ketamine as anesthesia. What is the nurse’s priority assessment? A) Blood pressure and pulse B) Respirations and airway C) Pain and respirations D) Temperature and airway Ans: A Feedback: If halothane and ketamine are used in combination, severe cardiac depression with hypotension and bradycardia may occur. If these agents must be used together, the patient should be monitored closely. Pain, respirations, airway, and temperature are all assessments the nurse will collect on any patient in the PACU, but they are not priority assessments associated with combining ketamine and halothane. The nurse is assisting while the physician is suturing a wound in the urgent care clinic. 31. The physician asks for lidocaine with epinephrine. The nurse identifies the primary reason for adding epinephrine to the lidocaine is what effect? A) It will sting more when it is injected into the tissue. B) Risk of systemic absorption is increased. C) Local effect is increased. D) Bleeding at the wound site is increased. Ans: C Feedback: There is less risk of systemic absorption and increased local effects if these drugs are combined with epinephrine. Epinephrine causes vasoconstriction, which reduces bleeding, slows absorption, and makes the duration of effect longer. It does sting more when injected, but that is not a reason to use it. The nurse is caring for a patient scheduled for surgery who is to receive a barbiturate as part of the planned balanced anesthesia. What drugs, if taken by the patient, could result in a clinically important drug drug interaction with the barbiturate? (Select all that 32. apply.) A) Thyroid hormone B) Ibuprofen C) Oral contraceptive D) Theophylline E) Anticoagulant Ans: C, D, E Feedback: Caution must be used when these drugs are used with any other central nervous system suppressants. Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants, beta-blockers, corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and carbamazepine. Combinations of barbiturate anesthetics and narcotics may produce apnea more commonly than occurs with other analgesics. Thyroid hormone and ibuprofen have no known drug interactions with barbiturates. 33. The nurse is caring for a patient experiencing malignant hyperthermia. What medication will be administered to treat this condition? A) Midazolam B) Dantrolene C) Halothane D) Thiopental Ans: B Feedback: Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily available whenever anesthetics are used that could trigger the syndrome. Midazolam and thiopental are barbiturates whereas halothane is a volatile gas that can trigger malignant hyperthermia. The nurse is caring for a patient who will undergo cardioversion in the patient’s room this 34. morning. The patient will receive propofol as anesthetic during the procedure. What are the benefits of using propofol for this procedure? (Select all that apply.) A) It has a very rapid clearance. B) It produces less of a hangover effect. C) It allows for quick recovery from anesthesia. D) Its onset of action is 5 minutes. E) It is painless to inject IV. Ans: A, B, C Feedback: Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is a very shortacting anesthetic with a rapid onset of action of 30 to 60 seconds. Propofol often causes local burning on injection. 35. The nurse applies a topical anesthetic to reduce sensation at the site while starting an IV. What age group is at greatest risk for systemic absorption of the topical anesthetic? A) Older adult B) Infant C) Toddler D) Adolescent Ans: B Feedback: When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. Therefore, the other options are incorrect.