General and Local Anesthetic Agents Quiz Part 2

12. The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia. While taking the admission history, the patient says she is allergic to lidocaine. What is the nurse’s priority action? A) Notify the anesthesiologist. B) Cancel the surgery. C) Notify the surgeon. D) Tell the perioperative nurse. Ans: A Feedback: The priority action is to inform the anesthesiologist who will administer the anesthetic because local anesthesia often involves use of lidocaine. It is not within the nurse’s scope of practice to cancel surgery. Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care. 13. The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this patient? A) Rub the patient’s back. B) Monitor vital signs. C) Provide eye care. D) Reposition the patient. Ans: B Feedback: Stage 2, the excitement stage, is a period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes). Monitoring vital signs can be lifesaving at this stage. Eye care is important in stages 3 and 4. Rubbing the patient’s back and repositioning the patient are not indicated in this stage of anesthesia. The patient received midazolam in combination with an inhaled anesthetic and a narcotic 14. during surgery. The postanesthesia care unit (PACU) nurse anticipates this combination of drugs will have what impact on the patient’s stay in the unit? A) Increased use of medications to offset adverse effects B) Extended time needed in the unit C) Decreased nursing support needed D) Increased analgesics needed Ans: B Feedback: Midazolam is associated with increased toxicity and length of recovery when used in combination with inhaled anesthetics, other central nervous system depressants, narcotics, propofol, or thiopental. Because this patient received both narcotics and inhaled anesthetics, the nurse will anticipate this patient’s time in the PACU will be extended. The patient is likely to need fewer analgesics because it will take longer for the patient to wake from anesthesia, which will also mean fewer medications will be used. Until the patient is awake, he or she will need continuous nursing support. The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be 15. administered by what method? A) Topical Administration B) Infiltration C) Field block D) Nerve block Ans: B Feedback: Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2-inch laceration. 16. A nurse is caring for a patient who received thiopental as an anesthetic agent during surgery. What adverse effects would the nurse attribute to the medication? A) Tachycardia B) Urinary retention C) Tachypnea D) Headache Ans: D Feedback: Adverse effects of thiopental include emergence delirium, headache, restlessness, anxiety, cardiovascular depression, respiratory depression, apnea, salivation, hiccups, and rashes. Tachycardia, tachypnea, and urinary retention are not usually associated with this drug. The nurse is caring for a patient who will receive an epidural block. What procedure is 17. this patient likely to be having? A) Rhinoplasty B) Inguinal hernia repair C) Removal of a brain tumor D) Closed reduction of the right humerus Ans: B Feedback: Nerve block is a method of administering local anesthesia by injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Several types of nerve blocks are possible. Epidural anesthesia is an injection of the drug into the epidural space where the nerves emerge from the spinal cord. As a result, only an inguinal hernia repair would be an appropriate procedure for administering an epidural. Surgery performed about the spinal cord, such as surgery on the nose or brain, could not be anesthetized by injection of medication into the spinal cord. Closed reduction of the right humerus would not be performed using a local anesthetic. The operating room nurse is taking the patient into the operating room when the patient 18. says his grandmother almost died from a high fever in surgery 15 years ago. The nurse shares this information with the surgical team, recognizing this information indicates the patient is at risk for what? A) An allergic reaction to anesthesia B) Malignant hyperthermia C) Anxiety D) Hypothermia Ans: B Feedback: The nurse assesses for a personal or family history of malignant hyperthermia, which may be triggered by the use of general anesthetics. Identifying patients at risk is imperative because the mortality rate is very high. All of these drugs have the potential to trigger malignant hyperthermia and should be used with caution in any patient at high risk. The patient’s anxiety is to be expected, all patients are at risk for hypothermia because they are often uncovered in a cold room. Allergy to anesthesia must always be considered a possibility but there is no indication of a higher than normal risk in this patient. The circulating nurse in the day surgery center is caring for a patient who is to receive a local anesthetic. What potential complications will the nurse monitor for? (Select all that 19. apply.) A) Malignant hypothermia B) Pain C) Blurred vision D) Peripheral vasodilation E) Nausea Ans: C, D, E Feedback: Adverse effects of local anesthetics are associated with the route of administration and the amount of drug that is absorbed systemically. These effects are related to the blockade of nerve depolarization throughout the system. Effects that may occur include central nervous system effects such as headache (especially with epidural and spinal anesthesia), restlessness, anxiety, dizziness, tremors, blurred vision, and backache; gastrointestinal (GI) effects such as nausea and vomiting; cardiovascular effects such as peripheral vasodilation, myocardial depression, arrhythmias, and blood pressure changes, all of which may lead to fatal cardiac arrest; and respiratory arrest. There is no such problem as malignant hypothermia (the condition is malignant hyperthermia) and pain may be caused by the procedure but not the anesthetic. 20. What nursing diagnosis would a circulating nurse use on his or her intraoperative patients who receive general anesthesia? (Select all that apply.) A) Disturbed sensory perception B) Risk for hypovolemia C) Risk for latex allergy response D) Disturbed body image E) Anxiety Ans: A, C, E Feedback: Nursing care of patients receiving general or local anesthetics should include safety precautions to prevent injury and skin breakdown, support and reassurance to deal with the loss of sensation and mobility, and patient teaching regarding what to expect to decrease stress and anxiety. Risk for hypovolemia and disturbed body image would be applicable to some surgical procedures but would not be related to general anesthesia. The patient receives lidocaine as a local anesthetic before insertion of a chest tube. After the procedure the patient tells the nurse, 21. last? What is the nurse’s best response? The area is still numb. How long will this A) 15 minutes B) 1 hour C) 2 hours D) 4 hours Ans: C Feedback: The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours. Options A, B, and D are distracters. The pharmacology instructor is explaining balanced anesthesia to the students. What agents would the instructor say are involved in balanced anesthesia? (Select all that 22. apply.) A) Neuromuscular junction blockers B) Narcotics C) Anticholinergics D) Salicylates E) Nonsteriodal anti-inflammatory drugs (NSAIDs) Ans: A, B, C Feedback: Balanced anesthesia involves giving a variety of drugs with specific effects to achieve analgesia, relax muscles, and invoke unconsciousness and amnesia. Classification of drugs administered includes anticholinergics, rapid intravenous anesthetics, inhaled anesthetics, neuromuscular junction blockers, and narcotics. Balanced anesthesia does not include use of salicylates or nonsteroidal anti-inflammatory drugs. The nurse is caring for a patient who received halothane as an anesthetic agent. The patient will require additional surgery. When can halothane be used again without risk of 23. halothane’s recovery syndrome? A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks Ans: C