Instructor Proof

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 19

Question 1Type: MCMAThe nursing instructor teaches the nursing students about the advantages of the newer local anesthetics, such as lidocaine (Xylocaine). What will the best plan of the nursing instructor include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.1. Amides have fewer side effects than esters.2. Amides block potassium entry into the cell.3. Amides are similar in structure to cocaine.4. Amides tend to last longer than esters.5. Amides block calcium entry into the cell.Correct Answer: 1,4Rationale 1: Amides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. Amides block sodium, not potassium, entry into the cell. Cocaine is a natural ester, not an amide. Amides block sodium, not calcium, entry into the cell.Rationale 2: Amides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. Amides block sodium, not potassium, entry into the cell. Cocaine is a natural ester, not an amide. Amides block sodium, not calcium, entry into the cell.Rationale 3: Amides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. Amides block sodium, not potassium, entry into the cell. Cocaine is a natural ester, not an amide. Amides block sodium, not calcium, entry into the cell.Rationale 4: Amides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. Amides block sodium, not potassium, entry into the cell. Cocaine is a natural ester, not an amide. Amides block sodium, not calcium, entry into the cell.Rationale 5: Amides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. Amides block sodium, not potassium, entry into the cell. Cocaine is a natural ester, not an amide. Amides block sodium, not calcium, entry into the cell.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-2Question 2Type: MCSAThe patient has entered Stage 3 of general anesthesia, known as surgical anesthesia. What will the best assessment of the nurse reveal?

1. Heart rate and breathing become irregular.2. Eye movements are slow, and general sensation is lost.3. The medulla region of the brain is paralyzed.4. Relaxation, stable respiration, and slow eye movementsCorrect Answer: 4Rationale 1: In surgical anesthesia, skeletal muscles become relaxed, cardiovascular and breathing activities stabilize, and eye movements are slow. Heart rate and breathing become irregular in Stage 2, not Stage 3. The medulla region of the brain is paralyzed in Stage 4, not Stage 3. Eye movements are slow, and general sensation is lost in Stage 1, not Stage 3.Rationale 2: In surgical anesthesia, skeletal muscles become relaxed, cardiovascular and breathing activities stabilize, and eye movements are slow. Heart rate and breathing become irregular in Stage 2, not Stage 3. The medulla region of the brain is paralyzed in Stage 4, not Stage 3. Eye movements are slow, and general sensation is lost in Stage 1, not Stage 3.Rationale 3: In surgical anesthesia, skeletal muscles become relaxed, cardiovascular and breathing activities stabilize, and eye movements are slow. Heart rate and breathing become irregular in Stage 2, not Stage 3. The medulla region of the brain is paralyzed in Stage 4, not Stage 3. Eye movements are slow, and general sensation is lost in Stage 1, not Stage 3.Rationale 4: In surgical anesthesia, skeletal muscles become relaxed, cardiovascular and breathing activities stabilize, and eye movements are slow. Heart rate and breathing become irregular in Stage 2, not Stage 3. The medulla region of the brain is paralyzed in Stage 4, not Stage 3. Eye movements are slow, and general sensation is lost in Stage 1, not Stage 3.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-6Question 3Type: MCMAThe nurse teaches the patient about the correct use of a topical anesthetic for a skin condition. The nurse determines that learning has occurred when the patient makes which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.1. "This lotion should only be used on small areas of skin."2. "I must wear gloves when I apply the lotion."3. "This lotion works well on cuts too."4. "I must wash my hands before touching my eyes."5. "It's all right to use a lotion after the expiration date."Correct Answer: 1,4Rationale 1: Topical anesthetics must be kept away from the eyes unless they are ophthalmic preparations, and injury could result if topical anesthetics are applied to large areas of skin. Topical anesthetics should be applied to intact skin only, not on cuts. Drugs, including lotions, should not be used past the expiration date. The nurse, not the patient, must wear gloves when applying topical anesthetics.Rationale 2: Topical anesthetics must be kept away from the eyes unless they are ophthalmic preparations, and injury could result if topical anesthetics are applied to large areas of skin. Topical anesthetics should be applied to intact skin only, not on cuts. Drugs, including lotions, should not be used past the expiration date. The nurse, not the patient, must wear gloves when applying topical anesthetics.Rationale 3: Topical anesthetics must be kept away from the eyes unless they are ophthalmic preparations, and injury could result if topical anesthetics are applied to large areas of skin. Topical anesthetics should be applied to intact skin only, not on cuts. Drugs, including lotions, should not be used past the expiration date. The nurse, not the patient, must wear gloves when applying topical anesthetics.Rationale 4: Topical anesthetics must be kept away from the eyes unless they are ophthalmic preparations, and injury could result if topical anesthetics are applied to large areas of skin. Topical anesthetics should be applied to intact skin only, not on cuts. Drugs, including lotions, should not be used past the expiration date. The nurse, not the patient, must wear gloves when applying topical anesthetics.Rationale 5: Topical anesthetics must be kept away from the eyes unless they are ophthalmic preparations, and injury could result if topical anesthetics are applied to large areas of skin. Topical anesthetics should be applied to intact skin only, not on cuts. Drugs, including lotions, should not be used past the expiration date. The nurse, not the patient, must wear gloves when applying topical anesthetics.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 19-1Question 4Type: MCSAWhat does the nurse recognize as the most dangerous adverse effect of inhalation anesthesia?

1. Hypertension2. Ventricular tachycardia3. Malignant hyperthermia4. Increased intracranial pressureCorrect Answer: 3Rationale 1: Malignant hyperthermia is rare, but it is fatal if not treated immediately. Ventricular tachycardia is serious, but can be treated. Increased intracranial pressure is not a common adverse effect, but can be treated. Hypotension is more likely to occur than hypertension.Rationale 2: Malignant hyperthermia is rare, but it is fatal if not treated immediately. Ventricular tachycardia is serious, but can be treated. Increased intracranial pressure is not a common adverse effect, but can be treated. Hypotension is more likely to occur than hypertension.Rationale 3: Malignant hyperthermia is rare, but it is fatal if not treated immediately. Ventricular tachycardia is serious, but can be treated. Increased intracranial pressure is not a common adverse effect, but can be treated. Hypotension is more likely to occur than hypertension.Rationale 4: Malignant hyperthermia is rare, but it is fatal if not treated immediately. Ventricular tachycardia is serious, but can be treated. Increased intracranial pressure is not a common adverse effect, but can be treated. Hypotension is more likely to occur than hypertension.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-4Question 5Type: MCSAThe patient receives succinylcholine (Anectine). What will be a priority assessment by the nurse?

1. Spontaneous bleeding2. Respiratory paralysis3. Anaphylactic shock4. DeliriumCorrect Answer: 2Rationale 1: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Spontaneous bleeding is not related to this drug. Delirium is not related to this drug. Allergic reactions, like anaphylactic shock, are uncommon with this drug.Rationale 2: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Spontaneous bleeding is not related to this drug. Delirium is not related to this drug. Allergic reactions, like anaphylactic shock, are uncommon with this drug.Rationale 3: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Spontaneous bleeding is not related to this drug. Delirium is not related to this drug. Allergic reactions, like anaphylactic shock, are uncommon with this drug.Rationale 4: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Spontaneous bleeding is not related to this drug. Delirium is not related to this drug. Allergic reactions, like anaphylactic shock, are uncommon with this drug.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-7Question 6Type: MCSAThe student nurse does an operating room rotation and notes that many patients receive succinylcholine (Anectine). The student nurse asks the nursing instructor how the drug works. What is the best response by the nursing instructor?

1. "The patient will rapidly lose consciousness when this drug is administered."2. "The patient's cardiac muscle will be impacted as well as the respiratory muscles."3. "The patient will need to be monitored with an electrocardiogram (ECG)."4. "The patient will need assistance with breathing; it paralyzes respiratory muscles."Correct Answer: 4Rationale 1: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Neuromuscular blockers only affect skeletal muscles, not cardiac muscle. Neuromuscular blockers do not affect consciousness. Neuromuscular blockers do not affect cardiac muscle; there is no need to monitor the patient with an electrocardiogram (ECG).Rationale 2: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Neuromuscular blockers only affect skeletal muscles, not cardiac muscle. Neuromuscular blockers do not affect consciousness. Neuromuscular blockers do not affect cardiac muscle; there is no need to monitor the patient with an electrocardiogram (ECG).Rationale 3: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Neuromuscular blockers only affect skeletal muscles, not cardiac muscle. Neuromuscular blockers do not affect consciousness. Neuromuscular blockers do not affect cardiac muscle; there is no need to monitor the patient with an electrocardiogram (ECG).Rationale 4: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Neuromuscular blockers only affect skeletal muscles, not cardiac muscle. Neuromuscular blockers do not affect consciousness. Neuromuscular blockers do not affect cardiac muscle; there is no need to monitor the patient with an electrocardiogram (ECG).Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-7Question 7Type: MCSAThe patient has a serious laceration to the arm. The patient receives a local anesthetic mixed with epinephrine prior to suturing. What does the nurse recognize as the rationale for the epinephrine?

1. Constricted blood vessels will extend the duration of action of the drug.2. Constricted blood vessels will decrease the amount of pain experienced.3. Constricted blood vessels will promote relaxation of the patient.4. Constricted blood vessels will result in decreased bleeding.Correct Answer: 1Rationale 1: Epinephrine is often added to local anesthetics to constrict blood vessels and extend the duration of action of the drug. The amount of vasoconstriction will not significantly decrease bleeding. Vasoconstriction does not decrease pain. Vasoconstriction will not promote relaxation in the patient.Rationale 2: Epinephrine is often added to local anesthetics to constrict blood vessels and extend the duration of action of the drug. The amount of vasoconstriction will not significantly decrease bleeding. Vasoconstriction does not decrease pain. Vasoconstriction will not promote relaxation in the patient.Rationale 3: Epinephrine is often added to local anesthetics to constrict blood vessels and extend the duration of action of the drug. The amount of vasoconstriction will not significantly decrease bleeding. Vasoconstriction does not decrease pain. Vasoconstriction will not promote relaxation in the patient.Rationale 4: Epinephrine is often added to local anesthetics to constrict blood vessels and extend the duration of action of the drug. The amount of vasoconstriction will not significantly decrease bleeding. Vasoconstriction does not decrease pain. Vasoconstriction will not promote relaxation in the patient.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 19-3Question 8Type: MCSAWhich patient is most likely to experience an adverse reaction to inhalation anesthesia?

1. A 15-year-old with diabetes mellitus2. A 6-year-old with no chronic health problems3. A 79-year-old with arteriosclerosis4. A 55-year-old with a serious neck injuryCorrect Answer: 3Rationale 1: The elderly are more sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs may not be healthy. Adolescents are similar to adults in risk factors associated with inhalation anesthesia; they are not at high risk for an adverse reaction. Children are more sensitive to inhalation anesthesia than adults, but this 6 year-old child is healthy and so should not be at high risk for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the neck injury is not a contraindication to anesthesia.Rationale 2: The elderly are more sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs may not be healthy. Adolescents are similar to adults in risk factors associated with inhalation anesthesia; they are not at high risk for an adverse reaction. Children are more sensitive to inhalation anesthesia than adults, but this 6 year-old child is healthy and so should not be at high risk for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the neck injury is not a contraindication to anesthesia.Rationale 3: The elderly are more sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs may not be healthy. Adolescents are similar to adults in risk factors associated with inhalation anesthesia; they are not at high risk for an adverse reaction. Children are more sensitive to inhalation anesthesia than adults, but this 6 year-old child is healthy and so should not be at high risk for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the neck injury is not a contraindication to anesthesia.Rationale 4: The elderly are more sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs may not be healthy. Adolescents are similar to adults in risk factors associated with inhalation anesthesia; they are not at high risk for an adverse reaction. Children are more sensitive to inhalation anesthesia than adults, but this 6 year-old child is healthy and so should not be at high risk for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the neck injury is not a contraindication to anesthesia.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-9Question 9Type: MCSAThe patient is in Stage 2 of general anesthesia. What are the priority nursing interventions at this time?

1. Assist the anesthesiologist in repositioning the patient.2. Complete the surgical scrub.3. Keep the environment quiet and calm.4. Insert the Foley catheter.Correct Answer: 3Rationale 1: The patient is hyperexcitable in Stage 2 of anesthesia so the environment must be kept quiet to minimize stimulation. It is not appropriate to reposition the patient during Stage 2 of anesthesia. It is not appropriate to insert a Foley catheter during Stage 2 of anesthesia. It is not appropriate to complete the surgical scrub during Stage 2 of anesthesia.Rationale 2: The patient is hyperexcitable in Stage 2 of anesthesia so the environment must be kept quiet to minimize stimulation. It is not appropriate to reposition the patient during Stage 2 of anesthesia. It is not appropriate to insert a Foley catheter during Stage 2 of anesthesia. It is not appropriate to complete the surgical scrub during Stage 2 of anesthesia.Rationale 3: The patient is hyperexcitable in Stage 2 of anesthesia so the environment must be kept quiet to minimize stimulation. It is not appropriate to reposition the patient during Stage 2 of anesthesia. It is not appropriate to insert a Foley catheter during Stage 2 of anesthesia. It is not appropriate to complete the surgical scrub during Stage 2 of anesthesia.Rationale 4: The patient is hyperexcitable in Stage 2 of anesthesia so the environment must be kept quiet to minimize stimulation. It is not appropriate to reposition the patient during Stage 2 of anesthesia. It is not appropriate to insert a Foley catheter during Stage 2 of anesthesia. It is not appropriate to complete the surgical scrub during Stage 2 of anesthesia.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-6Question 10Type: MCSAA pregnant woman has a malignant melanoma on her leg, and will need surgery. She is concerned about anesthesia. What is the best response by the nurse?

1. "You will probably have an epidural, and this won't harm your baby."2. "There are newer general anesthetics available that are safe for your baby."3. "You will most likely have local anesthesia; this will not affect your baby."4. "Inhalation anesthetics are safe because they remain in your lungs."Correct Answer: 3Rationale 1: Local anesthetics are most commonly used to remove lesions. They stay in the treatment area and do not impact the baby. There are not any general anesthetics that are considered safe, and this patient will most likely have local anesthesia. Epidural anesthesia is not indicated in this situation. Inhalation anesthesia is not indicated in this situation, and even though it remains primarily in the lungs, it can affect the baby.Rationale 2: Local anesthetics are most commonly used to remove lesions. They stay in the treatment area and do not impact the baby. There are not any general anesthetics that are considered safe, and this patient will most likely have local anesthesia. Epidural anesthesia is not indicated in this situation. Inhalation anesthesia is not indicated in this situation, and even though it remains primarily in the lungs, it can affect the baby.Rationale 3: Local anesthetics are most commonly used to remove lesions. They stay in the treatment area and do not impact the baby. There are not any general anesthetics that are considered safe, and this patient will most likely have local anesthesia. Epidural anesthesia is not indicated in this situation. Inhalation anesthesia is not indicated in this situation, and even though it remains primarily in the lungs, it can affect the baby.Rationale 4: Local anesthetics are most commonly used to remove lesions. They stay in the treatment area and do not impact the baby. There are not any general anesthetics that are considered safe, and this patient will most likely have local anesthesia. Epidural anesthesia is not indicated in this situation. Inhalation anesthesia is not indicated in this situation, and even though it remains primarily in the lungs, it can affect the baby.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-7Question 11Type: MCSAThe patient is scheduled for a surgical procedure. The nurse plans to teach the patient about anesthesia. Which statement would be included in the best plan of the nurse?

1. "An inhaled agent needs to be followed by an intravenous (IV) agent if it is ineffective."2. "An inhaled agent is used to induce sleep, followed by an intravenous (IV) agent for relaxation."3. "An intravenous (IV) agent to induce sleep is usually all that is required."4. "An intravenous (IV) agent will be used first to induce sleep; then, an inhaled agent will be used."Correct Answer: 4Rationale 1: Intravenous agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia. Patients require more anesthesia than just intravenous (IV) anesthesia. An intravenous (IV) agent, not an inhaled agent, is used to induce sleep. Inhaled agents are given after intravenous (IV) agents to maintain anesthesia, not if the intravenous (IV) agent is ineffective.Rationale 2: Intravenous agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia. Patients require more anesthesia than just intravenous (IV) anesthesia. An intravenous (IV) agent, not an inhaled agent, is used to induce sleep. Inhaled agents are given after intravenous (IV) agents to maintain anesthesia, not if the intravenous (IV) agent is ineffective.Rationale 3: Intravenous agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia. Patients require more anesthesia than just intravenous (IV) anesthesia. An intravenous (IV) agent, not an inhaled agent, is used to induce sleep. Inhaled agents are given after intravenous (IV) agents to maintain anesthesia, not if the intravenous (IV) agent is ineffective.Rationale 4: Intravenous agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia. Patients require more anesthesia than just intravenous (IV) anesthesia. An intravenous (IV) agent, not an inhaled agent, is used to induce sleep. Inhaled agents are given after intravenous (IV) agents to maintain anesthesia, not if the intravenous (IV) agent is ineffective.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-5Question 12Type: MCSAThe 2-year-old child comes to the emergency department with a laceration to the lower leg. The physician plans to use a local anesthetic, but the child screams at the sight of the needle. What is the best action by the nurse?

1. Wrap the child in a blanket to restrain him and ensure safety during suturing.2. Rub a local anesthetic cream on the skin so the child will not feel the needle.3. Administer a small dose of a medication such as lorazepam (Ativan).4. Ask the parents to leave the room so the child will quiet down.Correct Answer: 2Rationale 1: The child will be more cooperative if there isn't any pain from an injection. There isn't any indication to administer lorazepam (Ativan). Restraining the child will terrify him and is not indicated at this time. The presence of parents usually decreases a child's anxiety and increases cooperation.Rationale 2: The child will be more cooperative if there isn't any pain from an injection. There isn't any indication to administer lorazepam (Ativan). Restraining the child will terrify him and is not indicated at this time. The presence of parents usually decreases a child's anxiety and increases cooperation.Rationale 3: The child will be more cooperative if there isn't any pain from an injection. There isn't any indication to administer lorazepam (Ativan). Restraining the child will terrify him and is not indicated at this time. The presence of parents usually decreases a child's anxiety and increases cooperation.Rationale 4: The child will be more cooperative if there isn't any pain from an injection. There isn't any indication to administer lorazepam (Ativan). Restraining the child will terrify him and is not indicated at this time. The presence of parents usually decreases a child's anxiety and increases cooperation.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-8Question 13Type: MCSAThe patient has gastroesophageal reflux disease and receives lidocaine viscous prior to an endoscopy. What will the best assessment of the nurse include immediately after the procedure?

1. Assess for a return of the gag reflex.2. Assess for nausea and vomiting.3. Assess for any damage to the teeth or gums.4. Assess for a headache.Correct Answer: 1Rationale 1: The gag reflex must be assessed before giving the patient anything to eat or drink. Damage to the teeth or gums is rare following an endoscopy. Nausea and vomiting is not common after an endoscopy. Headaches are not common after an endoscopy.Rationale 2: The gag reflex must be assessed before giving the patient anything to eat or drink. Damage to the teeth or gums is rare following an endoscopy. Nausea and vomiting is not common after an endoscopy. Headaches are not common after an endoscopy.Rationale 3: The gag reflex must be assessed before giving the patient anything to eat or drink. Damage to the teeth or gums is rare following an endoscopy. Nausea and vomiting is not common after an endoscopy. Headaches are not common after an endoscopy.Rationale 4: The gag reflex must be assessed before giving the patient anything to eat or drink. Damage to the teeth or gums is rare following an endoscopy. Nausea and vomiting is not common after an endoscopy. Headaches are not common after an endoscopy.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-9Question 14Type: MCSAWhich clinical technique for administering anesthesia is common for pregnant women during labor and delivery?

1. Nerve block2. Topical3. Infiltration4. EpiduralCorrect Answer: 4Rationale 1: Anesthesia via the epidural route is the most common for women during labor and delivery. Rationale 2: Anesthesia via the epidural route is the most common for women during labor and delivery. Rationale 3: Anesthesia via the epidural route is the most common for women during labor and deliveryRationale 4: Anesthesia via the epidural route is the most common for women during labor and delivery. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-1Question 15Type: MCSALocal anesthetics work by

1. enhancing the influx of calcium into the cell.2. occupying potassium receptors.3. increasing nerve impulse transmission.4. blocking sodium channels.Correct Answer: 4Rationale 1: Local anesthetics block sodium channels, resulting in diminished motor and sensory impulse transmission. Rationale 2: Local anesthetics block sodium channels, resulting in diminished motor and sensory impulse transmission. Rationale 3: Local anesthetics block sodium channels, resulting in diminished motor and sensory impulse transmission. Rationale 4: Local anesthetics block sodium channels, resulting in diminished motor and sensory impulse transmission. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-8Question 16Type: MCSAWhich of the following local anesthetic agents would be considered first due to its lower rate of adverse effects?

1. Tetracaine (Pontocaine)2. Procaine (Novocain)3. Lidocaine (Xylocaine)4. Chloroprocaine (Nesacaine)Correct Answer: 3Rationale 1: All except lidocaine are classified as esthers. Lidocaine is classified as an amide, and amides produce fewer side effects than do esthers. Rationale 2: All except lidocaine are classified as esthers. Lidocaine is classified as an amide, and amides produce fewer side effects than do esthers. Rationale 3: All except lidocaine are classified as esthers. Lidocaine is classified as an amide, and amides produce fewer side effects than do esthers. Rationale 4: All except lidocaine are classified as esthers. Lidocaine is classified as an amide, and amides produce fewer side effects than do esthers. Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-2Question 17Type: MCSAWhich statement correctly identifies why epinephrine is used with local anesthetic agents?

1. Epinephrine use produces higher analgesia levels.2. Epinephrine use prolongs surgical time.3. Epinephrine use lowers the risk of bacterial infection.4. Epinephrine use reduces the occurrence of hypertension.Correct Answer: 2Rationale 1: Epinephrine causes vasoconstriction, prolonging the time the anesthetic is present, and therefore prolongs procedure time. Epinephrine would cause hypertension, not prevent it. Epinephrine is not antibacterial and is not an analgesic.Rationale 2: Epinephrine causes vasoconstriction, prolonging the time the anesthetic is present, and therefore prolongs procedure time. Epinephrine would cause hypertension, not prevent it. Epinephrine is not antibacterial and is not an analgesic.Rationale 3: Epinephrine causes vasoconstriction, prolonging the time the anesthetic is present, and therefore prolongs procedure time. Epinephrine would cause hypertension, not prevent it. Epinephrine is not antibacterial and is not an analgesic.Rationale 4: Epinephrine causes vasoconstriction, prolonging the time the anesthetic is present, and therefore prolongs procedure time. Epinephrine would cause hypertension, not prevent it. Epinephrine is not antibacterial and is not an analgesic.Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 19-3Question 18Type: MCSAWhich of the following correctly identifies a sign of general anesthesia?

1. A sleeping state that can be awakened easily2. An unconscious state, without analgesia3. A total loss of body movements4. A conscious but sleepy state of beingCorrect Answer: 3Rationale 1: General anesthesia involves total analgesia and loss of consciousness, memory, and body movements. Rationale 2: General anesthesia involves total analgesia and loss of consciousness, memory, and body movements. Rationale 3: General anesthesia involves total analgesia and loss of consciousness, memory, and body movements. Rationale 4: General anesthesia involves total analgesia and loss of consciousness, memory, and body movements. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-4Question 19Type: MCSAWhich of the following correctly identifies the initial use for an IV in a patient undergoing a lengthy abdominal surgery that requires general anesthesia?

1. To administer agents that will produce rapid unconsciousness2. To administer reversal agents or other medications used to treat the adverse effects associated with general anesthesia3. To administer large amounts of colloid solutions following surgical blood loss4. To administer a volatile liquid that will keep the patient asleepCorrect Answer: 1Rationale 1: IV lines are started prior to surgical procedures requiring general anesthesia to administer agents that will cause rapid loss of consciousness. The IV also may be used to treat adverse effects and administer replacement fluids, but these would not be initial uses. Volatile liquids are inhaled gases. Rationale 2: IV lines are started prior to surgical procedures requiring general anesthesia to administer agents that will cause rapid loss of consciousness. The IV also may be used to treat adverse effects and administer replacement fluids, but these would not be initial uses. Volatile liquids are inhaled gases. Rationale 3: IV lines are started prior to surgical procedures requiring general anesthesia to administer agents that will cause rapid loss of consciousness. The IV also may be used to treat adverse effects and administer replacement fluids, but these would not be initial uses. Volatile liquids are inhaled gases. Rationale 4: IV lines are started prior to surgical procedures requiring general anesthesia to administer agents that will cause rapid loss of consciousness. The IV also may be used to treat adverse effects and administer replacement fluids, but these would not be initial uses. Volatile liquids are inhaled gases. Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-5Question 20Type: MCSAWhich of the following correctly identifies a state of general anesthesia desirable for surgery?

1. The patient is unconscious, with arm and leg movement.2. The patient is not responsive to pain, and has no spontaneous breathing.3. The patient is unconscious with slow eye movements.4. The patient loses sensation, but is awake.Correct Answer: 3Rationale 1: Surgical anesthesia occurs at Stage 3, where the patient is not conscious and is relaxed, eye movement has slowed, and vital signs have stabilized. Rationale 2: Surgical anesthesia occurs at Stage 3, where the patient is not conscious and is relaxed, eye movement has slowed, and vital signs have stabilized. Rationale 3: Surgical anesthesia occurs at Stage 3, where the patient is not conscious and is relaxed, eye movement has slowed, and vital signs have stabilized. Rationale 4: Surgical anesthesia occurs at Stage 3, where the patient is not conscious and is relaxed, eye movement has slowed, and vital signs have stabilized. Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 19-6Question 21Type: MCSAA patient undergoing surgery is receiving general anesthesia as well as a neuromuscular blocking agent. Which statement best indicates the primary reason for the neuromuscular blocking agent?

1. To potentiate analgesic effects2. To prevent adverse effects associated with inhaled gases3. To cause total skeletal muscle relaxation4. To induce unconsciousnessCorrect Answer: 3Rationale 1: The primary purpose of administering neuromuscular blocking agents is to cause total skeletal muscle relaxation. Neuromuscular blocking agents do not potentiate analgesia or induce unconsciousness. They do allow for lower amounts of anesthetics to be used, which can reduce adverse effects, but this is not the primary reason. Rationale 2: The primary purpose of administering neuromuscular blocking agents is to cause total skeletal muscle relaxation. Neuromuscular blocking agents do not potentiate analgesia or induce unconsciousness. They do allow for lower amounts of anesthetics to be used, which can reduce adverse effects, but this is not the primary reason. Rationale 3: The primary purpose of administering neuromuscular blocking agents is to cause total skeletal muscle relaxation. Neuromuscular blocking agents do not potentiate analgesia or induce unconsciousness. They do allow for lower amounts of anesthetics to be used, which can reduce adverse effects, but this is not the primary reason. Rationale 4: The primary purpose of administering neuromuscular blocking agents is to cause total skeletal muscle relaxation. Neuromuscular blocking agents do not potentiate analgesia or induce unconsciousness. They do allow for lower amounts of anesthetics to be used, which can reduce adverse effects, but this is not the primary reason. (Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-6Question 22Type: MCMAMidazolam (Versed) may be administered as part of surgical anesthesia. This drug is recognized as having which effects?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. Producing effects consistent with those observed in administering other benzodiazepines2. Reducing anxiety and stress associated with surgery3. Producing central nervous system depression and skeletal muscle relaxation4. Maintaining stable cardiac and respiratory activity5. Preventing cardiac dysrhythmiasCorrect Answer: 1,2,3Rationale 1: Midazolam (Versed) can produce serious cardiovascular side effects, including hypotension, tachycardia, and cardiovascular collapse. Midazolam (Versed) can produce laryngospasm.Rationale 2: Midazolam (Versed) reduces anxiety and stress associated with surgery.Rationale 3: Midazolam (Versed) produces central nervous system depression and skeletal muscle relaxation.Rationale 4: Midazolam (Versed) is not associated with maintaining stable cardiac and respiratory activity.Rationale 5: Midazolam (Versed) does not prevent cardiac dysrhythmias.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-2Question 23Type: MCMABalanced anesthesia is the use of a combination of medications to produce general anesthesia. Which drugs may be used in combination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. Benzodiazepines2. Neuromuscular blockers3. Inhaled anesthetics4. Proton-pump inhibitors5. Intravenous anestheticsCorrect Answer: 1,2,3,5Rationale 1: Benzodiazepines reduce anxiety, produce central nervous system depression, and relax skeletal muscle.Rationale 2: Neuromuscular blockers provide skeletal muscle relaxation, which is an important component of general anesthesia.Rationale 3: Inhaled agents are used to maintain an anesthetized state.Rationale 4: Proton-pump inhibitors are not used in balanced anesthesiaRationale 5: Intravenous anesthetics relax muscles, diminish pain, and produce sleep.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 19-2Question 24Type: MCMAPreoperative adjunct medications are used for which reasons?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. To reduce anxiety and facilitate sedation2. To facilitate a faster recovery3. To reduce the risk of aspiration pneumonia4. To reduce the risk of a postoperative ileus5. To manage painCorrect Answer: 1,3,5Rationale 1: Benzodiazepines or short-acting barbiturates are used to reduce anxiety and facilitate sedation.Rationale 2: Preoperative adjuncts are not associated with a faster recovery.Rationale 3: Preoperative adjunct medications such as histamine-2 receptor agonists or anticholinergics are used to reduce the risk of aspiration pneumonia.Rationale 4: Preoperative adjuncts are not associated with a reduced risk of a postoperative ileus.Rationale 5: If the pain level is moderate or mild, nonsteroidal anti-inflammatory drugs are administered because they cause fewer serious adverse reactions than opioids.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-7Question 25Type: MCMAA nurse is assessing a postoperative patient who has a family history of malignant hyperthermia. Which findings would be of most concern to the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. Mild spasms of the patient's jaw muscles2. Dark urine 3 hours after surgery3. Tachycardia in the first hour after surgery4. Temperature elevation 3 hours after the procedure5. Respiratory rate increase to 18 breaths per minute 2 hours after the procedureCorrect Answer: 1,2,3Rationale 1: Mild jaw spasms often herald the development of malignant hyperthermia.Rationale 2: Darkened urine may signify rhabdomyolysis, which occurs with malignant hyperthermia.Rationale 3: Tachycardia is a potential herald of malignant hyperthermia.Rationale 4: Temperature elevation more than 2 hours after anesthesia is not a precursor of malignant hyperthermia.Rationale 5: Respiratory rate may increase as anesthesia passes, but this is a rate still within normal ranges.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 19-6Question 26Type: MCMAA patient has just been visited by the anesthesiologist who will provide anesthesia during the patient's abdominal surgery the next day. The patient says, "I think I heard the doctor say something about hypnosis. I don't believe in all of that." How should the nurse respond?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "Hypnosis is a standard method of relaxing the patient before anesthesia is started."2. "That just means the drugs are going to make you unaware of what is happening."3. "The doctor needs to block all of your reflexes so the surgeon can do the surgery."4. "This is not the same as the kind of hypnosis you might see on television."5. "The doctors do not want you to remember the pain of your procedure."Correct Answer: 2,4Rationale 1: This is not the interpretation of the word hypnosis as it applies to general anesthesia.Rationale 2: This statement is a good description of hypnosis as it applies to general anesthesia.Rationale 3: Blocking of reflexes is the "loss of reflexes" portion of balanced anesthesia and is not the same as the hypnosis portion.Rationale 4: This is a true statement.Rationale 5: While this is a true statement, it does not reflect the concept of hypnosis as it pertains to general anesthesia.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 19-2Question 27Type: MCMAA novice nurse says, "We want to keep our patients in Stage 4 anesthesia during their surgery." How should the supervising nurse interpret this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. The novice nurse has made an error in this statement.2. Stage 4 anesthesia is avoided.3. This is a good description of the goal of anesthesia.4. The novice nurse should have said Stage 3 anesthesia.5. A more accurate statement would be that the patient is maintained in anxiolysis anesthesia.Correct Answer: 1,2,4Rationale 1: Stage 4 is not the goal for anesthesia.Rationale 2: In Stage 4, the medulla is paralyzed and breathing and circulation could stop. This stage is avoided.Rationale 3: This is not the goal of anesthesia.Rationale 4: The goal of anesthesia is rapid induction through Stages 1 and 2 with the patient remaining in Stage 3 until the end of the procedure.Rationale 5: Anxiolysis is a term used to describe minimal sedation, not general anesthesia.Global Rationale: Cognitive Level: EvaluatingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 19-2Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.