11: GENERAL AND LOCAL ANESTHETICS STUDY GUIDE

Question 1

Topical

Answer 1

A type of anesthetic that is applied directly to the skin and mucous membranes

Question 2

Rocuronium

Answer 2

A rapid- to intermediate-acting non-depolarizing neuromuscular blocking drug (NMBD)

Question 3

General

Answer 3

The term for anesthetic drugs that alter the central nervous system (CNS), resulting in loss of consciousness and deep muscle relaxation

Question 4

Local

Answer 4

A type of anesthetic drug that reduces pain sensations at the level of the peripheral nerves

Question 5

Adjunctive Drugs

Answer 5

used in combination with anesthetics for anesthesia initiation (induction), sedation, reduction of anxiety, and amnesia

Question 6

Anesthetics

Answer 6

The term for drugs that depress the CNS; used for surgical procedures

Question 7

Balanced

Answer 7

The practice of using combinations of drugs to produce general anesthesia rather than using a single drug

Question 8

Atropine

Answer 8

An anticholinergic drug given preoperatively to dry secretions

Question 9

Midazolam

Answer 9

Generic name for the drug that is often used for moderate-sedation procedures

Question 10

Succinylcholine

Answer 10

The only depolarizing neuromuscular blocking drug (NMBD) available; used for endotracheal intubation

Question 11

Which drug(s) classes are used as adjunctive drugs with anesthesia? (Select all that apply.)
a. Sedative-hypnotics
b. Anticonvulsants
c. Anticholinergics
d. Inhaled gasses
e. Opioid analgesics

Answer 11

A, C, E

Question 12

While assisting with a procedure in the emergency department, the nurse prepares lidocaine for use with which type of anesthesia?
a. Moderate sedation
b. Infiltration
c. Intravenous
d. General

Answer 12

B

Question 13

The nurse monitoring a patient after surgery keeps in mind that the primary concern with the use of a neuromuscular blocking drug is which adverse effect?
a. Respiratory arrest
b. Headache
c. Bradycardia
d. Hypertension

Answer 13

A

Question 14

To decrease the possibility of a headache after spinal anesthesia, the nurse will provide which instruction to the patient?
a. Sit in high Fowler’s position.
b. Maintain strict bedrest.
c. Limit fluids.
d. Ambulate in the hall several times a day.

Answer 14

B

Question 15

The nurse is reviewing a policy for local anesthesia. Local anesthesia is indicated for which procedures? (Select all that apply.)
a. Cardioversions
b. Suturing a skin laceration
c. Diagnostic procedures
d. Long-duration surgery
e. Dental procedures

Answer 15

B, C, E

Question 16

A patient who has just returned from surgery has suddenly developed a severe elevation in body temperature. The nurse recognizes that this change may indicate which condition?
a. A normal temperature change after surgery
b. Malignant hypertension
c. Malignant hyperthermia
d. Fever

Answer 16

C

Question 17

During a procedure, the nurse is monitoring a patient who has received dexmedetomidine for moderate sedation. The nurse will observe for which potential adverse effect?
a. Respiratory depression
b. Tachycardia
c. Dizziness
d. Hypotension

Answer 17

D

Question 18

Which of the following is an identified advantage for the use of nitrous oxide?
a. It demonstrates effectiveness as a single agent.
b. It has good analgesic properties.
c. It does not promote postoperative nausea and vomiting.
d. It offers a parenteral and inhaled route option.

Answer 18

B

Question 19

When the effects of local anesthetics begin to wear off, which physiologic response is the first to occur?
a. Memory returns.
b. Motor activity returns.
c. Sensory activity returns.
d. Autonomic activity returns.

Answer 19

B

Question 20

Which is a new selective relaxant binding agent that is used for reversal of rocuronium or vecuronium?
a. Sugammadex
b. Succinylcholine
c. Rocuronium
d. Pancuronium

Answer 20

A

Question 21

A patient is receiving a neuromuscular blocking drug. Indicate the order in which the following areas become paralyzed once this drug is given (1 = first; 3 = last).
(2) a. Limbs, neck, trunk muscles
(3) b. Intercostal muscles and diaphragm
(1) c. Small, rapidly moving muscles, such as those of the fingers and eyes

Answer 21

1. small, rapidly moving muscles, such as those of the fingers and eyes
2. limbs, neck, trunk muscles
3. intercostal muscles and diaphragm

Question 22

A patient has an order to receive atropine sulfate, 0.4 mg IM, as a preoperative medication. The vial contains atropine sulfate, 1 mg/mL. How many milliliters of medication will the nurse draw up for this injection?

Answer 22

0.4 mL

Question 23

In preparation for a colonoscopy, a patient is to receive midazolam, 0.05 mg IV push over 2 minutes. The medication comes in a strength of 1 mg/mL. How much medication will the nurse draw up into the syringe for this dose?

Answer 23

0.05 mL

Question 24

PH. is a student nurse who has assisted the nurse anesthetist in surgery on prior occasions. Today, however, he is nervous because it is a child who will undergo general anesthesia. Why might this make H. more nervous than usual?

Answer 24

Pediatric patients are more susceptible to problems such as central nervous system depression, toxicity, atelectasis, pneumonia, and cardiac abnormalities because their hepatic, cardiac, respiratory, and renal systems are not fully developed or fully functional.

Question 25

S. is being administered a neuromuscular blocking drug while he is receiving mechanical ventilation. What is the most important thing the nurse needs to remember when working with him during this therapy?

Answer 25

These drugs cause paralysis of the respiratory muscles. The nurse will need to monitor the mechanical ventilation closely because if the ventilator does not work, the patient will not be able to breathe on his own. Emergency resuscitation equipment must be kept nearby. In addition, these drugs do not cause sedation, and the patient is still able to hear and feel. Most facilities have protocols for sedation during the use of these drugs. However, it is important to remain professional at all times and to take the time to reassure the patient and orient him to his surroundings, what noises mean, and what procedures are going to be done to him. Remind the family that he is still able to hear what is said.

Question 26

E. will undergo cardioversion this afternoon, and the nurse anesthetist has explained to her that she will not be asleep but that she will not remember the procedure. E. asks, “How can this be?” What is the nurse anesthetist’s explanation?

Answer 26

She will be given a combination of intravenous medications that will produce analgesia and amnesia of the procedure, but she will still be alert enough to breath on her own and follow verbal directions as needed. In some cases, local anesthesia will be used to enhance patient comfort. This type of sedation is called moderate (or procedural, or conscious) sedation; it is associated with fewer complications and a shorter recovery time than general anesthesia.

Question 27

A patient is in the emergency department because he accidentally put a nail into his arm with a nail gun. The emergency provider requests “lidocaine with epinephrine,” but the only type available in the supply cart is “plain” lidocaine. What is the difference, and why does it matter which one is used?

Answer 27

Yes, there is a difference. Lidocaine with epinephrine is used when the vasoconstriction effects of epinephrine are needed. The vasoconstriction confines the anesthetic (lidocaine) to the local area of injection and acts to reduce bleeding. The two types of lidocaine are not interchangeable.

Question 28

Case Study:

You are a nursing student, and today you are assigned to an observation day in the operating room, with a certified registered nurse anesthetist (CRNA) as your contact for the day. The first case is a patient undergoing a right lower lung lobectomy because of lung cancer. The patient has a history of paraplegia from an old automobile accident. The patient’s blood pressure has been maintained at 120/72 mm Hg, and the pulse has ranged from 100 to 110 beats/min during the surgery. The patient’s body temperature has lowered to 97.2° F (36.2° C) during surgery. The patient’s respirations have been maintained by a ventilator.

Answer 28

1. Before the surgery, the CRNA explains that the patient will undergo “balanced anesthesia.” What is meant by this term? In balanced anesthesia, minimal doses of a combination of anesthetic drugs (both intravenous and inhaled) are given to achieve the desired level of anesthesia for the surgical procedure. Adjunctive drugs may also be used and commonly include sedative-hypnotics, narcotics, and neuromuscular blocking drugs (NMBDs; depolarizing drugs such as succinylcholine and the nondepolarizing drugs such as rocuronium). Combining several different drugs makes it possible for general anesthesia to be accomplished with smaller amounts of anesthetic gasses and thereby reduces the side effects.
2. What is the purpose of administering the drug rocuronium during anesthesia? The main therapeutic use of the NMBD rocuronium is to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation during surgical procedures. When respiratory muscles are paralyzed by NMBDs, mechanical ventilation is easier because the body’s drive to control respirations is eliminated by the drug; this allows the ventilator to have total control of the respirations.

Question 29

The patient has arrived in the Post Anesthesia Care Unit (PACU), and is breathing on his own, off the ventilator, with oxygen at 2 liters/minute per facemask. The nurse is performing an assessment. Which of these assessment findings require immediate follow-up? (Select all that apply; choose two options.)
a. Blood pressure 122/68 mm Hg
b. Pulse 100 beats/minute
c. Respirations 28 breaths/minute
d. Temperature 102.9 ° F (39.4 ° C)
e. Diaphoresis (sweaty skin)
f. Muscle rigidity
g. Chest tube draining a slight amount of bloody drainage
h. SpO2 96%

Answer 29

C, D, E, F
Rationale: Malignant hyperthermia is a deadly reaction to general anesthesia. It is a rapid progression of hyperthermia that may be fatal if not recognized immediately and treated aggressively. The nurse needs to monitor for symptoms, such as: a rapid rise in body temperature, tachycardia, tachypnea, muscle rigidity, cyanosis, irregular heartbeat, skin mottling, unstable blood pressure, and profuse sweating. Malignant hyperthermia can occur during the surgical procedure or during the recovery period.
For this patient, the elevated respiratory rate, the high temperature, the muscle rigidity, and the diaphoresis are potential indicators of malignant hyperthermia. The BP, pulse, Sp02 are within acceptable parameters, and some bloody drainage in the chest tube is expected after lung surgery.

Question 30

Another patient is undergoing a procedure performed using local anesthesia. Are there advantages of this type of anesthesia over general anesthesia?

Answer 30

Local anesthesia is most commonly used in settings in which loss of consciousness, whole body relaxation, and loss of responsiveness are either unnecessary or unwanted. A lower incidence of toxic effects is associated with the use of local anesthetics because very little of these drugs is absorbed systemically.