Chapter 1: Anesthesia complications

Question 1

Which of the following best describes malignant hyperthermia?
A. A controlled form of hyperthermia
B. The onset of fever caused by the presence of an infection
C. A form of cancer that can cause life-threatening hyperthermia
D. An autosomal dominant genetic disorder that can cause hyperthermia in response to certain
triggers

Answer 1

D. An autosomal dominant genetic disorder that can cause hyperthermia in response to certain
triggers

Question 2

Which of the following statements about MH is FALSE?
A. MH is an autosomal dominant disorder.
B. MH can cause adverse complications, but is not life-threatening.
C. MH can be caused by certain anesthetics, muscle relaxants, or extreme stress in the form of heat or exercise.
D. MH is a hypermetabolic reaction affecting the transport of calcium in skeletal muscle.

Answer 2

B. MH can cause adverse complications, but is not life-threatening.

Question 3

Which of the following is NOT a triggering agent for an MH crisis?
A. Inhalation anesthetics (ie, isoflurane, sevoflurane, desflurane, enflurane)
B. Depolarizing muscle relaxants (ie, succinylcholine)
C. Extreme stress from heat, exercise, emotional stress, or trauma
D. All of these can be triggering agents

Answer 3

D. All of these can be triggering agents

Question 4

Which of the following responses during patient assessment does NOT need to be reported to the
anesthesia professional prior to the OR procedure?
A. I have had a strange reaction to anesthetics in the past.
B. I have King-Denborough syndrome.
C. My sister had a strange temperature increase the last time she was under anesthesia, but I’ve never had any problems with anesthesia.
D. All of these responses should be reported.

Answer 4

D. All of these responses should be reported.

Question 5

Of the following clinical signs of an MH crisis, which is considered an EARLY sign?
A. Abrupt increase in ETCO2
B. Acute renal failure
C. Elevated blood myoglobin level
D. Hyperkalemia

Answer 5

A. Abrupt increase in ETCO2

Question 6

Of the following clinical signs of an MH crisis, which is considered a LATE sign?
A. Muscle rigidity
B. Hyperthermia
C. Tachycardia
D. Hypoxia

Answer 6

B. Hyperthermia

Question 7

Which perioperative team member is primarily responsible for calling for additional help, assisting with dantrolene preparation, and obtaining necessary supplies?
A. Surgeon
B. Anesthesia professional
C. RN circulator
D. Scrub person

Answer 7

C. RN circulator

Question 8

Which of the following is a TRUE statement?
A. A physician office where a patient’s care includes receiving general anesthesia with isoflurane is exempt from stocking dantrolene.
B. As long as an ambulatory surgery center has a pharmacy agreement in place with neighboring facilities to obtain dantrolene, there is no need to stock dantrolene on-site for MH-susceptible patients.
C. Every facility where MH triggering anesthetics are administered should stock the recommended amount of dantrolene, medications, and supplies to treat an MH crisis.
D. Each vial of RYANODEX® and DANTRIUM® require reconstitution with 60 mL of sterile water for injection.

Answer 8

C. Every facility where MH triggering anesthetics are administered should stock the recommended amount of dantrolene, medications, and supplies to treat an MH crisis.

Question 9

Which part of the brain is primarily responsible for maintaining normothermia?
A. Amygdala
B. Brain stem
C. Cerebellum
D. Cortex
E. Hypothalamus

Answer 9

E. Hypothalamus

Question 10

Which of the following is an adverse effect of hypothermia?
A. Hypercoagulation
B. Increased collagen deposition
C. Increased neutrophil activity
D. Slower metabolism of anesthetic agents
E. Vasodilation

Answer 10

D. Slower metabolism of anesthetic agents

Question 11

The temperature in OR suites should be maintained at a minimum of
A. 17° C (62.6° F)
B. 18° C (64.4° F)
C. 19° C (66.2° F)
D. 20° C (68° F)
E. 21° C (69.8° F)

Answer 11

D. 20° C (68° F)

Question 12

All of the following are risk factors for unplanned perioperative hypothermia EXCEPT:
A. Female sex
B. History of organ transplantation
C. Hyperthyroidism
D. Hypotension
E. Trauma

Answer 12

C. Hyperthyroidism

Question 13

When should forced-air warming devices be applied in order to maximize their effectiveness?
A. After final positioning for surgery
B. As soon as a patient temperature outside the normothermic range is observed
C. At least 30 minutes preoperatively
D. When the patient arrives in the OR
E. When the patient starts shivering

Answer 13

C. At least 30 minutes preoperatively

Question 14

Name some factors to take into consideration before determining what anesthetic to use for a particular patient.

Answer 14

Patient preference, surgeon preference, patient’s co-existing diseases, patients mental and psychological status, length and type of surgery, position of patient during surgery

Question 15

List at least five complications that can occur during administration of anesthesia.

Answer 15

Difficult airway, laryngospasm, hypertension, hypotension, bradycardia, tachycardia, arrhythmias, hemorrhage, anaphylaxis, hypothermia, hyperthermia

Question 16

Identify the most commonly used monitoring devices for patients undergoing anesthesia

Answer 16

pulse oximeter, blood pressure, ekg, skin/esophageal temperature, end tidal Co2, nerve stimulation

Question 17

Explain why cricoid pressure may need to be applied and the perioperative RN’s role in its application.

Answer 17

To prevent aspiration or help with visualization of vocal cords & placement of ET tube. RN will apply firm pressure to cricoid cartilage with thumb and index finger to occlude esophagus. May be instructed to apply more or less pressure or more side-side, and will not release pressure until instructed by anesthesia.

Question 18

After spinal anesthesia is administered to a patient, the perioperative nurse should watch for hypotension or hypertension?

Answer 18

hypotension, caused by vasodilation

Question 19

How is hypothermia defined? What are some factors contributing to hypothermia in the operating room?

Answer 19

Hypothermia is a decrease in core body temperature below normothermic range. Normothermic range is 96.8-100.4.
Patients are required to wear thin gowns, OR’s are kept cool, large amounts of skin are often exposed to the air, wet prep solutions applied to the skin, IV and irrigation fluids are usually cooler than body temperature, surgery can last hours, anesthesia can interfere with body’s ability to regulate temperature.

Question 20

What are the main differences between a perioperative nurse and a perianesthesia nurse as far as education and duties?

Answer 20

Perianesthesia nurses are responsible for patient during pre op and post op, normally have ED or critical care experience, have ACLS and/or PALS

Question 21

The PACU is divided into two levels, Phase I and Phase II with different levels of care. Explain the levels of care in Phase 1 and Phase II.

Answer 21

Phase I - all patients who have received general anesthesia

Phase II - fast tracking patients, have received MAC