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GNURS630/Advanced Physical Assessement > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Following NPO guidelines assures gastric emptying has occurred?

A

False

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2
Q

Medication can be taken PO with up to 150 cc of water in the hour preceding anestheia induction?

A

True

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3
Q

Demerol will cause a hypertensive crisis if patient is on a MAO-I?

A

True

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4
Q

What medication is contraindicated in Acute intermittent porphyria?

A

-All barbiturates

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5
Q

Anesthesia procedures may proceed without consent in emergency situations?

A

True - this is called “Implied Consent”

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6
Q

A medico-legal document in permanent hospital record should contain?

A
  • Date and time of interview
  • Planned procedure
  • Description of extraordinary circumstances
  • Allergies, medication , Labs
  • Disease processes/treatments
  • ASA status
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7
Q

What is the standards for Nurse anesthesia Practice Standard 2?

A

Informed consent

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8
Q

What is the standards for nurse anesthesia practice standard 3?

A

Formulate a patient specific plan for anesthesia care

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9
Q

What pre-anesthesia machine checks should be standard before administering anesthetics? SOAP-M

A 
S-suction
O-oxygen
A-airway
P-positive pressure ventilation/laryngoscope
M-monitors/medication
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10
Q

What are the three anesthetic options?

A
  • General Anesthesia
  • Regional Anesthesia
  • Monitored Anesthesia Care (MAC)
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11
Q

What are the 3 types of general anesthesia?

A
  • inhalation
  • intravenous (TIVA)
  • Combination
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12
Q

What are some sites for regional anesthesia?

A
  • Spinal/subarachnoid Block(SAB)/Intrathecal
  • Epidural
  • Blocks (Upper and lower extremities)
  • –> Bier, Axillary
  • –> Femoral Nerve, Ankle
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13
Q

What are the types of monitored anesthesia care (MAC)?

A
  • Conscious sedation

- Deep sedation

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14
Q

What are the pre-op medication goals?

A 
A-anxienty relief
S-sedation
A-analgesia
A-Amnesia
A-antisialagogue (control secretions)
A-attenuate sympathetic nervous system response
D-decrease anesthetic requirements
P-prevent bronchospasm
P-prophylaxis against allergy
D-decrease PONV
I-increase gastric fluid pH (Bicitra)
D-decrease gastric fluid volume
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15
Q

GABA is the principle inhibitory neurotransmitter in the CNS?

A

True

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16
Q

How do benzodiazepines work on the receptor?

A

Enhance the affinity of the receptors for GABA

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17
Q

If you do surgery on someone without a signed consent, what could you be charged with? (Informed Consent in Anesth p 2)

A

Battery

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18
Q

With informed consent, are you required to inform the patient of every concievable risk of anesthesia? (Informed Consent in Anesth p 4)

A

No, that’s impossible. You should give them the most likely scenarios that could happen.

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19
Q

With informed consent, if a pt asks what their chances of a bad outcome due to anesthesia could be, what could you tell them? (Informed consent in Anesth p 5)

A

Recent studies show anesthesia related mortality rates are around 1:185,000 - 280,000

20
Q

What should an informed consent for anesthesia contain (6 items) (Informed consent in Anesth p 2)

A
  1. Diagnosis
  2. Nature and purpose of treatment
  3. Risks and consequences of procedure
  4. Probability of success
  5. Alternative treatment
  6. Prognosis if treatment is not given
21
Q

Will alcoholics require more or less anesthetic?

A

May require MORE anesthetics since they may have a tolerance built up to them. Although during Acute intoxication, pts may require less sedatives/analgesics

22
Q

For persons taking beta blockers, which pressor might be better for them during surgery, Ephedrine or Norepi?

A

Ephedrine - because it will affect both HR and BP. Norepi will decrease HR while increasing BP

23
Q

When planning an epidural or spinal, is it OK for the pt to recieve Heparin prior to the procedure?

A

NO. In fact, coags (PT, PTT, INR) should be reviewed prior to a spinal or epidural.

24
Q

If someone is allergic to eggs, which anesthetic induction agent should you avoid?

A

Propofol

25
Q

If someone is allergic to lotions and cosmetics, which anesthesia induction drug should you avoid?

A

Rocuronium

26
Q

If someone has a reported allergy to anesthesia, which are the more likely suspects?

A

Inhalents and Succ

27
Q

What is the medication used for Malignant Hypertension?

A

Dantroline

28
Q

What people are at increased risk of Malignant Hypertension?

A

persons with neuromuscular problems or a family history of Malignant Hypertension

29
Q

What should ALL women of childbearing age have done before a procedure?

A

Urine HCG - anesthetic agents can affect uterine blood flow and can be teratogenic

30
Q

If a pt has skin breaking on their back where you were going to be placing an epidural, what should you do?

A

Don’t perform the epidural. You should not do any blocks or spinal procedures through skin breakdown or cellulitis

31
Q

Is a Hgb/Hct required on all presurgical patients?

A

No. If they are healthy, they don’t require a current H&H and can get to a Hgb of 7 before they need transfusion.

32
Q

What patients should not be allowed to have a lower hgb or hct during surgery?

A

Pt with a history of CAD

33
Q

What 3 surgeries have the highest incidence of postoperative awareness?

A
  • Trauma
  • Open Heart Surgery
  • Emergency C-Section
34
Q

What is the structure of Midazolam that gives it stability in an aqueous solution and rapid metablolism?

A

The imidazole ring

35
Q

How long does it take for Midazolam to take effect?

A

0.9 - 5.6 minutes, give time for dose to take effect before you redose

36
Q

Midazolam is metabolized by CYP450 enzyme. What other common drugs are also metabolized there and what is the result of giving midazolam with these drugs?

A

Other drugs: Cimetidine, Erythromycin, Cal Channel Blockers, Antifungal drugs.

Giving together could result in unexpected CNS depression

37
Q

What is the IV and IM doses of Midazolam? Onset? Peak? Duration?

A

Dosing - IV: 1-5mg
- IM: 2.5-5mg

Onset: 30-60 sec

Peak: 3-5 min

Duration: 15-80 min

38
Q

Opiods:
Morphine dose
Fentanyl dose

A

Morphine 5-15mg IV

Fentanyl 25-100mcg IV

39
Q

Antihistamines: Benadryl dosage

A

12.5 - 25mg PO or IV

40
Q

Alpha 2 agonists: Clonidine dosage

A

0.1-0.3 mg PO or patch

41
Q

Antiemetics dosage:
Droperidol
Dolasetron
Ondansetron

A

Droperidol 1.25mg IV
Dolasetron 12.5mg IV
Ondansetron 4mg IV

42
Q

Anticholinergics dosage:
Glycopyrolate (Robinul)
Atropine

A

Glycopyrolate 0.1mg IV

Atropine 0.3-0.6mg IV

43
Q

H2 antagonists dosage:
Cimetidine
Ranitidine
Famotidine

A

Cimetidine 200-300mg PO
Ranitidine 100mg PO
Famotidine 20-40mg PO

44
Q

Proton Pump Inhibitors dose:
Omeprazole
Pantoprazole

A

Omeprazole (Prilosec) 20mg PO

Pantoprazole (Protonix) 40mg IV

45
Q

GI Stimulants dose:

Metoclopramide (Reglan)

A

Reglan 10mg PO or IV

46
Q

Not getting an informed consent before surgery would be an example of what?

A

Breach of Duty

47
Q

What are Mendelson’s Criteria (3 items) for severity of aspiration?

A

> 25 ml
pH < 2.5
Particulate vs clear

GNURS630/Advanced Physical Assessement (9 decks)

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