Unit 5: Chapter 27 (Karch 7th Ed) - General and Local Anesthetic Agents

Question 1

1. To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used?
A) Antihistamines
B) Antiemetics
C) Narcotics
D) Sedative-hypnotics

Answer 1

Ans: D
Feedback:
Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation.
Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease
the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic
and sedative effects.

Question 2

2. During what stage of anesthesia would the nurse see the patient’s skeletal muscles relax and return of
regular respirations?
A) Stage 1: Analgesia stage
B) Stage 2: Excitement stage
C) Stage 3: Surgical anesthesia stage
D) Stage 4: Medullary paralysis

Answer 2

Ans: C
Feedback:
Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular
respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be
safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of
excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure
changes); and stage 4 involves deep central nervous system depression with loss of respiratory and
vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.

Question 3

3. The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of care for this patient?
   A) Encourage clear fluids.
   B) Increase oxygen.
   C) Reassure the patient that about safety.
   D) Maintain regular repositioning.

Answer 3

Ans: D
Feedback:
The patient would need to be moved or turned periodically to prevent skin breakdown and the
formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from
the medications used in general anesthesia would prevent the patient from shifting himself or herself to
relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require
respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased
oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not
receive anything by mouth eliminating option A. Reassurance would not be necessary for the
unconscious patient.

Question 4

4. A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which
   diagnoses will the nurse include that is directly related to safety?
   A) Deficient knowledge regarding drug therapy
   B) Disturbed sensory perception (kinesthetic, tactile) related to anesthesia
   C) Risk for impaired skin integrity related to immobility
   D) Risk for injury related to central nervous system (CNS) depressive effects of drugs

Answer 4

Ans: D
Feedback:
The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options
are only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to
express safety concerns and must rely completely on the surgeon and OR staff for protection.

Question 5

5. What nursing interventions would help minimize the risk of a headache in a patient recovering from
   spinal anesthesia?
   A) Administer a triptan intramuscularly.
   B) Administer morphine intravenously.
   C) Maintain patient in recumbent position.
   D) Place patient in Trendelenburg position.

Answer 5

Ans: C
Feedback:
Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours.
Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine
would treat the headache but would not prevent it.

Question 6

6. An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states
   that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also
   complains that his or her head feels fuzzy and that the right words will not come to his or her. What is
   the priority nursing intervention for this patient?
   A) Provide analgesic medication for the discomfort.
   B) Stay with patient as much as possible and provide reassurance.
   C) Provide fluids to increase his or her wakefulness.
   D) Encourage the patient to turn from side to side periodically.

Answer 6

Ans: B
Feedback:
Most patients are disoriented and confused when awaking from anesthesia. It would be most important
for the nurse to be with the patient as much as possible and reassure the patient that everything is as
expected. Providing pain medication is important and may be needed during recovery if the patient
reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide
fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel
motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority
nursing action at this time. However, the most effective nursing action for anxious postoperative
patients is for the nurse to stay with them as much as possible.

Question 7

7. The patient appears awake but is unconscious and has no response to painful stimuli. What medication
   does the nurse suspect this patient has received?
   A) Thiopental (Pentothal)
   B) Midazolam (Generic)
   C) Ketamine (Ketalar)
   D) Propofol (Diprivan)

Answer 7

Ans: C
Feedback:
Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be
awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with
increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is
dangerous. Thiopental is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate
anesthetics. None of these medications have this type of effect.

Question 8

8. Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac
depression?
A) Droperidol (Inapsine)
B) Etomidate (Amidate)
C) Ketamine (Ketalar)
D) Propofol (Diprivan)

Answer 8

Ans: C
Feedback:
If ketamine and halothane are used in combination, severe cardiac depression with hypotension and
bradycardia may occur. Use of droperidol, etomidate, and propofol with halothane should not be a
concern

Question 9

9. The operating room nurse is developing the care plan for a 10-year-old child with asthma who is
   scheduled for a tonsillectomy and who will receive halothane as the anesthetic agent. Why is this an
   appropriate drug for this patient?
   A) Halothane is metabolized in the liver.
   B) Halothane dilates the bronchi.
   C) Halothane is excreted unchanged in the urine.
   D) Halothane causes an accumulation of secretions.

Answer 9

Ans: B
Feedback:
Halothane is of particular benefit to a child with asthma because it dilates bronchi. Halothane is inhaled
drug so it is not metabolized in the liver or excreted in the urine. It does not cause an accumulation of
secretions.

Question 10

10. The nurse should recognize what drug is classified as an amide local anesthetic?
A) Lidocaine (Xylocaine)
B) Benzocaine (Dermoplast)
C) Chloroprocaine (Nesacaine)
D) Tetracaine (Pontocaine)

Answer 10

Ans: A
Feedback:
Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester
anesthetics

Question 11

11. A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After
    the anesthesiologist induces the patient, what is the next phase of anesthesia?
    A) Induction
    B) Maintenance
    C) Recovery
    D) Medullary paralysis

Answer 11

Ans: D
Feedback:
Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached.
After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia
after the patient is in stage 3. This is followed by the recovery period that begins with the
discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option
C is a distracter.

Question 12

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.

Answer 12

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.

Question 13

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.

Answer 13

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.

Question 14

14. The patient received midazolam in combination with an inhaled anesthetic and a narcotic 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

Answer 14

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.

Question 15

15. 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 administered by what method?
    A) Topical Administration
    B) Infiltration
    C) Field block
    D) Nerve block

Answer 15

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.

Question 16

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

Answer 16

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

Question 17

17. The nurse is caring for a patient who will receive an epidural block. What procedure is 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

Answer 17

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.

Question 18

18. The operating room nurse is taking the patient into the operating room when the patient 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

Answer 18

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.

Question 19

19. 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 apply.)
    A) Malignant hypothermia
    B) Pain
    C) Blurred vision
    D) Peripheral vasodilation
    E) Nausea

Answer 19

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.

Question 20

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

Answer 20

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

Question 21

21. The patient receives lidocaine as a local anesthetic before insertion of a chest tube. After the procedure
    the patient tells the nurse, The area is still numb. How long will this last? What is the nurse’s best
    response?
    A) 15 minutes
    B) 1 hour
    C) 2 hours
    D) 4 hours

Answer 21

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.

Question 22

22. The pharmacology instructor is explaining balanced anesthesia to the students. What agents would the
    instructor say are involved in balanced anesthesia? (Select all that apply.)
    A) Neuromuscular junction blockers
    B) Narcotics
    C) Anticholinergics
    D)Salicylates
    E) Nonsteriodal anti-inflammatory drugs (NSAIDs)

Answer 22

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 antiinflammatory
drugs

Question 23

23. 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 halothane’s recovery syndrome?
    A) 1 week
    B) 2 weeks
    C) 3 weeks
    D) 4 weeks

Answer 23

Ans: C
Feedback:
Halothane’s recovery syndrome is characterized by fever, anorexia, nausea, vomiting, and eventual
hepatitis, which can progress to fatal hepatic necrosis. Although this syndrome is rare, halothane is not
used more frequently than every 3 weeks to reduce patient risk. Other options are incorrect.

Question 24

24. A 54-year-old patient with chronic obstructive pulmonary disease is admitted for emergency surgery.
    What anesthetic agent would be dangerous to use on this patient?
    A) Enflurane
    B) Desflurane
    C) Sevoflurane
    D) Isoflurane

Answer 24

Ans: B
Feedback:
Desflurane is associated with a collection of respiratory reactions, including cough, increased
secretions, and laryngospasm. The other options have far fewer respiratory adverse effects and would
be safer for use in this patient

Question 25

25. The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an elective
    inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse’s initial
    priority nursing assessment?
    A) Assess the patient’s anxiety.
    B) Start an IV.
    C) Show the family the waiting area.
    D) Weigh the patient.

Answer 25

Ans: D
Feedback:
Weighing the patient is an initial priority because his or her weight will be used to determine
appropriate dosing of all medications and will establish a baseline used for evaluation of any potential
adverse effects. Other options are all actions the nurse will need to perform, but none are of higher
priority than weighing the patient.

Question 26

26. A very anxious patient asks the nurse what type of anesthesia they will have for a scheduled tooth
    extraction. The nurse would describe what type of local anesthetic in laymen’s terms?
    A) Topical
    B) Infiltration
    C) Field block
    D) Nerve block

Answer 26

Ans: C
Feedback:
Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by
the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent
comes in contact with all of the nerve endings surrounding the area. This type of block is often used for
tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block
pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery.

Question 27

27. The nurse receives a patient into the postanaesthesia care unit who has had surgery using the anesthetic
    agent methohexital. The nurse anticipates the patient’s need for what in the postoperative period?
    A) Assistance in maintaining respirations
    B) Assistance in moving lower extremities
    C) Positioning in Semi-Fowler’s position
    D) Analgesia to control the patient’s pain

Answer 27

Ans: D
Feedback:
Methohexital lacks analgesic properties so the patient may require postoperative analgesics to control
pain. The patient who has surgery under methohexital does not generally require assistance in
maintaining respirations or assistance in moving their lower extremities. They also do not generally
require positioning in a semi-Fowler’s position.

Question 28

28. The emergency room nurse is teaching a class for newly hired graduate nurses on the different types of
local anesthetic agents. How would the nurse differentiate lidocaine and procaine as a local anesthetic
agent?
A) Lidocaine is an amide that is broken down slowly and this can lead to toxicity.
B) Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism.
C) Procaine is an amide that is broken down immediately in the tissues.
D) Procaine is metabolized by the liver with risk of toxicity and is classified as an ester.

Answer 28

Ans: A
Feedback:
The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma
esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide and procaine is an ester.

Question 29

29. A nursing student in a pharmacology class asks the instructor why nitrous oxide is used for dental
    surgery. What is the instructor’s most accurate response?
    A) Nitrous oxide stays in the body for a long time.
    B) Nitrous oxide does not cause pressure in body compartments.
    C) Nitrous oxide does not cause muscle relaxation.
    D) Nitrous oxide does not need to be administered with oxygen.

Answer 29

Ans: C
Feedback:
Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause
muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery
after dental work is quick. Nitrous oxide does need to be given in combination with oxygen to avoid
hypoxia in the patient.

Question 30

30. The nurse is admitting a patient to the postanesthesia care unit (PACU) who received halothane and
    ketamine as anesthesia. What is the nurse’s priority assessment?
    A) Blood pressure and pulse
    B) Respirations and airway
    C) Pain and respirations
    D) Temperature and airway

Answer 30

Ans: A
Feedback:
If halothane and ketamine are used in combination, severe cardiac depression with hypotension and
bradycardia may occur. If these agents must be used together, the patient should be monitored closely.
Pain, respirations, airway, and temperature are all assessments the nurse will collect on any patient in
the PACU, but they are not priority assessments associated with combining ketamine and halothane

Question 31

31. The nurse is assisting while the physician is suturing a wound in the urgent care clinic. The physician
    asks for lidocaine with epinephrine. The nurse identifies the primary reason for adding epinephrine to
    the lidocaine is what effect?
    A) It will sting more when it is injected into the tissue.
    B) Risk of systemic absorption is increased.
    C) Local effect is increased.
    D) Bleeding at the wound site is increased

Answer 31

Ans: C
Feedback:
There is less risk of systemic absorption and increased local effects if these drugs are combined with
epinephrine. Epinephrine causes vasoconstriction, which reduces bleeding, slows absorption, and
makes the duration of effect longer. It does sting more when injected, but that is not a reason to use it.

Question 32

32. The nurse is caring for a patient scheduled for surgery who is to receive a barbiturate as part of the
    planned balanced anesthesia. What drugs, if taken by the patient, could result in a clinically important
    drug drug interaction with the barbiturate? (Select all that apply.)
    A) Thyroid hormone
    B) Ibuprofen
    C) Oral contraceptive
    D) Theophylline
    E) Anticoagulant

Answer 32

Ans: C, D, E
Feedback:
Caution must be used when these drugs are used with any other central nervous system suppressants.
Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants, beta-blockers,
corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and
carbamazepine. Combinations of barbiturate anesthetics and narcotics may produce apnea more
commonly than occurs with other analgesics. Thyroid hormone and ibuprofen have no known drug
interactions with barbiturates.

Question 33

33. The nurse is caring for a patient experiencing malignant hyperthermia. What medication will be
administered to treat this condition?
A) Midazolam
B) Dantrolene
C) Halothane
D) Thiopental

Answer 33

Ans: B
Feedback:
Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily
available whenever anesthetics are used that could trigger the syndrome. Midazolam and thiopental are
barbiturates whereas halothane is a volatile gas that can trigger malignant hyperthermia

Question 34

34. The nurse is caring for a patient who will undergo cardioversion in the patient’s room this morning.
    The patient will receive propofol as anesthetic during the procedure. What are the benefits of using
    propofol for this procedure? (Select all that apply.)
    A) It has a very rapid clearance.
    B) It produces less of a hangover effect.
    C) It allows for quick recovery from anesthesia.
    D) Its onset of action is 5 minutes.
    E) It is painless to inject IV.

Answer 34

Ans: A, B, C
Feedback:
Propofol often is used for short procedures because it has a very rapid clearance and produces much
less of a hangover effect and allows for quick recovery. It is a very short-acting anesthetic with a rapid
onset of action of 30 to 60 seconds. Propofol often causes local burning on injection.

Question 35

35. The nurse applies a topical anesthetic to reduce sensation at the site while starting an IV. What age
    group is at greatest risk for systemic absorption of the topical anesthetic?
    A) Older adult
    B) Infant
    C) Toddler
    D) Adolescent

Answer 35

Ans: B
Feedback:
When topically applying a local anesthetic, it is important to remember that there is greater risk of
systemic absorption and toxicity with infants. Therefore, the other options are incorrect