Alexander's Care of the Patient in Surgery 16 Th Edition By Jane Rothrock - Test Bank

Alexander’s Care of the Patient in Surgery 16 Th Edition By Jane Rothrock – Test Bank

 

Instant Download – Complete Test Bank With Answers

 

 

Sample Questions Are Posted Below

 

Chapter 05: Anesthesia Test Bank

 

MULTIPLE CHOICE

 

1. The anesthesia department at a small medical center has a total staff of 102 These employees serve in many roles as care providers, technical assistants, materials management, clinical engineers, and clerical staff. Select the list of direct-care anesthesia providers.
   1. Certified registered nurse anesthetist (CRNA), anesthesia technician, anesthesia provider
   2. CRNA, certified nurse assistant (CAN), anesthesia scheduler
   3. Anesthesia technician, anesthesiologist assistant (AA), anesthesia scheduler
   4. Anesthesia provider, AA, CRNA

ANS:  D

In the United States, anesthesia care usually is provided by an anesthesiologist, by a CRNA working in collaboration with or under the direction of an anesthesiologist or a physician, or by an anesthesia provider’s assistant (AA) working under the direct supervision of an anesthesia provider.

 

REF:   p. 124

 

2. The potential for intraoperative awareness (IOA) can exist for patients in all modes of Select the anesthesia modality that presents the least likely opportunity for IOA.
   1. Regional anesthesia
   2. General endotracheal anesthesia
   3. Monitored anesthesia care (MAC)
   4. Local anesthesia

ANS:  B

Remaining conscious during anesthesia is a concern of both patients and anesthesia providers. Some patients are so anxious about being aware of anything during surgery that it may affect their reasoning when discussing the options for anesthesia. Many procedures, such as biopsies, inguinal hernias, or procedures on the lower extremities, can be done under regional anesthesia or MAC. These patients may want general anesthesia, however, because they do not want to be aware of anything during the procedure.

 

REF:   p. 125

 

3. At a regional malignant hyperthermia (MH) testing center a 14-year-old male is undergoing a muscle biopsy for suspected genetic predisposition to malignant The anesthesia provider will provide light intravenous (IV) sedation while the surgeon infiltrates the biopsy site with a local anesthetic. This will facilitate the patient’s tolerance of the procedure and minimize his risk for an MH episode. What is the current correct name for this anesthesia modality?
   1. Local with anesthesia standby
   2. MAC
   3. Basal narcosis
   4. Moderate sedation

 

ANS:  B

MAC is infiltration of the surgical site with a local anesthetic and is performed by the surgeon (note that local standby and anesthesia standby are older, less accurate terms frequently used interchangeably with MAC). The anesthesia provider then supplements the local anesthesia with IV medications that provide sedation and systemic analgesia, monitors the patient’s vital functions, and may use additional medication to optimize the patient’s physiologic status.

 

REF:   p. 130

 

4. A 38-year-old endoscopy nurse in a busy free-standing ambulatory surgery center is a registered nurse (RN) with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies, and upper gastrointestinal (GI) This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep. The nurse is competent and legally qualified to provide which modality of anesthesia?
   1. MAC
   2. Local infiltration
   3. Moderate sedation/analgesia
   4. Procedural narcosis

ANS:  C

Moderate sedation/analgesia (conscious sedation) is administered for specific short-term surgical, diagnostic, and therapeutic procedures performed within a hospital or ambulatory center. It is defined as “a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.” No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The demand for this modality in the ambulatory surgical setting has resulted in increased use of non–anesthesia providers (usually professional RNs with additional training in administering conscious sedation/analgesia medications and monitoring these patients) for these functions.

 

REF:   p. 130

 

5. The instillation of a local anesthetic into the subarachnoid space is termed:
   1. spinal
   2. epidural
   3. perfusion
   4. stellate ganglion

ANS:  A

Common regional anesthesia techniques include spinal anesthesia (subarachnoid block [SAB]), epidurals, caudals, and major peripheral nerve blocks. For epidural anesthesia, the local anesthetic usually is injected through the intervertebral spaces in the lumbar region (lumbar epidural), although it also can be injected into the cervical or thoracic regions. For caudal anesthesia, the local anesthetic also is injected into the epidural space, but the approach is through the caudal canal in the sacrum. For peripheral nerve blocks, the anesthetic is injected along the nerve pathway.

 

REF:   p. 1345

 

6. A 4-year-old preschool student was telling his friend about his He had a hernia fixed and told his friend that the nurse put “magic cream on his hand before she stuck the ivy in” and then the doctor “gave him surgery sleep medicine that was like milk in his ivy” and “another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up.” Based on the child’s self-report of his surgery experience, what three types of anesthesia, in the correct order of his story, did he receive?
   1. Local, general, spinal
   2. Local, regional, general
   3. Local, general, caudal
   4. Regional, general, caudal

ANS:  C

Local anesthesia refers to the administration of an anesthetic agent to one part of the body by local infiltration or topical application, usually administered by the surgeon. General anesthesia is a reversible, unconscious state characterized by amnesia (sleep, hypnosis, or basal narcosis), analgesia (freedom from pain), depression of reflexes, muscle relaxation, and homeostasis or specific manipulation of physiologic systems and functions. Common regional anesthesia techniques include spinals (SAB), epidurals, caudals, and major peripheral nerve blocks.

 

REF:   pp. 129, 130, 149

 

7. Local anesthetic medications, such as lidocaine hydrochloride, have more than one indication for use as an Which three anesthesia modalities use local anesthesia?
   1. Plastics; ear, nose, throat (ENT); dental
   2. Local, spinal, MAC
   3. General, plastics, spinal
   4. MAC, ENT, GenET

ANS:  B

Regional anesthesia is defined broadly as a reversible loss of sensation in a specific area or region of the body when a local anesthetic is injected to block or anesthetize nerve fibers in and around the operative site. Local anesthesia refers to the administration of an anesthetic agent to one part of the body by local infiltration or topical application, usually administered by the surgeon. MAC is infiltration of the surgical site with a local anesthetic and is performed by the surgeon (note that local standby and anesthesia standby are older, less accurate terms frequently used interchangeably with MAC).

 

REF:   p. 130

 

8. A 2-year-old scheduled for bilateral myringotomy with tube placement, was calm and giggling as her mother stood by her side stroking her Operating room (OR) policy permitted parents to be present during the initial administration of anesthetic. The anesthesia provider explained her actions and what they would experience as she gently placed the mask over the patient’s nose and mouth and turned on the flow of sevoflurane and oxygen. The child calmly slid into unconsciousness. The anesthesia provider told the mother that the child would soon begin to squirm and possibly thrash around a bit restlessly, but it is a normal effect and the child would soon be in a quiet sleep. What phase of anesthesia is the patient in and what stage is about to occur?
   1. Maintenance and stage 1
   2. Induction and stage 1

 

1. Induction and stage 2
2. Maintenance and stage 3

ANS:  C

Stage 1 is from initial administration (induction) of anesthetic agents to loss of consciousness. Stage 2 is from loss of consciousness to onset of regular breathing and loss of eyelid reflex.

Stage 2 also is called the delirium or excitement stage, and thrashing movements may occur. No auditory or physical stimulation should occur during this stage, especially in children.

Induction begins with administration of anesthetic agents and continues until the patient is ready for positioning or surgical prepping (surgical prep), surgical manipulation, or incision.

 

REF:   pp. 135-136

 

9. The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS). The processes by which they occur are explained by several proposed Which of the options describes a plausible anesthetic mechanism of action?
   1. Inhaled opiates are absorbed by dopamine antagonist receptors in the
   2. Sodium channels trade places with potassium ions in the cerebral cellular
   3. Endorphins undergo biotransformation into protein-soluble
   4. Synaptic transmission of nerve impulses in the CNS is

ANS:  D

Numerous proposed theories explain the action of general anesthetics. Investigations have involved inhalation anesthetics (volatile anesthetic, potent agent, and inhaled or inhalational anesthetic are virtually synonymous with inhalation anesthetic and used interchangeably).

Evidence suggests that synaptic transmission of nerve impulses is reversibly inhibited in several areas of the CNS. The extent of inhibition and consequent progressive depression of function correlate with partial pressure of the inhaled anesthetic at various sites. Inhibition is believed to occur at a lipophilic site on the biologic membrane of synapses and possibly on small, unmyelinated nerve fibers.

 

REF:   p. 135

 

10. A frail 92-year-old was positioned in lithotomy for a 90-minute rectal procedure under At the end of the procedure, when the circulating nurse and surgeon gently removed her legs from the position and placed her in a supine position, she experienced a common side effect of

spinal anesthesia,                          .

1. numbness of both legs and feet
2. paralysis with bilateral popliteal pain
3. hypotensive episode
4. esophageal reflux

ANS:  C

Hypotension may occur rapidly after an SAB. It results from vasodilation because the sympathetic nerves that control vasomotor tone are blocked. Peripheral pooling of blood occurs, resulting in reduced venous return to the heart and decreased cardiac output.

 

REF:   p. 145

 

11. A 24-year-old tennis coach was scheduled for an arthroscopy for recurrent knee This was his first surgical experience, and he was determined to optimize his chances for a successful outcome by complying with all his preoperative orders. He has a family history of anesthesia and surgery complications and did his best to provide a thorough preanesthetic assessment history. He denied any history of allergies, musculoskeletal abnormalities, obstructive sleep apnea, or reflux disease. He admitted to eating a cheese steak and drinking two cans of beer the night before at 11:30 PM, but promised that he finished food and fluid intake before midnight and did not eat or drink anything else. He stated that he felt calm even without preoperative sedation. The induction was smooth. On attempt at intubation, it was evident that total muscle relaxation had not been achieved. The circulating nurse gently restrained his arms as he began to move and gag on the laryngoscope. The patient vomited undigested stomach contents. His nasopharynx was suctioned and cleared, intubation was achieved, and a nasogastric tube was inserted and connected to suction. The patient experienced respiratory distress on extubation and was transferred to the intensive care unit (ICU) with acute respiratory distress syndrome. Based on his preanesthetic history, aspiration could have been prevented by which measure?
    1. The perioperative nurse applying cricoid pressure during induction through intubation
    2. The anesthesia provider inserting a nasogastric tube to suction before induction
    3. Intravenous proton pump inhibitors and an oral antacid being given 1 hour before induction
    4. Intubating with a nasotracheal tube instead of per ora

ANS:  A

The perioperative nurse assists the anesthesia provider in emergent procedures and when a surgical patient is at risk for aspiration (as in cases of a full stomach, intestinal obstruction, hiatal hernia, or significant esophageal reflux). The perioperative nurse must be ready to assist by applying cricoid pressure—exerting downward pressure on the cricoid cartilage with the thumb and index finger of one hand (Sellick maneuver).

 

REF:   p. 152

 

12. A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the:
    1. pulse oximetry device placed on the finger, toe, or ear lobe to measure oxygen
    2. stethoscope to listen to breath sounds in all lung
    3. capnometer/end-tidal CO2monitor to identify expired CO2 in the breathing
    4. postintubation arterial blood gas monitoring with a point-of-care testing

ANS:  C

A capnometer measures CO2 concentration; it produces a capnograph that displays the CO2 waveform. The capnograph provides a continuous display of the CO2 concentration of gases from the airways. CO2 concentration at the end of normal exhalation (ETCO2, PETCO2) is a reflection of gas from the distal alveoli; it therefore represents an estimate of alveolar concentration (PACO2). For patients with normal circulation and pulmonary function, capnography is an excellent method to evaluate alveolar ventilation, because the gradient between arterial and alveolar CO2 pressure is small.

 

REF:   p. 133

 

13. Two monitoring devices that are commonly used to determine ventilatory status are required by some insurance providers as reflective of high-quality care and by anesthesia provider professional organizations as a recommended standard of These two devices are:
    1. pulse oximetry and
    2. oxygen analyzer and low-limit alarm
    3. electrocardiography and
    4. electrocardiography and pulse

ANS:  A

Significant advances continue in perioperative monitoring. Among medical specialties, anesthesiology has been a pioneer in review and analysis of perioperative mishaps and implementation of improved monitoring techniques and guidelines. These monitors include pulse oximetry, which measures oxygen saturation in a pulsating vessel (SpO2), and capnography, which measures end-tidal carbon dioxide (ETCO2) level. These advances have resulted in significant decreases in morbidity and mortality.

 

REF:   p. 130

 

14. Perioperative nurses should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters in order to:
    1. relieve the anesthesia provider for short periods of time during long procedures with stable
    2. be familiar with the setup, operation and leak testing of the anesthesia
    3. safely monitor a patient under
    4. be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia

ANS:  D

As integral members of the patient care team in operative and other invasive procedure settings, perioperative nurses need to be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia provider.

 

REF:   p. 130

 

15. Somatosensory evoked potential (SEP) monitoring assesses neuromuscular transmission pathways during procedures where ischemia may occur because of surgical manipulation, resulting in sensory and motor This surveillance is most often employed in:
    1. lumbar puncture with chemotherapeutic agent
    2. carpal tunnel
    3. posterior spinal
    4. nerve biopsy when a nerve stimulator is

ANS:  C

SEP monitoring may be used during some neurosurgery procedures. It is used widely to assess the integrity of the spinal cord during surgery in which the spinal cord is manipulated. Upper and lower extremities may be monitored.

 

REF:   p. 132

 

16. The pulse oximeter is used during perioperative anesthesia The “pulse ox” reading can be adversely affected by a number of events. Pulsatile blood flow to the distal extremities may be inadequate because of:
    2. increased cardiac

ANS:  D

Pulsatile blood flow in the extremity may be inadequate because of hypovolemia, decreased cardiac output, malpositioning, constriction by the blood pressure cuff, or hypothermia. As a final step the nurse can place the sensor on his or her own finger to verify satisfactory function of the pulse oximetry unit, cable, and sensor.

 

REF:   p. 132

 

17. Whenever regional anesthesia is used, resuscitative equipment and drugs must be immediately available and the patient monitored for any substantial change in vital signs or untoward An example of a risk with regional anesthesia is:
    1. temporary numbness distal to the
    2. temporary loss of motor function distal to the
    3. intravascular injection of the anesthetic
    4. diminished pain along nerve

ANS:  C

Intravenously injected bupivacaine is associated with cardiac arrest. Toxicity from other local anesthetics can cause sudden and profound hypotension, convulsions from effects on the CNS, and tachycardia if the solution contains epinephrine.

 

REF:   p. 147

 

18. A 19-year-old male received an intravenous peripheral nerve block (PNB/Bier block) for an open reduction internal fixation (ORIF) of an ankle The anesthesia provider injected a distal dorsal vein of his right foot with 2% lidocaine, after placing a single cuffed pneumatic tourniquet circumferentially around his upper right thigh. The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR. The circulating nurse had his leg elevated and was prepping his ankle. The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient. The circulating nurse also noticed the movement under the protective towel placed over the cuff, and saw the tourniquet tubing fall to the floor. The nurse’s first response should be to:
    1. alert the anesthesia provider, run for the code cart, and tell the scrub person to wrap the Esmarch bandage around the deflated
    2. alert the anesthesia provider, reconnect the tubing to cuff and Send the surgeon for the code cart.
    3. send the scrub person for the code cart, alert the anesthesia provider to reconnect the tubing and reinflate the cuff, and continue the skin
    4. alert the anesthesia provider, reconnect the tubing and reinflate the cuff, and send the surgeon for a replacement

ANS:  B

 

Although problems can occur from an overdose or toxic reaction to lidocaine, these are rare if the tourniquet has been inflated more than 20 minutes. In this case, however, loss of pneumatic pressure in the tourniquet can cause a toxic reaction and loss of anesthesia.

 

REF:   p. 148

 

19. An experienced CRNA administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal She titrated midazolam and propofol to dull the patient’s level of consciousness. She was alerted by the dropping SpO2 reading and the patient’s loss of chest movement. The patient did not respond to a head tilt–chin lift maneuver. The CRNA’s next response to this event is to:
    1. alert the surgeon and ventilate the patient’s lungs with a self-inflating bag/valve/mask.
    2. increase the O2 to 10 L/min, gently tap the patient’s shoulder, and call the patient’s
    3. begin chest
    4. call for the code cart and difficult airway

ANS:  A

During MAC, vital signs, respiratory and cardiovascular status, and positioning are carefully monitored, and supplemental low-flow O2 often administered. In the described scenario, when the patient did not respond to head tilt-chin lift maneuver, the next response would be to alert the surgeon and to ventilate the patient’s lungs with a bag/valve/mask.

 

REF:   p. 149

 

20. Patient and family education are crucial for successful preanesthesia Which of the following information about regular medications should be provided as part of the preoperative preparation?
    1. Oral hyperglycemic medications should be discontinued 3 days before surgery
    2. Aspirin and aspirin-containing products can be taken until the evening before the
    3. NSAIDs should be discontinued 4 days before
    4. Warfarin should be discontinued 1 week before

ANS:  C

Patients should take any necessary medications, such as antihypertensive, cardiac, seizure, and asthma medications, with minimal sips of water, before they leave their homes to come to the facility. Patients with diabetes should continue taking oral hypoglycemic agents until the evening before surgery. Aspirin and aspirin-containing products should be discontinued 1  week before surgery. NSAIDs should be discontinued 4 days before surgery. If the patient is taking warfarin, it is usually discontinued 3 days before surgery, if appropriate.

 

REF:   p. 127

 

21. A 78-year-old female is scheduled for compression nail insertion of a left fractured She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. The patient immediately experienced rapid onset of hypotension, bradycardia, and apnea. This

 

unintentional condition is called  

                          .

and now must be managed with

 

1. total subarachnoid syndrome; mechanical ventilation
2. hypotensive apnea episode; tracheostomy and humidified positive end-expiratory pressure (PEEP)
3. cardiogenic shock; advanced cardiovascular life support (ACLS) protocol
4. total spinal anesthesia; general endotracheal anesthesia

ANS:  D

Subarachnoid injection occurs if the needle or catheter is unintentionally inserted into the subarachnoid space. If a large volume of local anesthetic is injected as a bolus, it causes “total spinal” anesthesia. This condition is associated with a rapid onset of hypotension caused by vasodilation and profound bradycardia as the sympathetic nerves to the heart are blocked, causing a totally paralyzed patient. Treatment includes intubation, control of ventilation, support of blood pressure and the cardiovascular system, and administration of amnestic medications until the block resolves.

 

REF:   p. 147

 

22. Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?
    1. Thiopental
    2. Desflurane
    3. Diazepam
    4. Diphenhydramine

ANS:  B

Desflurane (Suprane) is an inhalation agent.

 

REF:   p. 134

 

23. Which inhalational anesthetic agents have the fastest onset of induction, emergence, and recovery?
    1. Nitrous oxide and sevoflurane
    2. Isoflurane and cycloflurane
    3. Desflurane and isoflurane
    4. Nitrous oxide and cyclopropane

ANS:  A

Nitrous oxide and sevoflurane promote rapid induction, emergence, and recovery.

 

REF:   p. 137

 

24. Postoperative nausea and vomiting (PONV) is often a side effect of the analgesic

                      .

1. morphine
2. acetaminophen

 

1. chloral hydrate
2. meperithan

ANS:  A

Nausea and vomiting are side effects of morphine.

 

REF:   p. 137

 

25. What is the primary purpose of premedication before anesthesia?
    1. Tranquilize the patient and reduce stomach acidity (pH)
    2. Sedate the patient and reduce anxiety
    3. Elicit desirable amnesia and prevent awareness under anesthesia
    4. Promote rapid induction and airway management

ANS:  B

The primary purpose of premedication before anesthesia is to sedate the patient and reduce anxiety. Medications that may be given preoperatively include sedatives and hypnotics, anxiolytics, amnestics, tranquilizers, narcotics or other analgesics, antiemetics, and anticholinergics.

 

REF:   p. 153

 

26. Which statement best explains the mechanism of action of general anesthetic agents?
    1. Inhibition of synaptic transmission of nerve impulses
    2. Regional depression of the CNS with resultant narcosis
    3. Suppression of myoneural and musculoskeletal junctions
    4. Analgesia, amnesia, anesthesia, and systemic hyporeflexus

ANS:  A

Numerous proposed theories explain the action of general anesthetics. Investigations have involved inhalation anesthetics (volatile anesthetic, potent agent, and inhaled or inhalational anesthetic are virtually synonymous with inhalation anesthetic and used interchangeably).

Evidence suggests that synaptic transmission of nerve impulses is reversibly inhibited in several areas of the CNS.

 

REF:   p. 135

 

27. A desired anesthesia experience for a child is an anesthetic agent that offers a rapid and smooth induction with good relaxation, followed by rapid Which of the listed inhalational agents is the best choice for pediatric anesthesia?
    1. Isoflurane
    2. Nitrous oxide
    3. Sevoflurane
    4. Halogen

ANS:  C

Sevoflurane (Ultane) is used for induction and maintenance. It provides rapid induction and emergence and good relaxation; it is desired for rapid and smooth mask induction in children and adults.

 

REF:   p. 137

 

28. Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?
    1. Succinylcholine
    2. Mivacurium
    3. Pancuronium
    4. Rocuronium

ANS:  A

The standard depolarizing agent is succinylcholine (Anectine), which was introduced in 1952. It has a chemical structure similar to that of acetylcholine (ACh) and depolarizes the postjunctional neuromuscular membrane. Administration is followed by a brief period of muscle fasciculations that corresponds to initial membrane depolarization and muscle fiber activation.

 

REF:   p. 140

 

29. The term balanced anesthesia is described as:
    1. a combination of IV medications and inhalation
    2. nitrous oxide, air, and
    3. Premedication, induction agents, and reversal
    4. Induction agent, muscle relaxation, and

ANS:  A

In the past, the term balanced anesthesia was used when various combinations of IV medications were “balanced” to provide complete anesthesia. Today the term is often used to describe a combination of IV medications and inhalation agents used to obtain specific effects tailored to each patient and procedure.

 

REF:   p. 136

 

30. Many factors have contributed to the evolution and progressive growth of ambulatory Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend.
    1. Propofol, desflurane, sublimaze
    2. Ketamine, sevoflurane, propofol
    3. Desflurane, midazolam, halothane
    4. Sevoflurane, propofol, desflurane

ANS:  D

Goals for anesthesia in an ambulatory setting include minimal physiologic changes secondary to the anesthetic, fast induction, rapid emergence while maintaining patient comfort, intraoperative amnesia and analgesia, suitable operating conditions, minimal perioperative side effects, and minimized postoperative side effects, such as nausea. Use of a laryngeal mask airway (LMA), awareness monitoring, and certain anesthetics (such as propofol, sevoflurane, and desflurane) contribute to attaining these goals.

 

REF:   p. 128

 

31. Multiple studies have found that IOA occurs in a small percentage of patients undergoing general Which high risk populations have more incidence of IOA?
    1. Emergent trauma and obstetric patients

 

1. Pediatric patients
2. Ambulatory surgery patients
3. Elderly patients

ANS:  A

In rare cases, during general anesthesia for emergent procedures or trauma, the patient may be paralyzed, aware of what is occurring but unable to tell anyone. IOA is reported with multiple and differing anesthetic techniques. Several factors may contribute to its occurrence. Overall, 20,000 to 40,000 patients each year experience awareness during general anesthesia. The incidence of awareness may increase to 1% to 1.5% in higher-risk patient populations, such as patients requiring anesthesia for obstetrics, major trauma, and cardiac surgery.

 

REF:   p. 125

 

32. Ketamine is a short-acting induction and IV or intramuscular (IM) maintenance Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concern with this agent is that in large doses it may cause:
    3. respiratory
    4. hallucinations and respiratory

ANS:  D

Ketamine, in large doses, can cause hallucinations and respiratory depression. The patient needs a darkened, quiet room for recovery.

 

REF:   p. 138

 

33. During a surgical procedure using ketamine as the induction and maintenance agent, the perioperative nurse should:
    1. promote a safe, quiet, and low-stimulus environment of
    2. maintain close proximity to the patient and anesthesia provider in case the patient has
    3. have the difficult airway cart in the room in case of respiratory
    4. monitor the dosage and amount of ketamine

ANS:  A

The perioperative nurse should minimize noxious stimuli that might trigger hallucinations or respiratory distress when large doses of ketamine are used.

 

REF:   p. 138

 

34. While hypothermia was historically credited as a therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient Which of the following impairments can contribute to surgical site infections?
    1. Altered drug uptake
    2. Impaired wound healing
    3. Impaired platelet function
    4. Cardiac rhythm disturbances

ANS:  B

 

Vasoconstriction from hypothermia can interfere with skin perfusion and delay wound healing processes. Unintentional hypothermia can cause patient discomfort, untoward cardiac events, adrenergic stimulation, impaired platelet function, altered drug metabolism, delayed emergence from anesthesia, and impaired wound healing.

 

REF:   p. 151

 

35. Pediatric, geriatric, and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for The perioperative nurse should prepare the OR bed before patient arrival by placing:
    1. an infrared warming lamp 18 inches from the OR bed
    2. hot bath blankets over the OR bed surface as the patient transport vehicle enters the
    3. a forced air–warming hose towel clipped under the lifting
    4. a patient-sized forced air–warming blanket on top of the OR bed

ANS:  D

Forced air–warming devices that blow heated air onto the upper or lower body surface are commonly used to keep patients warm and maintain normothermia. These units are effective in maintaining body temperature even during a long abdominal procedure and can be used later in the postanesthesia care unit (PACU). Forced air–warming devices must be used according to manufacturers’ instructions. They must be used with appropriate disposable blanket and should not have the hose inserted under surgical drapes to warm the patient (this directs the heat on the patient, with the risk of a burn, rather than filtering it through the blanket).

 

REF:   p. 151

 

36. MH is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as:
    1. spinal cord
    2. muscular
    3. congenital
    4. muscular dystrophy and congenital

ANS:  D

The incidence of MH increases in patients with central core disease (a congenital myopathy) and some muscular dystrophies.

 

REF:   p. 151

 

37. In the past, MH mortality ranged up to 80%, but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 7%. What is dantrolene’s mechanism of action that reverses the hypermetabolic state and crisis?
    1. It is a succinylcholine reversal
    2. It is a skeletal muscle
    3. It is a metabolic
    4. It has diuretic

ANS:  B

 

Dantrolene is a hydantoin skeletal muscle relaxant that also has effects on vascular and heart muscle.

 

REF:   p. 152

 

38. During a hypermetabolic MH crisis, the patient will require major modalities of In addition to dantrolene what is another priority intervention?
    1. Giving mannitol
    2. Cooling the patient
    3. Reversing the malignancy
    4. Calling the Malignant Hyperthermia Association of the United States (MHAUS)

ANS:  B

In addition to dantrolene, the major modalities of treatment include cooling the patient with ice packs and cold IV solutions, administering diuretics, treating cardiac dysrhythmias, correcting acid–base and electrolyte imbalances, and monitoring fluid intake and output and body temperature.

 

REF:   p. 152

 

39. As a member of the surgical team, the perioperative nurse advocates for the surgical patient during the surgical Which nursing activity would positively influence patient safety and desired patient outcomes?
    1. Assisting the anesthesia provider during anesthesia induction and IV insertion
    2. Monitoring and documenting physiologic parameters on the anesthesia electronic system
    3. Maintaining balanced drug levels of hypnotics, analgesia, and muscle relaxants
    4. Never leaving the operating room (OR)

ANS:  A

Care of the surgical patient is a cooperative effort, and perioperative personnel should function as a smooth, well-coordinated team. A patient should never be left alone in the OR. When an anesthetized patient is in the OR, a perioperative nurse should always be immediately available to provide assistance if needed. During insertion of IV, arterial, central venous, or pulmonary arterial catheters, the nurse assists as required. During induction of anesthesia, particularly with urgent and emergency surgical procedures, the patient presumptively has a “full stomach.” The perioperative nurse should be ready to apply cricoid pressure to prevent regurgitation of stomach contents and to assist the anesthesia provider in visualizing the vocal cords.

 

REF:   p. 152

 

40. A 72-year-old morbidly obese male patient with uncontrolled diabetes is examined by the anesthesia nurse practitioner in the preoperative holding area for physical status and airway assessment prior to His most likely American Society of Anesthesiology (ASA) physical status is:
    1. P1
    2. P2
    3. P3
    4. P4

 

ANS:  C

The ASA defines a P3 status as a patient with a severe systemic disease that limits activity but is not incapacitating. Examples include cardiovascular or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction, angina pectoris, poorly controlled hypertension, or morbid obesity renal failure on dialysis or class 2 congestive heart failure. There is a significant impact on daily activity. These conditions likely have an impact on anesthesia and surgery.

 

REF:   p. 126

 

41. Which inhalation anesthetic gas can cause retinopathy in premature infants?
    1. Oxygen
    2. Sevoflurane
    3. Desflurane
    4. Nitrous oxide

ANS:  A

There are advantages and disadvantages to the use of any anesthetic gas. Although oxygen is essential for life and is commonly administered in supplemental form during surgical procedures, a drawback is the fact that it can cause retinopathy in premature infants.

 

REF:   p. 137