Chapter 04: Anesthesia

Chapter 04: Anesthesia

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The anesthesia department at Evergreen Medical Center has a total staff of 102 persons. 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.

ANS:  D

In the United States, anesthesia care usually is provided by an anesthesiologist, by a certified registered nurse anesthetist (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:   Page 111

2. The potential for intraoperative awareness (IOA) can exist for patients in all modes of anesthesia. Select the anesthesia modality that presents the least likely opportunity for IOA.

ANS:  B

IOA is expected during regional anesthesia, local anesthesia, and monitored anesthesia care (MAC), as these modalities do not render the patient unconscious and in a deep sleep state with a managed airway. General endotracheal anesthesia is a modality of unconsciousness with an anesthesia-managed airway. Multiple studies have found IOA to occur in 0.1% to 0.2% of patients undergoing general anesthesia. Research suggests that the two most common risk factors are light anesthesia and a history of awareness.

REF:   Pages 113-114

3. At a regional MH testing center Davis Washington is undergoing a muscle biopsy for suspected genetic predisposition to malignant hyperthermia. The anesthesia provider will provide light intravenous (IV) sedation while the surgeon infiltrates the biopsy site with a local anesthetic. This will facilitate Davis’ tolerance of the procedure and minimize his risk for an MH episode. What is the current correct name for this anesthesia modality?

ANS:  B

MAC is infiltration of the surgical site with a local anesthetic and is performed by the surgeon. “Local standby” and “anesthesia standby” are older, less accurate terms frequently used interchangeably with MAC. The anesthesia provider supplements the local anesthetic with IV drugs 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:   Page 118

4. Sherry Ames is an endoscopy nurse in a busy free-standing ambulatory surgery center. She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies, and upper GI endoscopies. This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep. Sherry is competent and legally qualified to provide which modality of anesthesia?

ANS:  C

Moderate sedation/analgesia (conscious sedation/analgesia) 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 registered nurses with additional training in administering conscious sedation/analgesia medications and monitoring these patients) for these functions.

REF:   Page 118

5. The instillation of a local anesthetic into the subarachnoid space is termed:

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.