Test Bank Pharmacology and the Nursing Process 10th Edition chapter11

Test Bank Pharmacology and the Nursing Process 10th Edition
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Chapter 11: General and Local Anesthetics
Lilley: Pharmacology and the Nursing Process, 10th Edition
MULTIPLE CHOICE
1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the
emergency department to have it removed. The nurse anticipates that which type of anesthesia
will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine/lidocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine
ANS: D
Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting
the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of
nerves supplying the area to be anesthetized. The local anesthetic may be administered in a
circular pattern around the operative field. The other types are not appropriate for this injury.
This is a painful procedure; therefore, the option of ―no anesthesia‖ is incorrect.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. While monitoring a patient who had surgery under general anesthesia 1 hour ago, the nurse
notes a sudden elevation in body temperature. This finding may be an indication of which
problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia
ANS: D
A sudden elevation in body temperature during the postoperative period may indicate the
occurrence of malignant hyperthermia, a life-threatening emergency. The elevated
temperature does not reflect the other problems listed.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
3. When assessing patients in the preoperative area, the nurse knows that which patient is at a
higher risk for an altered response to anesthesia?
a. The 18-year-old patient who has never had surgery before
b. The 32-year-old patient who stopped smoking 8 years ago
c. The 44-year-old patient who is to have a kidney stone removed
d. The 82-year-old patient who is to have gallbladder removal
ANS: D
The elderly patient is more affected by anesthesia than the young or middle-aged adult patient
Test Bank Pharmacology and the Nursing Process 10th Edition
because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
4. The nurse is caring for a patient who is on a ventilator for respiratory arrest. Which parenteral
anesthetic is also used for sedation during mechanical ventilation in ICU settings?
a. Ketamine
b. Midazolam
c. Propofol
d. Sevoflurane
ANS: C
Propofol is parenteral general anesthetic used for the induction and maintenance of general
anesthesia and also for sedation during mechanical ventilation in intensive care unit (ICU)
settings. Ketamine is used for both general anesthesia and moderate sedation. Midazolam is a
short-acting benzodiazepine used for moderate sedation; sevoflurane is an inhaled anesthetic.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When administering a neuromuscular blocking drug, the nurse needs to remember which
principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
ANS: D
Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation
because of the resultant paralysis of the respiratory muscles. In addition, they do not cause
sedation or pain relief. They are used along with, not instead of, general anesthesia during
surgery.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that
he will be awake during the procedure but probably will not remember it. What type of
anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia
ANS: B
Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the
medical procedure, yet it preserves a patient‘s ability to maintain his or her own airway and
respond to verbal commands. The other options are incorrect.
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Test Bank Pharmacology and the Nursing Process 10th Edition
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DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a
patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle
rigidity, and his temperature is 103°F (39.4°C). The nurse will prepare for what immediate
treatment?
a. Naltrexone hydrochloride injection
b. Dantrolene injection
c. Neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation
ANS: B
Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant
hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize
heart and lung function as well as with immediate treatment with the skeletal muscle relaxant
dantrolene. CPR is not immediately needed because the patient still has a pulse and
respirations. Naltrexone hydrochloride and anticholinesterase drugs are not appropriate in this
situation.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. The nurse is preparing to administer dexmedetomidine to a patient. Which is an appropriate
indication for dexmedetomidine? (Select all that apply.)
a. Procedural sedation
b. Surgeries of short duration
c. Surgeries of long duration
d. Postoperative anxiety
e. Sedation of mechanically ventilated patients
ANS: A, B, E
Dexmedetomidine is used for procedural sedation and for surgeries of short duration, and it is
also used in the intensive care setting for sedation of mechanically ventilated patients. The
other options are incorrect.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is reviewing the effects of inhaled and intravenous general anesthesia, which
includes which of these? (Select all that apply.)
a. Increased intracranial pressure
b. Increased glomerular filtration
c. CNS depression
d. Hypotension
e. Decreased hepatic clearance
Test Bank Pharmacology and the Nursing Process 10th Edition
ANS: A, C, D, E
Effects of inhaled and intravenous general anesthesia include increased intracranial pressure,
CNS depression, hypotension, decreased hepatic clearance, and other effects listed in Table
11-4. Glomerular filtration is decreased, not increased.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
COMPLETION
1. A patient is to receive midazolam 2 mg IV push over 2 minutes just before an endoscopy
procedure. The medication is available in a strength of 1 mg/mL. Identify how many
milliliters of medication will the nurse draw up into the syringe for this dose.
ANS:
2 mL
1 mg:1 mL::2 mg:x mL (1  x) = (1  2); 1x = 2; x = 2.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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