Deck 5: Anesthesia

Question 1

Somatosensory evoked potential (SEP)monitoring assesses neuromuscular transmission pathways during procedures where ischemia may occur because of surgical manipulation,resulting in sensory and motor function.This surveillance is most often employed in:

A) lumbar puncture with chemotherapeutic agent injection.
B) carpal tunnel release.
C) posterior spinal fusion.
D) nerve biopsy when a nerve stimulator is used.

Answer 1

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.

Question 2

A 78-year-old female is scheduled for compression nail insertion of a left fractured hip.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 administered to the patient.The patient immediately experienced rapid onset of hypotension,bradycardia,and apnea.This unintentional condition is called ______________ and now must be managed with _____________.

A) total subarachnoid syndrome; mechanical ventilation
B) hypotensive apnea episode; tracheostomy and humidified positive end-expiratory pressure (PEEP)
C) cardiogenic shock; advanced cardiovascular life support (ACLS) protocol
D) total spinal anesthesia; general endotracheal anesthesia

Answer 2

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.

Question 3

A registered nurse working in a busy free-standing ambulatory surgery center has additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies,bronchoscopies,and upper gastrointestinal (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.The nurse is competent and legally qualified to provide which modality of anesthesia?

A) Monitored anesthesia care (MAC)
B) Local infiltration
C) Moderate sedation/analgesia
D) Procedural narcosis

Answer 3

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.

Question 4

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:

A) pulse oximetry device placed on the finger, toe, or ear lobe to measure oxygen saturation.
B) precordial stethoscope to listen to breath sounds in all lung fields.
C) capnometer/end-tidal CO₂ monitor to identify expired CO₂ in the breathing circuit.
D) postintubation arterial blood gas monitoring with a point-of-care testing device.

Question 5

A 4-year-old preschool student was telling his friend about his operation.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?

A) Local, general, spinal
B) Local, regional, general
C) Local, general, caudal
D) Regional, general, caudal

Question 6

Perioperative nurses should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters to:

A) relieve the anesthesia provider for short periods of time during long procedures with stable patients.
B) be familiar with the setup, operation, and leak testing of the anesthesia machine.
C) safely monitor a patient under MAC.
D) be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia provider.

Question 7

A frail 92-year-old was positioned in lithotomy for a 90-minute rectal procedure under SAB.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,____________.

A) numbness of both legs and feet
B) paralysis with bilateral popliteal pain
C) hypotensive episode
D) hypertensive episode

Question 8

An experienced CRNA administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal incision.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:

A) alert the surgeon and ventilate the patient's lungs with a self-inflating bag-valve-mask.
B) increase the O₂ to 10 L/min, gently tap the patient's shoulder, and call the patient's name.
C) begin chest compressions.
D) call for the code cart and difficult airway cart.

Question 9

At a regional malignant hyperthermia (MH)testing center,a 14-year-old male 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 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?

A) Local with anesthesia standby
B) Monitored anesthesia care (MAC)
C) Basal narcosis
D) Moderate sedation

Question 10

Patient and family education are crucial for successful preanesthesia preparation.Which of the following information about regular medications should be provided as part of the preoperative preparation?

A) Oral hyperglycemic medications should be discontinued 3 days before surgery
B) Aspirin and aspirin-containing products can be taken until the evening before the surgery.
C) NSAIDs should be discontinued 4 days before surgery.
D) Warfarin should be discontinued 1 week before surgery.

Question 11

Two monitoring devices that are commonly used to determine ventilatory status are recommended by anesthesia provider professional organizations as a standard of care.These two devices are:

A) pulse oximetry and capnography.
B) oxygen analyzer and low-limit alarm system.
C) electrocardiography and capnography.
D) electrocardiography and pulse oximetry.

Question 12

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 reactions.An example of a risk with regional anesthesia is:

A) temporary numbness distal to the injection.
B) temporary loss of motor function distal to the injection.
C) intravascular injection of the anesthetic agent.
D) diminished pain along nerve pathways.

Question 13

A 24-year-old tennis coach was scheduled for an arthroscopy for recurrent knee pain.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.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,the incidence of aspiration could have been reduced by which measure?

A) The perioperative nurse applying cricoid pressure during induction through intubation
B) The anesthesia provider inserting a nasogastric tube to suction before induction
C) Intravenous proton pump inhibitors and an oral antacid being given 1 hour before induction
D) Intubating with a nasotracheal tube instead of per ora

Question 14

Which inhalational anesthetic agents have the fastest onset of induction,emergence,and recovery?

A) Nitrous oxide and sevoflurane
B) Isoflurane and cycloflurane
C) Desflurane and isoflurane
D) Nitrous oxide and cyclopropane

Question 15

The pulse oximeter is used during perioperative anesthesia monitoring.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:

A) hyperthermia.
B) increased cardiac output.
C) hypervolemia.
D) malpositioning.

Question 16

The anesthesia department at a small medical center has a total staff of 102 people.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.

A) Certified registered nurse anesthetist (CRNA), anesthesia technician, anesthesia provider
B) CRNA, surgical technician, first assistant
C) Anesthesia technician, anesthesiologist assistant (AA), anesthesia scheduler
D) Anesthesia provider, AA, CRNA

Question 17

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 theories.Which of the options describes a plausible anesthetic mechanism of action?

A) Inhaled opiates are absorbed by dopamine antagonist receptors in the CNS.
B) Sodium channels trade places with potassium ions in the cerebral cellular cytoplasm.
C) Endorphins undergo biotransformation into protein-soluble compounds.
D) Signaling proteins are the relevant molecular targets of anesthetic action.

Question 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 fracture.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:

A) alert the anesthesia provider, run for the code cart, and tell the scrub person to wrap the Esmarch bandage around the deflated cuff.
B) alert the anesthesia provider, reconnect the tubing to cuff and reinflate, and send for the code cart.
C) send the scrub person for the code cart, alert the anesthesia provider to reconnect the tubing and reinflate the cuff, and continue the skin prep.
D) alert the anesthesia provider, reconnect the tubing and reinflate the cuff, and send the surgeon for a replacement cuff.

Question 19

Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?

A) Thiopental
B) Desflurane
C) Diazepam
D) Diphenhydramine

Question 20

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

A) spinal anesthesia.
B) epidural anesthesia.
C) perfusion block.
D) stellate ganglion block.

Question 21

While hypothermia was historically credited as a therapeutic modality benefitting all surgery patients because it decreases metabolism and reduces oxygen demand,inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes.Which of the following impairments related to hypothermia can contribute to surgical site infections?

A) Altered drug uptake
B) Impaired wound healing
C) Impaired platelet function
D) Cardiac rhythm disturbances

Question 22

Pediatric,geriatric,and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia.The perioperative nurse should prepare the OR bed before patient arrival by placing:

A) an infrared warming lamp 18 inches from the OR bed surface.
B) hot bath blankets over the OR bed surface as the patient transport vehicle enters the room.
C) a forced air-warming hose towel clipped under the lifting sheet.
D) a patient-sized forced air-warming blanket on top of the OR bed surface.

Question 23

Ketamine is a short-acting induction and IV or intramuscular (IM)maintenance agent.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:

A) hallucinations.
B) thrombocytopenia.
C) respiratory depression.
D) hallucinations and respiratory depression.

Question 24

The ideal agent for pediatric anesthesia is one that offers a rapid and smooth induction with good relaxation,followed by rapid emergence.Which of the listed inhalational agents is the best choice for pediatric anesthesia?

A) Isoflurane
B) Nitrous oxide
C) Sevoflurane
D) Halogen

Question 25

Anesthetic gases decrease the patient's heart rate depending on the concentration of the agent being used,and each of the anesthetic gases cause vasodilation which decreases the patient's blood pressure.Interventions that perioperative nurses can provide to help ensure a safe anesthetic experience include:

A) positioning areas directly related to respiration (e.g., chest, diaphragm) with firm pressure.
B) monitoring and documenting physiologic parameters on the anesthesia electronic system.
C) maintaining balanced drug levels of hypnotics, analgesia, and muscle relaxants.
D) positioning patients slowly to assess impact on circulation.

Question 26

MH is a rare,multifaceted syndrome with an increased incidence in individuals with central core diseases such as:

A) spinal cord injury.
B) muscular dystrophy.
C) congenital myopathies.
D) muscular dystrophy and congenital myopathies.

Question 27

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 5%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

A) It is a succinylcholine reversal agent.
B) It is a skeletal muscle relaxant.
C) It is a metabolic antagonist.
D) It has diuretic properties.

Question 28

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

A) morphine
B) ketamine
C) ketorolac
D) esmolol

Question 29

Multiple studies have found that intraoperative awareness (IOA)occurs in a small percentage of patients undergoing general anesthesia.Which high risk populations have more incidence of IOA?

A) Emergent trauma and obstetric patients
B) Pediatric patients
C) Ambulatory surgery patients
D) Elderly patients

Question 30

Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?

A) Succinylcholine
B) Mivacurium
C) Pancuronium
D) Rocuronium

Question 31

Which inhalation anesthetic gas can cause retinopathy in premature infants?

A) Oxygen
B) Sevoflurane
C) Desflurane
D) Nitrous oxide

Question 32

What is the primary purpose of premedication before anesthesia?

A) Tranquilize the patient and reduce stomach acidity (pH).
B) Sedate the patient and reduce anxiety.
C) Elicit desirable amnesia and prevent awareness under anesthesia.
D) Promote rapid induction and airway management.

Question 33

The term balanced anesthesia is described as:

A) a combination of IV medications and inhalation agents.
B) nitrous oxide, air, and oxygen.
C) premedication, induction agents, and reversal agents.
D) induction agent, muscle relaxation, and analgesics.

Question 34

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 surgery.His most likely American Society of Anesthesiology (ASA)physical status is:

A) P1.
B) P2.
C) P3.
D) P4.

Question 35

Many factors have contributed to the evolution and progressive growth of ambulatory surgery.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.

A) Propofol, desflurane, sublimaze
B) Ketamine, sevoflurane, propofol
C) Desflurane, midazolam, halothane
D) Sevoflurane, propofol, desflurane

Question 36

During a hypermetabolic MH crisis,the patient will require major modalities of treatment.In addition to dantrolene what is another priority intervention?

A) Giving mannitol
B) Cooling the patient
C) Reversing the malignancy
D) Continuing succinylcholine