Deck 4: 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
Somatosensory evoked potential (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/or lower extremities may be monitored.

Question 2

While a sudden drop in the SpO₂ level may result from systemic hypoxia,blood flow to the distal extremity may be inadequate because of:

A) hypothermia.
B) malposition.
C) constriction by blood pressure cuff inflation.
D) All of these options may decrease SpO₂ level.

Answer 2

D
If trouble with the pulse oximeter is encountered when a local anesthetic is being used,the perioperative nurse should evaluate the patient's ventilatory status,verify proper placement of the sensor,and rule out the factors that may adversely affect operation of the unit.Pulsatile blood flow in the extremity may be inadequate because of hypovolemia,decreased cardiac output,malpositioning,constriction by the blood pressure cuff,or hypothermia.

Question 3

Vanessa Cavelle,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.Vanessa'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.

Answer 3

A
During MAC,the anesthesia provider may supplement the local anesthetic with an IV analgesic (e.g.,fentanyl)and with sedative and amnestic drugs (e.g.,midazolam or propofol).The nurse must be clinically competent in the use of monitoring equipment and oxygen-delivery devices,medications used for sedation/analgesia and resuscitation,and airway management.Healthcare professionals with ACLS skills should be readily available to render support if needed in an emergency situation,such as the one Vanessa is encountering with her patient.

Question 4

Vanessa was able to restore the patient's normal respirations and monitored her closely as she emerged from the propofol.The patient stated that her mouth,lips,and tongue were numb and prickly feeling and she had a metallic taste.Vanessa suspected that the patient had _ and responded by ___.

A) Propofol hypovolemia;giving her a fluid challenge of 50 ml of IV saline
B) An allergic reaction to the local anesthetic;administering diphenhydramine
C) A toxic overdose of local anesthetic;monitoring and increasing the flow rate of IV saline
D) A reaction to the propofol;giving her a rescue dose of naloxone

Question 5

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 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 6

Marvin Deloitte,a 19-year-old male,received an intravenous peripheral nerve block (PNB/Bier block)for an ORIF of an ankle fracture.The anesthesia provider injected a distal dorsal vein of Marvin's right foot with 2% lidocaine,after placing a single cuffed pneumatic tourniquet circumferentially around Marvin's 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 the leg elevated and was prepping the 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 inflate,and send the surgeon 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 7

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?

A) Moderate anesthesia care
B) Local infiltration
C) Conscious sedation/analgesia
D) Procedural narcosis

Question 8

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 an untoward reaction or 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 9

Local anesthetic medications,such as lidocaine hydrochloride,have more than one indication for use as an anesthetic.Which three anesthesia modalities use local anesthesia?

A) Plastics,ENT,dental
B) Local,spinal,MAC
C) General,plastics,spinal
D) MAC,ENT,GenET

Question 10

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.

A) Regional anesthesia
B) General endotracheal anesthesia
C) Monitored anesthesia care
D) Local anesthesia

Question 11

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 12

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) Synaptic transmission of nerve impulses in the CNS is inhibited.

Question 13

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.

A) CRNA,anesthesia tech,anesthesia provider
B) CRNA,CNA,anesthesia scheduler
C) Anesthesia tech,anesthesiologist assistant (AA),anesthesia scheduler
D) Anesthesia provider,AA,CRNA

Question 14

Justin,a 4-year-old preschool student,was telling his friend Jacob about his operation.He had a hernia fixed and told Jacob 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 Justin's self-report of his surgery experience,what three types of anesthesia,in the correct order to his story,did Justin receive?

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

Question 15

Rigo Vegas,a 24-year-old tennis coach,was scheduled for an arthroscopy for recurrent knee pain.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 2 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 Rigo's arms as he began to move and gag on the laryngoscope.Rigo vomited undigested stomach contents.His nasopharynx was suctioned and cleared,intubation was achieved,and a nasogastric tube was inserted and connected to suction.Rigo experienced respiratory distress on extubation and was transferred to ICU with acute respiratory distress syndrome.Based on his preanesthetic history,aspiration could have been prevented 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 16

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?

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

Question 17

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) 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 18

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

A) Maintenance and stage 1
B) Induction and stage 1
C) Induction and stage 2
D) Maintenance and stage 3

Question 19

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

A) relieve the anesthesia provider for short periods of time during long procedures with stable patients.
B) anticipate patient and anesthesia provider needs in terms of patient status and potential emergencies.
C) safely use the equipment when they monitor a patient under local anesthesia.
D) anticipate patient and anesthesia provider needs in terms of patient status and potential emergencies,and safely use the equipment when they monitor a patient under local anesthesia.

Question 20

Emma Clements,a frail 92-year-old,was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB).At the end of the procedure,when the circulating nurse and surgeon gently removed her legs from position and placed her in 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) esophageal reflux

Question 21

Two anesthetic gases that are included in the balanced inhalation mix during general anesthesia are:

A) nitrous oxide and air.
B) nitrous oxide and oxygen.
C) air and oxygen.
D) halothane and oxygen.

Question 22

As a member of the surgical team,the perioperative nurse advocates for the surgical patient during the surgical experience.Identify the nursing activities,from the list below,that positively influence patient safety and desired patient outcomes.

A) Assisting the anesthesia provider during patient transfer,anesthesia induction,and emergence
B) Monitoring patient fluid loss and physiologic parameters during the procedure
C) Maintaining vigilance and situational awareness throughout the procedure
D) All of the options plus open communication

Question 23

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

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

Question 24

During a surgical procedure using ketamine as the induction and maintenance agent,the perioperative nurse should:

A) promote a safe,quiet,and low-stimulus environment of care.
B) maintain close proximity to the patient and anesthesia provider in case the patient has hallucinations.
C) have the difficult airway cart in the room in case of respiratory distress.
D) monitor the dosage and amount of ketamine used.

Question 25

Miriam Glass is a 78-year-old female 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 emptied into the patient.Miriam immediately experienced rapid onset of hypotension,bradycardia,and apnea.Miriam's 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;ACLS protocol
D) total spinal anesthesia;general endotracheal anesthesia

Question 26

Ketamine is a short-acting induction and IV or 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 27

Minimizing risk factors and administering antiemetics are important preventive actions against PONV.Antiemetics are designed to interact with the four main neurotransmitters that affect PONV.These four neurotransmitters are:

A) cholinesterase,droperidol,dopamine,sterol.
B) histamine,acetylcholine,serotonin,and dopamine.
C) acetylcholinesterase,histamine,epinephrine,aldosterone.
D) norepinephrine,antihistamine,serotonin,oxytonin.

Question 28

Number the correct sequence of events in a well-managed intraoperative MH crisis.
a.Lavage the stomach,bladder,rectum,and open body cavities as feasible.
b.Give dantrolene sodium (Dantrium) 2.5 mg/kg.
c.Discontinue triggering anesthetic agents.
d.Counsel patient and family about MH.
e.Hyperventilate with 100% O₂ at highest flow rate.
f.If the patient is hyperthermic (>39° C),begin active cooling.
g.Monitor the temperature to avoid hypothermia.Stop cooling at 38° C.
h.Transfer to ICU.
i.Monitor and correct for dysrhythmias,hyperkalemia,metabolic acidosis,and urine output.

Question 29

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) Midazolam,sevoflurane,propofol
C) Desflurane,sevoflurane,halothane
D) Sevoflurane,propofol,desflurane

Question 30

A desired anesthesia experience for a child is an anesthetic agent 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 31

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 32

Postoperative nausea and vomiting (PONV)is often a side effect of the inhalational anesthetic _ and the analgesic ___.

A) nitrous oxide;morphine
B) desflurane;sublimaze
C) halothane;meperidine
D) desflurane;morphine

Question 33

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 34

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?

A) It is a succinylcholine reversal agent.
B) It is a skeletal muscle relaxant.
C) It is a metabolic antagonist.
D) None of the options is correct.

Question 35

Malignant hyperthermia (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 36

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 outcomes.Which of the following impairments can contribute to surgical site infections?

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

Question 37

Which statement best explains the mechanism of action of general anesthetic agents?

A) Inhibition of synaptic transmission of nerve impulses
B) Regional depression of the CNS with resultant narcosis
C) Suppression of myoneural and musculoskeletal junctions
D) Analgesia,amnesia,anesthesia,and systemic hyporeflexus

Question 38

Which inhalational anesthetic agent(s)has the fastest onset of induction,emergence,and recovery?

A) Nitrous oxide
B) Halothane
C) Desflurane
D) Nitrous oxide and halothane

Question 39

During a hypermetabolic MH crisis,the patient will eventually assume a state of metabolic acidosis.What is the desired drug used to reverse this trend?

A) Mannitol
B) Dopamine
C) Sodium bicarbonate
D) Potassium chloride

Question 40

Multiple studies have found that intraoperative awareness (IOA)occurs in 0.1% to 0.2% of patients undergoing general anesthesia.These studies also determined that even under seemingly adequate general anesthesia,implicit memory may be retained along with the ability to process auditory stimuli subconsciously.Based on these studies,it was determined that anesthesia techniques that rely solely on receptor-based drugs are a risk factor for IOA.Which classification of drugs should be avoided for patients at risk for IOA?

A) Nitrous oxide
B) Benzodiazepines
C) Opioids
D) Nitrous oxide,benzodiazepines,and opioids