TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 26-30
Chapter 26: Local Anesthetics
MULTIPLE CHOICE
1. A nurse is teaching a patient who has a second-degree burn on one arm about the use of a
topical anesthetic for pain. Which statement by the patient indicates understanding of the
teaching?
a. “I will apply a thin layer of the medication to a small area of skin.”
b. “I will cover the burn with a dressing after applying the medication.”
c. “I will make sure to apply the medication to the entire burn area.”
d. “I will use the medication only on the most painful, blistered areas.”
ANS: A
Topical anesthetics can be absorbed in sufficient amounts to cause serious and even
life-threatening systemic toxicity, so they should be applied in the smallest amount
needed to as small an area as possible. Covering the site increases the skin’s
temperature, which increases absorption, so this should be avoided. Applying the
medication to a large area increases systemic absorption. Applying the medication to
broken skin increases systemic absorption.
DIF: Cognitive Level: Application REF: Clinical Use of Local Anesthetics |
Topical Administration | Systemic Toxicity TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
2. A nurse is discussing the use of cocaine as a local anesthetic with a nursing student.
Which statement by the student indicates understanding of this agent?
a. “Anesthetic effects develop slowly and persist for several hours.”
b. “Cocaine is a local anesthetic administered by injection.”
c. “Vasoconstrictors should not be used as adjunct agents with this drug.”
d. “When abused, cocaine causes physical dependence.”
ANS: C
Cocaine should not be combined with epinephrine or other vasoconstrictors, because
it causes vasoconstriction itself, and the combination could precipitate severe
hypertension. Cocaine has a rapid onset of effects, which last about 1 hour. It is used
only topically for anesthesia. Although subject to widespread abuse with profound
psychologic dependence, it does not cause substantial physical dependence.
, DIF: Cognitive Level: Analysis REF: Properties of Individual
Local Anesthetics | Cocaine TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
3. A nurse is assisting a physician who is preparing to suture a superficial laceration on a
patient’s leg. The physician asks the nurse to draw up lidocaine with epinephrine. The
nurse understands that epinephrine is used with the lidocaine to:
a. allow more systemic absorption to speed up metabolism of the lidocaine.
b. increase the rate of absorption of the lidocaine.
c. improve perfusion by increasing blood flow to the area.
d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.
ANS: D
Epinephrine causes vasoconstriction, which reduces local blood flow and delays
systemic absorption of lidocaine, which prolongs local anesthetic effects and reduces
the risk of systemic toxicity. Epinephrine slows the rate of absorption. Epinephrine
delays systemic absorption of lidocaine, so metabolism is slowed and the effects are
prolonged in the periphery. Epinephrine does not increase local blood flow.
DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local
Anesthetics | Use with Vasoconstrictors TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
4. A nurse is assisting the physician during a procedure in which a local anesthetic is
administered. Within a few minutes of administration of the anesthetic, the patient has a
pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure
of 90/42 mm Hg. The nurse should monitor the patient for further signs of:
a. heart block.
b. anaphylaxis.
c. central nervous system excitation.
d. respiratory depression.
ANS: A
When absorbed in a sufficient amount, local anesthetics can affect the heart and blood
vessels. These drugs suppress excitability in the myocardium and conduction system
and can cause hypotension, bradycardia, heart block, and potentially cardiac arrest.
Anaphylaxis would be manifested by hypotension, bronchoconstriction, and edema of
the glottis. Central nervous system excitation would be manifested by hyperactivity,
restlessness, and anxiety and may be followed by convulsions. No evidence indicates
respiratory depression; this patient’s respirations are within normal limits.
DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local
Anesthetics | Adverse Effects TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
, Reduction of Risk Potential
5. A nurse is caring for a patient in the immediate postoperative period after surgery in
which a spinal anesthetic was used. The patient has not voided and complains of
headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths
per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is
appropriate?
a. Contact the anesthetist to request an order for ephedrine.
b. Have the patient sit up to relieve the headache pain.
c. Lower the head of the bed to a 10- to 15-degree head-down position.
d. Obtain an order for a urinary catheter for urinary retention.
ANS: C
Spinal anesthetics have several adverse effects, but the most significant is hypotension
caused by the venous dilation that occurs from blockade of sympathetic nerves. The
result is decreased blood return to the heart, which causes reduced cardiac output and
a drop in blood pressure. The first step in treating this is to put the patient in a 10- to
15-degree head-down position to promote venous return to the heart. Ephedrine or
phenylephrine is used if the first measure fails. Spinal headaches are common; the
intervention for this is to have the patient assume a supine position. Urinary retention
can occur secondary to autonomic blockade; it is a concern if the patient has not
voided for 8 hours after the procedure, but not in the immediate postoperative period.
DIF: Cognitive Level: Application REF: Clinical Use of Local Anesthetics |
Spinal (Subarachnoid) Anesthesia TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
6. A patient receives an epidural anesthetic during labor and delivery. The nurse caring for
the newborn in the immediate postpartum period will observe the infant for:
a. bradycardia.
b. hypoglycemia.
c. jitteriness.
d. tachypnea.
ANS: A
Local anesthetics can cross the placenta, causing bradycardia and central nervous
system (CNS) depression in the infant. They do not affect blood glucose. Jitteriness is
a sign of CNS excitation. Increased respirations are not an adverse effect in the
newborn.
DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local
Anesthetics | Use in Labor and Delivery TOP: Nursing Process:
Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
, 7. A nurse is preparing a patient to go home from the emergency department after receiving
sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a
local anesthetic. Which symptom in this patient causes the most concern?
a. Difficulty moving the fingers of the affected hand
b. Inability to feel pressure at the suture site
c. Nervousness and tachycardia
d. Sensation of pain returning to the wound
ANS: C
Absorption of the vasoconstrictor can cause systemic effects, including nervousness
and tachycardia. If severe, alpha- and beta-adrenergic antagonists can be given. Local
anesthetics are nonselective modifiers of neuronal function and also can block motor
neurons, so it is expected that patients may have difficulty with movement. The
sensation of pressure also is affected and is an expected effect. As the local anesthetic
wears off, the sensation of pain will return.
DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local
Anesthetics | Selectivity of Anesthetic Effects | Adverse Effects TOP:
Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. A nurse is assisting a physician who is performing a circumcision on a newborn. The
physician asks the nurse to prepare lidocaine and epinephrine for injection to provide
anesthesia. What will the nurse do?
a. Ask the provider why an injectable anesthetic is being used for this procedure.
b. Draw up the medication as ordered and prepare the infant for the procedure.
c. Make sure that seizure precautions are in place.
d. Question the use of the epinephrine for this procedure.
ANS: D
The physician is preparing to use infiltration anesthesia by injecting the local
anesthetic directly into the immediate area of surgery. Epinephrine can be used in
some cases but should never be used in areas supplied by end arteries, such as the
penis, toes, fingers, nose, or ears, because restriction of blood flow in these areas can
result in gangrene. Injectable agents are appropriate for this procedure. The nurse
should not draw up the medication as requested, because the combination of agents
can harm the patient. Seizure precautions are not necessary.
DIF: Cognitive Level: Application REF: Clinical Use of Local Anesthetics |
Infiltration Anesthesia TOP: Nursing Process: Planning MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
9. A nurse is teaching a group of nursing students about local anesthetics. Which statement
by a student reflects an understanding of the teaching?
a. “Local anesthetics affect large myelinated neurons first.”
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