NUR 141 Test 2 - Answered with Rationales (Complete Solutions)

NUR 141 Test 2 - Answered with Rationales (Complete Solutions) The nurse is providing education to a client who has been scheduled to receive spinal anesthesia. What anatomical location will the nurse identify as the site of administration? A) Mucous membrane B) Epidural space C) Nerve ganglion D) Lumbar region Rationale: Spinal anesthesia involves injecting the anesthetic agent into the cerebrospinal fluid, usually in the lumbar spine. Epidural anesthesia involves the injection of an anesthetic into the epidural space. Nerve block anesthesia blocks a group of nerves, called a plexus or ganglion, to a specific area of the body. Topical anesthesia involves the application of a local anesthetic on the skin or mucous membranes. The induction of a local anesthetic would decrease the permeability of the nerve cell membrane to which element? A) Sodium B) Glucose C) Bicarbonate D) Phosphorus Rationale: Local anesthetics decrease the permeability of the nerve cell membrane to ions, especially sodium. NCLEX: What medical diagnosis is likely to be managed with the daily administration of a 5% to 20% topical benzocaine solution? A) Psoriasis B) Hemorrhoids C) Stomatitis D) Chronic pain Rationale: Application of the 5% to 20% topical solution of benzocaine relieves hemorrhoid pain. This solution is not indicated in the treatment of psoriasis, chronic pain, or stomatitis. Which medication used for local and regional anesthesia has the longest duration of action? A) Mepivacaine B) Procaine C) Bupivacaine D) Lidocaine Rationale: Bupivacaine is used for local, regional, and spinal anesthesia for diagnostic and therapeutic procedures. The drug is more potent and has a longer duration of action than lidocaine, procaine, or mepivacaine. For what client is intravenous (IV) administration of 2% lidocaine most likely indicated? A) A client who requires a bolus of IV normal saline to restore vascular volume B) A client whose lower limb pain has not responded to opioids C) A client who is scheduled to receive an IV dose of propofol D) A client who has just had a peripherally inserted central catheter (PICC) inserted Rationale: A 2% lidocaine solution may be administered intravenously preceding administration of a painful IV medication such as propofol in the surgical arena. Bolus IV fluids, recent PICC insertion, and limb pain do not warrant IV administration of lidocaine. A client with a history that suggests a possible hypersensitivity to chloroprocaine requires administration of the drug. Following administration, what assessment should the nurse prioritize? A) Musculoskeletal B) Integumentary C) Respiratory D) Neurological Rationale: Excessive doses of chloroprocaine can result in respiratory depression; respiratory assessment is consequently indicated. It is less important to assess the client's temperature, neurologic function, or musculoskeletal status. To determine therapeutic effects, it is necessary to assess for cutaneous sensation in the client's integumentary system. A primiparous woman who has been in the first stage of labor for 2 hours will receive an anesthetic. What would the perinatal nurse anticipate being the anesthetic of choice? A) Intravenous anesthesia B) Spinal anesthesia C) Epidural anesthesia D) Topical anesthesia Rationale: Epidural anesthesia involves injecting the anesthetic into the epidural space. It is used most often in obstetrics during labor and birth. Topical, intravenous, and spinal anesthesia are unlikely choices for this client. The nurse is providing education to a client who will receive an injection of chloroprocaine. The nurse should instruct the client that sensation is likely to return how long after the injection? A) 60 minutes B) 10 minutes C) 20 minutes D) 3 hours Rationale: Chloroprocaine is absorbed rapidly at the injection site. The onset of action is 6 to 12 minutes, with a duration of 1 hour. The nurse has just completed administration of an oral local anesthetic mouthwash to a client. What undesired outcome is the nurse preventing by withholding food and fluids following administration? A) Gastroesophageal reflux B) Dysphagia C) Gastritis D) Aspiration Rationale: Clients should not drink fluids or eat after gargling with oral anesthetics due to the risk of aspiration. This intervention does not prevent gastritis, reflux, or dysphagia. While assisting the health care provider with a minor procedure involving a local anesthetic, the nurse monitors the client for a systemic toxicity event. What is the usual trigger for such an event? A) A genetic predisposition toward incomplete metabolism of the anesthetic B) A type II hypersensitivity response to the anesthetic C) A type I hypersensitivity response to the anesthetic D) Systemic absorption of a local anesthetic Rationale: LAST occurs when the local anesthetic is absorbed systemically, resulting in extreme central nervous system (CNS) excitation followed by cardiovascular excitation and cardiovascular collapse. LAST is not a hypersensitivity reaction or a result of incomplete metabolism. A client has been prescribed oral lidocaine solution prior to a bronchoscopy. What instruction should the nurse provide? A) ''Hold this solution under your tongue for a minute before swallowing it.'' B) ''Hold this solution in your mouth for a few seconds and then spit it out.'' C) ''Swish the solution around your mouth for a few seconds and then spit it into this basin.'' D) ''Gargle with the solution for 30 seconds and then swallow it.'' Rationale: When pharyngeal anesthesia is needed, such as prior to a bronchoscopy, the client gargles and then swallows the oral lidocaine. This process best effects the local anesthetic of the medication. The other described actions will result in a lesser anesthetic effect. The nurse is preparing to insert a peripheral intravenous catheter into a school-age client. What local anesthetic is the nurse likely to apply prior to insertion? A) Tetracaine hydrochloride B) Cocaine hydrochloride ointment C) Eutectic mixture of local anesthetics (EMLA) cream D) Benzocaine cream Rationale: Eutectic mixture of local anesthetics (EMLA) is a cream-based mixture of lidocaine and prilocaine applied to intact skin. The cream is applied at an injection site with an occlusive dressing at least 60 minutes before the vaccination or venipuncture. Tetracaine, cocaine, and benzocaine are not used for this purpose. A client is scheduled for a colonoscopy involving sedation with propofol. Prior to the procedure, the nurse should assess the client for what possible allergy? Select all that apply. 1) Nuts 2) Soybeans 3) Shellfish 4) Eggs 5) Dairy products A) 1,2,3 B) 2,4 C) 3,5 D) 1,4 E) None are F) All are Rationale: Clients who are allergic to soybean or soy products, or eggs or egg products, should not receive propofol. Allergies involving nuts, shellfish, and dairy products are not contraindications. What medication belongs to the category of inhaled anesthetics? A) Etomidate B) Desflurane C) Propofol D) Atracurium Rationale: Desflurane is an inhaled anesthetic. Propofol, etomidate, and atracurium are all intravenous medications. Balanced anesthesia is an approach that aims to provide equilibrium among which elements? Select all that apply. 1) Analgesia 2) Amnesia 3) Hemostasis 4) Muscle relaxation 5) Hypnosis A) 1,2,4,5 B) 2,4 C) 3,5 D) 1,4 E) None are F) All are Rationale: Balanced anesthesia refers to four elements of general anesthesia designed to work collectively to produce a superior outcome. These elements consist of amnesia, analgesia, hypnosis, and muscle relaxation. Hemostasis is not an element of balanced anesthesia. An otherwise healthy surgical client has developed sharply increased muscle tone and rapid increase in heart rate and core body temperature. The operating room team should proceed with assessments and interventions that address what health problem? A) Orthostatic hypotension B) Rhabdomyolysis C) Malignant hyperthermia D) Anaphylaxis Rationale: Malignant hyperthermia is a potentially fatal hypermetabolic response after exposure to volatile inhalation anesthetics or the drug succinylcholine. The presentation of malignant hyperthermia may be highly variable, and the response time may be immediate or delayed. The signs include tachycardia, elevated temperature, body rigidity, mixed metabolic and respiratory acidosis, mottling and sweating, masseter spasm (rigid jaw), hyperkalemia, elevated creatine kinase, myoglobinuria, and renal failure. None of the other options present with these signs and symptoms nor are they related to surgical anesthetics. A client is scheduled for the surgical removal of a spinal tumor. During the induction phase of anesthesia, what event will occur? A) Establishing intravenous (IV) access B) Securing a patent airway C) Inserting laparoscopic instruments D) Introduction of adjunctive medications Rationale: The first phase of anesthesia is induction, which is rendering the client unconscious. Surgical events during the induction phase include securing and maintaining a patent airway. The next phase is maintenance or maintenance anesthesia, which is administering a continuous level of inhalation and/or intravenous anesthetics until the procedure is complete. Adjunctive medications may be used at this time. IV access normally precedes the induction phase. A nurse in the postanesthetic recovery unit is performing an assessment of a client whose balanced anesthesia includes the use of vecuronium. The nurse should recognize an increased risk of recurarization due to the client's history of what medical condit A) Deep vein thrombosis (DVT) B) Myasthenia gravis C) Depression D) Type 2 diabetes Rationale: Clients at risk for recurarization include those with liver and kidney disease, acid–base or electrolyte imbalance, hypothermia, critical illness, myopathic disorders, and neuromuscular diseases such as myasthenia gravis or myasthenic (Eaton-Lambert) syndrome. DVT, depression, and diabetes are not noted risk factors. The nurse anesthetist is providing education to a client regarding scheduled surgery that will involve induction with propofol. What common adverse event should be mentioned in the teaching? A) Autonomic dysreflexia B) Acute pain C) Risk for infection D) Hemorrhage Rationale: The rapid intravenous administration of propofol can be unpleasant because of the emulsion formula. On injection, pain, burning, or stinging at the intravenous site may occur. Infection, hemorrhage, and autonomic dysreflexia are atypical. The nurse is preparing a client to have an operative procedure with general anesthesia. What statement made by the client should the nurse refer to the anesthesiologist immediately because it indicates risk for malignant hyperthermia? A) ''My parent developed a really high fever after being put to sleep and couldn't have the surgery.'' B) ''My sibling had a lot of nausea and vomited after surgery.'' C) ''I have an allergy to seafood and iodine.'' D) ''My heart started racing after I received procaine at the dentist's office.'' Rationale: Malignant hyperthermia is a genetic disorder that occurs after exposure to volatile inhalation anesthetics or to the neuromuscular blocking agent succinylcholine. Signs relate to a hypermetabolic response and include elevated temperature, tachycardia, body rigidity, and mixed metabolic and respiratory acidosis. The jaw becomes rigid, which makes intubation difficult. Since the client's parent demonstrated signs of this genetic disorder, the client may be at increased risk, and the anesthesiologist should be immediately notified. An allergic reaction does not place the client at risk for malignant hyperthermia. Nausea and vomiting are common after a surgical procedure, especially after abdominal surgery; they are not risk factors for malignant hyperthermia. A surgical client was administered a neuromuscular junction (NMJ) blocker in addition to balanced anesthesia. During the procedure, the anesthesiologist administers a cholinesterase inhibitor. The nurse should assess for what expected effect? A) Absence of nausea during recovery B) Return of voluntary movement C) Prolonged paralysis D) Absence of pain during recovery Rationale: A cholinesterase inhibitor (or anticholinesterase) overcomes excessive neuromuscular blockade caused by nondepolarizing NMJ blockers. It would end paralysis and would not affect the client's pain or nausea. Prolonged paralysis would not be expected. How does intravenous (IV) propofol achieve central nervous system (CNS) depression? A) Enhancing the effects of gamma-aminobutyric acid (GABA) B) Slowing the reuptake of serotonin c) Antagonizing the effects of acetylcholine D) Binding with acetylcholinesterase Rationale: Propofol causes depression of the CNS by amplifying the inhibitory neurotransmitter GABA. None of the remaining options accurately describe that action. What is the primary purpose of nitrous oxide in the surgical setting? A) It produces neuromuscular blockade when combined with volatile gases. B) It allows the anesthesia provider to initiate emergence immediately. C) It facilitates ventilation, perfusion, and diffusion while the client is intubated. D) It allows the anesthesia provider to administer lower doses of other anesthetics. Rationale: Nitrous oxide cannot produce general anesthesia by itself. However, its additive effect will permit a lower concentration or dose of the volatile or intravenous anesthetics. It does not promote gas exchange or neuromuscular blockade. Nitrous oxide does not directly make emergence more rapid. An operating room nurse is aware that isoflurane has sustained effects on the brain without significant absorption into blood or body tissues. What is an implication of these aspects of the drug's pharmacokinetics? A) Any route may be used for administration. B) Induction takes place quickly. C) Adverse effects are absent. D) Consciousness is altered with no effect on vital signs. Rationale: The characteristics of intermediate solubility and high potency of isoflurane allow for easy regulation of the depth of anesthesia, and it is possible to sustain its effect on the brain without significant absorption into blood or body tissues. This means that induction and emergence are rapid. This does not negate adverse effects. Isoflurane has a pronounced effect on vital signs. Administration is by inhalation. Term: A substance that produces insensitivity to pain A) Moderate Sedation B) General Anesthesia C) Anesthetic D) Conscious Sedation Rationale: Anesthesia is the broad category that the others fall under. This is anesthesia's definition/description. Term: A medication-induced reversible unconsciousness with loss of protective reflexes. A) Moderate Sedation B) General Anesthesia C) Anesthesia D) Conscious Sedation Term: Creates a deeper than sleep, more like a drug-induced coma, state. Arousal, even to pain stimuli, cannot occur. A) Moderate Sedation B) General Anesthesia C) Anesthesia D) Conscious Sedation Term: Patient maintains protective airway reflexes, can be aroused by stimuli. Common in colonoscopy and biopsy. A) Moderate/Conscious Sedation B) General Anesthesia C) Anesthesia D) Regional Sedation Select the common pre-anesthetic medications? Select all that apply. 1) Benzodiazepines 2) Opioids 3) Anticholinergic Drugs 4) Alpha2-Adrenergic Agonists 5) Histamine 2 Blocker/PPI A) 1,2,4,5 B) 2,4 C) 3,5 D) 1,4 E) None are F) All are Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Benzodiazepines are used as pre-anesthetics for its calming and amnesia effect. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Anticholinergic drugs are used as pre-anesthetics for their ability to dry you out, especially in the bladder. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Alpha2-Adrenergic Agonists are used as pre-anesthetics for its calming and amnesia effect. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Anticholinergic Drugs are used as pre-anesthetics for its calming and amnesia effect. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Benzodiazepines are used as pre-anesthetics for their ability to dry you out, especially in the bladder. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea (T or F) Alpha2-Adrenergic Agonists are used as pre-anesthetics for its anxiety relief. True False Rationale: Benzodiazepines - Calming and amnesia effects Opioids - Pain relief Anticholinergic Drugs - Dry you up Alpha2-Adrenergic Agonists - Anxiety relief Histamine 2 Blocker/PPI - helps w nausea What are the main group(s) of drugs used as General Anesthetics? A) Inhalation anesthetics B) Intravenous anesthetics C) Oral anesthetics D) A and B E) All of these (SATA) What are the phase(s) of anesthetics, in the proper order: 1) Emergence 2) Induction 3) Prevention 4) Maintenance A) 2,3,4,1 B) 2,4,1 C) 3,5 D) 4,1 E) None are F) All are