Pharmacology Chapter 11 General and Local Anesthetics – Flashcards
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Which general anesthetic is administered via the inhalational route? 1 Propofol 2 Ketamine 3 Lidocaine 4 Pancuronium
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2 Ketamine is a general anesthetic that is administered through the nose. Propofol is a general anesthetic drug that is administered intravenously. Lidocaine is a local anesthetic drug administered intravenously. Pancuronium is a neuromuscular blocking drug administered intravenously.
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The nurse is reviewing the medical reports of patients scheduled for surgery. Which patient is least likely to have contraindications for surgery? 1 A patient with severe depression 2 A patient in the first trimester of pregnancy 3 A patient susceptible to malignant hyperthermia 4 A patient suffering from narrow-angle glaucoma
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1 A patient with severe depression is not contraindicated for anesthesia. In fact, anesthesia is used with electroconvulsive therapy for severe depression. On the basis of prior experience with anesthetics, contraindications to general anesthesia may include pregnancy, known susceptibility to malignant hyperthermia, and narrow-angle glaucoma. These contraindications depend on the anesthetic used.
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Which conditions predispose a patient to toxic effects from neuromuscular blocking drugs (NMBDs)? Select all that apply. 1 Acidosis 2 Hemiplegia 3 Poliomyelitis 4 Myasthenia gravis 5 Clostridial infections
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1, 3, 4 NMBDs are the agents that prevent nerve transmission in the skeletal and smooth muscles. Some conditions such as acidosis, poliomyelitis, and myasthenia gravis increase the sensitivity of an individual to NMBDs and prolong their effects. Conditions such as hemiplegia and clostridial infections will oppose the effect of NMBDs, decreasing the patient's sensitivity to the toxic effects of NMBDs.
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Which drug is preferred for anesthesia before emergency intubation? 1 Propofol 2 Midazolam 3 Succinylcholine 4 Dexmedetomidine
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1 Succinylcholine is a neuromuscular blocking agent and is preferred for emergency intubation because of its rapid onset of action, which is less than a minute. It achieves peak plasma concentration within 60 seconds. Its duration of action is 4 to 6 minutes. Therefore, it is used for rapid-sequence induction of anesthesia. Propofol, midazolam, and dexmedetomidine do not have these characteristics. Therefore, these drugs are not preferred for emergency intubation. Propofol is a general anesthetic. Midazolam is an adjunct drug usually administered along with general anesthetics because it causes preoperative amnesia and decreases anxiety. Dexmedetomidine is also an adjunct drug administered with general anesthetics that causes sedation.
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Which opioid analgesic is used to induce anesthesia along with a general anesthetic drug? 1 Propofol 2 Fentanyl 3 Ketamine 4 Desflurane
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2 An adjunctive anesthetic is a drug that enhances the clinical therapy when it is used simultaneously with another drug. Fentanyl is an opioid analgesic that is also used to induce anesthesia during general anesthesia. Propofol is a parenteral anesthetic, but not an opioid analgesic. Ketamine is a parenteral anesthetic and an adjunct to inhalational anesthesia. Desflurane is an inhalational anesthetic used to induce general anesthesia.
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The nurse is caring for a patient who is intubated. The nurse observes that the patient was administered succinylcholine. Which parameter will the nurse assess in the patient to ensure safe drug administration? 1 Blood in urine 2 Yellowness of eyes 3 Hand grasp strength 4 Change in sputum color
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3 Succinylcholine is a neuromuscular blocking drug. The neuromuscular drugs act on the skeletal and smooth muscles, causing paralysis. Therefore, the nurse must assess the patient's hand grasp strength along with vital signs and neurologic status. Succinylcholine does not cause hematuria, so the nurse does not check for blood in the patient's urine. Succinylcholine affects eye movement but does not cause yellowness in the eyes. The drug does not affect the sputum, so the nurse does not look for change in the color of the patient's sputum.
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What effects are exerted by promethazine when it is administered simultaneously with propofol? Select all that apply. 1 Sedation 2 Anxiety reduction 3 Drying excessive secretions 4 Prevention of nausea and vomiting 5 Reduction of pain and other sensations
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1, 2, 4 Promethazine is an antihistamine that induces sedation, reduces anxiety, and prevents nausea and vomiting when administered simultaneously with a general anesthetic drug. Atropine is an anticholinergic drug that will help dry excessive secretions. Opioid analgesics such as meperidine and morphine reduce pain and other sensations but induce nausea and vomiting.
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A patient is prescribed pyridostigmine after surgery. Which anesthetic drug was administered to the patient before surgery? 1 Propofol 2 Lidocaine 3 Midazolam 4 Pancuronium
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4 Pyridostigmine is an anticholinesterase drug that reverses the effect of neuromuscular blocking drugs by preventing the cholinesterase enzyme from breaking down acetylcholine. Therefore, the drug prescribed to the patient before surgery must be pancuronium, a neuromuscular blocking drug. Propofol is a general anesthetic that acts by affecting the receptors. Lidocaine is a local anesthetic and does not have a neuromuscular blocking effect, so this drug may not have been administered to the patient. Midazolam is an opioid prescribed as adjuvant that causes sedation; it does not have any effect in relation to pyridostigmine.
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The nurse is caring for a patient who is scheduled for a colonoscopy. The anesthetist has explained the procedure to the patient. The patient tells the nurse, "I am very scared of this test." Which medication should the nurse expect the anesthetist to administer to the patient along with lidocaine? 1 Propofol 2 Midazolam 3 Succinylcholine 4 Dexmedetomidine
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2 The patient's response indicates that the patient is anxious about the surgery. Therefore, an adjunct drug such as midazolam should be administered to reduce anxiety and to produce a sedative effect. Propofol is a general anesthetic that is given before surgery. It is not administered for a colonoscopy because the patient needs to be awake. Succinylcholine is a neuromuscular blocking drug that causes paralysis of the smooth muscles, so this drug is not administered. Dexmedetomidine is also a general anesthetic that causes complete sedation; hence, it is not prescribed to the patient.
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A patient was administered succinylcholine for intubation during surgery. The patient complains of muscle pain 2 days after the surgery. What does the nurse interpret from this? 1 The patient may have hyperkalemia. 2 The patient may have myasthenia gravis. 3 The patient may have an allergic reaction. 4 The patient may have malignant hyperthermia.
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1 Succinylcholine is a neuromuscular blocking agent. The muscle paralysis induced by succinylcholine is sometimes preceded by muscle spasms and injury to muscle cells. Injury to muscle cells releases potassium ions in the bloodstream, thereby leading to hyperkalemia. Myasthenia gravis is a disease characterized by chronic muscular weakness. Muscle pain is not a symptom of an allergic reaction. Tachypnea, tachycardia, and muscular rigidity are symptoms of malignant hyperthermia, which occurs during administration of anesthesia. This is an adverse metabolic reaction to general anesthetic. Because the nurse did not find these symptoms in the patient, the patient does not have malignant hyperthermia.
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A patient expresses fear of nausea and vomiting postoperatively from the anesthesia. Which is the nurse's best response? 1 "Don't worry, because you'll be heavily sedated if that occurs." 2 "I understand your concern; that is one of the pitfalls of surgery." 3 "Nausea and vomiting occur much less frequently than in the past because of the use of a balanced approach to anesthesia." 4 "You will need to speak to both the surgeon and the anesthesiologist to identify possible allergies to drugs that may cause this side effect."
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3 Explaining to the patient advances in anesthesia may help alleviate fear. Openly discuss with the patient all fears and anxieties about anesthesia and related procedures/surgery. Telling the patient not to worry or counseling acceptance is unlikely to alleviate the patient's fears. Telling the patient to speak to the surgeon and anesthesiologist is not openly discussing the patient's fear and anxiety.
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The nurse is caring for a patient who underwent a hernia repair with a spinal anesthesia. Which sign will the nurse monitor closely in this patient? 1 Heart rate 2 Temperature 3 Blood pressure 4 Pupillary reflexes
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3 Spinal anesthesia can result in a sudden drop in blood pressure as a result of vasodilation caused by the anesthetic block to sympathetic vasomotor nerves. Therefore, the nurse should monitor the patient's blood pressure to prevent hypotension. Monitoring of heart rate, temperature, and pupillary reflexes are more important if the patient received general anesthesia. These vital signs may indicate whether the patient is responding well to the general anesthesia.
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Which body functions are affected last after administering an anesthetic drug? Select all that apply. 1 Visual acuity 2 Consciousness 3 Cardiac function 4 Hearing sensation 5 Pulmonary function
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3, 5 Cardiac and pulmonary functions would be interrupted last after administration of an anesthetic agent, because these functions are controlled by the medulla of the brainstem. Visual acuity, consciousness, and hearing sensation are interrupted first, because these functions are not regulated by the medulla of the brainstem. These are the first sensations that are lost after administering anesthesia.
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What are the symptoms of malignant hyperthermia? Select all that apply. 1 Tachypnea 2 Tachycardia 3 Blood in urine 4 Muscular rigidity 5 Yellowness of eyes
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1, 2, 4 Malignant hyperthermia is an uncommon, genetically linked adverse metabolic reaction to general anesthesia. The symptoms of malignant hyperthermia include tachypnea, tachycardia, and muscular rigidity. Blood in the urine and yellowness of the eyes are not symptoms of malignant hyperthermia. Blood in the urine is hematuria, which is associated with urinary tract infections. Yellowness of the eyes is a symptom of jaundice.
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While a nurse is taking a patient's history before surgery for a cardiac problem, the patient informs the nurse of being addicted to cocaine. The nurse alerts the anesthesiologist of the finding, because the nurse knows the use of cocaine can cause which effect when a patient is under anesthesia? 1 Blood-clotting problems 2 Complications during recovery 3 Immediate withdrawal symptoms 4 Anesthetic-induced complications
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4 A patient with a history of substance abuse is at higher risk of anesthetic-related complications and will require closer monitoring by the anesthesia team. Use of cocaine will not cause blood-clotting problems while the patient is under anesthesia. Complications during recovery and withdrawal symptoms are not related to the question, which asks about effects caused by cocaine while the patient is under anesthesia.
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The nurse is assessing a patient before surgery. Which conditions are concerns for the administration of anesthesia? Select all that apply. 1 The patient is a smoker. 2 The patient is an alcoholic. 3 The patient has liver failure. 4 The patient has hypotension. 5 The patient has hyperglycemia.
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1, 2, 3 A patient who is a smoker would have nicotine in his or her blood. Cigarette smoke has a paralyzing effect on the cilia, which may interfere with the function of anesthesia. A patient who has consumed alcohol may show withdrawal symptoms during recovery from anesthesia. Liver failure reduces the response of the patient to anesthesia because of decreased drug metabolism. Hypotension does not aggravate or relieve the effects of anesthetic agents. However, anesthesia often lowers the patient's blood pressure. Hyperglycemia shows no effect on the action of anesthesia.
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What are the possible effects of garlic when used concomitantly with an anesthetic? Select all that apply. 1 Sedating effects 2 Potential liver toxicity 3 Irritability and insomnia 4 Risk of increased bleeding 5 Changes in blood pressure
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4, 5 Herbal and drug interactions are very common in clinical practice. The possible effects of garlic when used concomitantly with anesthetic drugs include the risk of increased bleeding and changes in blood pressure. Sedation is a common effect of ginger when used in combination with anesthetic drugs because of decreased blood supply to the central nervous system. Potential liver toxicity is a possible effect of using kava in combination with anesthetic drugs. Irritability and insomnia are possible adverse effects of combined use of ginseng and anesthetic drugs.
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What is a notable complication associated with the use of centrally acting local anesthesia? 1 Spinal headache 2 Respiratory arrest 3 Muscle fasciculations 4 Malignant hyperthermia
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1 Intrathecal anesthesia and epidural anesthesia are the two types of spinal or intraspinal anesthesia that are given locally, but they act centrally. Spinal headache is a notable complication with spinal anesthesia because of injury to the spinal layers or structures involved. Respiratory depression or arrest is a complication of high doses of general parenteral or inhalational anesthetics. Muscle fasciculations are muscle spasms that are a result of the damage caused to the muscles by neuromuscular blocking drugs (NMBDs), but they are not a complication of local anesthetic drugs. Malignant hyperthermia is an uncommon, potentially fatal, adverse metabolic reaction to general anesthetics.
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The nurse conducts preoperative teaching with a patient scheduled to undergo a laparotomy who will receive pancuronium during the procedure. What explanation does the nurse give for the administration of pancuronium? 1 It will maintain a stable blood pressure. 2 It will reduce upper respiratory secretions. 3 It will keep the heartbeat slow and regular. 4 It will relax the abdominal muscles for the surgery.
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4 Pancuronium is a neuromuscular blocking agent that is used during surgery to relax muscles for exposure of the surgical site and for intubation and mechanical ventilation. Pancuronium acts by blocking the action of acetylcholine. The nurse should not describe the muscle relaxation as paralysis, because this term could cause unnecessary fear in the patient. Pancuronium does not help maintain stable blood pressure, reduce upper respiratory secretions, or keep the heartbeat slow and regular.
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The nurse is caring for a patient who has undergone surgery with administration of an epidural anesthetic. Two days after the surgery, the patient complains of a severe headache that is more severe when the patient is in an upright position. What is the best choice of treatment for the management of the severe headache? 1 Administration of a 0.05 mg/kg dose of fentanyl over a 2-minute period 2 Administration of a 4 mg/kg dose of succinylcholine over a 2-minute period 3 Administration of a one dose per day of dantrolene to the patient for 4 days 4 Administration of a small volume of the patient's own blood into the epidural space
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4 The patient has a spinal headache from anesthesia. Spinal headaches occur as a result of leakage of the cerebrospinal fluid from the insertion site. This leakage occurs from inadvertent dural puncture during epidural anesthesia. Therefore, a small volume of the patient's own blood is administered into the epidural space. It works like a blood patch and helps to seal the leak and also contributes to relieving the headache. Fentanyl is used for moderate sedation and is not useful for the treatment of a spinal headache. Dantrolene is a muscle relaxant that is used in the treatment of malignant hyperthermia. Succinylcholine is a depolarizing neuromuscular blocking drug which is used to facilitate endotracheal intubation.
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An immediate postoperative assessment of a patient reveals a body temperature of 104° F. What is the nurse's first action? 1 Apply a cooling blanket per the agency's protocol. 2 Assess for signs and symptoms of a wound infection. 3 Administer acetaminophen as prescribed and recheck in 1 hour. 4 Notify the primary health care provider to discuss the risk of malignant hyperthermia.
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4 A fever in the immediate postoperative period may indicate malignant hyperthermia. Malignant hyperthermia is treated with the skeletal muscle relaxant dantrolene and cardiorespiratory supportive care as needed to stabilize heart and lung function. A cooling blanket does not help with this condition. Infection of a surgical wound takes several days to develop. Acetaminophen plays no role in this situation.
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A patient about to undergo surgery states that a family member has a history of difficulty with surgery. Which subjective information about a family member contraindicates the use of succinylcholine in this patient? 1 Loop diuretic use 2 Essential hypertension 3 Malignant hyperthermia 4 Decreased serum sodium
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3 Succinylcholine is contraindicated in patients with a personal or familial history of malignant hyperthermia or conditions that can lead to hyperkalemia, including denervation of skeletal muscles, upper motor neuron disease, or a personal history of major burns or multiple traumas. None of the remaining family information represents a high risk in connection with the use of succinylcholine.
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The nurse is caring for a patient who underwent a procedure that involved the use of lidocaine. How long should the nurse expect the action of the lidocaine to last? 1 30 to 60 minutes 2 60 to 90 minutes 3 90 to 120 minutes 4 120 to 150 minutes
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2 Lidocaine is a parenteral local anesthetic drug. The duration of action of lidocaine is 60 to 90 minutes. The duration of action of procaine is 30 to 60 minutes. The duration of action of tetracaine is 90 to 120 minutes, and the duration of action of mepivacaine is 120 to 150 min.
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Which postoperative nursing action will help the patient recover from the effects of anesthesia? 1 Ambulating once a day 2 Forcing fluids to 400 mL per shift 3 Administering loperamide as needed 4 Turning, coughing, and deep breathing every 2 hours
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4
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An intubated, mechanically ventilated patient in the intensive care unit is becoming increasingly restless and anxious. The nurse should expect to administer which intravenous anesthetic drug? 1 Propofol 2 Halothane 3 Isoflurane 4 Nitrous oxide
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1 Propofol is an intravenous sedative-hypnotic drug used for induction and maintenance of anesthesia as well as controlled sedation in patients who are intubated and mechanically ventilated in the intensive care unit. It has a rapid onset and short duration of action, allowing for easy titration and maintenance of the patient's level of consciousness. Halothane, isoflurane and nitrous oxide are inhaled, not administered intravenously.
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A patient receives succinylcholine during surgery. Which postoperative assessment is of greatest concern to the nurse? 1 Skeletal muscle pain 2 Elevated temperature 3 Serum potassium 4.8 mEq/L 4 Blood pressure 90/62 mm Hg
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2 Malignant hyperthermia is a rare and potentially fatal condition that can be triggered by succinylcholine, a depolarizing neuromuscular blocking drug. Clinical indicators of malignant hyperthermia, including high temperature, tachycardia, and muscle rigidity, should trigger immediate treatment, because the condition can be fatal. Postoperative muscle pain is a common adverse effect of succinylcholine; however, the drug continues to be used because of its rapid onset and short duration of action. Succinylcholine promotes release of potassium but rarely causes severe hyperkalemia. The patient's blood pressure is adequate, even though succinylcholine can cause alterations in blood pressure.
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While completing preoperative patient teaching, which information should the nurse explain about general anesthesia? 1 Produces deep muscle relaxation and loss of consciousness 2 Typically is achieved using combinations of different drug classes 3 Provides anesthesia to a specific region of the body and generalized sedation 4 Results in moderate sedation in which the patient can follow commands but will not remember anything after the procedure
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1 General anesthesia produces deep muscle relaxation (both visceral and skeletal) as well as loss of consciousness. Balanced anesthesia is the practice of using combinations of different drug classes rather than a single drug to produce anesthesia. Local anesthesia provides anesthesia to a specific region of the body and generalized sedation. Conscious sedation (also called moderate sedation) results in moderate sedation in which the patient can follow commands but will not remember anything after the procedure.
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A mechanically ventilated patient receiving a neuromuscular blocking drug has tearing in the eyes and increased heart rate and blood pressure. Which does the nurse conclude? 1 The patient's level of sedation is inadequate. 2 The patient's response to the drug is appropriate. 3 The patient is having an adverse reaction to the medication. 4 The patient's dose of the neuromuscular blocking drug is insufficient.
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1 Tearing in the eyes and increased heart rate and blood pressure are symptoms of increased anxiety or pain. A patient receiving a neuromuscular blocking drug cannot move or communicate; thus the nurse must rely on subtle changes to assess adequate sedation.
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Anesthetic drugs are contraindicated in patients with which conditions? Select all that apply. 1 Osteoarthritis 2 Diabetes mellitus 3 Gastrointestinal ulcer 4 Narrow-angle glaucoma 5 Malignant hyperthermia
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4, 5 The administration of anesthetic drugs is contraindicated in patients who have narrow-angle glaucoma or malignant hyperthermia. In narrow-angle glaucoma, the ocular pressure is high. The administration of anesthetic drugs increases intraocular pressure and aggravates glaucoma. Malignant hyperthermia is an uncommon, genetically-linked adverse metabolic reaction to general anesthesia. The administration of anesthetic drugs to a patient with malignant hyperthermia causes tachycardia, tachypnea, muscular rigidity, and a rise in body temperature. Anesthetic drugs do not affect joint structure and function, blood sugar levels, or gastrointestinal function. Thus they can be safely administered to patients with osteoarthritis, diabetes mellitus, or gastrointestinal ulcer.
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Which is a long-acting nondepolarizing neuromuscular blocking drug? 1 Rocuronium 2 Vecuronium 3 Pancuronium 4 Cisatracurium
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3 Pancuronium is a long-acting nondepolarizing neuromuscular blocking drug. Rocuronium, vecuronium, and cisatracurium are intermediate-acting nondepolarizing neuromuscular blocking drugs.
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Which anesthetic technique involves the injection of anesthetics into the subarachnoid space? 1 Infiltration 2 Nerve block 3 Epidural anesthesia 4 Intrathecal anesthesia
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4 Intrathecal anesthesia is a type of local anesthetic technique that involves injecting the drug into the subarachnoid space. Infiltration is an anesthetic technique that involves injecting small amounts of anesthetic into the tissue that surrounds the operative site. Nerve block is an anesthetic technique in which the anesthetic solution is injected at the site where a nerve innervates a specific area, such as a tissue. Epidural anesthesia is a local anesthetic technique in which the drug is injected through a small catheter into the epidural space.
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A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug they use in the emergency room when patients have cardiac arrest." Select the nurse's best response. 1 "Epinephrine allows anesthetic effects to occur more quickly." 2 "Epinephrine is commonly used with lidocaine to prevent adverse effects." 3 "Epinephrine causes the anesthetic effect to wear off quickly once the laceration is sutured." 4 "Epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site."
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4 Epinephrine causes localized vasoconstriction, not only allowing for a bloodless field to suture but also delaying absorption of the lidocaine and thus enhancing its numbing effect. It does not help the anesthetic effect wear off more quickly. Epinephrine is used to prevent adverse effects, but more specifically it helps to minimize toxicity caused by local anesthetics. Epinephrine is often coadministered with the local anesthetic to maintain localized drug activity, but it does not help with the systemic absorption of lidocaine.
