Chapter 51: Drug Therapy With General Anesthetics
A client is preparing 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? "My sibling had a lot of nausea and vomited after surgery." "I have an allergy to seafood and iodine." "My heart started racing after I received procaine at the dentist's office." "My parent developed a really high fever after being put to sleep and couldn't have the surgery."
"My parent developed a really high fever after being put to sleep and couldn't have the surgery." Explanation: 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.
In a patient who is to be given vecuronium (Norcuron), anesthesia is induced before neuromuscular blockade is started. What is the reason for this? Because it helps reduce the adverse effects of vecuronium Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe Because it enhances the therapeutic effects of vecuronium Because it ensures that vecuronium does not cross the blood-brain barrier
Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe Explanation: Vecuronium does not cross the blood-brain barrier and has no action on the CNS. For this reason, anesthesia is induced before neuromuscular blockade is started; otherwise, the unanesthetized patient would have the frightening experience of paralysis and the inability to breathe.
A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital? Skeletal muscle relaxation Neuroleptanalgesia Profound analgesia CNS depression
CNS depression Explanation: The nurse is most likely to observe CNS depression. Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia. Skeletal muscle relaxation is caused by skeletal muscle relaxants, halothane and enflurane. An anesthetic state characterized by profound analgesia is produced by ketamine, which is a rapid-acting general anesthetic. Neuroleptanalgesia is caused by a combination of fentanyl and droperidol.
A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital? CNS depression Skeletal muscle relaxation Profound analgesia Neuroleptanalgesia
CNS depression Explanation: The nurse is most likely to observe CNS depression. Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia. Skeletal muscle relaxation is caused by skeletal muscle relaxants, halothane and enflurane. An anesthetic state characterized by profound analgesia is produced by ketamine, which is a rapid-acting general anesthetic. Neuroleptanalgesia is caused by a combination of fentanyl and droperidol.
The nurse administered morphine 30 minutes ago to a client in the postanesthesia recovery unit (PACU), and now notes that the client vital signs are: Temp: 97.9 F, Pulse: 98 bpm, Respirations: 9 breaths/min, and BP: 107/69. What is the nurse's next best action? Document the findings. Place a warm blanket on the client. Recheck vital signs in 5 minutes. Contact the health care provider.
Contact the health care provider. Explanation: The health care provider is contacted if the client's respiratory rate is below 10 breaths/min before or after the nurse administers an opioid medication. The client's respiratory rate is 9 breaths/min; it would not be appropriate to document the findings or to recheck in five minutes. Also, the client's temperature does not indicate the need for a warm blanket.
A patient develops malignant hyperthermia after receiving a NMJ blocker. Which would the nurse expect to be given? Succinylcholine Naloxone Dantrolene Protamine sulfate
Dantrolene Explanation: Dantrolene would be used to treat malignant hyperthermia. Succinylcholine is associated with the development of malignant hyperthermia and would not be given. Naloxone would be used to treat opioid overdose. Protamine sulfate is the antidote for heparin
A patient develops malignant hyperthermia after receiving a NMJ blocker. Which would the nurse expect to be given? Protamine sulfate Naloxone Dantrolene Succinylcholine
Dantrolene Explanation: Dantrolene would be used to treat malignant hyperthermia. Succinylcholine is associated with the development of malignant hyperthermia and would not be given. Naloxone would be used to treat opioid overdose. Protamine sulfate is the antidote for heparin.
A priority assessment prior to a 70-year-old client being given succinylcholine as adjunct to general anesthesia for surgery is: Activity level Nutritional status and weight Blood glucose level and complete blood count Renal and hepatic function
Renal and hepatic function Explanation: Renal or hepatic disease could interfere with the metabolism or excretion of this drug, which could lead to toxic effects. Complete blood count and glucose level, nutritional status, and activity level are all important to assess and would be vital to the client's recovery. However, interference with drug metabolism could cause serious, life-threatening complications for the client.
An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states , "My arms and legs feel like tree trunks and my head feels "fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client? A-Provide fluids orally to increase the client's wakefulness. B-Provide analgesic medication for the discomfort. C-Stay with client as much as possible and provide reassurance. D-Contact the provider and ensure naloxone is available.
Stay with client as much as possible and provide reassurance. Explanation: Most clients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the client as much as possible and reassure the client while providing frequent assessment. Providing pain medication is important and may be needed during recovery if the client reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to clients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. There is no indication that the provider should be contacted. Naloxone treats opioid overdose, which is not the cause of the client's symptoms.
An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states , "My arms and legs feel like tree trunks and my head feels "fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client? Contact the provider and ensure naloxone is available. Provide analgesic medication for the discomfort. Provide fluids orally to increase the client's wakefulness. Stay with client as much as possible and provide reassurance.
Stay with client as much as possible and provide reassurance. Explanation: Most clients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the client as much as possible and reassure the client while providing frequent assessment. Providing pain medication is important and may be needed during recovery if the client reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to clients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. There is no indication that the provider should be contacted. Naloxone treats opioid overdose, which is not the cause of the client's symptoms.
A postsurgical patient is awake and extremely anxious while in the postanesthesia recovery unit. She states that "my arms and legs feel like tree trunks and they are hard to move." She also states that "my head feels fuzzy and the right words will not come out." Which of the following is the most appropriate nursing action for this patient? A-Provide analgesia medication for the discomfort B-Provide fluids to increase her wakefulness C-Stay with the patient as much as possible and provide reassurance D-Encourage the patient to turn from side to side periodically
Stay with the patient as much as possible and provide reassurance Explanation: Most patients are disoriented and confused when awaking from anesthesia. It would be a priority for the nurse to be with the patient as much as possible and to reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery, but the patient does not state that she is in pain. The nurse would not provide fluids to patients immediately after surgery. Most patients cannot take anything by mouth for several hours after surgery. The nurse will help the patient turn from side to side but it would do little to decrease her fears.
A 6-year-old child has been brought to the emergency department in apparent status asthmaticus. The care team recognizes the need to intubate the client, who is inconsolably agitated. The nurse should anticipate a STAT prescription for what medication? Pancuronium Succinylcholine Atracurium Rocuronium
Succinylcholine Explanation: The very rapid onset and short duration of succinylcholine make it appropriate for facilitating intubation in a distraught child. None of the nondepolarizing neuromuscular junction blockers has such a rapid onset or short duration.
The operating room nurse has performed an assessment of a preoperative client and the client reports a family history of malignant hyperthermia. The nurse has confirmed with the anesthesiologist that this has been identified. The nurse should anticipate what consequence of this for the client's intraoperative care? The use of neuromuscular junction blockers is absolutely contraindicated The client will likely recover most slowly than usual from the administration of neuromuscular junction blockers The client will require higher-than-normal doses of neuromuscular junction blockers to achieve desired effects The anesthesiologist will exercise caution when giving the client neuromuscular junction blockers
The anesthesiologist will exercise caution when giving the client neuromuscular junction blockers Explanation: A family history of malignant hyperthermia requires cautious use of NMJ blockers, but they are not absolutely contraindicated. There is no reason to believe the client will recover slower than usual. High doses are not required.
Balanced anesthesia is an approach that aims to provide equilibrium among which elements? Select all that apply. hemostasis muscle relaxation hypnosis amnesia analgesia
amnesia analgesia hypnosis muscle relaxation Explanation: 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.
A client scheduled for a surgical procedure will receive intravenous propofol. What effects does the nurse expect the drug to have on the client? Select all that apply. amnesia analgesia euphoria hypnosis increased clotting
amnesia euphoria hypnosis Intravenous general anesthetics render a client unconscious in a fast and safe manner. Propofol is an intravenous anesthetic with wide acceptance and extensive use for surgical, therapeutic, and diagnostic procedures. Propofol produces amnesia, euphoria, and hypnosis. These effects allow the drug to block the perception of pain, but it does not provide analgesia, which is the reduction or absence of pain. It does not affect the clotting mechanism.
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? orthostatic hypotension rhabdomyolysis malignant hyperthermia anaphylaxis
malignant hyperthermia Explanation: 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.
The client is scheduled for a colonoscopy. Which drug would the nurse expect to be given to the client prior to the procedure to promote conscious sedation? Citanest midazolam Robinul Ativan
midazolam Explanation: Midazolam, a benzodiazepine, is used as a pre-anesthetic to relieve anxiety, for induction of anesthesia, for conscious sedation before minor surgery, and to supplement nitrous oxide and oxygen for short surgical procedures. Citanest is used for local anesthesia and Robinul and Ativan are pre-anesthesia drugs used to manage anxiety.
The nurse is admitting a client to the postanesthesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments? A-skin integrity and peripheral perfusion B-respirations and airway C-lung auscultation and apical heart rate D-pain and temperature
respirations and airway Explanation: Postanesthetic recovery requires frequent, comprehensive assessments including all of the listed parameters. Among the priority assessments, however, are the client's airway patency and respiratory status. This is because both are heavily influenced by anesthesia and have rapid, serious consequences if disrupted.
The nurse is caring for a patient who is receiving pancuronium to aid in their mechanical ventilation. The patient is also receiving a barbiturate. What does the nurse need to know about these drugs? They can be mixed and given in the same syringe. When mixed, they need to be given IM. They cannot be given IM. If they are given together, a precipitate may form.
If they are given together, a precipitate may form. Explanation: Do not mix the drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use.
The nurse is admitting a client in preparation of surgery. The nurse is aware that propofol is contraindicated in a client who is allergic to what product? Pollen Latex Eggs Gluten
Eggs Explanation: Propofol is contraindicated in clients who are allergic to egg
The nurse is admitting a client in preparation of surgery. The nurse is aware that propofol is contraindicated in a client who is allergic to what product? Gluten Eggs Pollen Latex
Eggs Explanation: Propofol is contraindicated in clients who are allergic to eggs.
The nurse is working in the postanesthesia care unit, and several patients are having surgery today. Which patient would be at greatest risk for complications after surgery? A 35-year-old female who had a hysterectomy using general anesthesia A 26-year-old female who had a tubal ligation using general anesthesia A 64-year-old male who had bilateral femoral bypass grafting using spinal anesthesia A 72-year-old female who had general anesthesia for lung removal
A 72-year-old female who had general anesthesia for lung removal Explanation: The oldest patient is at risk for increased complications with general anesthesia, due to the changes that occur in the body as part of the natural aging process.
The nurse is assisting in the care of a client during surgery. The nurse will be prepared to administer which drug if the client develops malignant hyperthermia? Acetaminophen Dantrolene sodium Diazepam Toradol
Dantrolene sodium Explanation: Clients who develop malignant hyperthermia will receive dantrolene sodium
A surgical client will be administered sedative followed by a neuromuscular junction (NMJ) blocker. What nursing action best preserves the client's safety? Auscultate the client's apical heart rate with a stethoscope for 2 minutes. Apply physical restraints as prescribed. Administer bronchodilators as prescribed to facilitate intubation. Ensure that emergency equipment is readily available.
Ensure that emergency equipment is readily available. Explanation: It is imperative to ensure that emergency supplies and equipment are readily available to maintain airway and provide mechanical ventilation. Cardiac monitoring will negate the need for manual auscultation of the client's heart rate. Physical restraints are only used in exceptional circumstances, and bronchodilators are not used to ease intubation
What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)? A-Ensure the client has adequate respirations. B-Administer pain medication. C-Position the client on his side to prevent aspiration of vomitus. D-Check the client's pulse and blood pressure
Ensure the client has adequate respirations. Explanation: The nurse's most important responsibilities when the client is admitted to the PACU are to check the client's airway for patency and assess the client's respiratory status. Taking pulse and blood pressure, and positioning the client on his side are the nurse's next actions. The nurse will then administer pain medication if necessary.
The anesthesia care provider visits with the client prior to surgery. The choice of type of drugs to administer to the client during surgery are based on what factors? Select all that apply. Cost of the drugs General physical condition of the client Client's personal preference Area, organ, or system being operated on Anticipated length of the surgical procedure
General physical condition of the client Area, organ, or system being operated on Anticipated length of the surgical procedure Explanation: The administration of general anesthesia requires the use of one or more drugs. The choice of anesthetic drug depends on many factors, including general physical condition of the client; area, organ, or system being operated on; and anticipated length of the surgical procedure. Personal preference does not come into play, nor does cost of the drugs. It is always what is best for the clien
The nurse is caring for a client who will undergo an emergency repair of an open fracture to the femur that occurred during a motor vehicle accident. Because of the client's elevated blood alcohol, the nurse expects that the client may experience what reaction to the use of isoflurane anesthesia? Profound coma Decreased effect of isoflurane Extreme agitation Increased effect of isoflurane
Increased effect of isoflurane Explanation: Alcohol causes an increase in the effect of isoflurane so the client will need to be monitored closely for delayed emergence from anesthesia.
The nurse understands that propofol differs from isoflurane in what way? It doesn't produce anesthesia. It doesn't produce amnesia. It doesn't produce analgesia. It doesn't produce respiratory depression.
It doesn't produce analgesia. Explanation: Propofol does not produce analgesia.
A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure? Ketamine Bupivacaine Midazolam Nitrous oxide
Midazolam Explanation: Midazolam is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures. Ketamine carries a higher risk of adverse effects. Nitrous oxide is not used for this purpose, and could not be inhaled during a bronchoscopy. Bupivacaine only provides local anesthesia.
A nurse may be asked to administer which drug prior to a colonoscopy in order to help the client relax? Fentanyl Meperidine Midazolam Lidocaine
Midazolam Explanation: An antianxiety drug such as midazolam prior to a colonoscopy will help the client relax.
While assessing a patient prior to surgery, what would the nurse assess for? (Select all that apply.) Narrow angle glaucoma Paraplegia Multiple sclerosis Fractures Myasthenia gravis
Narrow angle glaucoma Fractures Myasthenia gravis Paraplegia Assess for contraindications or cautions: Narrow-angle glaucoma because an increase in intraocular pressure can occur with succinylcholine; paraplegia that might lead to potassium imbalance with administration of succinylcholine; fractures that might lead to additional trauma with administration of succinylcholine; myasthenia gravis, which may be exacerbated by the use of this drug. Multiple sclerosis is not a contraindication or caution with the NMJ blockers. Reference:
Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client? Nitrogen Oxygen Water Helium
Oxygen Explanation: Gas anesthetics such as nitrous oxide and cyclopropane must be combined with oxygen, and then administered by inhalation to the client to produce anesthesia. Nitrous oxide is not combined with water, nitrogen, or helium.
The nurse is preparing a client who will receive intravenous anesthetic during a short surgical procedure. The nurse understands that this client is most likely to receive which medication? Isoflurane Diazepam Nitrous oxide Propofol
Propofol Explanation: Propofol is the prototype drug for intravenous anesthesia.
Prior to administering morphine sulfate to a client in the postanesthesia recover unit (PACU), what information must the nurse obtain? (Select all that apply.) Urinary output Pulse Blood pressure IV fluid rate Respirations
Pulse Respirations Blood pressure Explanation: The nurse must check the client's pulse, respiratory rate and blood pressure before an opioid such as morphine sulfate is administered in the PACU. The client's IV rate and urinary output are not necessary information to administer an opioid.
The nurse is supporting a client who is undergoing a diagnostic procedure using neuromuscular junction blockers. What intervention should the nurse prioritize? Implement seizure precautions Reposition the client as possible to prevent skin breakdown Monitor the client's urine output every half hour Monitor the client for signs of internal or external bleeding
Reposition the client as possible to prevent skin breakdown Explanation: A client's inability to move when NMJ blockers are administered creates a high risk for skin breakdown. Seizures are not a high risk and skin breakdown is a more significant risk than short-term decrease in urine output. Hemorrhage is not a high risk and monitoring for this complication would not be prioritized over preventing skin breakdown by the nurse.
The post-anesthetic recovery unit nurse is caring for a client whose balanced anesthesia included midazolam. The nurse should prioritize assessments for what health problems? Myoclonic and tonic movements Nausea and vomiting Chills and hypotension Respiratory depression and CNS suppression
Respiratory depression and CNS suppression Explanation: Respiratory depression and CNS suppression may occur during recovery from midazolam, making these areas priorities for post-operative assessment.
What client is most likely to require the least time in recovery from anesthesia? a client who had a cholecystectomy using balanced anesthesia a client whose surgery required the administration of propofol a pediatric client who had surgery using sevoflurane a client who had oral surgery using nitrous oxide
a client who had oral surgery using nitrous oxide Explanation: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Propofol, sevoflurane, and the combinations that constitute balanced anesthesia would require much more extensive recovery.
What medication belongs to the category of inhaled anesthetics? atracurium desflurane propofol etomidate
desflurane Explanation: Desflurane is an inhaled anesthetic. Propofol, etomidate, and atracurium are all intravenous medications.
A nurse is spending clinical hours with a CRNA. The nursing instructor asks the nurse what causes the respiratory obstruction that can occur with many of the depolarizing NMJ blockers. What would be the correct response? Serotonin Hyperkalemia Histamine release ACh
histamine release The histamine release associated with many of the depolarizing NMJ blockers can cause respiratory obstruction with wheezing and bronchospasm. Hyperkalemia is an adverse effect of the depolarizing NMJ blockers, ACh is what is acted on by the NMJ blockers, and serotonin is a distracter for this question.
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 condition? myasthenia gravis type 2 diabetes depression deep vein thrombosis (DVT)
myasthenia gravis Explanation: 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.
A client is scheduled for a surgical procedure during which the anesthetist intends to administer succinylcholine. What preoperative teaching should the nurse provide related to the use of this medication? A-"You'll muscles will probably feel numb while you're recovering from the procedure." B-"You'll probably find that you'll have some paralysis for a few hours after the procedure." C-"It's likely that your muscles will be sore and uncomfortable after the procedure." D-"Sometimes this medication causes muscle twitches for a day or two, but this disappears with time.
"It's likely that your muscles will be sore and uncomfortable after the procedure." Explanation: Succinylcholine is associated with pain and discomfort in the time immediately following its use. Prolonged numbness and paralysis do not occur because the drug has a short duration and half life. Succinylcholine is not associated with residual muscle twitches.
After teaching a group of students about NMJ blockers, the instructor determines that the students have understood the teaching when they state: "Paralysis and total CNS depression occur with these drugs." "The drugs are associated with relatively few adverse effects." "Most of the drugs do not alter pain perception and consciousness." "Nondepolarizing NMJs are lipophilic so they cross the blood-brain barrier."
"Most of the drugs do not alter pain perception and consciousness." Explanation: NMJ blockers in most cases do not affect pain perception or consciousness. NMJ blockers are associated with serious adverse effects. Nondepolarizing NMJ blockers are hydrophilic and do not readily cross the blood-brain barrier. NMJ blockers cause paralysis, but do not totally depress the CNS.
The nurse is admitting a client to the postanesthesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments? skin integrity and peripheral perfusion respirations and airway pain and temperature lung auscultation and apical heart rate
respirations and airway Explanation: Postanesthetic recovery requires frequent, comprehensive assessments including all of the listed parameters. Among the priority assessments, however, are the client's airway patency and respiratory status. This is because both are heavily influenced by anesthesia and have rapid, serious consequences if disrupted.
The nurse is admitting a client to the postanesthesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments? A-lung auscultation and apical heart rate B-respirations and airway C-pain and temperature D-skin integrity and peripheral perfusion
respirations and airway Explanation: Postanesthetic recovery requires frequent, comprehensive assessments including all of the listed parameters. Among the priority assessments, however, are the client's airway patency and respiratory status. This is because both are heavily influenced by anesthesia and have rapid, serious consequences if disrupted
An older adult client will receive a neuromuscular junction blocker during surgery. The nurse should identify what nursing diagnosis when planning this client's care? A-chronic confusion B-risk for impaired skin integrity C-chronic pain D-imbalanced nutrition: less than body requirements
risk for impaired skin integrity Explanation: An elderly or frail client will need extra nursing care to prevent skin breakdown during the period of paralysis because skin tends to be thinner and more susceptible to breakdown. Therefore, risk of impaired skin integrity would be an appropriate nursing diagnosis. The client may be acutely confused when awakening, but there is no reason to think he or she would remain chronically confused if he was not before surgery. Similarly, surgical pain would not be expected to be chronic. The short-term fasting that is required for surgery does not normally pose a significant threat to a client's nutritional status.
The operating room nurse is developing the care plan for a distraught and combative 4-year-old child scheduled for removal of a foreign body from the sinus cavity. The nurse should anticipate the administration of what anesthetic? ketamine lidocaine propofol bupivacaine
propofol Explanation: Propofol is widely used for diagnostic tests and short procedures in children older than 3 years of age because of its rapid onset and metabolism and generally smooth recovery. Ketamine has a high risk for adverse effects. Lidocaine and bupivacaine provide local anesthesia, but this child would likely require short-acting general anesthetic.
A 71-year-old patient with a history of depression will be receiving vecuronium to prevent trauma during electroconvulsive therapy. Prior to the procedure, the care team must assess the patient's: A-understanding of the pharmacodynamics of vecuronium. B-renal and hepatic status. C-blood glucose levels D-goals for recovery.
renal and hepatic status. Explanation: Before the administration of vecuronium, it is important to evaluate the patient for a history of hypersensitivity to any NMJ blocker or for any renal or hepatic disease. This assessment supersedes the importance of blood glucose monitoring or goals for recovery. It is unnecessary to teach the patient about the pharmacodynamics of the drug.
Which agent would the nurse identify as always being given with oxygen? Enflurane Nitrous oxide Halothane Thiopental
Nitrous oxide Explanation: Nitrous oxide can block the reuptake of oxygen after surgery and cause hypoxia. Subsequently, it is always given in combination with oxygen.
A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure? Midazolam Bupivacaine Nitrous oxide Ketamine
Midazolam Explanation: Midazolam is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures. Ketamine carries a higher risk of adverse effects. Nitrous oxide is not used for this purpose, and could not be inhaled during a bronchoscopy. Bupivacaine only provides local anesthesia.
The nursing student identifies which people as qualified to administer anesthesia? (Check all that apply.) Physician assistant Surgeon Operating room nurse Nurse anesthetist Anesthesiologist
Anesthesiologist Nurse anesthetist Explanation: Both specially trained nurses and health care providers can administer anesthesia. An anesthesiologist is a physician with special training in administering anesthesia. A nurse anesthetist is a nurse with a master's degree and special training who is qualified to administer anesthetics.
What would require a decrease in dosage of a nondepolarizing NMJ blocker? Cholinesterase inhibitors Penicillins Aminoglycoside antibiotics Halogenated hydrocarbon anesthetics
Aminoglycoside antibiotics Explanation: Aminoglycosides lead to an increase in neuromuscular blockage, requiring a decreased dosage of NMJ blocker. Cholinesterase inhibitors would decrease the effective of the NMJ blocker, possibly requiring an increased dosage of the NMJ blocker. Penicillins are not associated with any interaction with nondepolarizing NMJ blockers. The combination of halogenated hydrocarbon anesthetics greatly enhances the paralysis of the nondepolarizing NMJ blocker; dosage adjustments are necessary, but these dosage adjustments may be related to either the anesthetic or NMJ blocker depending on the effect necessary.
The perioperative nurse is caring for a client who is undergoing abdominal surgery with the inclusion of succinylcholine in the client's anesthesia. The anesthesiologist tells the team that the client is exhibiting signs and symptoms suggestive of malignant hyperthermia. What is the nurse's best action? A-Prepare to administer acetylcysteine IV B-Anticipate IV administration of dantrolene C-Administer naloxone IV as per facility protocol D-Initiate resuscitation
Anticipate IV administration of dantrolene Explanation: Dantrolene is the treatment for malignant hyperthermia. Naloxone treats opioid overdoses and acetylcysteine treats acetaminophen overdoses. Resuscitation efforts would be based on the client's current cardiopulmonary status and would not necessarily be required.
The nurse is working in collaboration with a nurse anesthetist to assess a preoperative client. When addressing the client's risk for malignant hyperthermia as a result of neuromuscular junction blockers, what assessment should be prioritized? A-Assessing for a family history of malignant hyperthermia B-Assessing for a history of febrile seizures in childhood C-Assessing for any history of cytochrome P450 dysfunction D-Assessing the client's allergy status
Assessing for a family history of malignant hyperthermia Explanation: Family history is the most salient risk factor for malignant hyperthermia. This adverse effect is physiologically unrelated to childhood febrile seizures and does not result from cytochrome P450 dysfunction. Malignant hyperthermia is not a hypersensitivity response
In a patient who is to be given vecuronium (Norcuron), anesthesia is induced before neuromuscular blockade is started. What is the reason for this? A-Because it enhances the therapeutic effects of vecuronium B-Because it helps reduce the adverse effects of vecuronium C-Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe D-Because it ensures that vecuronium does not cross the blood-brain barrier
Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe Explanation: Vecuronium does not cross the blood-brain barrier and has no action on the CNS. For this reason, anesthesia is induced before neuromuscular blockade is started; otherwise, the unanesthetized patient would have the frightening experience of paralysis and the inability to breathe
A surgical client will be administered sedative followed by a neuromuscular junction (NMJ) blocker. What nursing action best preserves the client's safety? Auscultate the client's apical heart rate with a stethoscope for 2 minutes. Ensure that emergency equipment is readily available. Apply physical restraints as prescribed. Administer bronchodilators as prescribed to facilitate intubation.
Ensure that emergency equipment is readily available. Explanation: It is imperative to ensure that emergency supplies and equipment are readily available to maintain airway and provide mechanical ventilation. Cardiac monitoring will negate the need for manual auscultation of the client's heart rate. Physical restraints are only used in exceptional circumstances, and bronchodilators are not used to ease intubation
A client who is scheduled for a diagnostic procedure has learned that the procedure will take place with a neuromuscular junction blocker rather than with a general anesthetic. The nurse should describe what benefit of this approach? Enhanced long-term control of neuromuscular spasticity Completion of procedures in a community setting Fewer effects of central nervous system depression Absence of pain during the procedure
Fewer effects of central nervous system depression Explanation: NMJ blockers have fewer of the CNS depressing effects of anesthetics. Their use requires close monitoring so they are not given in the community setting. Anesthetics control pain, whereas NMJ blockers only control muscle movement. NMJ blockers are not used for long-term therapy
The nurse is caring for a patient who is receiving pancuronium to aid in their mechanical ventilation. The patient is also receiving a barbiturate. What does the nurse need to know about these drugs? A-If they are given together, a precipitate may form. B-They can be mixed and given in the same syringe. C-They cannot be given IM. D-When mixed, they need to be given IM.
If they are given together, a precipitate may form. Explanation: Do not mix the drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use.
A patient admitted to a local health care facility has to be administered general anesthesia. The nurse knows that which of the following factors will influence the selection of the general anesthesia for the patient? Pre-anesthetic drug prescribed Postoperative care involved Length of surgical procedure Age of the patient
Length of surgical procedure Explanation: The nurse should know that the choice of general anesthesia depends on factors that include the general physical condition of the patient; the area, organ, or system being operated on; and the anticipated length of the surgical procedure. The selection of general anesthesia does not depend on the age of the patient specifically on the pre-anesthetic drug prescribed for the patient, or on the postoperative care involved.
The nursing instructor is teaching the students about anesthesia and informs them that there are two types. What are those two types of anesthesia? (Select both that apply.) General anesthesia Topical anesthesia Spinal anesthesia Local anesthesia Regional anesthesia
Local anesthesia General anesthesia Explanation: Anesthesia is divided into local and general. Topical, regional, and spinal are types of local anesthesia.
A client who has multiple sclerosis has experienced a fall and requires open reduction and internal fixation of a femoral fracture. The anesthesiologist has informed the perioperative nurse that the client will be given a neuromuscular junction (NMJ) blocker to facilitate anesthesia. What is the nurse's best action? A-Inform the surgeon of the anesthesiologist's statement and document in the client's health record. B-Monitor the client's status before, during, and after surgery as per usual protocol. C-Document this statement and inform the perioperative nurse manager. D-Question the anesthesiologist about the use of an NMJ blocker with this client.
Monitor the client's status before, during, and after surgery as per usual protocol. Explanation: Multiple sclerosis does not contraindicate the safe and effective use of NMJ blockers. For this reason, the nurse's standard assessments and interventions are likely sufficient and there is no reason to report this to other members of the care team.
The student asks the physiology instructor where the motor neuron communicates with a skeletal muscle fiber. What would the instructor respond? A-Neuromuscular junction B-Synaptic cleft C-Synapse D-Afferent junction
Neuromuscular junction Explanation: The neuromuscular junction simply is the point at which a motor neuron communicates with a skeletal muscle fiber. The synapse and the synaptic cleft are part of the NMJ.
A client with a long-standing history of schizophrenia is experiencing a decline in status despite the consistent use of antipsychotics. The client has been scheduled for electroconvulsive therapy (ECT). When planning the client's care, the nurse should identify the use of a neuromuscular junction (NMJ) blocker as an intervention addressing what nursing diagnosis? A-Ineffective breathing pattern related to anesthesia B-Acute pain related to administration of electric current C-Risk for injury related to muscle contraction D-Ineffective airway clearance related to intubation
Risk for injury related to muscle contraction Explanation: NMJ blockers prevent injury from excessive muscle contraction during ECT. During this procedure, their use is unrelated to respiratory function. NMJ blockers are not administered for analgesia.
A client scheduled for surgery is to have a nondepolarizing neuromuscular junction (NMJ) blocker as adjunctive anesthesia. The nurse will have cause for concern about prolonged paralysis if the client has been taking what medication? Levothyroxine Streptomycin Acetaminophen with codeine Propranolol
Streptomycin Explanation: Combining nondepolarizing NMJ blockers with aminoglycosides such as streptomycin can result in prolonged paralysis, and this combination should be avoided. This interaction does not occur with acetaminophen, codeine, beta-blockers (propranolol) or levothyroxine.
During an operation where the patient has been given isoflurane, the nurse has been asked to frequently change carbon dioxide absorbents. Why is this necessary? A-To minimize the risk of nephrotoxicity B-To minimize the incidence of spontaneous abortions, birth defects, and stillbirths C-To minimize the risk of carboxyhemoglobinemia D-To minimize the risk of adverse effects such as shivering and tremor
To minimize the risk of carboxyhemoglobinemia Explanation: Isoflurane has been observed to react with carbon dioxide dry absorbents in anesthetic circle systems to form carbon monoxide and cause carboxyhemoglobinemia. To avoid this adverse effect, it is important to change carbon dioxide absorbents frequently. However, it does not help minimize the risk of nephrotoxicity, adverse effects such as shivering and tremor, or incidence of spontaneous abortions, birth defects, and stillbirths.
During an operation where the patient has been given isoflurane, the nurse has been asked to frequently change carbon dioxide absorbents. Why is this necessary? To minimize the risk of nephrotoxicity To minimize the risk of adverse effects such as shivering and tremor To minimize the risk of carboxyhemoglobinemia To minimize the incidence of spontaneous abortions, birth defects, and stillbirths
To minimize the risk of carboxyhemoglobinemia Explanation: Isoflurane has been observed to react with carbon dioxide dry absorbents in anesthetic circle systems to form carbon monoxide and cause carboxyhemoglobinemia. To avoid this adverse effect, it is important to change carbon dioxide absorbents frequently. However, it does not help minimize the risk of nephrotoxicity, adverse effects such as shivering and tremor, or incidence of spontaneous abortions, birth defects, and stillbirths.
The postanesthesia care unit (PACU) nurse is caring for a client that had succinylcholine as an adjunct to anesthesia. What action best addresses the potential adverse effects of this medication? A-monitoring the client's IV sites for extravasation B-repositioning the client every 15 minutes, if possible C-ensuring dantrolene is readily available D-monitoring the client for signs and symptoms of increased intracranial pressure
ensuring dantrolene is readily available Explanation: Succinylcholine is more likely to cause malignant hyperthermia than other drugs so it is very important that dantrolene be available. The nurse should frequently reposition the client, but this is unrelated to the adverse effects of succinylcholine. This drug is not closely associated with increased ICP or extravasation.
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-anaphylaxis B-orthostatic hypotension C-malignant hyperthermia D-rhabdomyolysis
malignant hyperthermia Explanation: 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.
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? rhabdomyolysis anaphylaxis malignant hyperthermia orthostatic hypotension
malignant hyperthermia Explanation: 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.
