PA - Exam 2 - General Principles - 9-23-19
You are preparing to perform an awake intubation. Which local anesthetic would have the fastest onset when used on the oral mucosa? A. Lidocaine B. Tetracaine C. Bupivacaine D. Benzocaine
D. Benzocaine Benzocaine is an ester local anesthetic that is popular because it has an extremely fast onset (less than 1 minute compared to 15 minutes for lidocaine) and a short duration.
Which procedure has the least risk of bleeding and has no minimum platelet count prior to proceeding? A. Liver biopsy B. Thyroid surgery C. Bronchoscopy D. Cataract extraction
D. Cataract extraction Procedures with a high risk of bleeding such as neurosurgery, thyroid surgery, and prostatectomy require a starting platelet count of 75,000-100,000 per microliter. Moderate risk procedures include liver biopsies, dental extractions, and most other surgical procedures. For these, the patient should have a platelet count of at least 50,000 per microliter. Low-risk procedures such as endoscopy and bronchosopy require a starting platelet count of at least 30,000 per microliter. Very low risk procedures such as bone marrow biopsy or cataract extraction do not have a minimum platelet count to proceed.
Which of the following is not a cause of hypercalcemia? A. Sarcoidosis B. Hyperthyroidism C. Vitamin D intoxication D. Hypoparathyroidism
D. Hypoparathyroidism Hypercalcemia results from disorders that result from increased absorption of calcium from the gastrointestinal tract or increased calcium resorption from the bones. Conditions that predispose a patient to hypercalcemia include milk alkali syndrome, vitamin D intoxication, sarcoidosis, hyperparathyroidism, malignancy, hyperthyroidism, and prolonged immobilization.
How does the addition of clonidine to a spinal influence the effects of the local anesthetic? A. It shortens the motor block but prolongs the sensory block B. It shortens both the motor and sensory block C. It shortens the sensory block but prolongs the motor block D. It prolongs both the motor and sensory block
D. It prolongs both the motor and sensory block The addition of clonidine to a local anesthetic spinal will prolong the duration of both the motor and sensory block by about 30%.
How is a two-level combined spinal-epidural performed? A. The spinal anesthetic is performed, then the epidural catheter is inserted two interspaces above B. The spinal anesthetic is performed, then the epidural catheter is inserted two interspaces below C. The epidural catheter is inserted, then the spinal is performed two interspaces above the epidural D. The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural
D. The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural A two-level combined spinal/epidural is performed by first placing the epidural catheter, then performing a spinal anesthetic one or two interspaces below the epidural.
During the preoperative interview, a patient expresses concern that a blood transfusion may result in a bacterial or viral infection. Which of the following statements regarding bacterial and viral pathogens and blood transfusion is false? A. The risk of contracting hepatitis B is greater than hepatitis C B. Banked blood is laboratory-tested for the West Nile virus C. The Epstein-Barr virus can be transmitted by transfusion D. The incidence of acquiring syphilis by transfusion is about 1 in 1000
D. The incidence of acquiring syphilis by transfusion is about 1 in 1000 Banked blood in the US is tested in the laboratory for the West Nile virus, syphilis, and HTLV. For other diseases like Creutzfeld-Jakob and malaria donors are interviewed regarding exposure to endemic areas and history of fevers. Syphilis transmission is highly unlikely because the organism cannot survive in cold storage. There are cases where infectious mononucleosis (Epstein-Barr virus) was transmitted via transfusion.
The use of hyperbaric local anesthetics such as lidocaine 5% in spinal anesthesia is associated with A. central cord syndrome B. anterior cord syndrome C. Brown-Sequard syndrome D. cauda equina syndrome
D. cauda equina syndrome Cauda equina syndrome consists of lower back pain, sciatica, motor and sensory loss, and bladder and bowel dysfunction that has been associated with the use of hyperbaric lidocaine 5% in spinal anesthesia.
Following an anesthetic, preterm infants should be monitored A. until their heart rate stabilizes below 100 bpm B. until their arterial blood gas is within normal limits C. in the intensive care unit D. for at least 12 hours
D. for at least 12 hours Because preterm infants have a higher risk for postoperative apnea, they should be monitored for at least 12 hours.
The presence of cough or chest pain while performing a supraclavicular, infraclavicular, or interscalene brachial plexus block may indicate what? A. Horner's syndrome B. hemidiaphragmatic paresis C. needle contact with the first rib D. pneumothorax
D. pneumothorax Chest pain or cough during the procedure can be an indication of an inadvertent pneumothorax.
The medial cricoarytenoid muscles are innervated by the A. glossopharyngeal nerve B. superior laryngeal nerve C. superior thyroid nerve D. recurrent laryngeal nerve
D. recurrent laryngeal nerve The lateral and medial cricoarytenoids are innervated by the recurrent laryngeal nerve.
Advance directives for patients undergoing anesthesia are typically A. enforced throughout the perioperative period B. rewritten by an attorney prior to the procedure C. canceled until resubmitted by a durable power of attorney D. suspended temporarily and resumed after the postoperative period
D. suspended temporarily and resumed after the postoperative period Because anesthesia frequently requires the use of measures that are otherwise considered life-sustaining, advance directives are often suspended temporarily and resumed at a specified time after the postoperative period. The healthcare providers, patient, and any others involved should discuss exactly what measures should be withheld or applied, in what situations, and when the advance directive should be resumed.
The primary means a newborn infant has to respond to hypothermia is A. shivering B. vasoconstriction C. shunting blood to the peripheral tissues D. the increased release of norepinephrine
D. the increased release of norepinephrine A newborn infant will respond to a 2 degree Celsius drop in temperature by releasing norepinephrine into the bloodstream which will cause lipolysis of brown adipose tissue. This is called nonshivering thermogenesis. The increased adipose metabolism will produce heat but will also produce ketones and increase oxygen consumption.
Injecting 2 mL of local anesthetic at the base of the palatoglossal arch would anesthetize A. the superior laryngeal nerve B. the recurrent laryngeal nerve C. the anterior 1/3 of the tongue D. the posterior 1/3 of the tongue
D. the posterior 1/3 of the tongue The posterior 1/3 of the tongue and tonsillar pillars can be anesthetized by blocking the lingual and pharyngeal branches of the glossopharyngeal nerve with 2 mL of local anesthetic at the base of the palatoglossal arch.
Match the intravenous fluid with it's corresponding sodium content.
Plasma to 142 mEq/L Lactated Ringer's to 130 mEq/L Normal Saline to 154 mEq/L.
Match the abdominal muscles that are located between the subcostal margin and iliac crest with their position from most superficial to most deep.
Superficial to External oblique Middle to Internal oblique Deep to Transversus abdominis.
In the figure below, click the area innervated by the medial brachial cutaneous nerve of the arm. Click the Exhibit button if necessary to view the image.
The yellow area on the picture. The intercostobrachial and medial brachial cutaneous nerves supply the inner aspect of the arm from the axilla to the elbow. Fibers from C8, T1, and T2 contribute to this distribution of nerves.
The image depicts an ECG tracing and the corresponding central venous pressure waveform below it. Use your mouse to place the pin on the 'v' wave of the central venous pressure waveform. Click the Exhibit button if necessary to view the image.
You selected the correct area of the diagram. A central venous pressure tracing exhibits several waveforms worth noting: the 'a' wave represents atrial contraction, the 'c' wave represents elevation of the tricuspid valve during ventricular contraction, the 'v' wave represents venous return against a closed tricuspid valve, and the x and y descents represent downward displacement of the ventricle during systole and opening of the tricuspid valve during diastole.
Use your mouse to click on the long thoracic nerve. Click the Exhibit button if necessary to view the image.
You selected the correct area of the diagram. In this diagram, the long thoracic nerve is seen as the descending branch that takes contributions from C5, C6 and C7.
Match the area of the lung with the location of West Zone III based upon the position of the patient.
*correct*
Calculate the mean arterial pressure (MAP) in mmHg for a patient with the following hemodynamics: SBP/DBP: 147/89; HR: 85. Round to the nearest whole number.
108 MAP = DP + ((SP-DP)/3) or 108 = 89 + ((147-89) / 3)
What is the appropriate dose of clonidine in micrograms that should be added to the local anesthetic to augment a caudal anesthetic for a 33 pound, three year-old patient undergoing corrective surgery on both legs? (calculate your answer to the nearest whole number)
15 The dose of clonidine that should be added to the local anesthetic to augment a caudal anesthetic is 1 mcg/kg of bodyweight. In this case, the patient weighs 33 pounds or 15 kilograms. 15 mcg of clonidine is the appropriate dose.
Which is the appropriate fluid treatment for patients that acutely develop water intoxication or seizures due to IV fluid administration? A. 3% saline B. 0.9% saline C. 0.5% saline D. D5 1/2 normal saline
A. 3% saline Hypertonic 3% saline is indicated in patients who have seizures or those that develop acute water intoxication due to IV fluid administration. By itself, hypertonic saline will only temporarily increase serum sodium. Combined with furosemide, however, it will quickly increase serum sodium levels.
Which of the following requires monitoring during MAC cases? (select two) A. Blood pressure at least every five minutes B. Pulse oximetry C. Temperature D. Capnography
A. Blood pressure at least every five minutes B. Pulse oximetry According to the standards set forth by the ASA, the patient's oxygenation, ventilation, and circulation shall be continually monitored. This includes pulse oximetry, ECG, and blood pressure (which must be assessed at least every five minutes). During monitored anesthesia care cases, capnography is not required, but ventilation must be assessed, at least, by continual observation of qualitative clinical signs (e.g. chest rise and breath sounds). The temperature is to be monitored any time clinically significant changes in body temperature are intended or anticipated.
You are using dexemedetomidine as an intravenous sedative for an elective, awake intubation. What side effect would you expect to see? A. Bradycardia B. Increased salivation C. Resistance to local anesthetics D. Tremors
A. Bradycardia Bradycardia is commonly seen with dexmedetomidine and is treatable with glycopyrrolate or atropine. Hypotension and hypertension may both be seen with dexmedetomidine.
You are preparing to perform a cervical plexus block. What spinal nerves contribute to the cervical plexus? (select two) A. C3 B. C4 C. C5 D. C6
A. C3 B. C4 The cervical plexus is derived from the C1, C2, C3, and C4 spinal nerves.
Hyperalgesia, allodynia, autonomic abnormalities, and pain that occurs spontaneously without an apparent stimulus are features characteristic of: A. Complex regional pain syndrome B. Radiculopathy C. Phantom pain D. Neuralgia
A. Complex regional pain syndrome Complex regional pain syndrome is characterized by pain that occurs spontaneously without an apparent stimulus, hyperalgesia, allodynia, and sudomotor and vasomotor dysfunction.
Which scoring system is used to objectively describe the difficulty of a laryngoscopy? A. Cormack and Lehane B. Mallampati classification C. Thyromental distance D. Stanford classification
A. Cormack and Lehane The Cormack and Lehane scoring system is used to describe the difficulty of laryngoscopy based on the anatomical structures visible. With a Grade I view, the entire glottic opening is visible. With a Grade II view, only the posterior glottic opening is visible and the anterior commissure is not visible. With a Grade III view, only the epiglottis can be seen. With a Grade IV view, only the soft palate is visible. The Mallampati classification and thyromental distance are used to predict airway management difficulty, and the Stanford classification is used to describe the severity of an aortic dissection.
Select two tests that can assess cardiac ejection fraction at rest and under stress. A. Echocardiography B. Holter monitoring C. Exercise ECG D. Radionuclide angiography
A. Echocardiography D. Radionuclide angiography Echocardiography and radionuclide angiography can evaluate cardiac EF at rest and under stressful conditions. The advantages of echocardiography are that it is less invasive, and it is able to check for wall abnormalities, wall thickness, valvular function, and valve area.
Plain 2% lidocaine has a specific gravity between 1.0004 and 1.0066. In relation to cerebrospinal fluid, this solution would be A. Hypobaric B. Isobaric C. Hyperbaric D. There is not enough information to answer this question
A. Hypobaric CSF has a specific gravity of 1.004 to 1.009. 2% plain lidocaine is hypobaric in relation to CSF.
Which factor decreases ETCO2 during anesthesia? A. Hypothermia B. Shivering C. Malignant hyperthermia D. Sepsis
A. Hypothermia Factors that will decrease ETCO2 include hypothermia and hypothyroidism.
An adverse event occurs during a patient's anesthetic. Which apology carries the least risk for liability exposure? A. I am sorry that this event occurred. B. I am sorry I caused your injury. C. I am sorry. This was my fault. D. I am sorry my mistake caused this
A. I am sorry that this event occurred. An apology is an expression of regret or sorrow. To help encourage disclosure or errors, some states do not allow information provided in a disclosure conversation or an apology to be used as evidence in malpractice litigation. Although these apology laws permit sympathetic statements, they do not provide protection from admissions of guilt. For example, the statement, 'I am sorry this happened' may be protected, but the statement, 'I am sorry that my mistake caused this' would not be protected.
Select two contraindications to the use of a supraglottic airway. A. Intestinal obstruction B. Poor lung compliance C. Inguinal hernia D. Diverticulitis
A. Intestinal obstruction B. Poor lung compliance Contraindications to the use of a supraglottic airway include: intestinal obstruction, full stomach, delayed gastric emptying, poor history, hiatal hernia with significant reflux, poor lung compliance, limited mouth opening of less than 1.5 cm, glottic or subglottic airway obstruction.
Which of the following has the greatest effect on the block height of a spinal anesthetic? A. Intra-abdominal pressure B. Patient age C. Patient height D. The body mass index of the patient
A. Intra-abdominal pressure Factors such as patient height, age, BMI, and length of the vertebral column don't affect the spread of a spinal anesthetic. Pregnancy, obesity, and increased intra-abdominal pressure increase the height of sensory block, however. It is believed that these conditions increase the block height because of a lower lumbar CSF volume.
You are performing a combined spinal/epidural anesthetic. You have already administered the spinal anesthetic and are preparing to inject local anesthetic through the epidural catheter. How will this affect the spinal block? A. It will increase the height of the spinal block B. It will decrease the height of the spinal block C. It will shorten the duration of the spinal block D. The epidural injection has no effect on the spinal block
A. It will increase the height of the spinal block Injection of solution through the epidural catheter is known to increase the spread of the spinal anesthetic. It is believed that the increased volume injected into the epidural space compresses the subarachnoid space, resulting in an increase in pressure that 'pushes' the local anesthetic in the subarachnoid space higher. Another cause is the leakage of local anesthetic from the epidural space into the subarachnoid space via the dural puncture made for the spinal anesthetic.
Which of the following conditions that contribute to a difficult airway scenario are associated with diabetes mellitus? (select two) A. Limited range of mobility in the cervical spine B. Gastroesophageal reflux disease C. Prominent incisors D. Large tongue
A. Limited range of mobility in the cervical spine B. Gastroesophageal reflux disease Patients with diabetes have an increased risk for gastroesophageal reflux disease and may require intubation. They also have an increased risk of developing limited-mobility joint syndrome and a decreased range of motion in the cervical spine which can make intubation difficult.
Which steroid would be most likely to produce an embolism from inadvertent arterial particulate injection during an epidural steroid injection? A. Methylprednisolone B. Betamethasone C. Triamcinolone D. Dexamethasone
A. Methylprednisolone Methylprednisolone has the largest particle size and would be more likely to produce a significant embolus if injected arterially. Betamethasone has the smallest particles and triamcinolone is between the two. Dexamethasone contains no particles at all.
A drug-induced state where the patient's cognitive function may be impaired, but he/she can still respond verbally, and ventilatory and cardiovascular function is unchanged is the definition of A. Minimal sedation B. Moderate sedation C. Monitored anesthesia care D. General anesthesia
A. Minimal sedation Minimal sedation, also known as anxiolysis, is a drug-induced state where the patient's cognitive function may be impaired, but he/she can still respond verbally, and ventilatory and cardiovascular function is unchanged.
Select two true statements about nerve fibers. A. Myelinated fibers conduct faster B. Smaller fibers conduct faster C. A-delta and C nerve fibers are associated with pain transmission D. Smaller fibers are typically involved with motor and sensory functions
A. Myelinated fibers conduct faster C. A-delta and C nerve fibers are associated with pain transmission Larger nerves and myelinated nerve conduct impulses more quickly. Both A-delta and C nerve fibers are associated with pain function. Large nerve fibers are involved with motor and sensory functions.
What fluid would be the most appropriate for use in the treatment of hemorrhagic shock in a patient with traumatic brain injury? A. Normal saline B. Hetastarch C. D5 Lactated Ringer's D. Albumin
A. Normal saline Isotonic crystalloids are preferred when performing volume resuscitation in patients with traumatic brain injury. Normal saline is probably the best option because it can be mixed with packed red blood cells. The caution in using large volumes of saline is the predisposition to developing hyperchloremic acidosis. Any solution containing glucose should be avoided.
Which of the following solutions has the highest sodium concentration? A. Normal saline B. Lactated Ringer's C. Plasma D. Normosol-R
A. Normal saline Normal saline has a sodium of 154 mEq/L. Plasma has a sodium concentration of 142 mEq/L and Normosol-R contains 140 mEq/L of sodium. Lactated Ringer's solution has a sodium of 130 mEq/L
What nerves are blocked as part of an ankle block? (select four) A. Saphenous B. Superficial femoral C. Popliteal D. Deep peroneal E. Superficial peroneal F. Lateral sural cutaneous G. Posterior tibial H. Obturator
A. Saphenous D. Deep peroneal E. Superficial peroneal G. Posterior tibial The deep peroneal, saphenous, posterior tibial, sural, and superficial peroneal are anesthetized during an ankle block.
Which of the following nerves does not contribute to the lumbar plexus? A. Sciatic B. Iliohypogastric C. Femoral D. Obturator
A. Sciatic The nerves that contribute to the lumbar plexus are the subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator.
What law established regulations protecting patient privacy by defining how protected health information is used and who can use it? A. The Health Insurance Portability and Accountability Act B. The Protected Information Act C. The Health and Personal Privacy Act D. The Medicare Act
A. The Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 established regulations protecting patient privacy by defining how protected health information is used, the circumstances in which it can be used, and who can use it.
You are performing a subarachnoid block using the paramedian approach. As you are advancing the needle, you contact bone. What specific bone have you most likely encountered? A. The lamina B. The spinous process C. The pedicle D. The vertebral body
A. The lamina The most common bone to encounter when performing a subarachnoid block via a paramedian approach is the vertebral lamina.
What muscles of the hand receive their motor innervation from the median nerve? A. The muscles of the thenar eminence B. All of the small muscles of the fingers C. The lumbrical muscles of the 3rd, 4th, and 5th digits D. The biceps
A. The muscles of the thenar eminence The median nerve provides motor innervation to the muscles of the thenar eminence, the forearm flexors, and the lumbrical muscles of the first and second fingers.
Select two true statements about the pediatric airway. A. The narrowest portion is the cricoid B. The larynx is located at the level of C4-C6 C. The larynx is proportionately larger than in the adult D. The epiglottis is relatively longer and more narrow than in the adult
A. The narrowest portion is the cricoid D. The epiglottis is relatively longer and more narrow than in the adult Compared to adults, the narrowest portion of the pediatric airway is at the level of the cricoid, the relative vertical location of the larynx is C2-C4 (C3-C6 in adults), the larynx is proportionately smaller, and the epiglottis is longer, more narrow, and stiff.
Ideally the time-out procedure should be performed A. before the induction of anesthesia while the patient is awake B. immediately after induction of anesthesia C. immediately prior to incision D. Immediately after incision
A. before the induction of anesthesia while the patient is awake Both the WHO's Surgical Safety Checklist and the Joint Commission's Universal Protocol utilize the time-out. The time-out serves as a safety check and communication tool between the surgical, nursing, and anesthesia teams, and it is the final assessment that ascertains that the correct procedure will be done on the correct patient at the correct site. It is advised that it be performed before induction of anesthesia so that the patient can participate in the verification process.
A properly performed popliteal block will anesthetize which of the following nerves? (select four) A. common peroneal nerve B. tibial nerve C. femoral nerve D. deep peroneal nerve E. saphenous nerve F. sural nerve G. obturator nerve H. genitofemoral nerve
A. common peroneal nerve B. tibial nerve D. deep peroneal nerve F. sural nerve A nerve block in the popliteal fossa will anesthetize both the common peroneal and tibial branches of the sciatic nerve which terminate as the superficial peroneal, deep peroneal, sural, and posterior tibial nerves.
You are performing a spinal on a patient in the sitting position and wish for the local anesthetic to move in a caudal direction after injection. To accomplish this, you should dissolve the local anesthetic in A. dextrose 5% B. cerebrospinal fluid C. sterile water D. hyaluronidase
A. dextrose 5% In order to encourage it to move more caudally in this patient, the local anesthetic injection will need to be hyperbaric. Dissolving the drug in 5% or 8% dextrose will make the solution hyperbaric.
Where in the popliteal fossa can the popliteal artery be found? A. immediately lateral to the semitendinosus tendon B. inferior to the head of the gastrocnemius muscle C. immediately lateral to the biceps femoris D. immediately to the right of the fibular head
A. immediately lateral to the semitendinosus tendon The popliteal artery may be found immediately lateral to the semitendinosus tendon.
The failure to take a known and planned action or using the wrong plan of action to achieve an outcome that may or may not result in patient harm is the definition of a A. medical error B. adverse event C. critical incident D. near miss
A. medical error An adverse event is any unintended patient injury, harm, or complication that results in a prolonged hospitalization, disability, or death. It is typically caused by a healthcare management process rather than the underlying disease process of the patient. The AANA defines a critical incident as a powerful and overwhelming event that lies outside the range of human experience. It can overwhelm normal coping mechanisms and disrupt normal psychological functioning. A critical incident typically evolves from a breakdown in an overall health system rather than the negligence of one individual. A medical error is the failure to take a known and planned action or using the wrong plan of action to achieve an outcome. A medical error may or may not result in patient harm. A near miss is any event or situation that could have resulted in accident, injury, or harm, but did not, either by chance or specific intervention.
Somatosensory evoked potentials are useful for A. monitoring during a carotid endarterectomy B. assessing the 3rd cranial nerve C. assessing the anterior spinal column D. monitoring the integrity of the corticospinal tract
A. monitoring during a carotid endarterectomy Somatosensory evoked potentials assess the dorsal spinal column and sensory cortex and are best for monitoring during spinal surgery, carotid endarterectomy, and aortic surgery. Motor evoked potentials (MEPs) are useful in the monitoring of functional integrity of motor tracts, namely, the corticospinal tract.
The principal use for epidural droperidol is A. reducing pruritus and nausea B. treating acute pain C. treating chronic pain D. treating bradycardia
A. reducing pruritus and nausea Epidural droperidol has been shown to be extremely effective at reducing pruritus and postoperative nausea and vomiting. It is believed that it exerts direct actions on the chemoreceptor trigger zone.
All of the following are significant contributing factors for the development of postoperative apnea in the premature infant except A. the administration of aminoglycoside antibiotics B. postconceptual age C. the type of anesthetic delivered D. the presence of anemia
A. the administration of aminoglycoside antibiotics The major risk factors contributing to apnea after anesthesia in preterm infants are the type of anesthetic, postconceptual age, and the presence of anemia.
The administration of 'washed' red blood cells helps reduce the incidence of reactions mediated by A. IgG antibodies B. IgA antibodies C. IgF antibodies D. IgM antibodies
B. IgA antibodies Washed red blood cells are rinsed with isotonic saline solutions. This removes plasma proteins, leukocytes, and platelets. Doing so helps prevent severe allergic reactions mediated by recipient antibodies to IgA in the donor plasma which can result in anaphylaxis in IgA-deficient recipients
Which of the following is one of the three primary factors that influence the renal absorption of phosphate? A. Serum potassium levels B. Insulin-like growth factor levels C. Bone degeneration D. Dietary sodium intake
B. Insulin-like growth factor levels Dietary intake of phosphate, parathyroid hormone, and insulin-like growth factor are the three primary factors that influence the renal absorption of phosphate.
Select two populations with a higher incidence of postdural puncture headache. A. Geriatric B. Pregnant C. Female D. Male
B. Pregnant C. Female There is a higher incidence of postdural puncture headache in young, female, and pregnant populations. Most often affected are postpartum females in their 30's.
Which risk factor is the most significant predictor of a difficult mask ventilation? A. History of snoring B. Presence of a beard C. Lack of teeth D. Body mass index > 26
B. Presence of a beard In order of importance: the presence of a beard (most significant), body mass index > 26, lack of teeth, age > 55 years, and a history of snoring are independent risk factors associated with difficult mask ventilation.
How do you convert degrees Kelvin into degrees Celsius? A. Subtract 100 B. Subtract 273 C. Divide by 1.8 and add 32 D. Add 273
B. Subtract 273 To convert Celsius to Kelvin, you simply add 273 to it. Technically it's 273.15, but we're not going to complicate things any further than we have to. To go from Kelvin to Celsius, simply subtract 273. 100 degrees Kelvin would equal -173 degrees Celsius.
What two anatomical landmarks need to be identified first in order to perform an ultrasound-guided axillary nerve block? A. Subclavian artery B. Terminal branches of the brachial plexus C. Axillary artery D. Musculocutaneous muscle
B. Terminal branches of the brachial plexus C. Axillary artery The brachial plexus terminal nerve branches and the axillary artery need to be identified first in order to perform an ultrasound-guided axillary nerve block.
Which of the following would be classified as part of the structural component of the quality of care model in the analysis of an event where a patient was injured? (select two) A. The sequence of activities that were performed during the event B. The facility where the event occurred C. The change in health status of the patient after care was delivered D. Policies and procedures
B. The facility where the event occurred D. Policies and procedures Quality of care is typically referred to as being comprised of three components: structure, process, and outcome. Structure refers to the setting in which the care is provided including the location, personnel, policies, and facilities used. Process incorporates the sequence of activities and what was actually done. Outcome refers to the change in health status after care was delivered.
A caudal anesthetic is used to provide pain relief for which of the following procedures? A. Mediastinoscopy B. Ureteral stone removal C. Wrist surgery D. Tonsillectomy
B. Ureteral stone removal Caudal anesthesia is used most commonly as an adjunct to general anesthesia in pediatric surgery. It can also be used for perirectal surgery, urologic surgery, lower extremity orthopedic surgery, labor and delivery, and chronic pain.
You are preparing to perform a Bier block for a procedure that may take longer than 45 minutes. Which of the following methods would be appropriate to help alleviate the pain from the tourniquet? A. Inject bupivacaine B. Use a double-tourniquet C. Deflate the tourniquet when the patient complains of pain and the re-inflate it after 1 minute D. Inject more local anesthetic into the IV of the surgical limb.
B. Use a double-tourniquet Patients can tolerate a procedure under Bier block for a longer period of time if a double-tourniquet is used. The distal cuff is inflated first followed by the proximal cuff. The distal cuff is then deflated to allow the area under it to become anesthetized. If the proximal cuff of the tourniquet becomes too painful for the patient to tolerate, the distal cuff can be inflated and then the proximal cuff deflated to allow the surgeon more time to complete the procedure.
Failure to obtain informed consent prior to anesthesia would be an example of A. tort B. breach of duty C. respondeat superior D. implied consent
B. breach of duty Except in cases where consent is implied (such as emergency situations where it is assumed the patient would consent to life-saving treatment) informed consent must be obtained prior to administering anesthesia. Failure to do so is considered a breach of duty.
During an axillary brachial plexus block, you can choose to begin the injection high in the axilla, in the middle, or near the inferior border of the axilla. What is the primary benefit of choosing a higher approach? A. reduced risk of pneumothorax B. greater chance of blocking the musculocutaneous nerve C. greater chance of anesthetizing the lateral deltoid D. decreased motor block following the procedure
B. greater chance of blocking the musculocutaneous nerve Any one of these locations can be used for an axillary brachial plexus block, but the higher the approach, the greater the chances that the block will anesthetize the musculocutaneous nerve before it exits the sheath.
You are doing a preoperative assessment on a patient that is receiving long-term total parenteral nutrition. You know that this patient may be at increased risk for developing A. hypochloremic metabolic alkalosis B. hyperchloremic metabolic acidosis C. respiratory alkalosis D. hyperkalemia
B. hyperchloremic metabolic acidosis TPN contains amino acids as chloride salts. Because of this, long-term administration of TPN can produce hyperchloremic metabolic acidosis. Hypercarbia is a potential complication with intense nutritional support because it increases carbon dioxide production.
Dysfunction of the serratus anterior muscle and winging of the scapula are consistent with injury to the A. median nerve B. long thoracic nerve C. axillary nerve D. brachial plexus
B. long thoracic nerve Dysfunction of the serratus anterior muscle and winging of the scapula are consistent with injury to the long thoracic nerve. The long thoracic nerve is not routinely involved in stretch injuries from positioning, so a link between dysfunction of this nerve and patient positioning is not clear.
During an elective procedure, the surgeon changes his plan and prepares to undertake a procedure for which he does not have privileges. The nurse anesthetist should: A. document that he did not have privileges for the procedure B. tell the surgeon to halt and notify the chief of surgery C. monitor the surgeon carefully for incompetence D. proceed with the anesthetic as planned
B. tell the surgeon to halt and notify the chief of surgery According to the AANA code of ethics, the CRNA has a duty to take appropriate action to protect patients from healthcare providers who may subject the patient to situations that may cause harm, whether due to incompetence, impairment, illegality, or unethical practices. In this case, the CRNA should tell the surgeon to stop and immediately notify a person with authority over the surgeon.
A caudal anesthetic is used predominantly in pediatric anesthesia because in patients under the age of 12 (select two) A. they are more resistant to local anesthetic toxicity than adults B. the spread of local anesthetic in the caudal epidural space is more reliable C. the sacral hiatus is larger D. the duration of the block is twice as long in pediatric patients
B. the spread of local anesthetic in the caudal epidural space is more reliable C. the sacral hiatus is larger After the age of 12, the sacral bone structure begins to change. The sacral hiatus is more difficult to locate and the spread of local anesthetic in the caudal epidural space is less reliable.
Which of the following tests would be most appropriate for testing neural integrity during posterior fossa surgery? A. Somatosensory evoked potentials B. Visual evoked potentials C. Brainstem auditory evoked potentials D. Wake-up test
C. Brainstem auditory evoked potentials Brainstem auditory evoked potentials assess the integrity of the 8th cranial nerve and the auditory pathways above the pons. Somatosensory evoked potentials assess the dorsal spinal column and sensory cortex and are best for monitoring during spinal surgery, carotid endarterectomy, and aortic surgery. Visual evoked potentials assess the integrity of the optic nerve and upper brainstem and are best for monitoring during pituitary resection. The wake-up test assesses movement and evaluates the integrity of the motor tracts in the ventral spinal column. Nagelhout JJ, Elisha S. Nurse Anesthesia. 6th ed. St. Louis, MO: Elsevier, Inc.; 2018: 307-307
The cricoid cartilage is an anatomic landmark that corresponds to the vertebral body of A. C4 B. C5 C. C6 D. C7
C. C6 The cricoid cartilage is an anatomic landmark that corresponds to the vertebral body of C6.
Which of the following statements regarding COX-2 inhibitors is false? A. COX-2 inhibitors have a lower incidence of gastrointestinal side effects than non-selective NSAIDs B. COX-2 inhibitors inhibit prostaglandin synthesis C. COX-2 inhibitors decrease platelet aggregation D. COX-2 inhibitors are highly protein bound
C. COX-2 inhibitors decrease platelet aggregation COX-1 receptor inhibition by NSAIDs is responsible for the gastric irritation, decrease in renal blood flow, and platelet inhibition associated with nonselective NSAIDs. COX-2 receptor inhibition is responsible for the decrease in pain and inflammation.
A surgeon has ordered cefazolin for preoperative antibiotic prophylaxis. However, the patient is allergic to cefazolin. Which antibiotics would be the most appropriate alternatives? (select two) A. Cefuroxime B. Ketoconazole C. Clindamycin D. Vancomycin
C. Clindamycin D. Vancomycin Both clindamycin and vancomycin can be administered safely. Cefazolin is a cephalosporin antibiotic; cefuroxime is in this same drug classification and would not be appropriate for this patient. Ketoconazole is an antifungal agent, not an antibiotic.
A patient presents to your hospital with acute appendicitis. You are planning a rapid sequence induction with succinylcholine (Sch). You interview the patient who indicates he had a positive fluoride test with a value of 36. What does this indicate, what do you do, and what will you see clinically if you administer Sch? A. Heterozygous pseudocholinesterase deficiency, use one-half the dose of Sch, normal duration of action B. Homozygous pseudocholinesterase deficiency, avoid Sch, shorter duration of action C. Homozygous pseudocholinesterase deficiency, avoid Sch, prolonged duration of action D. Heterozygous pseudocholinesterase deficiency, double the dose of Sch, shorter duration of action
C. Homozygous pseudocholinesterase deficiency, avoid Sch, prolonged duration of action A fluoride resistance test can help confirm a diagnosis of atypical pseudocholinesterase function. A result of 60 indicates normal pseudocholinesterase function. A result of 36 is consistent with the homozygous atypical pseudocholinesterase function and would result in a prolonged duration of action of succinylcholine.
What is the most common cause of postoperative vision loss from a spine operation? A. Central retinal artery occlusion B. Corneal abrasion C. Ischemic optic neuropathy D. Cortical blindness
C. Ischemic optic neuropathy Ischemic optic neuropathy is the most frequent cause of postoperative visual loss following prone spinal surgery.
Which nerve roots contribute to the femoral nerve? (select three) A. T12 B. L1 C. L2 D. L3 E. L4 F. L5 G. S1 H. S2
C. L2 D. L3 E. L4 The L2-L4 nerve roots contribute fibers to the femoral nerve.
Which of the following drugs is suitable for use in an intravenous regional anesthetic (Bier block)? A. Bupivacaine B. Ropivacaine C. Lidocaine D. Etidocaine
C. Lidocaine Lidocaine is suitable for Bier blocks because of the low risk of toxicity at the doses used at a minimum tourniquet time of 20 minutes. Because of its high risk for prolonged cardiotoxicity, bupivacaine in absolutely contraindicated for this procedure.
Which of the following represents a contraindication to nasotracheal intubation? A. Parietal fracture B. Mandibular fracture C. Maxillary fracture D. Temporal fracture
C. Maxillary fracture Relative contraindications to nasotracheal intubation include the setting of maxillary fractures and fractures to the base of the skull. Because it bypasses the gag reflex, it is generally tolerated better in the awake patient.
Blockade of which of the following nerves would result in an inability to adduct the legs? A. Femoral B. Sciatic C. Obturator D. Saphenous
C. Obturator The obturator nerve provides sensation to the medial aspect of the thigh and motor innervation to the adductor muscles located in the medial thigh.
A patient's preoperative labwork reveals an elevated calcium level. Which of the following are common causes of hypercalcemia? (select four) A. Hypoparathyroidism B. Renal disease C. Prolonged immobilization D. Hyperphosphatemia E. Sarcoidosis F. Vitamin D intoxication G. Hyperthyroidism H. Massive blood transfusion
C. Prolonged immobilization E. Sarcoidosis F. Vitamin D intoxication G. Hyperthyroidism Hypercalcemia results from disorders that result from increased absorption of calcium from the gastrointestinal tract or increased calcium resorption from the bones. Conditions that predispose a patient to hypercalcemia include milk alkali syndrome, vitamin D intoxication, sarcoidosis, hyperparathyroidism, malignancy, hyperthyroidism, and prolonged immobilization. Hyperphosphatemia and massive blood transfusion can both result in hypocalcemia.
You are about to perform a caudal anesthetic in an adult patient. You know that in this patient the dural sac normally ends at about the level of A. T12 B. L1 C. S2 D. S4
C. S2 The epidural sac extends to S2 in adults and S4 in children making inadvertent intrathecal injection more likely in children.
Which of the following structures would be visible in a patient with a Mallampati III airway classification? A. Hard palate only B. Soft palate, fauces, pillars C. Soft palate, uvular base D. Uvular base only
C. Soft palate, uvular base In a patient with a Mallampati III airway classification, the soft palate and base of the uvula are visible.
Which patient safety initiative outlines a list of serious, reportable adverse outcomes such as surgery on the wrong site? A. The WHO Safe Surgery Saves Lives Initiative B. The WHO Surgical Safety Checklist C. The National Quality Forum D. The National Patient Safety Group
C. The National Quality Forum The NQF devised and endorsed a list of serious reportable events. These events are serious, adverse, unambiguous, and mainly preventable, demonstrating a defect in a healthcare setting's safety system. Many of these events are related to invasive or surgical procedures that are performed on the wrong patient, wrong site, or performance of the wrong procedure.
Which of the following regarding retrobulbar block is false? (select two) A. Retrobulbar block may result in bradycardia B. Blindness is a potential risk in performing retrobulbar block C. The injection can be performed both above or below the eye with the same degree of risk D. Retrobulbar blocks typically paralyze the orbicularis oculi muscles
C. The injection can be performed both above or below the eye with the same degree of risk D. Retrobulbar blocks typically paralyze the orbicularis oculi muscles Retrobulbar block may result in bradycardia as there is a risk of eliciting the oculocardiac reflex during injection. Because of potential trauma resulting from puncture or perforation of the globe or hemorrhage from puncture of a vessel located behind the globe, blindness is a potential risk of retrobulbar block. The injection is typically only performed below the globe as most of the vessels are positioned superiorly to the globe. Although the larger volume of anesthetic injected when performing peribulbar blocks results in akinesia of the eyelids, retrobulbar blocks typically leave the orbicularis oculi muscles intact, requiring a separate block of the facial nerve branches supplying these muscles to achieve akinesia.
Which of the following statements regarding cervical plexus blocks are true? (select two) A. A superficial cervical block can produce motor blockade in the prevertebral muscles B. A cervical plexus block can protect against the carotid sinus reflex C. The sensory and motor fibers in the cervical plexus can be blocked separately D. Subarachnoid injection is a possible complication of a cervical plexus block
C. The sensory and motor fibers in the cervical plexus can be blocked separately D. Subarachnoid injection is a possible complication of a cervical plexus block The cervical plexus block is unique in that the sensory fibers (superficial cervical plexus block) can be blocked separately from the motor fibers (deep cervical plexus block). A superficial cervical plexus block only provides anesthesia to the cutaneous sensation of the skin between the face and the T2 dermatome. A cervical plexus block does not protect against the carotid sinus reflex and local injection of the carotid sinus at the point where the carotid artery bifurcates is often necessary. Intravenous injection, spread of the local anesthetic into the epidural or subarachnoid space, and blockade of the phrenic or superior laryngeal nerves are potential complications of a cervical plexus block.
An inability to oppose the fifth finger and a decrease in sensation to the fourth and fifth fingers is consistent with injury to which nerve? A. Radial B. Median C. Ulnar nerve D. Spinal accessory
C. Ulnar nerve An inability to oppose the fifth finger and decreased sensation to the fourth and fifth fingers is consistent with injury to the ulnar nerve.
A coupling gel must be placed between the skin and a Doppler probe when assessing for the presence of a pulse because A. an electrically conductive interface increases the reliability of assessment when using a Doppler B. it provides a source of grounding to prevent inadvertent electrical discharge to the patient C. air reflects ultrasound waves D. it helps protect the patient from infection
C. air reflects ultrasound waves Because air reflects sound waves, placement of a coupling gel eliminates any layer of air between the skin and the Doppler probe and thereby increases the reliability of assessment. Electrically conductive gel is not necessary for use when using a Doppler.
A history of chronic alcohol abuse would result in A. an exaggerated response to hypnotics B. an exaggerated response to opioids C. an increased inhalational anesthetic requirement D. an increased albumin concentration
C. an increased inhalational anesthetic requirement Chronic alcohol consumption leads to an increased anesthetic requirement of inhalational agents, opioids, and hypnotics. A patient who is acutely intoxicated will have an exaggerated response to anesthetics. Alcoholic hepatic insufficiency can lead to decreased albumin concentrations.
You are preparing to perform an intercostal nerve block. After preparing the skin with antiseptic solution, you make a skin wheal A. at the superior border of the corresponding rib near the lateral edge of the scapula B. at the inferior border of the corresponding rib near the medial edge of the scapula C. directly over the rib near the midaxillary line D. 2 centimeters lateral to the edge of the sternum
C. directly over the rib near the midaxillary line Ideally, the patient is in the prone position, but can be performed with the patient lying on the unaffected side. The correct rib is identified by palpation, a skin wheal is made directly over it at the level of the midaxillary line, and then a 22 gauge B-bevel needle is walked off the inferior border of the rib and advanced about 0.5 cm. After careful aspiration for blood or air, 3 to 5 mL of local anesthetic is injected.
Which would be an expected side effect in a patient taking atorvastatin? A. rash B. orthostatic hypotension C. myalgia D. constipation
C. myalgia Atorvastatin is a statin lipid-lowering drug. The most common side effects are skeletal muscle pain. It can also be associated with increases in creatine kinease levels.
According to the AANA, institutional policies regarding advance directives (ADs) for patients undergoing anesthesia should be oriented towards A. maintaining the current AD until the patient arrives in PACU B. maintaining the AD throughout anesthesia C. suspending the AD until a specified time postop D. suspending the AD for 7 days postop
C. suspending the AD until a specified time postop The AANA recommends that institutions form patient-centered policies and create documentation to help educate patients and their families with the goal of suspending advance directives during anesthesia and for a specified time postoperatively.
Which of the following intravenous solutions are hypotonic? (select two) A. D5 LR B. D5W C. 1/2 NS D. D5 1/2 NS E. Plasmalyte F. 0.9% Saline G. D5 NS H. 7.5% NaHCO3
B. D5W C. 1/2 NS D5W (252 mOsm/L) and 1/2 NS (154 mOsm/L) are hypotonic.
Which local anesthetic solution would tend to drift higher vertically in the spinal canal? A. Hyperbaric solution B. Hypobaric solution C. Isobaric solution D. Normobaric solution
B. Hypobaric solution Hyperbaric solutions have a higher density than the CSF and will drift towards the dependent areas of the spinal canal. Hypobaric solutions are less dense than CSF and will drift upwards. Isobaric solutions have the same density as CSF. Normobaric is not a generally used term used to describe the density of local anesthetics in relation to CSF.
You are placing an epidural catheter using an air-filled syringe while performing the loss of resistance technique. For which patient should you switch to a fluid-filled syringe when checking for loss of resistance? A. A patient undergoing pancreatectomy B. A patient undergoing lithotripsy C. A patient undergoing vaginal delivery D. A patient undergoing pneumonectomy
B. A patient undergoing lithotripsy (I meant D, but clicked B) In patients presenting for lithotripsy, there is the possibility that turbulence at the air-water interface could cause neural damage if air is used.
You administer a liter of isotonic crystalloid to a patient. After 30 minutes, what percentage of the crystalloid is estimated to be left within the confines of the circulation? A. 0% B. 25% C. 50% D. 75%
B. 25% Approximately 25-30 minutes after intravenous administration of isotonic saline, about 75% of the administered fluid will have migrated outside the circulatory system (leaving only 25% still within the vessels). Because of this, crystalloids have limitations in their ability to treat hypovolemia.
What volume of local anesthetic would you expect to use in an ultrasound-guided popliteal sciatic block? A. 5 mL B. 10 mL C. 20 mL D. 40 mL
C. 20 mL The typical dose of local anesthetic used in an ultrasound-guided popliteal sciatic block is 20 mL.
What is 98.6 degrees Fahrenheit in degrees Celsius? A. 371.6 B. 72 C. 37 D. 0
C. 37 To go from Fahrenheit to Celsius, first subtract 32 degrees and then divide the answer by 1.8. For example, if we take 98.6 degrees fahrenheit and subtract 32 from it, we get 66.6 degrees. If we then divide that by 1.8, we get 37 degrees Celsius, which is the normal body temperature.
What is the recommended number of days for cessation of smoking to reduce postoperative pulmonary complications? A. 7 days B. 14 days C. 21 days D. 28 days
D. 28 days Smoking cessation for 2 days can decrease carboxyhemoglobin levels and improve mucous clearance. A patient must cease smoking for at least 4-8 weeks to reduce the rate of postoperative pulmonary complications.
Which of the following patients warrant close evaluation of cervical spine stability? A. A 44 year-old with carcinoid syndrome B. A 56 year-old with Huntington's chorea C. A 19 year-old with cystic fibrosis D. A 9 year-old with Down syndrome
D. A 9 year-old with Down syndrome Patients with Down syndrome have an increased risk for cervical spine instability.
Which of the following statements about ultrasound-guided nerve blocks are true? A. A low-frequency ultrasound is best for viewing superficial structures B. Tissue that reflects ultrasound waves poorly appears white on the monitor C. An ultrasound can identify structures as small as 0.1 mm in diameter D. A medical ultrasound machine functions between the frequencies of 2-13 MHz
D. A medical ultrasound machine functions between the frequencies of 2-13 MHz A medical ultrasound machine functions between the frequencies of 2-13 MHz. An ultrasound can identify structures as small as 1 mm in diameter, but doesn't have the resolution to accurately identify smaller structures. Tissue that reflects ultrasound waves poorly appears gray to black on the monitor. A high-frequency ultrasound is best for viewing superficial structures.
