Pharm Ch 27 General and Local Anesthetic Agents

The parents of a teething infant ask about over-the-counter (OCT) solutions to help minimize the pain. What assessment question has priority when preparing to provide suggestions?

"How old is your infant?"

A 12-year-old client will undergo surgery with spinal anesthesia. The client expresses a severe fear of needles. Which nurse response is appropriate and therapeutic for this client? "I understand that you are nervous, but I'll hold your hand and be right there with you." "You don't have to worry about the needle because you won't see it. It's going into your back." "Aren't you a little old to be afraid of needles?" "They will give you a numbing needle so you won't feel anything."

"I understand that you are nervous, but I'll hold your hand and be right there with you."

A client sustained a severe laceration to the right thumb and index finger that will require local anesthetic to facilitate suturing. Which statement should prompt the nurse to provide further client health education? "If I understand correctly, I won't be able to move my hand normally for a while after getting the anesthesia." "I have to admit I'm relieved that they'll be freezing my hand before they stitch it up." "They told me that it will take a few hours before I can feel my hand again." "I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out."

"I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out."

A 30-year-old client is to receive tetracaine (Pontocaine) via spinal anesthesia for an abdominal procedure. What should the nurse do to prevent side effects of this type of anesthesia? Attach Venodyne boots. Insert a Foley catheter. Maintain the client in a supine position following the procedure. Monitor the vital signs every 2 hours.

Maintain the client in a supine position following the procedure.

The nurse is educating an adult client diagnosed with herpetic lesions of the throat about the prescribed 1% viscous lidocaine gargle and swallow. Which statement made by the client establishes the need for further clarification?

"The drug may cause stinging and burning temporarily before the area is numb."

A 36-year-old will receive Carbocaine for a dental procedure. The maximum dose of mepivacaine (Carbocaine, Polocaine) is 6 mg/kg. If this client weighs 60 kg, what is the maximum dose the client could receive?

360 mg

Anatomically, where is the insertion point for spinal anesthesia?

lumbar spine

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 72-year-old female who had general anesthesia for lung removal A 35-year-old female who had a hysterectomy using general anesthesia A 64-year-old male who had bilateral femoral bypass grafting using spinal anesthesia A 26-year-old female who had a tubal ligation using general anesthesia

A 72-year-old female who had general anesthesia for lung removal

An otherwise healthy surgical client has developed sharply increased muscle tone and rapid increase in heart rate and core body temperature. The operating room (OR) team should proceed with assessments and interventions that address what health problem? orthostatic hypotension anaphylaxis rhabdomyolysis malignant hyperthermia

malignant hyperthermia

The client is to have a spinal anesthesia for surgery. While educating the client, which statement by the nurse is correct regarding the insertion of the needle? A needle is placed under the skin at the cervical vertebrae and the medication is administered via infiltration of the tissues. A large bore needled will be inserted into the antecubital area and medication will be administered into the vein. There will be no needles because spinal anesthesia is given via inhaled gasses. A small gauge needle will be inserted into the subarachnoid space and medication will be administered into the cerebrospinal fluid.

A small gauge needle will be inserted into the subarachnoid space and medication will be administered into the cerebrospinal fluid.

A 34-year-old man received a skin laceration while playing soccer that will require a few stitches. A local anesthetic will be used. Which medication would the nurse question for the use in this procedure?

A volatile liquid such as halothane or isoflurane (Fluothane)

What is the most important teaching point for a client after surgery when the client had epidural anesthesia? Remain supine for 24 hours after the epidural. Ambulate with assistance. Do not continue to take regularly prescribed medications. Do not eat or drink anything for 24 hours after the epidural.

Ambulate with assistance

The nurse instructs a client to use benzocaine to soothe the itching and pain related to an insect bite. Benzocaine is considered to be what type of dermatologic agent? Soothing Pain relief Anesthetic Antiseptic

Anesthetic

What is one of the registered nurse's primary roles in the administration of general anesthetic?

Assessing the client's status during recovery from anesthetic

What is one of the registered nurse's primary roles in the administration of general anesthetic? Administering intravenous anesthetics as prescribed Determining the client's most appropriate medication Assessing the client's status during recovery from anesthetic Administering inhaled anesthetics as prescribed

Assessing the client's status during recovery from anesthetic

A 39-year-old client will receive a caudal block for a perineal/vaginal repair. When counseling this client, which description is optimal for where the medication will be administered?

At the sacral portion of the spine

The nurse is aware that which medication will be used in the provision of local infiltrate anesthesia?

Bupivacaine (Marcaine)

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

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 CNS depression Neuroleptanalgesia Profound analgesia

CNS depression

A patient admitted to a local health care facility for surgery is to be administered general anesthesia. What are the nurse's responsibilities when caring for a patient receiving general anesthesia?

Checking the chart for any abnormal laboratory test results.

Administration of which class of medications can decrease secretions of the upper respiratory tract? Antiemetics Antianxiolytics Opioids Cholinergic antagonists

Cholinergic antagonists

The client suddenly develops numbness, tingling of face, tinnitus, and restlessness after receiving a nerve block with bupivacaine. Which action would the nurse implement first? Pad the rails and remove loose objects from the bed. Clamp the pain ball to stop the infusion of bupivacaine. Assess the airway and provide emergency support. Activate the emergency system, and stay with the client.

Clamp the pain ball to stop the infusion of bupivacaine.

The client is having a surgical procedure and does not want to know what is happening during surgery. The nurse in the operating room is aware that the client who has received etomidate, for induction of anesthesia, still maintains which vulnerability?

Client is able to feel pain

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?

Contact the health care provider

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?

Dantrolene sodium

A 44-year-old woman has been admitted to the hospital for lower abdominal surgery. She appears anxious and expresses concerns about the epidural procedure. What would be a therapeutic way to manage this client's anxiety?

Demonstrate active listening through eye contact and posture and then ask open-ended questions.

A man with no significant medical history is being prepared for outpatient surgery under general anesthesia. As part of the preparation for surgery, the anesthesiologist administers atropine, a anticholinergic agent. What is the purpose of administering this medication at this time? Relax the muscles. Decrease anxiety. Dry up secretions in the respiratory tract. Sedate the client.

Dry up secretions in the respiratory tract

A man with no significant medical history is being prepared for outpatient surgery under general anesthesia. As part of the preparation for surgery, the anesthesiologist administers atropine, an anticholinergic agent. What is the purpose of administering this medication at this time?

Dry up secretions in the respiratory tract.

What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)? Check the client's pulse and blood pressure. Position the client on his side to prevent aspiration of vomitus. Administer pain medication. Ensure the client has adequate respirations.

Ensure the client has adequate respirations.

The nurse is caring for a woman who received epidural anesthesia during the labor and delivery of her baby. The client is anxious to get up and take a shower. What is the nurse's best action in this situation? Give the woman a bed bath. Ensure the woman has return of normal feelings and movement in the lower extremities. Place the woman in a wheelchair and wheel her to the bathroom. Inform the woman that she will not be allowed out of bed for the next 24 hours.

Ensure the woman has return of normal feelings and movement in the lower extremities.

The nurse is caring for a client in the emergency department who will need sutures. The health care provider plans to use lidocaine. The nurse prepares the suture tray and places lidocaine and what other drug on the tray that helps prolong the local anesthetic effects?

Epinephrine

A 28-year-old patient has a history of malignant hyperthermia following anesthesia. Today, this patient is on the operating room schedule for a D&C;. Which method of anesthesia would not be acceptable for this patient? Spinal anesthesia Epidural anesthesia General anesthesia with an inhalation agent Local anesthesia

General anesthesia with an inhalation agent

During recovery from general anesthesia, what would be a priority? Monitoring temperature and reflexes Have emergency equipment readily available Providing comfort measures Providing pain relief as ordered

Have emergency equipment readily available

An operating room nurse is aware that isoflurane has sustained effects on the brain without significant absorption into blood or body tissues. What is an implication of the aspect of the drug's pharmacokinetics?

Induction takes place quickly

The nurse is caring for a patient who will receive an epidural block. In what surgeries would an epidural block be useful for pain control? Thoracotomy Closed reduction of a right humerous Breast reduction Inguinal hernia repair

Inguinal hernia repair

When preparing a client for the application of a local anesthetic, what would be most important? Assessing the peripheral pulses Checking the reflexes in that area Inspecting the application area for intactness Determining muscle tone

Inspecting the application area for intactness

Prior to the administration of a topical local anesthetic, what is the nurse's priority assessment?

Intact skin

What is the primary purpose of nitrous oxide in the surgical setting? It produces neuromuscular blockade when combined with volatile gases. It allows the anesthesia provider to initiate emergence immediately. It allows the anesthesia provider to administer lower doses of other anesthetics. It facilitates ventilation, perfusion, and diffusion while the client is intubated.

It allows the anesthesia provider to administer lower doses of other anesthetics.

The nurse at an urgent care clinical is reviewing local anesthetics. What drug should the nurse recognize as an amide? Benzocaine Tetracaine Procaine Lidocaine

Lidocaine

The client has had a swimming accident and lacerated his foot on a broken bottle in the water approximately 3 cm. The nurse is prepared to assist the healthcare provider with what type of anesthesia?

Local

Because of the risk of a spinal epidural hematoma, a client taking which medication is not a candidate for an epidural or spinal anesthesia?

Low molecular weight heparin (LMWH)

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

A nurse may be asked to administer which drug prior to a colonoscopy in order to help the client relax?

Midazolam

A client received fentanyl during a surgical procedure. The nurse will have what drug available to treat any possible respiratory depression associated with the use of fentanyl? Naloxone Propofol Midazolam Vecuronium

Naloxone

A client is most likely to experience respiratory adverse effects from which method of administration of a local anesthetic?

Nebulizer

Which agent would the nurse identify as always being given with oxygen?

Nitrous oxide

Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?

Oxygen

In ophthalmology, anticholinergic drugs are used because they produce which effect? Pupil dilation Decreased lacrimal secretions Sedation Pupil constriction

Pupil dilation

The nurse is preparing to admit a client who has received conscious sedation. What is the most important area to assess when the client returns from the procedureusing this type of anesthesia? Pulse Temperature Respirations Blood pressure

Respirations

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?

Respiratory depression and CNS suppression

A client is scheduled for dental surgery and will be given nitrous oxide. What assessment should the nurse prioritize before administering the medication?

Respiratory status

A client has received lidocaine 2% for a skin laceration repair. Before the repair begins, how would the nurse assess this client for adequate pain relief? Wait 20 to 30 minutes and assess the client for the presence of pain and pressure. Wait 10 to 15 minutes and ask the client if he or she is feeling pain once the repair begins. Wait 2 to 5 minutes and assess the area for pain and sensitivity to touch or pressure. Wait 30 to 60 minutes and assess the client for the presence of sensitivity to touch and pressure.

Wait 2 to 5 minutes and assess the area for pain and sensitivity to touch or pressure.

The 35-year-old client has presented to the OB ward for her third delivery by cesarean section. The nurse who is caring for this client prepares for which type of anesthesia? Topical General Spinal Local infiltrate

Spinal

The nursing instructor is teaching students about anesthesia and instructs that general surgical anesthesia is divided into four different stages. In which stage would the nurse expect to see delirium?

Stage 2

When describing the stages of anesthesia, during which stage does pupillary dilation occur?

Stage 3

The client is undergoing surgery for a small bowel resection. At this time the client is experiencing complete respiratory paralysis and is in the most dangerous stage of general anesthesia. Which stage is this?

Stage 4

There are different stages of anesthesia the client will go through in surgery. The circulating nurse is aware that extra caution is needed during which stage of general anesthesia, when the client may experience brief periods of delirium and excitement?

Stage II

The client is having a kidney removed due to a tumor. The circulating nurse in the operating room knows that which stage of anesthesia will be most dangerous to the client?

Stage IV

A 29-year-old female client in labor has just received epidural anesthesia. Before the procedure her blood pressure was 120/78 and her pulse was 60 bpm. Now her blood pressure is 100/60 and her pulse is 80 bpm. She reports a metallic taste in her mouth, hears a ringing in her ears, and appears confused. What is this client most likely experiencing?

Systemic toxicity from local anesthesia

How will the addition of nitrous oxide or IV anesthetics affect the minimum alveolar concentration (MAC) of isoflurane?

The MAC will decrease

A 37-year-old client has received procaine hydrochloride (Novocain) in the mouth for a dental procedure. How would the nurse evaluate that the outcome of reduced pain related to a dental procedure has been met?

The client's facial expressions are calm and relaxed.

The operating room nurse is taking a male patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104°F temperature in the operating room and nearly died 15 years ago. The nurse knows that the anesthetist is planning to use a volatile liquid as part of the anesthetic. What relevance is this information regarding the patient? The patient may be at risk for hypothermia. The patient may be nervous. The patient may be at risk for developing malignant hyperthermia. The grandmother's surgery has no relevance to the patient's surgery.

The patient may be at risk for developing malignant hyperthermia.

The nursing students are learning about synergistic effects of combined medications. Which is a desired effect of combining epinephrine with a local anesthetic? Select all that apply. There are fewer cardiac effects. There is a lower risk of systemic toxicity. There is potent vasodilatation. There are fewer gastrointestinal side effects. The local anesthetic stays in the desired tissues longer.

There is a lower risk of systemic toxicity. The local anesthetic stays in the desired tissues longer.

When local anesthetics are given, the nurse is aware that these drugs are able to induce a loss of pain and motor sensations by which methods? Select all that apply. They decrease the excitability of the cell. They elicit amnesia. They decrease the permeability of the cell membranes to sodium. They inhibit nerve impulses and pain signals are therefore not sent to the brain. They produce central nervous system depression.

They decrease the permeability of the cell membranes to sodium. They inhibit nerve impulses and pain signals are therefore not sent to the brain. They decrease the excitability of the cell.

When epinephrine is mixed with a local injectable anesthetic, it is done for what purpose?

To cause vasoconstriction

After reviewing information about general anesthetics, a group of students demonstrate understanding of the information when they identify which as acting like gas anesthetics?

Volatile liquids

Ursula is having a lesion excised. The health care provider plans to use a local anesthesia with the drug lidocaine. However, during the assessment, the nurse notices inflammation at the injection site. Is it necessary for the nurse to make a note of the observation, and why or why not?

Yes, to avoid systemic absorption of lidocaine

Prior to elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the client. The nurse should perform this education in the understanding that general anesthesia is best understood as what result? a stage N3 non-rapid eye movement sleep a state of reversible unconsciousness a nonreversible, temporary state of unresponsiveness a stage N2 non-rapid eye movement sleep

a state of reversible unconsciousness

A client is scheduled to undergo craniofacial surgery, a procedure that will necessitate the use of propofol. The operating room nurse should be aware that alternative medications will be absolutely necessary in order to produce what effect in the client? euphoria amnesia analgesia hypnosis

analgesia

A surgical client's balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize?

assessing and protecting the client's airway

1. The most dangerous period for many patients undergoing general anesthesia is during which stage? a. Stage 1, when communication becomes difficult b. Stage 2, when systemic stimulation occurs c. Stage 3, when skeletal muscles relax d. There is no real danger during general anesthesia

b. Stage 2, when systemic stimulation occurs

3. While a patient is receiving a general anesthetic, he or she must be continually monitored because a. the patient has no pain sensation. b. generalized CNS depression affects all body functions. c. the patient cannot move. d. the patient cannot communicate.

b. generalized CNS depression affects all body functions.

2. Recovery after a general anesthetic refers to the period of time a. from the beginning of anesthesia until the patient is ready for surgery. b. during the surgery when anesthesia is maintained at a certain level. c. from discontinuation of the anesthetic until the patient has regained consciousness, movement, and the ability to communicate. d. when the patient is in the most danger of CNS depression.

c. from discontinuation of the anesthetic until the patient has regained consciousness, movement, and the ability to communicate.

When in postanesthetic recovery, the nurse should assess for what adverse effect when ketamine is included in a surgical client's balanced anesthesia?

delirium and agitation

What medication belongs to the category of inhaled anesthetics?

desflurane

What should the perinatal nurse anticipate will be the anesthetic of choice for a primiparous woman has been in the first stage of labor for 2 hours?

epidural anesthesia

The anesthesiologist has informed the operating room nurse that opioids will be used to supplement anesthesia for a client undergoing a partial mastectomy. What opioid is most likely to be utilized?

fentanyl

What medical diagnosis is likely to be managed with the daily administration of a 5% to 20% topical benzocaine solution?

hemorrhoids

A 76-year-old woman has a complex medical history that includes emphysema, osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside her home as a result of weakness and suffered a fracture to her femoral head. The woman's subsequent hip-replacement surgery has been scheduled and the care team recognizes that the use of isoflurane will be most significantly influenced by

her history of emphysema

A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult client's imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means? intravenous (IV) administration of opioid analgesics subcutaneous (sub-Q) injection of a rapid-acting anesthetic intramuscular (IM) injection of anesthetics and benzodiazepines intravenous administration of anesthetics

intravenous administration of anesthetics

The nurse is working in a dental clinic assisting the dentist with a tooth extraction. The dentist numbs the gum with lidocaine before removing the tooth. This type of anesthetic is:

local infiltration

How does spinal procaine achieve anesthesia?

preventing the influx of sodium into nerve cells

After the administration of procaine to a client with a history that suggests a possible hypersensitivity to the drug, the nurse should prioritize what assessment?

respiratory

A client is scheduled for the surgical removal of a spinal tumor. During the induction phase of anesthesia, what event will occur?

securing a patent airway

A patient who has suffered a crushing injury to his thumb and two fingers in an accident at a factory is relieved to be administered a local anesthetic prior to treatment. The drugs that were administered decrease the permeability of the nerve cell membrane to: sodium. glucose. bicarbonate. phosphorus.

sodium

The nursing student identifies which people as qualified to administer anesthesia? (Check all that apply.) Physician assistant Surgeon Anesthesiologist Operating room nurse Nurse anesthetist

• Anesthesiologist • Nurse anesthetist

Which represent responsibilities of a nurse prior to a client's surgery? (Select all that apply.)

• Describe the preparation for surgery ordered by the health care provider. • Assess the physical status of the client. • Describe postoperative care. • Demonstrate postoperative client activities. • Demonstrate the use of a PCA pump.

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.

• General physical condition of the client • Area, organ, or system being operated on • Anticipated length of the surgical procedure

Inhaled anesthetic vapors are composed of volatile liquids. Which represent volatile liquids? (Select all that apply.)

• Halothane • Desflurane • Enflurane

The nurse knows there are certain effects with the use of epidural anesthesia. When a client is receiving epidural anesthesia, which will help to reduce the potential for a headache caused by the epidural? Select all that apply.

• IV hydration • Lying supine

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 Local anesthesia Regional anesthesia Spinal anesthesia

• Local anesthesia • General anesthesia

The nurse assists the health care provider during a diagnostic procedure as the health care provider administers by infiltration 2% chloroprocaine with preservatives to an adult client. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

• Monitor vital signs and report the development of tachycardia and hypertension to the health care provider. • Assess the respiratory status, including lung sounds, and report any development of bronchospasms. • Ask if the client feels any pain, pressure, or discomfort before or during the procedure.

The nurse is caring for a client in the postanesthesia care unit (PACU) and is aware that the client may experience what effects while emerging from inhalation anesthesia? (Select all that apply.)

• Nausea • Vomiting • Hypotension • Respiratory depression

Prior to administering morphine sulfate to a client in the postanesthesia recover unit (PACU), what information must the nurse obtain? (Select all that apply.)

• Pulse • Respirations • Blood pressure

Which stages of anesthesia are correctly paired? (Select all that apply.)

• Stage II - delirium • Stage IV - respiratory paralysis • Stage I - analgesia

What are responsibilities of the nurse when local injectable anesthesia is to be administered to a client? (Select all that apply.)

• Taking the client's allergy history • Explaining how the anesthetic will be administered • Preparing the area to be anesthetized • Applying a dressing to the area if appropriate

The following sensations are lost when local anesthetics are administered in increasing doses. Place the sensations in the proper sequence starting with the sensation lost first.

• Temperature • Touch • Proprioception • Skeletal muscle tone

The administration of local anesthetics will cause of loss of sensation of varying functions as the dosage is increased. Place the following sensations in the order that they fade away first when local anesthesia is given.

• Temperature • Touch • Proprioception (position sense) • Skeletal muscle tone

A client requires local anesthesia to be administered. The nurse identifies that the anesthetic may be administered by which route? Select all that apply.

• Topical anesthesia • Regional anesthesia • Local-infiltration anesthesia

The students are studying for an exam in pharmacology. They know several local anesthetics have been covered along with other forms. Which medication can they anticipate as being local anesthetics on the exam? Select all that apply. novocain xylocaine inapsine vistaril marcaine

• marcaine • xylocaine • novocain