Pharmacology Prep U Chapter 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 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?

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

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

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

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 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?

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?

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

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 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?

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?

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?

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)?

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?

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

During recovery from general anesthesia, what would be a priority?

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

When preparing a client for the application of a local anesthetic, what would be most important?

Inspecting the application area for intactness

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

Intact skin

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

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 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?

Maintain the client in a supine position following the procedure.

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

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

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

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?

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.

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 state of reversible unconsciousness

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

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

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

Anatomically, where is the insertion point for spinal anesthesia?

lumbar spine

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

The nursing student identifies which people as qualified to administer anesthesia? (Check all that apply.)

• 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.)

• 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.

• marcaine • xylocaine • novocain