Chapter 11: General and Local Anesthetics

Test Bank

MULTIPLE CHOICE

1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the
emergency department to have it removed. The nurse anticipates that which type of anesthesia
will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine
ANS: D
Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting
the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of
nerves supplying the area to be anesthetized. The local anesthetic may be administered in a
circular pattern around the operative field. The other types are not appropriate for this injury.
This is a painful procedure; therefore, the option of “no anesthesia” is incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 175

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2. A patient is to receive local anesthesia for removal of a lymph node from his armpit. The
physician asks for a solution of premixed lidocaine and epinephrine. The nurse knows that the
epinephrine is used for which reason?
a. It prevents an anaphylactic reaction from occurring.
b. The anesthetic enhances the effect of the epinephrine.
c. Epinephrine contributes to a balanced anesthetic state.
d. It keeps the anesthetic at its local site of action and decreases incisional bleeding.
ANS: D
Vasoconstrictors such as epinephrine are coadministered with local anesthetics to keep the
anesthetic at its local site of action and to prevent systemic absorption. The other options are
not correct rationales for using this medication.

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3. During the immediate postoperative recovery period, what is the nurse’s priority assessment?
a. Pupil responses
b. Return to sensation
c. Level of consciousness
d. Airway, breathing, and circulation
ANS: D
 After surgery and the termination of general anesthesia, the priority assessment is the patient’s
airway, breathing, and circulation status. The other assessments are important but are not the
immediate concern.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 180

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MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse
notes a sudden elevation in body temperature. This finding may be an indication of which
problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia
ANS: D
A sudden elevation in body temperature during the postoperative period may indicate the
occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature
does not reflect the other problems listed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 172

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5. When assessing patients in the preoperative area, the nurse knows that which patient is at a
higher risk for an altered response to anesthesia?
a. The 30-year-old patient who has never had surgery before
b. The 45-year-old patient who stopped smoking 10 years ago
c. The 21-year-old patient who is to have a kidney stone removed
d. The 78-year-old patient who is to have gallbladder removal
ANS: D
The elderly patient is more affected by anesthesia than the young or middle-aged adult patient
because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 172

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6. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which
nursing diagnosis would be appropriate for this patient?
a. Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c. Decreased cardiac output related to systemic effects of local anesthesia
d. Impaired gas exchange related to central nervous system depression produced by
general anesthesia
ANS: D
 The nursing diagnosis of impaired gas exchange is appropriately worded for this patient.
Anxiety would not be appropriate while the patient is in surgery. Sensorium would be
decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not
local anesthesia.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 182

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7. When administering a neuromuscular blocking drug such as pancuronium (Pavulon), the

nurse needs to remember which principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
ANS: D
Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation
because of the resultant paralysis of the respiratory muscles. In addition, they do not cause
sedation or pain relief. They are used along with, not instead of, general anesthesia during
surgery.

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8. A patient has been given succinylcholine (Anectine) after a severe injury that necessitated
controlled ventilation. The physician now wants to reverse the paralysis. The nurse would
expect to use which drug to reverse the succinylcholine?
a. valium (Diazepam)
b. caffeine
c. neostigmine (Prostigmin)
d. vecuronium (Norcuron)
ANS: C
The antidote for neuromuscular blocking drugs is an anticholinesterase drug, such as
neostigmine. Neostigmine reverses the effects of neuromuscular blocking drugs. The other
drugs listed are not antidotes for neuromuscular blocking drugs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 179

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9. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that
he will be awake during the procedure but probably will not remember it. What type of
anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia
 ANS: B
Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the
medical procedure, yet it preserves a patient’s ability to maintain his or her own airway and
respond to verbal commands. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 173

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10. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a
patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle
rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate
treatment?
a. naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
b. dantrolene (Dantrium) injection, a skeletal muscle relaxant
c. An anticholinesterase drug, such as neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation
ANS: B
Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant
hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize
heart and lung function as well as with immediate treatment with the skeletal muscle relaxant
dantrolene. CPR is not immediately needed because the patient still has a pulse and
respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 172

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MULTIPLE RESPONSE

1. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an

appropriate indication for dexmedetomidine? (Select all that apply.)
a. Procedural sedation
b. Surgeries of short duration
c. Surgeries of long duration
d. Postoperative anxiety
e. Sedation of mechanically ventilated patients
ANS: A, B, E
Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short
duration, and it is also used in the intensive care setting for sedation of mechanically
ventilated patients. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 173

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MATCHING
 When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the
drug effects in the correct order, using the choices A through C listed below.
a. Cessation of respirations due to paralysis of diaphragm and intercostal muscles
b. Total flaccid paralysis
c. Weakness

1. Occurs first
2. Occurs second
3. Occurs last

1. ANS: C DIF: COGNITIVE LEVEL: Applying (Application)

REF: p. 177 TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
NOT: The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is
typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly
moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next
are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are
paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.
2. ANS: B DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 177 TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
NOT: The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is
typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly
moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next
are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are
paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.
3. ANS: A DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 177 TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
NOT: The drug effects of the neuromuscular blocking drugs are as follows: The first sensation that is
typically felt is muscle weakness. This is usually followed by total flaccid paralysis. Small, rapidly
moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next
are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are
paralyzed. Respirations stop as a result; the patient can no longer breathe on his or her own.

OTHER

1. A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an

endoscopy procedure. The medication is available in a strength of 5 mg/mL. How many
milliliters of medication will the nurse draw up into the syringe for this dose?

ANS:
0.4 mL
5 mg : 1 mL :: 2 mg : x mL
(5 ´ x) = (1 ´ 2); 5x = 2; x = 0.4

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. N/A

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