Chapter 50 Drug Therapy With General Anesthetics


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Chapter 50  Drug Therapy With General Anesthetics



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1. Prior to her elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the patient. The nurse should perform this education in the understanding that general anesthesia is best understood as

  1. A)  a nonreversible, temporary state of unresponsiveness.
  2. B)  a state of reversible unconsciousness.
  3. C)  stage N2 non–rapid eye movement sleep.
  4. D)  stage N3 non–rapid eye movement sleep.

Ans: B
General anesthesia is defined as a medication-induced reversible unconsciousness with loss of protective reflexes. There is the misconception that general anesthesia is a deep sleep.

2. A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult patient’s imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means?

  1. A)  Intramuscular injection of anesthetics and benzodiazepines
  2. B)  Intravenous administration of opioid analgesics
  3. C)  Subcutaneous injection of a rapid-acting anesthetic
  4. D)  Intravenous administration of anesthetics

Ans: D
The administration of a general anesthetic can be divided into three phases. The first phase is induction, which is rendering the patient unconscious by using inhalation anesthetics, intravenous anesthetics, or both. Adult patients usually receive a rapid-acting intravenous anesthetic medication. IM medications, sub-Q medications, and opioids are not used.

3. An adult patient who is currently undergoing rhinoplasty has developed the characteristic signs and symptoms of malignant hyperthermia. The operating room nurse should anticipate what intervention?

  1. A)  Hemodialysis
  2. B)  Tracheal intubation
  3. C)  IV administration of naloxone (Narcan)
  4. D)  IV administration of dantrolene sodium (Dantrium)

Ans: D
The treatment for malignant hyperthermia consists of intravenous dantrolene sodium (Dantrium), oxygenation and hyperventilation, hydration, and body cooling. The patient will already be intubated. Narcan and dialysis are not indicated.

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4. The operating room nurse is reading the anesthesiologist’s consult of a 30-year-old female patient who will undergo surgical repair of a meniscus tear later that day. The nurse reads that total intravenous anesthesia (TIV A) is indicated. What is the most likely rationale for this intervention?

  1. A)  The patient has a diagnosis of chronic obstructive pulmonary disease (COPD).
  2. B)  The patient’s insurer does not reimburse for inhaled anesthesia.
  3. C)  The patient has previously experienced severe postoperative nausea and vomiting.
  4. D)  The patient is in the first trimester of pregnancy.

Ans: C
In patients who have history of severe postoperative nausea and vomiting, the anesthetist may substitute the inhalation anesthetic with a technique called total intravenous anesthesia (TIVA). TIVA is not necessarily indicated in patients who are pregnant or who have COPD. Insurance considerations would not normally be an absolute indication for the use of TIVA.

5. A certified registered nurse anesthetist is describing the minimum alveolar concentration (MAC) of isoflurane. How will the addition of nitrous oxide or IV anesthetics affect the MAC of isoflurane?

  1. A)  The MAC will remain the same.
  2. B)  The MAC will decrease.
  3. C)  The MAC of isoflurane will not be relevant.
  4. D)  The MAC will be more difficult to calculate.

Ans: B
With the addition of other medications such as opioids, intravenous anesthetics, or nitrous oxide, the MAC values decrease.

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

  1. A)  Amnesia
  2. B)  Euphoria
  3. C)  Analgesia
  4. D)  Hypnosis

Ans: C
Propofol produces amnesia, euphoria, and hypnosis. It therefore blocks the perception of pain. It does not, however, provide analgesia.

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