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Anesthesia, Moderate Sedation, Pre
and Post Nursing Care Practice
Questions And Answers 2023
Updated Review
A nurse administered midazolam IV bolus to a client before a procedure. His BP is 86/40 mm Hg, and his pulse is 134/min. Which of the following IV medications should the nurse administer? A. Naloxone B. Morphine C. Flumazenil D. Atropine - Correct Answer-C. Flumazenil Rationale: Flumazenil is the antidote for benzos, naloxone is the antidote for opioids, morphine is given for pain and atropine treats bradycardia A nurse is assisting an anesthesiologist in the delivery of nitrous oxide by face mask to a client during the induction of anesthesia. Which of the following is the priority nursing action? A. Assess O2 saturation B. Measure BP C. Palpate pulse rate D. Check temp - Correct Answer-A. Assess O2 saturation Rationale: The greatest risk for injury during anesthesia is hypoxia, the priority action is to maintain and ensure a patent airway A nurse is caring for a client who develops malignant hyperthermia. Which of the following actions should the nurse take? SATA A. Infuse iced IV fluids B. Provide 100% O C. Place cooling blanket on client D. Treat complication while continuing surgery E. Administer IV dantrolene - Correct Answer-A. Infuse iced IV fluids B. Provide 100% O C. Place cooling blanket on client E. Administer IV dantrolene Rationale: Measures to cool down patient and maintain a patent airway is priority. Administer IV dantrolene which is a muscle relaxant that treats malignant hyperthermia. The procedure should be canceled immediately
A nurse is caring for a client who develops a systemic toxic reaction following a regional block. Which of the following actions should the nurse take? A. Monitor serum creatinine levels B. Provide airway support C. Turn client to the right side D. Administer 0.9% sodium chloride 500 ml bolus - Correct Answer-B. Provide airway support Rationale: Systemic shock reaction casues CNS depression, priority action is to provide airway support. ABGs should be monitored instead of creatinine, turning client would not improve condition, fluid bolus would make it worse b/c hypertension is one of the manifestations A nurse is caring for a client who reports a headache following an epidural regional nerve block. Which of the following actions should the nurse take? A. Decrease the clients fluid intake B. Apply pressure to the puncture site C. Place head of bed flat D. Instruct client to lie prone - Correct Answer-C. Place head of bed flat Rationale: Client is experiencing a headache due to CSF leak. Increasing fluids would help replace CSF loss, applying pressure to site will not stop leakage as CSF composition is different from blood, keeping head of bed flat promotes dura tear to seal, lying prone will worsen the headache When is general anesthesia used? - Correct Answer-Major surgery When complete muscle relaxation is required What is local anesthesia? - Correct Answer-Loss of sensation w/o loss of consciousness Paralysis in a specific area of the body What population is most susceptible to the effects of anesthesia? - Correct Answer- Older adults What can help control the incidence of adverse effects of anesthesia? - Correct Answer- Careful titration What is the main priority in anesthesia patients? - Correct Answer-Airway patency However, cardiac problems can arise much more quickly Risk Factors for General Anesthesia - Correct Answer-Hx of malignant hyperthermia Hypoventilation Dysrhythmias Altered cardiac output Gastric contents (may cause aspiration)
E. Respiratory Depression F. Delayed awakening - Correct Answer-A. Nausea/ vomiting B. Constipation D. Urinary retention E. Respiratory Depression F. Delayed awakening A nurse is preparing a client for a procedure. The doctors orders are for a medication that will provide mild sedation w/o respiratory depression. Which medication should the nurse know the doctor is referring to? A. Fentanyl B. Promethazine C. Diazepam D. Pentobarbital - Correct Answer-C. Diazepam Rationale: Benzodiazepines provide unconsciousness with little to no respiratory depression. However, cardiac and respiratory arrest may occur with rapid administration or overdose Which antiemetic also induces sedation? A. Ondansetron B. Metoclopramide C. Promethazine D. Reglan - Correct Answer-C. Promethazine A nurse is caring for a client who is taking metoclopramide. For which adverse effects should the nurse monitor for? SATA A. Dry mouth B. Constipation C. Dizziness D. Parkinsonism E. Dyskinesia - Correct Answer-A. Dry mouth C. Dizziness D. Parkinsonism E. Dyskinesia What is the purpose of administering atropine preoperatively? A. To induce a slow heart rate for surgery B. To decrease the risk of aspiration during surgery C. To enhance thermoregulation during the procedure D. To promote the effects of anesthesia - Correct Answer-B. To decrease the risk of aspiration during surgery Rationale: Atropine blocks the muscarinic response, slowing GI motility, salivation, bowel movements and GI secretions ultimately decreasing the risk of aspiration
For which condition should the nurse question the order for atropine? A. Gout B. Glasgow coma score of 13 C. GI irritation D. Glaucoma - Correct Answer-D. Glaucoma For which of the following reasons should the nurse4 question an order for sedatives (pentobarbital or secobarbital)? A. Constipation B. Started MAOI's 10 days ago C. Stopping MAOI's 3 weeks ago D. Tachycardia - Correct Answer-B. Started MAOI's 10 days ago Rationale: Avoid giving sedatives within 14 days of starting or stopping MAOI's What is a disadvantage of using neuromuscular blocking agents (Succinylcholine or Vecuronium)? A. It requires mechanical ventilation B. It takes longer to begin effects than other medications C. It has more adverse effects than other medications D. It requires an ECG monitor - Correct Answer-A. It requires mechanical ventilation Used or skeletal muscle relaxtation and Airway placement In conjunction with IV anesthetic ~ AE: total flaccid paralysis What are pre~anesthesia objectives? - Correct Answer-~Ensure consent form is signed, if client receives sedation they may not give legal consent ~urinate prior to reduce risk of falls, trying to get up ~place bed in low position with side rails up If hypotension occurs while under anesthesia the nurse should...? SATA A. Administer fluid IV bolus B. Place cooling blanket over patient C. Lower the head of the bed D. Place client in semi~fowlers E. Monitor clients status - Correct Answer-A. Administer fluid IV bolus C. Lower the head of the bed E. Monitor clients status Who should be notified first if there are abnormalities while client is under anesthesia? - Correct Answer-Anesthesiologist or surgeon What are early signs of Malignant hyperthermia? - Correct Answer-Increased Co2 levels Decreased O2 sat Tachycardia
Rationale: Epidural analgesia is administered in the epidural space, nerve block is administered into the extremity that will be operated on, A field block is injected near site for procedures of the chest, plastic surgery, dental or hernia repairs A nurse is caring for a patient who is experiencing headaches, blurred vision and has a metallic taste in his mouth. What complication does the nurse suspect? A. Toxic shock syndrome B. Systemic shock reaction C. Neurogenic Shock D. Septic Shock - Correct Answer-B. Systemic shock reaction ~w/o treatment, it leads to unconsciousness, hypotension, apnea, cardiac arrest and death ~ nursing actions: Establish airway, admin O2, monitor In what order does feeling return after anesthesia?
- cold
- sense of touch
- pain
- warmth
- ability to move - Correct Answer-2. sense of touch
- pain
- warmth
- cold
- ability to move A nurse is caring for a client reported to have autonomic nervous system blockade. The nurse knows the client will show which of the following signs and symptoms? SATA A. Hypertension B. Bradycardia C. Nausea/ vomiting D. Constipation E. Bruising - Correct Answer-B. Bradycardia C. Nausea/ vomiting Rationale: client will have hypotension, bradycardia, nausea and vomiting ~Nursing Actions: Lower head of bed, increase fluid infusion rate if no restrictions and monitor vitals What is moderate sedation? - Correct Answer-Patient is given sedatives, hypnotics, opioids so that client relaxes, has no discomfort yet can respond to verbal stimuli, retains protective reflexes and is arousable. Also maintains airway independently ~used for minor procedures
Which medications can alter a clients response to anesthesia? - Correct Answer- Diuretics Antihypertensives Opioids How long should a client be NPO prior to anesthesia? A. 7 hrs B. 6hrs C. 3 hrs D. 1 hr - Correct Answer-B. 6hrs However they may have clear liquids until 2 hrs prior Have client remove dentures in case intubation becomes necessary Which equipment is needed to be present when a client is under anesthesia? (SATA) A. Emergency cart B. 100% oxygen source C. ECG monitor D. Thermometer E. Forceps - Correct Answer-A. Emergency cart B. 100% oxygen source C. ECG monitor D. Thermometer Typical Discharge Criteria - Correct Answer-LOC same as admission Stable vitals for 30~90 min Ability to cough and deep breathe Ability to tolerate oral fluids Ability to urinate No nausea, vomiting, SOB or dizziness No obvious bleeding A nurse is assessing a client's lab values before surgery. Which of the following results should the nurse report to the provider? (SATA) A. Potassium 3. B. Sodium 145 C. Creatinine 2. D. Blood glucose 235 E. WBC 17,850 - Correct Answer-C. Creatinine 2. D. Blood glucose 235 E. WBC 17, Rationale: Potassium and sodium are WNL, Creatinine is 0.6~1.3, blood glucose should be 70~110, WBCs should be 4,500~10,
A preoperative nurse is caring for a client who is having a colon resection. Which of the following actions should the nurse take? A. Encourage the client to void after preoperative med admin B. Admin antibiotics 2 hrs prior to surgery C. Remove hair using a manual razor D. Remove all nail polish on fingers and toes - Correct Answer-D. Remove all nail polish on fingers and toes Rationale: Client should void prior to preoperative meds, antibiotics should be given 1 hr prior to surgery, hair should be removed using an electric razor or chemical depilatory. Nail polish, jewelry, dentures, prosthetics, makeup and glasses should all be removed prior to procedure What is the nurse's biggest concern when a pregnant woman requires surgery? A. Blood loss B. Fetal response to anesthesia - Correct Answer-B. Fetal response to anesthesia What should the nurse be concerned about for a diabetic patient requiring surgery? - Correct Answer-Delayed healing What should the nurse be concerned about for a patient requiring surgery with altered liver and kidney function? - Correct Answer-Altered med metabolism and excretion If a client states they are allergic to bananas or kiwi, this should also alert the nurse to a possible allergy to..? A. latex B. flu vaccine C. proprofol D. iodine - Correct Answer-A. latex When would a nurse use a 12 lead ECG if the client has no symptoms of cardiac problems? A. Family hx of cardiac problems B. Male gender C. Obese pt D. Age 40+ - Correct Answer-D. Age 40+ What preoperative procedures should a nurse perform for a client undergoing a bowel surgery? A. Enema the night before B. Laxative 1 hr prior - Correct Answer-A. Enema the night before Rationale: enemas and laxatives should be administered the night before or morning of Scheduled meds that can be held until after a procedure include? - Correct Answer- Antihypertensives, anticoagulants and antidepressants
How long should a patient be NPO before local anesthesia? A. 6 hrs B. 5 hrs C. 3 hrs D. 2 hrs - Correct Answer-C. 3 hrs 3~4 hrs What are complications associated with hypothermia during surgery? - Correct Answer- Increased chance for surgical wound infections, alters metabolism of medication, causes coagulation problems and dysrhythmias What gauge needle should be used to establish IV access prior to surgery? - Correct Answer-18 gauge What should the nurse do for a client on beta blockers or who was previously on beta blockers? - Correct Answer-Administer a beta blocker prior to surgery to prevent a cardiac event Who can give informed consent? - Correct Answer-Individuals 18+ or emancipated Mentally competent individuals Individuals not under the influence of opioids, benzos, sedatives or substance use Legal guardian of patient Patient that is not coerced What is required of clients with hearing or vision impairments or those who speak English as a second language when giving informed consent? - Correct Answer-Client signs with an X if unable to do a signature, if signed with an X, two witnesses are required When is informed consent required? - Correct Answer-Surgical procedures, invasive procedures, procedures requiring sedation or anesthesia, radiation, or has risk for serious complications When should aspirin be stopped prior to surgery? A. day before B. 2 weeks C. 1 week D. 3 days - Correct Answer-C. 1 week When should gingko biloba, ginseng, and feverfew be stopped prior to surgery? A. day before B. 2 weeks C. 1 week D. 3 days - Correct Answer-B. 2 weeks
A nurse is caring for a client who arrived in PACU following a total hip arthroplasty. The client is not responding to verbal stimuli. Which of the following actions should the nurse perform first? A. compare peripheral pulses B. Apply a warm blanket C. Assess dressings D. Place the client in lateral position - Correct Answer-D. Place the client in lateral position Rationale: Risk of aspiration A nurse is planning care for a client to prevent postoperative atelectasis. Which of the following interventions should the nurse include in the plan of care? (SATA) A. Encourage use of incentive spirometer every 2 hrs B. Instruct client to splint incision when coughing and deep breathing C. Reposition every 2 hrs D. Administer antibiotic therapy E. Assist with early ambulation - Correct Answer-A. Encourage use of incentive spirometer every 2 hrs B. Instruct client to splint incision when coughing and deep breathing C. Reposition every 2 hrs E. Assist with early ambulation Rationale: Promote lung expansion A nurse is caring for a client who reports nausea and vomiting 2 days postop following a hysterectyomy. Which of the following actions should the nurse perform first? A. Assess bowel sounds B. Administer antiemetics C. Restart prescribed IV fluids D. Insert a prescribed NG tube - Correct Answer-A. Assess bowel sounds Rationale: Nursing process Who is responsible for transferring a patient from the operating suite to PACU? - Correct Answer-The anesthesia provider (anesthesiologist or certified registered nurse anesthetist What are the three priorities immediately postop? - Correct Answer-Airway patency Ventilation Monitor circulatory status What kind of assessment is key for general anesthesia? A. sensory function B. motor function C. cardiac function
D. respiratory function - Correct Answer-D. respiratory function What kind of assessment is key for epidural/spinal anesthesia? A. sensory function/motor function B. GI function C. cardiac function D. respiratory function - Correct Answer-A. sensory function/motor function What is required to discharge a patient home postop? - Correct Answer-Demonstrate ability to swallow, safely ambulate to bathroom and wheelchair with assistance. Should be accompanied by a significant other, family member or caregiver who can receive discharge instructions and transport the patient home What is the first priority of the nurse receiving a patient in PACU? A. Full head to toe assessment B. Call family member to let them know the patient is out of surgery C. Document the time the patient arrived D. Position client to high fowlers - Correct Answer-A. Full head to toe assessment Rationale: Although documenting the time the patient arrived to the unit is important it is not the priority and should be included when documenting the assessment A nurse is assessing a client and hears absent breath sounds on the left. The nurse would suspect which of the following? A. Atelectatsis B. Pneumonia C. Migration of endotracheal tube D. Migration of chest tube - Correct Answer-C. Migration of endotracheal tube ~indicates migration of ET tube down right mainstem bronchus Rationale: It can also indicate pneumothorax A nurse is assessing a client with stridor on the left side of the chest. The nurse would suspect which of the following? A. Atelectasis B. Poor oxygen exchange C. Pneumonia D. Hemothorax - Correct Answer-B. Poor oxygen exchange A nurse is caring for a patient who is having a hard time coughing up secretions. The patient describes the secretions as thick. Which type of suction would the nurse use if the client does not want suction from his nose? A. Endotracheal suction tube B. Large French suction catheter C. Yankauer suction D. Nasopharyngeal suction - Correct Answer-C. Yankauer suction
A nurse is assessing a client postop who is responsive to verbal stimuli. What is the nurse's first action for the patient after completing a full head to toe assessment? A. Turn the client lateral B. Place pillows under the clients knees C. Get the client to shower D. Place the bed in semi Fowlers - Correct Answer-D. Place the bed in semi Fowlers Rationale: Facilitate chest expansion. The client should be turned lateral if they are unresponsive to stimuli to decrease the risk of aspiration. Do not place anything under clients knees unless indicated, due to decreased venous return. If client becomes hypotensive or shock is suspected. elevate legs and lower the head of the bed A nurse in the PACU unit is caring for a patient who had a regional block. The nurse knows that what qualifications are necessary for the client to be transferred back to a different unit? (SATA) A. Ability to speak B. Voluntary movement C. Score of 15 on the Glasgow coma scale D. Sensory function E. Pain of less than 5 on a scale of 1~10 - Correct Answer-B. Voluntary movement D. Sensory function A nurse is caring for a client postop of a C~section and notices scant new drainage spots on the wound dressing. What action should the nurse take at this time? A. Call the surgeon B. Change the dressing to a clean one C. Outline the drainage D. Document and monitor - Correct Answer-C. Outline the drainage Rationale: The first step is to outline the drainage and put the date and time it was discovered to track how quickly the patient is having new bleeding. If it becomes concerning the surgeon should then be notified. Once the new spots are outlined and dated, the finding may be documented and monitored. The surgeon performs the first dressing change in most instances. Causes of Delirium in Older Adults - Correct Answer-Anesthesia (can last 2 days) or other meds Dehydration Hypoxia Blood loss Electrolyte imbalance What factors are included in an Aldrete score? (SATA) A. Consciousness B. Circulation C. Activity
D. Pain E. O2 sat - Correct Answer-A. Consciousness B. Circulation C. Activity E. O2 sat Rationale: The five factors of an aldrete score are activity, cosnsciousness, circulation, O2 sat and respiration. Each is given a score between 0~2, 8~10 being a normal score Who's signature is needed before a client can be transferred to another unit or discharged home? A. Charge nurse at PACU B. Surgeon C. Anesthesiologist D. Social Work - Correct Answer-C. Anesthesiologist What is needed? ~aldrete score of 8~ ~stable vitals ~no evidence of bleeding ~Return of reflexes ~Minimal or absent n/v ~Minimal to moderate wound drainage ~Urine output at least 30/hr When is it contraindicated for a client to cough post op? - Correct Answer-Cosmetic, eye or intracranial surgeries During the first 48 hrs post op PRN meds are more effective than scheduled around the clock meds. True OR False - Correct Answer-False ~if PRN, patient should ask for pain meds BEFORE it gets severe ~manifestations of pain: tachycardia, tachypnea, hypertension, restlessness, wincing or moaning ~common adverse effects of opioids: resp depression, nausea, urinary retention and constipation A nurse is caring for a client postop who had anesthesia. The client just voided for the first time. What action should the nurse take at this time? A. Palpate for bladder distention B. Ask patient to rate pain C. Assess bowel sounds D. Take a set of vitals - Correct Answer-A. Palpate for bladder distention
A. Valsalva maneuver B. Head tilt/chin lift maneuver C. Heimlich maneuver D. Hubschers manuever - Correct Answer-B. Head tilt/chin lift maneuver Rationale: Hubschers maneuver is to test flexibility. Valsalva maneuver is to equalize pressure in the ears. Heimlich is if they are choking
- notify anesthesiologist
- elevate head of bed if not contraindicated (consider lateral)
- provide humidified oxygen
- plan for reintubation What is a penrose drain? - Correct Answer-Open drainage system Placed in the wound to drain fluid What is a JP drain? (Jackson~Pratt) - Correct Answer-Closed drainage system Suction device for postop drain What is a Hemovac Drain? - Correct Answer-Closed drainage system Placed under the skin during surgery Removes blood and other fluids that might build up Patients are able to go home with it. A nurse is caring for a patient who recently had abdominal surgery. Upon assessment the patient has absent bowel sounds. What actions are appropriate for the nurse to take? (SATA) A. Insert an NG tube B. Administer erythromycin C. Have the patient ambulate unless contraindicated D. Have the client consume food E. Give the patient ice chips - Correct Answer-A. Insert an NG tube B. Administer erythromycin C. Have the patient ambulate unless contraindicated Rationale: Patient is experiencing paralytic ileus. THe stomach contents are not moving. NG tube to empty stomach contents. Erythromycin is a prokinetic agent which helps (also metoclopramide). Risk Factors for Dehiscence and Evisceration - Correct Answer-Obesity Coughing Moving without splinting Poor nutritional status DM Infection Hematoma
Steroid use What actions should the nurse take if dehiscence or evisceration occurs? - Correct Answer-1. Call for help
- Stay with client
- Cover wound with sterile towel or dressing moistened with sterile saline
- Do not attempt o reinsert organs
- Place in low fowlers position with hips and knees bent
- Monitor for shock
- Notify provider immediately Causes of DVT - Correct Answer-Dehydration Stress response that leads to hypercoaguability Immobility Obesity Trauma Malignancy History of thrombosis Hormones Use of indwelling venous catheter
