NUR,..323,..FINAL,..EXAM,..|,..COMPREHENSIVE,..STUDY,..GUIDE,,..NCLEX-
STYLE,..PRACTICE,..QUESTIONS,..AND,..ANSWERS,..2026/2027
~20-25,..questions,..on,..psychotherapeutics
PK,..&,..PT,..–
,..inducing,,..inhibiting,,..bioavailability,..
Beta,..blockers,,..CCB’s,,..diuretics
7-8
64,..questions
Anesthetics
Local,..Anesthetics
• Reversibly,..block,..all,..nerve,..impulses,..by,..disrupting,..permeability,..to,..sodium,..d
uring,..action,..potential.
• Suppress,..impulse,..conduction,..along,..axons
o Conduction,..blocked,..only,..in,..neurons,..near,..the,..site,..of,..administration
• Sensations,..are,..blocked,..at,..different,..rates:,..pain,..first,,..followed,..by,..cold,,..war
mth,,..touch,,..and,..deep,..pressure
• Not,..limited,..to,..sensory,,..may,..affect,..motor
• Onset,..and,..duration,..affected,..by:
o Molecular,..size
o Lipid,..solubility
o Degree,..of,..ionization
o Regional,..blood,..flow,..–
,..more,..regional,..blood,..flow,,..the,..faster,..it,..will,..be,..carried,..away,,..the,..s
horter,..the,..duration
• Frequently,..combined,..with,..epinephrine
o Vasoconstrictor,..decreases,..local,..blood,..flow,..and,..decreases,..toxicity,..risk
▪ Decreases,..blood,..flow
▪ Delays,..absorption,..of,..anesthetic
▪ Less,..anesthetic,..needed
• But…toxicity,..can,..occur,..from,..the,..epinephrine…
o What,..is,..epi?
▪ Vasoconstrictor;,.. adrenergic,.. agonist
▪ Increased,..HR,,..BP,,..tremors,,..diaphoresis
▪ Fight,..or,..flight,..stimulation
• Adverse,..effects,..(absorption,..to,..metabolism,..ratio):
o Central,..Nervous,..System
▪ CNS,..agitation,..followed,..by,..depression
o Cardiovascular,.. system
▪ Heart,..cause,..suppression,..of,..excitability,..(bradycardia,,..AV,..
blocks,,..decreased,..contractility/suppresses,..the,..heart)
▪ Vessels,..causes,..vasodilation,..(hypotension)
o Allergic,..reactions
▪ Varied
o Methemoglobinemia
, ▪Topical,..benzocaine
▪Do,..not,..use,..for,..those,..<2,..years,..of,..age
▪Cautious,..use,..for,..all,..if,..mucous,..membrane,..use
o Labor,..and,..delivery
▪ Prolong,..labor,..by,..decreasing,..uterine,..contractility,..and,..maternal,.
.expulsion,..effort;,..can,..cause,..bradycardia,..and,..CNS,..depression
,..in,..the,..neonate
• Prototypes/Structures
, o Ester-type,..–,..Procaine,..(Novocain)
▪ Inactivated,..by,..plasma,..esterases
▪ Increased,..risk,..of,..hypersensitivity,..and,..allergic,..reactions
o Amide-type,..–,..Lidocaine
▪ Inactivated,..by,..hepatic,..enzymes
• Procaine
o Injection,..only
o Rarely,..used
• Lidocaine,..–,..lots,..of,..different,..preparations
o Administered,..topically,..and,..by,..injection
o Also,..used,..as,..an,..antidysrhythmic,..agent
o Duration,..of,..action,..depends,..on,..strength
o Addition,..of,..epinephrine
o Risk,..of,..systemic,..toxicity
• Topical,..Preparations
o Lidocaine,..-,..amide
o Cocaine,..–,..ester
o Tetracaine,..-,..ester
▪ Surface,..anesthesia
▪ Pain,,..itching,,..soreness,..caused,..by,..infections,,..thermal,..burns,,..b
ruises,,..abrasions,,..plant,..poisonings,,..insect,..bites
▪ Used,..in,..mucous,..membranes
o Risk,..for,..systemic,..toxicity
o Systemic,..absorption,..determined,..by…
▪ Amount,..applied
▪ Skin,..condition,..–
,..if,..there,..is,..some,..break,..in,..the,..skin,..then,..more,..of,..it,..is,..going,..t
o,..be,..absorbed
▪ Skin,..temperature,..–,..heat,..causes,..increased,..absorption
o Administration
▪ Smallest,..amount,..possible
▪ Avoid,..application,..to,..large,..areas
▪ Avoid,..application,..to,..broken,..skin
▪ Avoid,..strenuous,..exercise
▪ Avoid,..wrapping,..the,..site,..(occlusion)
▪ Avoid,..heating,..the,..site
• Injection,..Preparations
o Resuscitation,..equipment,..should,..be,..immediately,..available
o Maintain,..IV,..line,..for,..rapid,..treatment,..of,..toxicity
o Aspirate,..to,..ensure,..not,..administering,..in,..a,..vessel
o Monitor,..CV,..status,,..respiratory,..function,,..LOC
o Infiltration,..Anesthesia,..–,..lidocaine,..or,..bupivacaine
▪ Injected,..directly,..into,..area,..of, . . surgery,..or,..manipulation
▪ If,..combined,..with,..epinephrine
> No,..end,..artery,..areas
> No,..fingers,,..toes,,..noses,,..ears,,..or,..penis
, o Nerve,..block
STYLE,..PRACTICE,..QUESTIONS,..AND,..ANSWERS,..2026/2027
~20-25,..questions,..on,..psychotherapeutics
PK,..&,..PT,..–
,..inducing,,..inhibiting,,..bioavailability,..
Beta,..blockers,,..CCB’s,,..diuretics
7-8
64,..questions
Anesthetics
Local,..Anesthetics
• Reversibly,..block,..all,..nerve,..impulses,..by,..disrupting,..permeability,..to,..sodium,..d
uring,..action,..potential.
• Suppress,..impulse,..conduction,..along,..axons
o Conduction,..blocked,..only,..in,..neurons,..near,..the,..site,..of,..administration
• Sensations,..are,..blocked,..at,..different,..rates:,..pain,..first,,..followed,..by,..cold,,..war
mth,,..touch,,..and,..deep,..pressure
• Not,..limited,..to,..sensory,,..may,..affect,..motor
• Onset,..and,..duration,..affected,..by:
o Molecular,..size
o Lipid,..solubility
o Degree,..of,..ionization
o Regional,..blood,..flow,..–
,..more,..regional,..blood,..flow,,..the,..faster,..it,..will,..be,..carried,..away,,..the,..s
horter,..the,..duration
• Frequently,..combined,..with,..epinephrine
o Vasoconstrictor,..decreases,..local,..blood,..flow,..and,..decreases,..toxicity,..risk
▪ Decreases,..blood,..flow
▪ Delays,..absorption,..of,..anesthetic
▪ Less,..anesthetic,..needed
• But…toxicity,..can,..occur,..from,..the,..epinephrine…
o What,..is,..epi?
▪ Vasoconstrictor;,.. adrenergic,.. agonist
▪ Increased,..HR,,..BP,,..tremors,,..diaphoresis
▪ Fight,..or,..flight,..stimulation
• Adverse,..effects,..(absorption,..to,..metabolism,..ratio):
o Central,..Nervous,..System
▪ CNS,..agitation,..followed,..by,..depression
o Cardiovascular,.. system
▪ Heart,..cause,..suppression,..of,..excitability,..(bradycardia,,..AV,..
blocks,,..decreased,..contractility/suppresses,..the,..heart)
▪ Vessels,..causes,..vasodilation,..(hypotension)
o Allergic,..reactions
▪ Varied
o Methemoglobinemia
, ▪Topical,..benzocaine
▪Do,..not,..use,..for,..those,..<2,..years,..of,..age
▪Cautious,..use,..for,..all,..if,..mucous,..membrane,..use
o Labor,..and,..delivery
▪ Prolong,..labor,..by,..decreasing,..uterine,..contractility,..and,..maternal,.
.expulsion,..effort;,..can,..cause,..bradycardia,..and,..CNS,..depression
,..in,..the,..neonate
• Prototypes/Structures
, o Ester-type,..–,..Procaine,..(Novocain)
▪ Inactivated,..by,..plasma,..esterases
▪ Increased,..risk,..of,..hypersensitivity,..and,..allergic,..reactions
o Amide-type,..–,..Lidocaine
▪ Inactivated,..by,..hepatic,..enzymes
• Procaine
o Injection,..only
o Rarely,..used
• Lidocaine,..–,..lots,..of,..different,..preparations
o Administered,..topically,..and,..by,..injection
o Also,..used,..as,..an,..antidysrhythmic,..agent
o Duration,..of,..action,..depends,..on,..strength
o Addition,..of,..epinephrine
o Risk,..of,..systemic,..toxicity
• Topical,..Preparations
o Lidocaine,..-,..amide
o Cocaine,..–,..ester
o Tetracaine,..-,..ester
▪ Surface,..anesthesia
▪ Pain,,..itching,,..soreness,..caused,..by,..infections,,..thermal,..burns,,..b
ruises,,..abrasions,,..plant,..poisonings,,..insect,..bites
▪ Used,..in,..mucous,..membranes
o Risk,..for,..systemic,..toxicity
o Systemic,..absorption,..determined,..by…
▪ Amount,..applied
▪ Skin,..condition,..–
,..if,..there,..is,..some,..break,..in,..the,..skin,..then,..more,..of,..it,..is,..going,..t
o,..be,..absorbed
▪ Skin,..temperature,..–,..heat,..causes,..increased,..absorption
o Administration
▪ Smallest,..amount,..possible
▪ Avoid,..application,..to,..large,..areas
▪ Avoid,..application,..to,..broken,..skin
▪ Avoid,..strenuous,..exercise
▪ Avoid,..wrapping,..the,..site,..(occlusion)
▪ Avoid,..heating,..the,..site
• Injection,..Preparations
o Resuscitation,..equipment,..should,..be,..immediately,..available
o Maintain,..IV,..line,..for,..rapid,..treatment,..of,..toxicity
o Aspirate,..to,..ensure,..not,..administering,..in,..a,..vessel
o Monitor,..CV,..status,,..respiratory,..function,,..LOC
o Infiltration,..Anesthesia,..–,..lidocaine,..or,..bupivacaine
▪ Injected,..directly,..into,..area,..of, . . surgery,..or,..manipulation
▪ If,..combined,..with,..epinephrine
> No,..end,..artery,..areas
> No,..fingers,,..toes,,..noses,,..ears,,..or,..penis
, o Nerve,..block
