CNS Anesthetics ELSEVIER Exam With Complete Solutions
A patient undergoing surgery reports that a relative experienced some sort of problem
related to surgery. What subjective information about a family member history would be
a contraindication for succinylcholine in the patient? -Answer Succinylcholine is
contraindicated in patients with a personal or familial history of malignant hyperthermia
or conditions which result in hyperkalemia, including denervation of skeletal muscles,
upper motor neuron disease, or a personal history of major burns or multiple traumas.
What is the site for the administration of which type of anesthetic agent, subarachnoid
space? Answer In intrathecal anesthesia, the anesthetic agent is injected into the
subarachnoid space. In epidural anesthesia, through a small catheter, the anesthetic
agent is injected into the epidural space without puncturing the dura. In the case of
infiltration, the anesthetic solution is injected into the tissue that surrounds the
operative site. Nerve block anesthesia is accomplished by injecting the anesthetic
solution at the site where a nerve innervates a specific area such as a tissue.
The patient questions the use of epinephrine to repair a laceration stating, "I thought
that was the drug they use in the emergency room when patients have cardiac arrest."
Select the nurse's best response. Epinephrine brings about vasoconstriction in the
localized region of the suture, enabling not only a bloodless field but also having a
delaying action on its absorption of lidocaine, thereby prolonging its anesthetic action.
It does not help the wearing off of the anesthetic effect sooner. Epinephrine is applied
for preventing adverse effects, but more precisely it is used in order to reduce toxicity
caused due to local anesthetics. Epinephrine is often added to the local anesthetic to
prolong local drug action. It does not, however, contribute to the systemic absorption of
lidocaine
Which of the following are clinical uses of the infiltration method of anesthesia? Select
all that apply - Answer The infiltration method is a technique of local anesthesia
involving injections of small amounts of anesthetic drug into tissue surrounding a site of
proposed surgery. Clinical applications of infiltration anesthesia commonly include
dental surgery and suturing of wounds. Epidural anesthesia is one of the most common
ways to reduce maternal discomfort during labor and delivery and pain after pelvic
surgery. Intrathecal anesthesia is one usual approach for abdominal or limb surgery.
Nerve block anesthesia is a usual method for severe pain such as chronic orthopaedic
pain.
, Which of the following opioid analgesics may be administered to induce anesthesia
when combined with a general anesthetic drug? Answer An adjunctive anesthetic is a
drug that enhances the clinical effect when administered in combination with another
drug. Fentanyl is an opioid analgesic that also used to induce anesthesia when
combined with a general anesthetic. Propofol is a parenteral anesthetic, but it is not an
opioid analgesic. Ketamine is a parenteral anesthetic and an adjunct to inhalational
anesthesia. Desflurane is an inhalational anesthetic used to induce general anesthesia.
A specifically significant complication associated with centrally acting local anesthesia
is: Answer Intrathecal anesthesia and epidural anesthesia are varieties of spinal or
intraspinal anesthesia given locally but acting centrally. Injury to the spinal layers or
involved structures is one of the notable complications with spinal anesthesia.
Respiratory depression or arrest is a complication of high doses from general
parenteral or inhalational anesthetics. Muscle fasciculations are muscle spasms
because of the damage caused to the muscles by NMBDs, but it's not a complication of
local anesthetic drugs. Malignant hyperthermia is a rare but potentially lethal adverse
metabolic response to general anesthetics.
Which of the following is a long-acting nondepolarizing neuromuscular blocking agent?
-Answer Pancuronium is a long-acting nondepolarizing neuromuscular blocking agent.
Rocuronium, vecuronium, and cisatracurium are intermediate acting nondepolarizing
neuromuscular blocking agents.
What are the signs and symptoms of malignant hyperthermia? Select all that apply. -
Answer Malignant hyperthermia is a rare, genetically linked adverse metabolic
response to general anesthesia. Tachypnea, tachycardia, and muscular rigidity are
some of the manifestations of malignant hyperthermia. Blood in the urine and
yellowness of the eyes are not manifestations of malignant hyperthermia. Blood in the
urine is hematuria, which is related to urinary tract infections. Yellowness of the eyes is
a sign of jaundice.
A patient with diabetes mellitus receives succinylcholine and becomes hypothermic;
mechanical ventilation is initiated. The nurse learns that the patient has been receiving
routine supplementation with vitamin A. The laboratory studies indicate hypocalcemia
and hypokalemia. What was the role of this patient's history in the development of the
patient's need for the ventilator? Answer Succinylcholine is a neuromuscular blocking
drug which, if overdosed, may cause respiratory muscles to paralyze thus needing a
prolonged mechanical ventilation. Hypocalcemia, hypokalemia, and hypothermia are
A patient undergoing surgery reports that a relative experienced some sort of problem
related to surgery. What subjective information about a family member history would be
a contraindication for succinylcholine in the patient? -Answer Succinylcholine is
contraindicated in patients with a personal or familial history of malignant hyperthermia
or conditions which result in hyperkalemia, including denervation of skeletal muscles,
upper motor neuron disease, or a personal history of major burns or multiple traumas.
What is the site for the administration of which type of anesthetic agent, subarachnoid
space? Answer In intrathecal anesthesia, the anesthetic agent is injected into the
subarachnoid space. In epidural anesthesia, through a small catheter, the anesthetic
agent is injected into the epidural space without puncturing the dura. In the case of
infiltration, the anesthetic solution is injected into the tissue that surrounds the
operative site. Nerve block anesthesia is accomplished by injecting the anesthetic
solution at the site where a nerve innervates a specific area such as a tissue.
The patient questions the use of epinephrine to repair a laceration stating, "I thought
that was the drug they use in the emergency room when patients have cardiac arrest."
Select the nurse's best response. Epinephrine brings about vasoconstriction in the
localized region of the suture, enabling not only a bloodless field but also having a
delaying action on its absorption of lidocaine, thereby prolonging its anesthetic action.
It does not help the wearing off of the anesthetic effect sooner. Epinephrine is applied
for preventing adverse effects, but more precisely it is used in order to reduce toxicity
caused due to local anesthetics. Epinephrine is often added to the local anesthetic to
prolong local drug action. It does not, however, contribute to the systemic absorption of
lidocaine
Which of the following are clinical uses of the infiltration method of anesthesia? Select
all that apply - Answer The infiltration method is a technique of local anesthesia
involving injections of small amounts of anesthetic drug into tissue surrounding a site of
proposed surgery. Clinical applications of infiltration anesthesia commonly include
dental surgery and suturing of wounds. Epidural anesthesia is one of the most common
ways to reduce maternal discomfort during labor and delivery and pain after pelvic
surgery. Intrathecal anesthesia is one usual approach for abdominal or limb surgery.
Nerve block anesthesia is a usual method for severe pain such as chronic orthopaedic
pain.
, Which of the following opioid analgesics may be administered to induce anesthesia
when combined with a general anesthetic drug? Answer An adjunctive anesthetic is a
drug that enhances the clinical effect when administered in combination with another
drug. Fentanyl is an opioid analgesic that also used to induce anesthesia when
combined with a general anesthetic. Propofol is a parenteral anesthetic, but it is not an
opioid analgesic. Ketamine is a parenteral anesthetic and an adjunct to inhalational
anesthesia. Desflurane is an inhalational anesthetic used to induce general anesthesia.
A specifically significant complication associated with centrally acting local anesthesia
is: Answer Intrathecal anesthesia and epidural anesthesia are varieties of spinal or
intraspinal anesthesia given locally but acting centrally. Injury to the spinal layers or
involved structures is one of the notable complications with spinal anesthesia.
Respiratory depression or arrest is a complication of high doses from general
parenteral or inhalational anesthetics. Muscle fasciculations are muscle spasms
because of the damage caused to the muscles by NMBDs, but it's not a complication of
local anesthetic drugs. Malignant hyperthermia is a rare but potentially lethal adverse
metabolic response to general anesthetics.
Which of the following is a long-acting nondepolarizing neuromuscular blocking agent?
-Answer Pancuronium is a long-acting nondepolarizing neuromuscular blocking agent.
Rocuronium, vecuronium, and cisatracurium are intermediate acting nondepolarizing
neuromuscular blocking agents.
What are the signs and symptoms of malignant hyperthermia? Select all that apply. -
Answer Malignant hyperthermia is a rare, genetically linked adverse metabolic
response to general anesthesia. Tachypnea, tachycardia, and muscular rigidity are
some of the manifestations of malignant hyperthermia. Blood in the urine and
yellowness of the eyes are not manifestations of malignant hyperthermia. Blood in the
urine is hematuria, which is related to urinary tract infections. Yellowness of the eyes is
a sign of jaundice.
A patient with diabetes mellitus receives succinylcholine and becomes hypothermic;
mechanical ventilation is initiated. The nurse learns that the patient has been receiving
routine supplementation with vitamin A. The laboratory studies indicate hypocalcemia
and hypokalemia. What was the role of this patient's history in the development of the
patient's need for the ventilator? Answer Succinylcholine is a neuromuscular blocking
drug which, if overdosed, may cause respiratory muscles to paralyze thus needing a
prolonged mechanical ventilation. Hypocalcemia, hypokalemia, and hypothermia are
