Pharm. 23, 24, 25, 26, 27, & 28 Exam 4
Questions and Correct Answers
The nurse evaluates the patient's serum phenytoin (Dilantin) level and determines the level is
therapeutic when it is within what range?
A) Between 5 and 12 mcg/mL
B) Between 10 and 20 mcg/mL
C) Between 15 and 50 mcg/mL
D) Between 40 and 100 mcg/mL - correct answers:B
The therapeutic serum level range for phenytoin is between 10 and 20 mcg/mL. The other options are
incorrect.
To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used?
A) Antihistamines
B) Antiemetics
C) Narcotics
D) Sedative-hypnotics - correct answers:D
Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation.
Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease
the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic
and sedative effects.
During what stage of anesthesia would the nurse see the patient's skeletal muscles relax and return of
regular respirations?
A) Stage 1: Analgesia stage
B) Stage 2: Excitement stage
C) Stage 3: Surgical anesthesia stage
D) Stage 4: Medullary paralysis - correct answers:C
,Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular
respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely
performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of
excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure
changes); and stage 4 involves deep central nervous system depression with loss of respiratory and
vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.
The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of
care for this patient?
A) Encourage clear fluids.
B) Increase oxygen.
C) Reassure the patient that about safety.
D) Maintain regular repositioning. - correct answers:D
The patient would need to be moved or turned periodically to prevent skin breakdown and the
formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from
the medications used in general anesthesia would prevent the patient from shifting himself or herself to
relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require
respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased
oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not
receive anything by mouth eliminating option A. Reassurance would not be necessary for the
unconscious patient.
A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which
diagnoses will the nurse include that is directly related to safety?
A) Deficient knowledge regarding drug therapy
B) Disturbed sensory perception (kinesthetic, tactile) related to anesthesia
C) Risk for impaired skin integrity related to immobility
D) Risk for injury related to central nervous system (CNS) depressive effects of drugs - correct answers:D
The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are
only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to
express safety concerns and must rely completely on the surgeon and OR staff for protection.
,What nursing interventions would help minimize the risk of a headache in a patient recovering from
spinal anesthesia?
A) Administer a triptan intramuscularly.
B) Administer morphine intravenously.
C) Maintain patient in recumbent position.
D) Place patient in Trendelenburg position. - correct answers:C
Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours.
Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine
would treat the headache but would not prevent it.
An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states
that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also
complains that his or her head feels fuzzy and that the right words will not come to his or her. What is
the priority nursing intervention for this patient?
A) Provide analgesic medication for the discomfort.
B) Stay with patient as much as possible and provide reassurance.
C) Provide fluids to increase his or her wakefulness.
D) Encourage the patient to turn from side to side periodically. - correct answers:B
Most patients are disoriented and confused when awaking from anesthesia. It would be most important
for the nurse to be with the patient as much as possible and reassure the patient that everything is as
expected. Providing pain medication is important and may be needed during recovery if the patient
reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide
fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel
motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority
nursing action at this time. However, the most effective nursing action for anxious postoperative patients
is for the nurse to stay with them as much as possible.
A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the
anesthesiologist induces the patient, what is the next phase of anesthesia?
A) Induction
B) Maintenance
, C) Recovery
D) Medullary paralysis - correct answers:B
Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached.
After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A
slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia
after the patient is in stage 3. This is followed by the recovery period that begins with the
discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C
is a distracter.
The nurse should recognize what drug is classified as an amide local anesthetic?
A) Lidocaine (Xylocaine)
B) Benzocaine (Dermoplast)
C) Chloroprocaine (Nesacaine)
D) Tetracaine (Pontocaine) - correct answers:A
Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester
anesthetics.
The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia.
While taking the admission history, the patient says she is allergic to lidocaine. What is the nurse's
priority action?
A) Notify the anesthesiologist.
B) Cancel the surgery.
C) Notify the surgeon.
D) Tell the perioperative nurse. - correct answers:Ans: A
The priority action is to inform the anesthesiologist who will administer the anesthetic because local
anesthesia often involves use of lidocaine. It is not within the nurse's scope of practice to cancel surgery.
Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.
The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this
patient?
Questions and Correct Answers
The nurse evaluates the patient's serum phenytoin (Dilantin) level and determines the level is
therapeutic when it is within what range?
A) Between 5 and 12 mcg/mL
B) Between 10 and 20 mcg/mL
C) Between 15 and 50 mcg/mL
D) Between 40 and 100 mcg/mL - correct answers:B
The therapeutic serum level range for phenytoin is between 10 and 20 mcg/mL. The other options are
incorrect.
To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used?
A) Antihistamines
B) Antiemetics
C) Narcotics
D) Sedative-hypnotics - correct answers:D
Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation.
Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease
the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic
and sedative effects.
During what stage of anesthesia would the nurse see the patient's skeletal muscles relax and return of
regular respirations?
A) Stage 1: Analgesia stage
B) Stage 2: Excitement stage
C) Stage 3: Surgical anesthesia stage
D) Stage 4: Medullary paralysis - correct answers:C
,Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular
respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely
performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of
excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure
changes); and stage 4 involves deep central nervous system depression with loss of respiratory and
vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.
The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of
care for this patient?
A) Encourage clear fluids.
B) Increase oxygen.
C) Reassure the patient that about safety.
D) Maintain regular repositioning. - correct answers:D
The patient would need to be moved or turned periodically to prevent skin breakdown and the
formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from
the medications used in general anesthesia would prevent the patient from shifting himself or herself to
relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require
respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased
oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not
receive anything by mouth eliminating option A. Reassurance would not be necessary for the
unconscious patient.
A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which
diagnoses will the nurse include that is directly related to safety?
A) Deficient knowledge regarding drug therapy
B) Disturbed sensory perception (kinesthetic, tactile) related to anesthesia
C) Risk for impaired skin integrity related to immobility
D) Risk for injury related to central nervous system (CNS) depressive effects of drugs - correct answers:D
The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are
only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to
express safety concerns and must rely completely on the surgeon and OR staff for protection.
,What nursing interventions would help minimize the risk of a headache in a patient recovering from
spinal anesthesia?
A) Administer a triptan intramuscularly.
B) Administer morphine intravenously.
C) Maintain patient in recumbent position.
D) Place patient in Trendelenburg position. - correct answers:C
Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours.
Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine
would treat the headache but would not prevent it.
An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states
that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also
complains that his or her head feels fuzzy and that the right words will not come to his or her. What is
the priority nursing intervention for this patient?
A) Provide analgesic medication for the discomfort.
B) Stay with patient as much as possible and provide reassurance.
C) Provide fluids to increase his or her wakefulness.
D) Encourage the patient to turn from side to side periodically. - correct answers:B
Most patients are disoriented and confused when awaking from anesthesia. It would be most important
for the nurse to be with the patient as much as possible and reassure the patient that everything is as
expected. Providing pain medication is important and may be needed during recovery if the patient
reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide
fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel
motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority
nursing action at this time. However, the most effective nursing action for anxious postoperative patients
is for the nurse to stay with them as much as possible.
A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the
anesthesiologist induces the patient, what is the next phase of anesthesia?
A) Induction
B) Maintenance
, C) Recovery
D) Medullary paralysis - correct answers:B
Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached.
After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A
slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia
after the patient is in stage 3. This is followed by the recovery period that begins with the
discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C
is a distracter.
The nurse should recognize what drug is classified as an amide local anesthetic?
A) Lidocaine (Xylocaine)
B) Benzocaine (Dermoplast)
C) Chloroprocaine (Nesacaine)
D) Tetracaine (Pontocaine) - correct answers:A
Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester
anesthetics.
The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia.
While taking the admission history, the patient says she is allergic to lidocaine. What is the nurse's
priority action?
A) Notify the anesthesiologist.
B) Cancel the surgery.
C) Notify the surgeon.
D) Tell the perioperative nurse. - correct answers:Ans: A
The priority action is to inform the anesthesiologist who will administer the anesthetic because local
anesthesia often involves use of lidocaine. It is not within the nurse's scope of practice to cancel surgery.
Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.
The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this
patient?
