NGR 6172 QUIZ 6 UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
Question:
A patient states that the dose of oxycodone he currently receives does not provide the
same pain relief as it used
to. The nurse understands that the patient has developed what?
A. Physical dependence
B. Tolerance
C. Withdrawal syndrome
D. An addiction
Answer:
Answer: B Rationale: Tolerance occurs with regular drug use and is a state in which a
particular dose elicits a smaller response than it did with prior use.
Question:
A patient is in treatment for alcohol addiction and has relapsed since his last
visit. The nurse knows this does not mean treatment has failed. Why?
A. Relapse indicates pharmacologic treatments are working.
B. Addiction is a chronic, relapsing disease that takes time to treat.
C. Alcohol addiction is particularly difficult to treat.
D. Patients often relapse during initial treatment.
Answer:
Answer: B Rationale: Addiction is a complex phenomenon that will have causes and
consequences unique to each individual's experience of the disease. Additionally,
neurological remodeling that occurs during treatment takes time.
Question:
Which of the following best explains why local anesthetics are preferred over general
anesthetics for minor procedures?
A) They cause generalized nervous system depression
B) They block pain without affecting consciousness
C) They have a longer duration of action
D) They always require intravenous administration
Answer:
Answer: B Rationale: Local anesthetics block nerve impulse conduction locally,
suppressing pain without causing generalized depression of the entire nervous system,
unlike general anesthetics.
,Question:
Lidocaine is classified as which type of local anesthetic?
A) Ester-type
B) Amide-type
C) Both ester and amide
D) Neither
Answer:
Answer: B Rationale: Lidocaine contains an amide linkage and is metabolized by
hepatic enzymes; it has a very low incidence of allergic reactions compared to
ester-type agents.
Question:
Which property of a local anesthetic primarily determines its onset of action?
A) Molecular size
B) Lipid solubility
C) Degree of ionization at physiological pH
D) All of the above
Answer:
Answer: D Rationale: Onset depends on molecular size, lipid solubility, and ionization
degree, which affect the drug's ability to penetrate nerve membranes quickly.
Question:
The addition of epinephrine to a local anesthetic primarily:
A) Increases systemic toxicity
B) Prolongs the duration of anesthesia
C) Causes immediate systemic absorption
D) Is contraindicated in all patients
Answer:
Answer: B Rationale: Epinephrine causes vasoconstriction, reducing blood flow to the
site, delaying systemic absorption, prolonging anesthesia, and reducing toxicity risk.
Question:
Which local anesthetic is most likely to cause allergic reactions?
A) Lidocaine
B) Procaine
C) Bupivacaine
D) Ropivacaine
Answer:
Answer: B Rationale: Procaine is an ester-type anesthetic, which has a higher incidence
of allergic reactions than amide-type agents like lidocaine.
,Question:
Select all adverse effects associated with systemic toxicity of local anesthetics:
A) Seizures
B) Bradycardia
C) Hypertension
D) Respiratory depression
E) Hyperglycemia
Answer:
Answer: A, B, D Rationale: Systemic toxicity can cause CNS excitation (seizures),
followed by depression (respiratory depression), and cardiovascular depression
(bradycardia). Hypertension and hyperglycemia are not typical direct effects.
Question:
Which of the following are true regarding cocaine as a local anesthetic? (Select that
apply)
A) It causes vasoconstriction
B) It is an amide-type anesthetic
C) It can cause significant CNS stimulation
D) It is safe for use in patients with cardiovascular disease
Answer:
Answer: A, C Rationale: Cocaine is an ester-type anesthetic that causes intense
vasoconstriction by blocking norepinephrine reuptake, leading to CNS stimulation. It is
risky in cardiovascular disease due to tachycardia and hypertension risk.
Question:
Which factors increase systemic absorption of topical local anesthetics? (Select that
apply)
A) Application to broken skin
B) Use over small areas
C) Increased skin temperature
D) Wrapping or heating the application site
Answer:
Answer: A, C, D Rationale: Broken skin, increased temperature, and wrapping increase
blood flow or permeability, enhancing absorption and toxicity risk.
Question:
Select all correct statements about ester-type local anesthetics:
A) Metabolized by plasma esterases
B) Cross-reactivity with amide-type anesthetics is common
C) More likely to cause allergic reactions than amides
D) Procaine is an example
Answer:
Answer: A, C, D Rationale: Ester anesthetics are metabolized by plasma esterases, have
a higher allergy risk, and procaine is a prototype. Cross-reactivity with amides does not
occur.
, Question:
Which monitoring parameters are essential after injection of a local anesthetic? (Select
all that apply)
A) Blood pressure
B) Respiratory rate
C) Level of consciousness
D) Liver function tests
Answer:
Answer: A, B, C Rationale: Cardiovascular and CNS toxicity require close monitoring of
blood pressure, respiratory function, and consciousness; liver function tests are not
immediately relevant post-injection.
Question:
True or False: Local anesthetics selectively block pain fibers while sparing motor fibers.
Answer:
Answer: False Rationale: Local anesthetics block all nerve fibers they reach, including
motor neurons, but small, nonmyelinated pain fibers are blocked more rapidly.
Question:
True or False: Topical benzocaine is contraindicated in children younger than 2 years
due to risk of methemoglobinemia.
Answer:
Answer: True Rationale: Benzocaine can cause methemoglobinemia, particularly
dangerous in young children.
Question:
True or False: Epinephrine should be avoided in local anesthetics administered to
fingers or toes due to risk of ischemia.
Answer:
Answer: True Rationale: Vasoconstriction from epinephrine can cause ischemic
necrosis in end-artery areas like digits.
Question:
True or False: Allergic reactions to amide local anesthetics are common.
Answer:
Answer: False Rationale: Allergic reactions to amide anesthetics are very rare
compared to ester types.
Question:
True or False: Cocaine is no longer used clinically due to its high abuse potential and
toxicity.
Answer:
Answer: False Rationale: Cocaine is still used topically in ENT procedures for its potent
vasoconstrictive and anesthetic effects despite abuse potential.
CORRECT ANSWERS
Question:
A patient states that the dose of oxycodone he currently receives does not provide the
same pain relief as it used
to. The nurse understands that the patient has developed what?
A. Physical dependence
B. Tolerance
C. Withdrawal syndrome
D. An addiction
Answer:
Answer: B Rationale: Tolerance occurs with regular drug use and is a state in which a
particular dose elicits a smaller response than it did with prior use.
Question:
A patient is in treatment for alcohol addiction and has relapsed since his last
visit. The nurse knows this does not mean treatment has failed. Why?
A. Relapse indicates pharmacologic treatments are working.
B. Addiction is a chronic, relapsing disease that takes time to treat.
C. Alcohol addiction is particularly difficult to treat.
D. Patients often relapse during initial treatment.
Answer:
Answer: B Rationale: Addiction is a complex phenomenon that will have causes and
consequences unique to each individual's experience of the disease. Additionally,
neurological remodeling that occurs during treatment takes time.
Question:
Which of the following best explains why local anesthetics are preferred over general
anesthetics for minor procedures?
A) They cause generalized nervous system depression
B) They block pain without affecting consciousness
C) They have a longer duration of action
D) They always require intravenous administration
Answer:
Answer: B Rationale: Local anesthetics block nerve impulse conduction locally,
suppressing pain without causing generalized depression of the entire nervous system,
unlike general anesthetics.
,Question:
Lidocaine is classified as which type of local anesthetic?
A) Ester-type
B) Amide-type
C) Both ester and amide
D) Neither
Answer:
Answer: B Rationale: Lidocaine contains an amide linkage and is metabolized by
hepatic enzymes; it has a very low incidence of allergic reactions compared to
ester-type agents.
Question:
Which property of a local anesthetic primarily determines its onset of action?
A) Molecular size
B) Lipid solubility
C) Degree of ionization at physiological pH
D) All of the above
Answer:
Answer: D Rationale: Onset depends on molecular size, lipid solubility, and ionization
degree, which affect the drug's ability to penetrate nerve membranes quickly.
Question:
The addition of epinephrine to a local anesthetic primarily:
A) Increases systemic toxicity
B) Prolongs the duration of anesthesia
C) Causes immediate systemic absorption
D) Is contraindicated in all patients
Answer:
Answer: B Rationale: Epinephrine causes vasoconstriction, reducing blood flow to the
site, delaying systemic absorption, prolonging anesthesia, and reducing toxicity risk.
Question:
Which local anesthetic is most likely to cause allergic reactions?
A) Lidocaine
B) Procaine
C) Bupivacaine
D) Ropivacaine
Answer:
Answer: B Rationale: Procaine is an ester-type anesthetic, which has a higher incidence
of allergic reactions than amide-type agents like lidocaine.
,Question:
Select all adverse effects associated with systemic toxicity of local anesthetics:
A) Seizures
B) Bradycardia
C) Hypertension
D) Respiratory depression
E) Hyperglycemia
Answer:
Answer: A, B, D Rationale: Systemic toxicity can cause CNS excitation (seizures),
followed by depression (respiratory depression), and cardiovascular depression
(bradycardia). Hypertension and hyperglycemia are not typical direct effects.
Question:
Which of the following are true regarding cocaine as a local anesthetic? (Select that
apply)
A) It causes vasoconstriction
B) It is an amide-type anesthetic
C) It can cause significant CNS stimulation
D) It is safe for use in patients with cardiovascular disease
Answer:
Answer: A, C Rationale: Cocaine is an ester-type anesthetic that causes intense
vasoconstriction by blocking norepinephrine reuptake, leading to CNS stimulation. It is
risky in cardiovascular disease due to tachycardia and hypertension risk.
Question:
Which factors increase systemic absorption of topical local anesthetics? (Select that
apply)
A) Application to broken skin
B) Use over small areas
C) Increased skin temperature
D) Wrapping or heating the application site
Answer:
Answer: A, C, D Rationale: Broken skin, increased temperature, and wrapping increase
blood flow or permeability, enhancing absorption and toxicity risk.
Question:
Select all correct statements about ester-type local anesthetics:
A) Metabolized by plasma esterases
B) Cross-reactivity with amide-type anesthetics is common
C) More likely to cause allergic reactions than amides
D) Procaine is an example
Answer:
Answer: A, C, D Rationale: Ester anesthetics are metabolized by plasma esterases, have
a higher allergy risk, and procaine is a prototype. Cross-reactivity with amides does not
occur.
, Question:
Which monitoring parameters are essential after injection of a local anesthetic? (Select
all that apply)
A) Blood pressure
B) Respiratory rate
C) Level of consciousness
D) Liver function tests
Answer:
Answer: A, B, C Rationale: Cardiovascular and CNS toxicity require close monitoring of
blood pressure, respiratory function, and consciousness; liver function tests are not
immediately relevant post-injection.
Question:
True or False: Local anesthetics selectively block pain fibers while sparing motor fibers.
Answer:
Answer: False Rationale: Local anesthetics block all nerve fibers they reach, including
motor neurons, but small, nonmyelinated pain fibers are blocked more rapidly.
Question:
True or False: Topical benzocaine is contraindicated in children younger than 2 years
due to risk of methemoglobinemia.
Answer:
Answer: True Rationale: Benzocaine can cause methemoglobinemia, particularly
dangerous in young children.
Question:
True or False: Epinephrine should be avoided in local anesthetics administered to
fingers or toes due to risk of ischemia.
Answer:
Answer: True Rationale: Vasoconstriction from epinephrine can cause ischemic
necrosis in end-artery areas like digits.
Question:
True or False: Allergic reactions to amide local anesthetics are common.
Answer:
Answer: False Rationale: Allergic reactions to amide anesthetics are very rare
compared to ester types.
Question:
True or False: Cocaine is no longer used clinically due to its high abuse potential and
toxicity.
Answer:
Answer: False Rationale: Cocaine is still used topically in ENT procedures for its potent
vasoconstrictive and anesthetic effects despite abuse potential.
