NGR 6172 Quiz 6 Questions and Answers
Question 1.
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
Correct 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 2.
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.
Correct 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 3.
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
Correct 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 4.
Lidocaine is classified as which type of local anesthetic? A) Ester-type B) Amide-type C)
Both ester and amide D) Neither
Correct 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 5.
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
Correct 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 6.
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
Correct Answer: B Rationale: Epinephrine causes vasoconstriction, reducing
blood flow to the site, delaying systemic absorption, prolonging anesthesia, and
reducing toxicity risk.
Question 7.
Which local anesthetic is most likely to cause allergic reactions? A) Lidocaine B) Procaine
C) Bupivacaine D) Ropivacaine
Correct Answer: B Rationale: Procaine is an ester-type anesthetic, which has a
higher incidence of allergic reactions than amide-type agents like lidocaine.
Question 8.
Select all adverse effects associated with systemic toxicity of local anesthetics: A) Seizures
B) Bradycardia C) Hypertension D) Respiratory depression E) Hyperglycemia
Correct 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 9.
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
Correct 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 10.
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
Correct Answer: A, C, D Rationale: Broken skin, increased temperature, and
wrapping increase blood flow or permeability, enhancing absorption and toxicity
risk.
Question 11.
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
,Correct 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 12.
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
Correct 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 13.
True or False: Local anesthetics selectively block pain fibers while sparing motor fibers.
Correct Answer: False Rationale: Local anesthetics block all nerve fibers they
reach, including motor neurons, but small, nonmyelinated pain fibers are
blocked more rapidly.
Question 14.
True or False: Topical benzocaine is contraindicated in children younger than 2 years due
to risk of methemoglobinemia.
Correct Answer: True Rationale: Benzocaine can cause methemoglobinemia,
particularly dangerous in young children.
Question 15.
True or False: Epinephrine should be avoided in local anesthetics administered to fingers
or toes due to risk of ischemia.
Correct Answer: True Rationale: Vasoconstriction from epinephrine can cause
ischemic necrosis in end-artery areas like digits.
Question 16.
True or False: Allergic reactions to amide local anesthetics are common.
Correct Answer: False Rationale: Allergic reactions to amide anesthetics are
very rare compared to ester types.
Question 17.
True or False: Cocaine is no longer used clinically due to its high abuse potential and
toxicity.
Correct Answer: False Rationale: Cocaine is still used topically in ENT
procedures for its potent vasoconstrictive and anesthetic effects despite abuse
potential.
, Question 18.
A 45-year-old patient undergoing dental extraction reports a history of allergy to procaine.
Which local anesthetic is safest to use? A) Lidocaine B) Procaine C) Benzocaine D) Cocaine
Correct Answer: A Rationale: Lidocaine is an amide-type and does not
cross-react with ester allergies, making it safe for this patient.
Question 19.
A patient develops seizures shortly after administration of lidocaine for nerve block. What
is the most appropriate immediate intervention? A) Administer intravenous
benzodiazepines B) Provide mechanical ventilation with oxygen C) Start CPR D) Administer
epinephrine
Correct Answer: A Rationale: Seizures from CNS toxicity due to lidocaine
overdose should be managed initially with benzodiazepines to suppress
excessive excitation.
Question 20.
Which of the following local anesthetics would be preferred for a 4-hour surgical
procedure? A) Lidocaine B) Bupivacaine C) Procaine D) Chloroprocaine
Correct Answer: B Rationale: Bupivacaine has a long duration (2-4 hours)
suitable for prolonged procedures.
Question 21.
During epidural anesthesia, epinephrine is added to lidocaine. What is an expected effect?
A) Faster onset of anesthesia B) Prolonged duration of action C) Increased systemic
toxicity D) Increased allergic reactions
Correct Answer: B Rationale: Epinephrine-induced vasoconstriction slows
absorption, prolonging anesthesia duration and reducing systemic toxicity.
Question 22.
A patient applying topical benzocaine gel on inflamed oral mucosa develops cyanosis and
shortness of breath. What is the likely diagnosis? A) Anaphylaxis B) Methemoglobinemia C)
Seizure D) Cardiac arrest
Correct Answer: B Rationale: Benzocaine can cause methemoglobinemia,
reducing oxygen delivery and causing cyanosis and respiratory distress.
Question 23.
True or False: Injection of local anesthetic into a blood vessel increases the risk of systemic
toxicity.
Correct Answer: True Rationale: Intravascular injection leads to rapid systemic
absorption, increasing CNS and cardiovascular toxicity risk.
Question 1.
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
Correct 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 2.
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.
Correct 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 3.
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
Correct 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 4.
Lidocaine is classified as which type of local anesthetic? A) Ester-type B) Amide-type C)
Both ester and amide D) Neither
Correct 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 5.
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
Correct 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 6.
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
Correct Answer: B Rationale: Epinephrine causes vasoconstriction, reducing
blood flow to the site, delaying systemic absorption, prolonging anesthesia, and
reducing toxicity risk.
Question 7.
Which local anesthetic is most likely to cause allergic reactions? A) Lidocaine B) Procaine
C) Bupivacaine D) Ropivacaine
Correct Answer: B Rationale: Procaine is an ester-type anesthetic, which has a
higher incidence of allergic reactions than amide-type agents like lidocaine.
Question 8.
Select all adverse effects associated with systemic toxicity of local anesthetics: A) Seizures
B) Bradycardia C) Hypertension D) Respiratory depression E) Hyperglycemia
Correct 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 9.
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
Correct 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 10.
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
Correct Answer: A, C, D Rationale: Broken skin, increased temperature, and
wrapping increase blood flow or permeability, enhancing absorption and toxicity
risk.
Question 11.
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
,Correct 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 12.
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
Correct 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 13.
True or False: Local anesthetics selectively block pain fibers while sparing motor fibers.
Correct Answer: False Rationale: Local anesthetics block all nerve fibers they
reach, including motor neurons, but small, nonmyelinated pain fibers are
blocked more rapidly.
Question 14.
True or False: Topical benzocaine is contraindicated in children younger than 2 years due
to risk of methemoglobinemia.
Correct Answer: True Rationale: Benzocaine can cause methemoglobinemia,
particularly dangerous in young children.
Question 15.
True or False: Epinephrine should be avoided in local anesthetics administered to fingers
or toes due to risk of ischemia.
Correct Answer: True Rationale: Vasoconstriction from epinephrine can cause
ischemic necrosis in end-artery areas like digits.
Question 16.
True or False: Allergic reactions to amide local anesthetics are common.
Correct Answer: False Rationale: Allergic reactions to amide anesthetics are
very rare compared to ester types.
Question 17.
True or False: Cocaine is no longer used clinically due to its high abuse potential and
toxicity.
Correct Answer: False Rationale: Cocaine is still used topically in ENT
procedures for its potent vasoconstrictive and anesthetic effects despite abuse
potential.
, Question 18.
A 45-year-old patient undergoing dental extraction reports a history of allergy to procaine.
Which local anesthetic is safest to use? A) Lidocaine B) Procaine C) Benzocaine D) Cocaine
Correct Answer: A Rationale: Lidocaine is an amide-type and does not
cross-react with ester allergies, making it safe for this patient.
Question 19.
A patient develops seizures shortly after administration of lidocaine for nerve block. What
is the most appropriate immediate intervention? A) Administer intravenous
benzodiazepines B) Provide mechanical ventilation with oxygen C) Start CPR D) Administer
epinephrine
Correct Answer: A Rationale: Seizures from CNS toxicity due to lidocaine
overdose should be managed initially with benzodiazepines to suppress
excessive excitation.
Question 20.
Which of the following local anesthetics would be preferred for a 4-hour surgical
procedure? A) Lidocaine B) Bupivacaine C) Procaine D) Chloroprocaine
Correct Answer: B Rationale: Bupivacaine has a long duration (2-4 hours)
suitable for prolonged procedures.
Question 21.
During epidural anesthesia, epinephrine is added to lidocaine. What is an expected effect?
A) Faster onset of anesthesia B) Prolonged duration of action C) Increased systemic
toxicity D) Increased allergic reactions
Correct Answer: B Rationale: Epinephrine-induced vasoconstriction slows
absorption, prolonging anesthesia duration and reducing systemic toxicity.
Question 22.
A patient applying topical benzocaine gel on inflamed oral mucosa develops cyanosis and
shortness of breath. What is the likely diagnosis? A) Anaphylaxis B) Methemoglobinemia C)
Seizure D) Cardiac arrest
Correct Answer: B Rationale: Benzocaine can cause methemoglobinemia,
reducing oxygen delivery and causing cyanosis and respiratory distress.
Question 23.
True or False: Injection of local anesthetic into a blood vessel increases the risk of systemic
toxicity.
Correct Answer: True Rationale: Intravascular injection leads to rapid systemic
absorption, increasing CNS and cardiovascular toxicity risk.
