Question 1

Anesthetic gases decrease the patient's heart rate depending on the concentration of the agent being used,and each of the anesthetic gases cause vasodilation which decreases the patient's blood pressure.Interventions that perioperative nurses can provide to help ensure a safe anesthetic experience include:

Accepted Answer

A)   positioning areas directly related to respiration (e.g., chest, diaphragm)  with firm pressure.
B)   monitoring and documenting physiologic parameters on the anesthesia electronic system.
C)   maintaining balanced drug levels of hypnotics, analgesia, and muscle relaxants.
D)   positioning patients slowly to assess impact on circulation. A

Question 2

The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS).The processes by which they occur are explained by several proposed theories.Which of the options describes a plausible anesthetic mechanism of action?

Accepted Answer

A)   Inhaled opiates are absorbed by dopamine antagonist receptors in the CNS.
B)   Sodium channels trade places with potassium ions in the cerebral cellular cytoplasm.
C)   Endorphins undergo biotransformation into protein-soluble compounds.
D)   Signaling proteins are the relevant molecular targets of anesthetic action. D

Question 3

A 72-year-old morbidly obese male patient with uncontrolled diabetes is examined by the anesthesia nurse practitioner in the preoperative holding area for physical status and airway assessment prior to surgery.His most likely American Society of Anesthesiology (ASA)physical status is:

Accepted Answer

A)   P1.
B)   P2.
C)   P3.
D)   P4. C

Question 4

In the past,MH mortality ranged up to 80%,but the immediate infusion of dantrolene (Dantrium)and proper treatment have reduced the death rate to about 5%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

Accepted Answer

A)   It is a succinylcholine reversal agent.
B)   It is a skeletal muscle relaxant.
C)   It is a metabolic antagonist.
D)   It has diuretic properties.

Question 5

Many factors have contributed to the evolution and progressive growth of ambulatory surgery.Select the three anesthetic agents that promote fast induction,rapid emergence,and minimal side effects and have been credited as a significant factor in this trend.

Accepted Answer

A)   Propofol, desflurane, sublimaze
B)   Ketamine, sevoflurane, propofol
C)   Desflurane, midazolam, halothane
D)   Sevoflurane, propofol, desflurane

Question 6

Somatosensory evoked potential (SEP)monitoring assesses neuromuscular transmission pathways during procedures where ischemia may occur because of surgical manipulation,resulting in sensory and motor function.This surveillance is most often employed in:

Accepted Answer

A)   lumbar puncture with chemotherapeutic agent injection.
B)   carpal tunnel release.
C)   posterior spinal fusion.
D)   nerve biopsy when a nerve stimulator is used.

Question 7

MH is a rare,multifaceted syndrome with an increased incidence in individuals with central core diseases such as:

Accepted Answer

A)   spinal cord injury.
B)   muscular dystrophy.
C)   congenital myopathies.
D)   muscular dystrophy and congenital myopathies.

Question 8

Perioperative nurses should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters to:

Accepted Answer

A)   relieve the anesthesia provider for short periods of time during long procedures with stable patients.
B)   be familiar with the setup, operation, and leak testing of the anesthesia machine.
C)   safely monitor a patient under MAC.
D)   be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia provider.

Question 9

A 78-year-old female is scheduled for compression nail insertion of a left fractured hip.She was positioned for a spinal injection to induce spinal anesthesia.During the process,the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space,not noticing the error until the entire syringe of lidocaine was administered to the patient.The patient immediately experienced rapid onset of hypotension,bradycardia,and apnea.This unintentional condition is called ______________ and now must be managed with _____________.

Accepted Answer

A)   total subarachnoid syndrome; mechanical ventilation
B)   hypotensive apnea episode; tracheostomy and humidified positive end-expiratory pressure (PEEP) 
C)   cardiogenic shock; advanced cardiovascular life support (ACLS)  protocol
D)   total spinal anesthesia; general endotracheal anesthesia

Question 10

Postoperative nausea and vomiting (PONV)is often a side effect of the analgesic ___________.

Accepted Answer

A)   morphine
B)   ketamine
C)   ketorolac
D)   esmolol

Question 11

What is the primary purpose of premedication before anesthesia?

Accepted Answer

A)   Tranquilize the patient and reduce stomach acidity (pH) .
B)   Sedate the patient and reduce anxiety.
C)   Elicit desirable amnesia and prevent awareness under anesthesia.
D)   Promote rapid induction and airway management.

Question 12

Multiple studies have found that intraoperative awareness (IOA)occurs in a small percentage of patients undergoing general anesthesia.Which high risk populations have more incidence of IOA?

Accepted Answer

A)   Emergent trauma and obstetric patients
B)   Pediatric patients
C)   Ambulatory surgery patients
D)   Elderly patients

Question 13

Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?

Accepted Answer

A)   Thiopental
B)   Desflurane
C)   Diazepam
D)   Diphenhydramine

Question 14

A frail 92-year-old was positioned in lithotomy for a 90-minute rectal procedure under SAB.At the end of the procedure,when the circulating nurse and surgeon gently removed her legs from the position and placed her in a supine position,she experienced a common side effect of spinal anesthesia,____________.

Accepted Answer

A)   numbness of both legs and feet
B)   paralysis with bilateral popliteal pain
C)   hypotensive episode
D)   hypertensive episode

Question 15

During a hypermetabolic MH crisis,the patient will require major modalities of treatment.In addition to dantrolene what is another priority intervention?

Accepted Answer

A)   Giving mannitol
B)   Cooling the patient
C)   Reversing the malignancy
D)   Continuing succinylcholine

Question 16

The anesthesia department at a small medical center has a total staff of 102 people.These employees serve in many roles as care providers,technical assistants,materials management,clinical engineers,and clerical staff.Select the list of direct-care anesthesia providers.

Accepted Answer

A)   Certified registered nurse anesthetist (CRN
A)  , anesthesia technician, anesthesia provider
B)   CRNA, surgical technician, first assistant
C)   Anesthesia technician, anesthesiologist assistant (A
A)  , anesthesia scheduler
D)   Anesthesia provider, AA, CRNA

Question 17

The term balanced anesthesia is described as:

Accepted Answer

A)   a combination of IV medications and inhalation agents.
B)   nitrous oxide, air, and oxygen.
C)   premedication, induction agents, and reversal agents.
D)   induction agent, muscle relaxation, and analgesics.

Question 18

A registered nurse working in a busy free-standing ambulatory surgery center has additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies,bronchoscopies,and upper gastrointestinal (GI)endoscopies.This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep.The nurse is competent and legally qualified to provide which modality of anesthesia?

Accepted Answer

A)   Monitored anesthesia care (MA
C)  
B)   Local infiltration
C)   Moderate sedation/analgesia
D)   Procedural narcosis

Question 19

Patient and family education are crucial for successful preanesthesia preparation.Which of the following information about regular medications should be provided as part of the preoperative preparation?

Accepted Answer

A)   Oral hyperglycemic medications should be discontinued 3 days before surgery
B)   Aspirin and aspirin-containing products can be taken until the evening before the surgery.
C)   NSAIDs should be discontinued 4 days before surgery.
D)   Warfarin should be discontinued 1 week before surgery.

Question 20

At a regional malignant hyperthermia (MH)testing center,a 14-year-old male is undergoing a muscle biopsy for suspected genetic predisposition to malignant hyperthermia.The anesthesia provider will provide light intravenous (IV)sedation while the surgeon infiltrates the biopsy site with a local anesthetic.This will facilitate the patient's tolerance of the procedure and minimize his risk for an MH episode.What is the current correct name for this anesthesia modality?

Accepted Answer

A)   Local with anesthesia standby
B)   Monitored anesthesia care (MA
C)  
C)   Basal narcosis
D)   Moderate sedation

Exam 5: Anesthesia

A 72-year-old morbidly obese male patient with uncontrolled diabetes is examined by the anesthesia nurse practitioner in the preoperative holding area for physical status and airway assessment prior to surgery.His most likely American Society of Anesthesiology (ASA) physical status is:

In the past,MH mortality ranged up to 80%,but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 5%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?