NURSING PHARMACOLOGY: ANESTHETIC AND
NARCOTIC DRUGS 2026 EXAM
1. Question
During surgery, there is an increased potential for arrhythmias when
catecholamines are given with:
A. halothane (Fluothane)
Correct Answer
B. digoxin (Lanoxin)
C. bupivacaine (Marcaine)
Incorrect
D. lidocaine (Xylocaine)
Incorrect
Correct Answer: A. halothane (Fluothane)
,Arrhythmias are a result of an interaction that can occur with halothane and
catecholamines. Halothane is a clear, heavy, and colorless liquid with a sweet and
non-irritating odor. Halothane’s structure is that of an alkane. It has primarily
been used clinically as an inhalational anesthetic. Cardiorespiratory instability
(i.e., hypotension, bradycardia), sensitizing the myocardium to catecholamine-
induced arrhythmias, and mild liver dysfunction are relatively common side
effects of halothane. Arrhythmias are especially common in neonates and
children after the administration of halothane, particularly bradyarrhythmias.
Other choices do not interact with halothane to cause arrhythmias.
Option B: Digoxin toxicity is clinically relevant as it can lead to fatal cardiac
arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady
digoxin therapy. The rate of toxicity increases as serum digoxin concentration
reaches over 2.0 ng/ml. However, toxicity can also occur at lower levels,
especially in the setting of other risk factors such as low body weight, advanced
age, decreased renal function, and hypokalemia.
Option C: Rarely, patients can exhibit toxicity to bupivacaine in doses much lower
than the suggested upper limits of dosing. This toxicity appears to be due to a rare
condition related to l-carnitine deficiency. Patients affected may exhibit cardiac
toxicity at doses as low as 1.1 mg kg of bupivacaine injected cutaneously. Case
reports exist describing these cases of low dose toxicity in patients later
discovered to be deficient in l-carnitine.
Option D: Signs and symptoms of mild toxicity become apparent at plasma levels
greater than 5 mcg/mL, beginning with slurred speech, tinnitus, circumoral
,paresthesia, and feeling faint. Above 10 mcg/mL, the patient may experience
seizures or loss of consciousness. The myocardium and central nervous system
are further depressed at 15 mcg/mL, progressing to cardiac arrhythmias,
respiratory arrest, and cardiac arrest above 20 mcg/mL.
2. Question
General anesthetics potentiate the effects of which of the following drugs?
A. Depolarizing agents
B. Skeletal muscle relaxants
Correct Answer
C. Volatile liquids
Incorrect
D. Inhalation anesthetics
Incorrect
Correct Answer: B. Skeletal muscle relaxants
The effects of skeletal muscle relaxants are potentiated with the use of general
anesthetics. Skeletal muscle relaxants are drugs that are used to relax and reduce
tension in muscles. They are more simply referred to as muscle relaxants. Some
work in the brain or spinal cord to block or dampen down excessively stimulated
nerve pathways.
, Option A: Depolarizing agents do not interact with general anesthetics.
Depolarizing agents produce their block by binding to and activating the ACh
receptor, at first causing muscle contraction, then paralysis. They bind to the
receptor and cause depolarization by opening channels just like acetylcholine
does.
Option C: Desflurane, isoflurane, and sevoflurane are the most widely used
volatile anesthetics today. They are often combined with nitrous oxide. Older, less
popular, volatile anesthetics include halothane, enflurane, and methoxyflurane.
Option D: Inhalation anesthetics (nitrous oxide, halothane, isoflurane, desflurane,
sevoflurane most commonly used agents in practice today) are used for induction
and maintenance of general anesthesia in the operating room. The volatile
anesthetics (halothane, isoflurane, desflurane, and sevoflurane) are liquids at
room temperature and require the use of vaporizers for inhalational
administration.
3. Question
The most dangerous metabolic side effect of general anesthesia that can occur
during surgery is:
A. Hyperglycemia
Incorrect
B. Hyperthermia
NARCOTIC DRUGS 2026 EXAM
1. Question
During surgery, there is an increased potential for arrhythmias when
catecholamines are given with:
A. halothane (Fluothane)
Correct Answer
B. digoxin (Lanoxin)
C. bupivacaine (Marcaine)
Incorrect
D. lidocaine (Xylocaine)
Incorrect
Correct Answer: A. halothane (Fluothane)
,Arrhythmias are a result of an interaction that can occur with halothane and
catecholamines. Halothane is a clear, heavy, and colorless liquid with a sweet and
non-irritating odor. Halothane’s structure is that of an alkane. It has primarily
been used clinically as an inhalational anesthetic. Cardiorespiratory instability
(i.e., hypotension, bradycardia), sensitizing the myocardium to catecholamine-
induced arrhythmias, and mild liver dysfunction are relatively common side
effects of halothane. Arrhythmias are especially common in neonates and
children after the administration of halothane, particularly bradyarrhythmias.
Other choices do not interact with halothane to cause arrhythmias.
Option B: Digoxin toxicity is clinically relevant as it can lead to fatal cardiac
arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady
digoxin therapy. The rate of toxicity increases as serum digoxin concentration
reaches over 2.0 ng/ml. However, toxicity can also occur at lower levels,
especially in the setting of other risk factors such as low body weight, advanced
age, decreased renal function, and hypokalemia.
Option C: Rarely, patients can exhibit toxicity to bupivacaine in doses much lower
than the suggested upper limits of dosing. This toxicity appears to be due to a rare
condition related to l-carnitine deficiency. Patients affected may exhibit cardiac
toxicity at doses as low as 1.1 mg kg of bupivacaine injected cutaneously. Case
reports exist describing these cases of low dose toxicity in patients later
discovered to be deficient in l-carnitine.
Option D: Signs and symptoms of mild toxicity become apparent at plasma levels
greater than 5 mcg/mL, beginning with slurred speech, tinnitus, circumoral
,paresthesia, and feeling faint. Above 10 mcg/mL, the patient may experience
seizures or loss of consciousness. The myocardium and central nervous system
are further depressed at 15 mcg/mL, progressing to cardiac arrhythmias,
respiratory arrest, and cardiac arrest above 20 mcg/mL.
2. Question
General anesthetics potentiate the effects of which of the following drugs?
A. Depolarizing agents
B. Skeletal muscle relaxants
Correct Answer
C. Volatile liquids
Incorrect
D. Inhalation anesthetics
Incorrect
Correct Answer: B. Skeletal muscle relaxants
The effects of skeletal muscle relaxants are potentiated with the use of general
anesthetics. Skeletal muscle relaxants are drugs that are used to relax and reduce
tension in muscles. They are more simply referred to as muscle relaxants. Some
work in the brain or spinal cord to block or dampen down excessively stimulated
nerve pathways.
, Option A: Depolarizing agents do not interact with general anesthetics.
Depolarizing agents produce their block by binding to and activating the ACh
receptor, at first causing muscle contraction, then paralysis. They bind to the
receptor and cause depolarization by opening channels just like acetylcholine
does.
Option C: Desflurane, isoflurane, and sevoflurane are the most widely used
volatile anesthetics today. They are often combined with nitrous oxide. Older, less
popular, volatile anesthetics include halothane, enflurane, and methoxyflurane.
Option D: Inhalation anesthetics (nitrous oxide, halothane, isoflurane, desflurane,
sevoflurane most commonly used agents in practice today) are used for induction
and maintenance of general anesthesia in the operating room. The volatile
anesthetics (halothane, isoflurane, desflurane, and sevoflurane) are liquids at
room temperature and require the use of vaporizers for inhalational
administration.
3. Question
The most dangerous metabolic side effect of general anesthesia that can occur
during surgery is:
A. Hyperglycemia
Incorrect
B. Hyperthermia
