NURSING 6005 CHAPTER 26: LOCAL ANESTHETICS

NURSING 6005 CHAPTER 26: LOCAL ANESTHETICS Test Bank MULTIPLE CHOICE 1. A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching? a. “I will apply a thin layer of the medication to a small area of skin.” b. “I will cover the burn with a dressing after applying the medication.” c. “I will make sure to apply the medication to the entire burn area.” d. “I will use the medication only on the most painful, blistered areas.” ANS: A Topical anesthetics can be absorbed in sufficient amounts to cause serious and even life-threatening systemic toxicity, so they should be applied in the smallest amount needed to as small an area as possible. Covering the site increases the skin’s temperature, which increases absorption, so this should be avoided. Applying the medication to a large area increases systemic absorption. Applying the medication to broken skin increases systemic absorption. DIF: Cognitive Level: Application REF: Clinical Use of Local Anesthetics | Topical Administration | Systemic Toxicity TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 2. A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent? a. “Anesthetic effects develop slowly and persist for several hours.” b. “Cocaine is a local anesthetic administered by injection.” c. “Vasoconstrictors should not be used as adjunct agents with this drug.” d. “When abused, cocaine causes physical dependence.” ANS: C Cocaine should not be combined with epinephrine or other vasoconstrictors, because it causes vasoconstriction itself, and the combination could precipitate severe hypertension. Cocaine has a rapid onset of effects, which last about 1 hour. It is used only topically for anesthesia. Although subject to widespread abuse with profound psychologic dependence, it does not cause substantial physical dependence. DIF: Cognitive Level: Analysis REF: Properties of Individual Local Anesthetics | Cocaine TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 3. A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient’s leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to: a. allow more systemic absorption to speed up metabolism of the lidocaine. b. increase the rate of absorption of the lidocaine. c. improve perfusion by increasing blood flow to the area. d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine. ANS: D Epinephrine causes vasoconstriction, which reduces local blood flow and delays systemic absorption of lidocaine, which prolongs local anesthetic effects and reduces the risk of systemic toxicity. Epinephrine slows the rate of absorption. Epinephrine delays systemic absorption of lidocaine, so metabolism is slowed and the effects are prolonged in the periphery. Epinephrine does not increase local blood flow. DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local Anesthetics | Use with Vasoconstrictors TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic, the patient has a pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of: a. heart block. b. anaphylaxis. c. central nervous system excitation. d. respiratory depression. ANS: A When absorbed in a sufficient amount, local anesthetics can affect the heart and blood vessels. These drugs suppress excitability in the myocardium and conduction system and can cause hypotension, bradycardia, heart block, and potentially cardiac arrest. Anaphylaxis would be manifested by hypotension, bronchoconstriction, and edema of the glottis. Central nervous system excitation would be manifested by hyperactivity, restlessness, and anxiety and may be followed by convulsions. No evidence indicates respiratory depression; this patient’s respirations are within normal limits. DIF: Cognitive Level: Application REF: Basic Pharmacology of the Local Anesthetics | Adverse Effects TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate? a. Contact the anesthetist to request an order for ephedrine. b. Have the patient sit up to relieve the headache pain. c. Lower the head of the bed to a 10- to 15-degree head-down position. d. Obtain an order for a urinary catheter for urinary retention. ANS: C