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
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
