Chapter 11: General and Local Anesthetics Lilley: Pharmacology and the
Nursing Process, 10th Edition
1. When administering a neuromuscular blocking drug, the nurse needs to
remember which principle?
A. It is used instead of general anesthesia during surgery.
B. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
C. It causes sedation and pain relief while allowing for lower doses of anesthetics.
D. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
Answer: D
Explanation: Neuromuscular blocking agents paralyze all skeletal muscles, including the
diaphragm and intercostal muscles, necessitating mechanical ventilation to support
respiration. They provide no sedation or analgesia.
2. While monitoring a patient who had surgery under general anesthesia 1 hour
ago, the nurse notes a sudden elevation in body temperature. This finding may
be an indication of which problem?
A. Tachyphylaxis
B. Postoperative infection
C. Malignant hypertension
D. Malignant hyperthermia
Answer: D
Explanation: A sudden, rapid rise in body temperature shortly after general anesthesia may
signal malignant hyperthermia, a rare but life-threatening genetic disorder triggered by
certain anesthetics.
3. The nurse is caring for a patient who is on a ventilator for respiratory arrest.
Which parenteral anesthetic is also used for sedation during mechanical
ventilation in ICU settings?
A. Ketamine
B. Midazolam
C. Propofol
D. Sevoflurane
Answer: C
,Explanation: Propofol is commonly used for both induction and maintenance of general
anesthesia and for continuous sedation in mechanically ventilated patients in the ICU due to
its rapid onset and short duration of action.
4. A patient is being prepared for an oral endoscopy, and the nurse anesthetist
reminds him that he will be awake during the procedure but probably will not
remember it. What type of anesthetic technique is used in this situation?
A. Local anesthesia
B. Moderate sedation
C. Topical anesthesia
D. Spinal anesthesia
Answer: B
Explanation: Moderate sedation (formerly called conscious sedation) reduces anxiety and
pain while impairing memory of the procedure, yet allows the patient to maintain their airway
and respond to verbal stimuli.
5. During a fishing trip, a patient pierced his finger with a large fishhook. He is
now in the emergency department to have it removed. The nurse anticipates that
which type of anesthesia will be used for this procedure?
A. No anesthesia
B. Topical benzocaine spray on the area
C. Topical prilocaine/lidocaine (EMLA) cream around the site
D. Infiltration of the puncture wound with lidocaine
Answer: D
Explanation: Infiltration anesthesia, involving injection of a local anesthetic like lidocaine
directly into the tissue, is appropriate for minor surgical procedures such as fishhook removal
to provide effective pain control.
6. When assessing patients in the preoperative area, the nurse knows that which
patient is at a higher risk for an altered response to anesthesia?
A. The 18-year-old patient who has never had surgery before
B. The 32-year-old patient who stopped smoking 8 years ago
C. The 44-year-old patient who is to have a kidney stone removed
D. The 82-year-old patient who is to have gallbladder removal
Answer: D
, Explanation: Elderly patients are at higher risk for altered responses to anesthesia due to age-
related declines in hepatic, renal, cardiac, and respiratory function, which affect drug
metabolism and clearance.
7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse
is assessing a patient who had hip surgery. The patient is experiencing
tachycardia, tachypnea, and muscle rigidity, and his temperature is 103°F
(39.4°C). The nurse will prepare for what immediate treatment?
A. Naltrexone hydrochloride injection
B. Dantrolene injection
C. Neostigmine
D. Cardiopulmonary resuscitation (CPR) and intubation
Answer: B
Explanation: The symptoms described are classic for malignant hyperthermia. Dantrolene is
the specific antidote that acts by inhibiting calcium release in skeletal muscle cells to reduce
rigidity and hypermetabolism.
8. The nurse is preparing to administer dexmedetomidine to a patient. Which is an
appropriate indication for dexmedetomidine? (Select all that apply.)
A. Procedural sedation
B. Surgeries of short duration
C. Surgeries of long duration
D. Postoperative anxiety
E. Sedation of mechanically ventilated patients
Answer: A, B, E
Explanation: Dexmedetomidine is used for procedural sedation, short-duration surgeries, and
sedation of intubated patients in the ICU. It is not typically used for long surgeries or
postoperative anxiety.
9. The nurse is reviewing the effects of inhaled and intravenous general anesthesia,
which includes which of these? (Select all that apply.)
A. Increased intracranial pressure
B. Increased glomerular filtration
C. CNS depression
D. Hypotension
E. Decreased hepatic clearance
Answer: A, C, D, E
Nursing Process, 10th Edition
1. When administering a neuromuscular blocking drug, the nurse needs to
remember which principle?
A. It is used instead of general anesthesia during surgery.
B. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
C. It causes sedation and pain relief while allowing for lower doses of anesthetics.
D. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
Answer: D
Explanation: Neuromuscular blocking agents paralyze all skeletal muscles, including the
diaphragm and intercostal muscles, necessitating mechanical ventilation to support
respiration. They provide no sedation or analgesia.
2. While monitoring a patient who had surgery under general anesthesia 1 hour
ago, the nurse notes a sudden elevation in body temperature. This finding may
be an indication of which problem?
A. Tachyphylaxis
B. Postoperative infection
C. Malignant hypertension
D. Malignant hyperthermia
Answer: D
Explanation: A sudden, rapid rise in body temperature shortly after general anesthesia may
signal malignant hyperthermia, a rare but life-threatening genetic disorder triggered by
certain anesthetics.
3. The nurse is caring for a patient who is on a ventilator for respiratory arrest.
Which parenteral anesthetic is also used for sedation during mechanical
ventilation in ICU settings?
A. Ketamine
B. Midazolam
C. Propofol
D. Sevoflurane
Answer: C
,Explanation: Propofol is commonly used for both induction and maintenance of general
anesthesia and for continuous sedation in mechanically ventilated patients in the ICU due to
its rapid onset and short duration of action.
4. A patient is being prepared for an oral endoscopy, and the nurse anesthetist
reminds him that he will be awake during the procedure but probably will not
remember it. What type of anesthetic technique is used in this situation?
A. Local anesthesia
B. Moderate sedation
C. Topical anesthesia
D. Spinal anesthesia
Answer: B
Explanation: Moderate sedation (formerly called conscious sedation) reduces anxiety and
pain while impairing memory of the procedure, yet allows the patient to maintain their airway
and respond to verbal stimuli.
5. During a fishing trip, a patient pierced his finger with a large fishhook. He is
now in the emergency department to have it removed. The nurse anticipates that
which type of anesthesia will be used for this procedure?
A. No anesthesia
B. Topical benzocaine spray on the area
C. Topical prilocaine/lidocaine (EMLA) cream around the site
D. Infiltration of the puncture wound with lidocaine
Answer: D
Explanation: Infiltration anesthesia, involving injection of a local anesthetic like lidocaine
directly into the tissue, is appropriate for minor surgical procedures such as fishhook removal
to provide effective pain control.
6. When assessing patients in the preoperative area, the nurse knows that which
patient is at a higher risk for an altered response to anesthesia?
A. The 18-year-old patient who has never had surgery before
B. The 32-year-old patient who stopped smoking 8 years ago
C. The 44-year-old patient who is to have a kidney stone removed
D. The 82-year-old patient who is to have gallbladder removal
Answer: D
, Explanation: Elderly patients are at higher risk for altered responses to anesthesia due to age-
related declines in hepatic, renal, cardiac, and respiratory function, which affect drug
metabolism and clearance.
7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse
is assessing a patient who had hip surgery. The patient is experiencing
tachycardia, tachypnea, and muscle rigidity, and his temperature is 103°F
(39.4°C). The nurse will prepare for what immediate treatment?
A. Naltrexone hydrochloride injection
B. Dantrolene injection
C. Neostigmine
D. Cardiopulmonary resuscitation (CPR) and intubation
Answer: B
Explanation: The symptoms described are classic for malignant hyperthermia. Dantrolene is
the specific antidote that acts by inhibiting calcium release in skeletal muscle cells to reduce
rigidity and hypermetabolism.
8. The nurse is preparing to administer dexmedetomidine to a patient. Which is an
appropriate indication for dexmedetomidine? (Select all that apply.)
A. Procedural sedation
B. Surgeries of short duration
C. Surgeries of long duration
D. Postoperative anxiety
E. Sedation of mechanically ventilated patients
Answer: A, B, E
Explanation: Dexmedetomidine is used for procedural sedation, short-duration surgeries, and
sedation of intubated patients in the ICU. It is not typically used for long surgeries or
postoperative anxiety.
9. The nurse is reviewing the effects of inhaled and intravenous general anesthesia,
which includes which of these? (Select all that apply.)
A. Increased intracranial pressure
B. Increased glomerular filtration
C. CNS depression
D. Hypotension
E. Decreased hepatic clearance
Answer: A, C, D, E
