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Thelans Critical Care Nursing 5th Edition Urden Stacy Lough Test Bank

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Thelans Critical Care Nursing 5th Edition Urden Stacy Lough Test Bank

ISBN-13: 978-0323032483

ISBN-10: 0323032486

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Thelans Critical Care Nursing 5th Edition Urden Stacy Lough Test Bank

ISBN-13: 978-0323032483

ISBN-10: 0323032486

 

 

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Free Nursing Test Questions:

Urden: Thelan’s Critical Care Nursing, 5th Edition

 

Test Bank

 

Chapter 14: Perianesthesia Management

 

MULTIPLE CHOICE

 

  1. Which stage of general anesthesia begins with the initiation of an anesthetic agent and ends with loss of consciousness?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

ANS:   A

Stage I begins with the initiation of an anesthetic agent and ends with the loss of consciousness. Patients can open their eyes on command, breathe normally, maintain protective reflexes, and tolerate mild painful stimuli.

 

DIF:    Cognitive Level: Knowledge             REF:    249

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which stage of general anesthesia is known as surgical anesthesia?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

ANS:   C

Stage III is the stage of surgical anesthesia. During this stage the response to surgical incision is absent and patients experience a depression in all elements of nervous system function.

 

DIF:    Cognitive Level: Knowledge             REF:    250

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which of the following antagonizes the effects of benzodiazepines?
a. Naloxone
b. Neostigmine
c. Fentanyl
d. Flumazenil

 

 

ANS:   D

Flumazenil antagonizes or reverses the effects of benzodiazepines, including sedation, amnesia, anxiolysis, and muscle relaxation.

 

DIF:    Cognitive Level: Knowledge             REF:    251

OBJ:    Nursing Process Step: Evaluation      TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. The effects of nitrous oxide include
a. anesthesia, analgesia, and amnesia.
b. vasodilation, analgesia, and myocardial depression.
c. respiratory and cardiovascular depression.
d. bronchodilation, myocardial excitation, and muscle tremors.

 

ANS:   A

The effects of nitrous oxide include anesthesia, analgesia, and amnesia.

 

DIF:    Cognitive Level: Comprehension      REF:    251

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which of the following benzodiazepines has a slow onset of action and long duration?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Lorazepam (Ativan)
d. Droperidol (Inapsine)

 

ANS:   C

Lorazepam (Ativan) has a slow onset of action and long duration.

 

DIF:    Cognitive Level: Comprehension      REF:    252

OBJ:    Nursing Process Step: Planning         TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Naloxone’s duration of action is
a. 30 minutes to 1 hour.
b. 1 to 4 hours.
c. 4 to 6 hours.
d. 6 to 10 hours.

 

ANS:   B

Naloxone’s duration of action is 1 to 4 hours.

 

DIF:    Cognitive Level: Knowledge             REF:    253

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What is the principal depolarizing skeletal muscle relaxant?
a. Succinylcholine
b. Pancuronium
c. Mivacurium
d. Rocuronium

 

ANS:   A

The principal depolarizing skeletal muscle relaxant is succinylcholine.

 

DIF:    Cognitive Level: Knowledge             REF:    254                  TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Postoperatively, dysrhythmias occur in patients
a. during the first minute.
b. during the first 2 minutes.
c. during the first 5 minutes.
d. at any time.

 

ANS:   D

Dysrhythmias of any type may occur at any time and in any patient during the postoperative period.

 

DIF:    Cognitive Level: Knowledge             REF:    267

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Oral intake is prohibited after anesthesia until
a. the patient is ambulatory.
b. the patient is strong enough to hold a cup of water.
c. all nausea has ceased.
d. laryngeal and pharyngeal reflexes are fully regained.

 

ANS:   D

Oral intake must be prohibited after anesthesia until the laryngeal and pharyngeal reflexes are fully regained, as evidenced by the patient’ s ability to gag and swallow effectively.

 

DIF:    Cognitive Level: Knowledge             REF:    263

OBJ:    Nursing Process Step: Planning         TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. The stir-up regimen consists of
a. deep breathing exercises, suctioning, warming, and nausea management.
b. incentive spirometry, abdominal breathing, warming, drinking, and pain management.
c. incentive spirometry, coughing, suctioning, warming, mobilization, and eating.
d. deep breathing exercises, coughing, positioning, mobilization, and pain management.

 

ANS:   D

The stir-up regimen consists of deep breathing exercises, coughing, positioning, mobilization, and pain management.

 

DIF:    Cognitive Level: Application             REF:    256

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. In the postanesthesia care unit, the patient should be stimulated to take three to four deep breaths every
a. 1 to 2 minutes.
b. 3 to 5 minutes.
c. 5 to 10 minutes.
d. 30 to 60 minutes.

 

ANS:   C

The patient should be stimulated to take three or four deep breaths every 5 to 10 minutes to reduce or eliminate potential pulmonary complications from low lung volumes.

 

DIF:    Cognitive Level: Knowledge             REF:    256

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. The sustained maximal inspiration maneuver is performed by having the patient take
a. a deep breath and hold it for 3 to 5 seconds before exhaling.
b. a slow deep breath and then forcefully exhale.
c. a deep breath and, at the peak of inspiration, expand the chest and take in a little more air.
d. in a slow deep breath, then exhale slowly.

 

ANS:   A

The sustained maximal inspiration maneuver consists of having the patient inhale as close to lung capacity as possible, then hold the volume for 3 to 5 seconds at the peak of inspiration before exhaling.

 

DIF:    Cognitive Level: Knowledge             REF:    256-257

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. The coughing maneuver in which a patient takes a deep breath, then performs multiple coughs on exhalation of that breath is known as the
a. serial cough.
b. cascade cough.
c. sustained maximal cough.
d. deep cough.

 

ANS:   B

The cascade cough is the most effective coughing maneuver.

 

DIF:    Cognitive Level: Knowledge             REF:    257

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Initial management of laryngospasm includes
a. intubating the patient and providing manual ventilation with 100% oxygen.
b. hyperextending the patient’s head and administering positive-pressure ventilations on 100% oxygen.
c. administering 10 mg succinylcholine.
d. administering nebulized racemic epinephrine.

 

ANS:   B

Initial management of laryngospasm includes hyperextending the patient’s head and administering positive-pressure ventilations on 100% oxygen.

 

DIF:    Cognitive Level: Application             REF:    264

OBJ:    Nursing Process Step: Planning         TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which of the following is a consequence of postoperative hypothermia?
a. Decreased blood viscosity
b. Metabolic alkalosis
c. Decreased systemic vascular resistance
d. Decreased metabolic processes

 

ANS:   D

Decreased metabolic processes are a consequence of postoperative hypothermia.

 

DIF:    Cognitive Level: Comprehension      REF:    268

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Patients who shiver
a. are always hypothermic.
b. are always hyperthermic.
c. may be normothermic.
d. always shiver because of pain.

 

ANS:   C

Shivering may be a result of either the compensatory response to the hypothermia or the effects of anesthetic agents.

 

DIF:    Cognitive Level: Comprehension      REF:    263

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Snoring, stridor, nostril flaring, and intercostal retractions are clinical manifestations of
a. angina.
b. airway obstruction.
c. pain.
d. sedation.

 

ANS:   B

Clinical manifestation of airway obstruction includes snoring, stridor, flaring of the nostrils, retractions at the intercostal spaces and suprasternal notch, abnormal use of accessory muscles, asynchronous movements of the chest and abdomen, increased pulse rate, decreased oxygen saturation level, and decreased breath sounds.

 

DIF:    Cognitive Level: Knowledge             REF:    263

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What medication may be used to treat laryngeal edema?
a. Racemic epinephrine
b. Succinylcholine
c. Albuterol
d. Morphine

 

ANS:   A

Management of laryngeal edema consists of placing the patient in the upright position; using cool, humidified oxygen; and administering nebulized racemic epinephrine.

 

DIF:    Cognitive Level: Knowledge             REF:    264

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What medication may be used to treat laryngospasm?
a. Racemic epinephrine
b. Succinylcholine
c. Albuterol
d. Morphine

 

ANS:   B

If complete obstruction is unrelieved by positive-pressure ventilation, a small dose of succinylcholine (10 to 20 mg) may be needed to relax the vocal cords to allow for ventilation.

 

DIF:    Cognitive Level: Knowledge             REF:    263

OBJ:    Nursing Process Step: Planning         TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What medication can be used to treat bronchospasm?
a. Racemic epinephrine
b. Succinylcholine
c. Albuterol
d. Morphine

 

ANS:   C

The first line of therapy consists of inhaled bronchodilators such as isoetharine, metaproterenol, albuterol, and beclomethasone.

 

DIF:    Cognitive Level: Knowledge             REF:    265

OBJ:    Nursing Process Step: Planning         TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What is the most common cause of hypoxemia?
a. Laryngeal edema
b. Laryngospasm
c. Bronchospasm
d. Ventilation/perfusion mismatching

 

ANS:   D

The most common cause of hypoxemia is ventilation/perfusion mismatching.

 

DIF:    Cognitive Level: Knowledge             REF:    265

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which anesthetic agent has the most significant hypotensive effect and the least negative inotropic effect?
a. Halothane
b. Enflurane
c. Isoflurane
d. Epithane

 

ANS:   C

Volatile anesthetic agents, such as halothane, enflurane, and isoflurane, can cause a dose-related reduction in myocardial function. Isoflurane has the most significant hypotensive action and the fewest negative inotropic effects of the three agents.

 

DIF:    Cognitive Level: Knowledge             REF:    266

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which of the following dysrhythmias is most common in the immediate postanesthetic period?
a. Sinus tachycardia
b. Ventricular fibrillation
c. Atrioventricular block
d. Asystole

 

ANS:   A

The most common dysrhythmias in the immediate postoperative period are sinus tachycardia, sinus bradycardia, premature ventricular contractions, supraventricular tachydysrhythmias, and ventricular tachycardia.

 

DIF:    Cognitive Level: Knowledge             REF:    267

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Which of the following is a common cause of postoperative hypertension?
a. Administration of morphine
b. Fluid overload
c. Bladder distension
d. Tachycardia

 

ANS:   B

Most commonly, postoperative hypertension is related to fluid overload, heightened sympathetic nervous system activity, or preexisting hypertension. Bladder distention can contribute to postoperative hypertension but is not the most common cause.

 

DIF:    Cognitive Level: Comprehension      REF:    267

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. How large of an increase in the body’s metabolic demand can shivering can produce?
a. 400%
b. 250%
c. 100%
d. 500%

 

ANS:   D

Shivering can produce a 500% increase in the metabolic rate.

 

DIF:    Cognitive Level: Knowledge             REF:    268

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. The most definitive test for detecting malignant hyperthermia susceptibility is a(n)
a. venous blood sample.
b. arterial blood sample.
c. core temperature reading.
d. skeletal muscle biopsy.

 

ANS:   D

Malignant hyperthermia is precipitated by certain general inhalation anesthetics, depolarizing skeletal muscle relaxants, local anesthetics, and stress. The most definitive test for detecting malignant hyperthermia susceptibility is a biopsy of skeletal muscle. The skeletal muscle of the susceptible patient has an increased isometric tension when exposed to caffeine or halothane.

 

DIF:    Cognitive Level: Knowledge             REF:    269-270

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. What is the most effective treatment of postoperative nausea and vomiting?
a. Prevention
b. Droperidol given immediately when nausea is reported
c. Phenergan given immediately when nausea is reported
d. Metoclopramide given immediately when nausea is reported

 

ANS:   A

The most effective treatment of postoperative nausea and vomiting is prevention.

 

DIF:    Cognitive Level: Knowledge             REF:    273

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. An electrolyte disturbance that can cause delayed arousal in the postoperative patient is
a. hypercalcemia.
b. hyponatremia.
c. hyperkalemia.
d. hypermagnesemia.

 

ANS:   B

Hyponatremia is an electrolyte disturbance that can cause delayed arousal in the postoperative patient.

 

DIF:    Cognitive Level: Comprehension      REF:    271

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Nursing management of the postoperative patient who is nauseated and vomiting includes
a. withholding all pain medication until the nausea has subsided.
b. removing the nasogastric tube.
c. inserting an oral airway.
d. increasing intravenous fluids.

 

ANS:   D

Nursing management of the postoperative patient who is nauseated and vomiting includes increasing intravenous fluids.

 

DIF:    Cognitive Level: Application             REF:    273

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. Mr. N is a 72-year-old patient transferred to the postanesthesia care unit from the operating room after the induction of halothane anesthesia. Mr. N has no significant history. On admission Mr. N appeared comatose and extremely diaphoretic, with severe muscle rigidity and tremors. His vital signs were heart rate, 145 beats/min, sinus tachycardia; blood pressure, 85/50 mm Hg; respiratory rate, 35 breaths/min; and temperature, 103.8° F. Arterial blood gases on 100% oxygen by ventilator were PaO2, 70%; PaCO2, 35 mm Hg; pH, 7.21; HCO3, 16 mm Hg; and SaO2, 90%. Fluid resuscitation and vasoactive therapy were started. Initial abnormal laboratory results were blood urea nitrogen, 66 mg/dl; sodium, 155 mEq/L; potassium, 5.5 mEq/L; glucose, 68 mg/dl; creatinine, 2.4 mg/dl; and creatine phosphokinase, 1896 U/L. The nurse would anticipate a diagnosis of:
a. noncardiogenic pulmonary edema.
b. sepsis.
c. malignant hyperthermia.
d. emergency delirium.

 

ANS:   C

Clinical manifestations of malignant hyperthermia include hypoxemia; metabolic acidosis; respiratory acidosis; hyperkalemia; myoglobinuria; elevated creatine phosphokinase; tachycardia; tachypnea; ventricular dysrhythmias; cyanosis; skin mottling; fever or hot, flushed skin; rigidity; profuse sweating; and unstable blood pressure.

 

DIF:    Cognitive Level: Application             REF:    270

OBJ:    Nursing Process Step: Diagnosis       TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

COMPLETION

 

  1. The __________  consists of deep breathing exercises, coughing, positioning, mobilization, and pain management.

 

ANS:

stir-up regimen

Rationale: This process is the key to successful recovery from anesthesia.

 

DIF:    Cognitive Level: Comprehension      REF:    256

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. __________ is characterized by muscle rigidity and temperature elevations as high as 46° C.

 

ANS:

Malignant hyperthermia

Rationale: Malignant hyperthermia is a true anesthetic emergency that usually occurs within minutes of induction but can occur as many as 3 days later.

 

DIF:    Cognitive Level: Application             REF:    270

OBJ:    Nursing Process Step: Application    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

MATCHING

 

Match the stage of anesthesia with the correct definition.

a. STAGE I
b. STAGE II
c. STAGE III
d. STAGE IV

 

  1. Stage of delirium, loss of consciousness, and eyelid reflexes

 

  1. Begins with analgesia initiation and  ends with loss of consciousness

 

  1. Circulatory failure occurs

 

  1. Decreased nervous system function and skeletal muscle relaxation

 

 

  1. ANS: B                 DIF:    Cognitive Level: Comprehension      REF:    249-250

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: A                 DIF:    Cognitive Level: Comprehension      REF:    249-250

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: D                 DIF:    Cognitive Level: Comprehension      REF:    249-250

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: C                 DIF:    Cognitive Level: Comprehension      REF:    249-250

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

Match each anesthetic agent with its pharmacologic category.

a. HALOTHANE
b. THIOPENTAL
c. LORAZEPAM
d. FENTANYL
e. VECURONIUM

 

  1. Barbiturate

 

  1. Benzodiazepines

 

  1. Inhalation anesthetic

 

  1. Neuromuscular blocking agents

 

  1. Opioids

 

 

  1. ANS: B                 DIF:    Cognitive Level: Comprehension      REF:    252-254

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: C                 DIF:    Cognitive Level: Comprehension      REF:    252-254

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: A                 DIF:    Cognitive Level: Comprehension      REF:    252-254

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: E                 DIF:    Cognitive Level: Comprehension      REF:    252-254

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

  1. ANS: D                 DIF:    Cognitive Level: Comprehension      REF:    252-254

OBJ:    Nursing Process Step: Assessment    TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

 

OTHER

 

  1. Place these nursing actions for treating airway obstruction in a  patient recovering from anesthesia in the correct order.
  2. Provide emergency intubation.
  3. Perform head tilt/chin lift maneuver.
  4. Insert oropharyngeal airway.
  5. Stimulate the patient.
  6. Turn patient to the side.

 

ANS:

e, b, c, a, d

Rationale: Stimulating the patient is often only necessary as he or she begins to awaken; however, emergency measures should always be at hand.

 

DIF:    Cognitive Level: Analysis                  REF:    263

OBJ:    Nursing Process Step: Intervention   TOP:    Perianesthesia Management

MSC:   NCLEX: Physiologic Integrity

 

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