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Anesthesia Considerations
Physiology
Perianesthesia monitoring
ASPAN standards
Care Considerations
100

Elderly patients have an increased risk of aspiration during general anesthesia because of:      

  1. a decrease in vagal sensitivity.                
  2. an increase in sphincter tone.                
  3. an increase in gastric emptying.                
  4. a decrease in esophageal motility. 

4. a decrease in esophageal motility.

100

The perianesthesia nurse should question the accuracy of the SpO2 measurement when caring for a patient with which of the underlying condition?

  1. Cushing's disease
  2. hypothyroidism
  3. Raynaud's disease
  4. hyperthyroidism

3. Raynaud's disease

100

Coughing at the end of an ophthalmic procedure could result in:                        

  1. the rupture of the globe.                
  2. an increase in intraocular pressure.                
  3. oculocardiac reflex.                
  4. Sjögren's syndrome.                       

2. an increase in intraocular pressure.      

100

In order to safely transport a pediatric postoperative patient, ASPAN Standards of Perianesthesia Nursing Practice recommend that the patient should be accompanied by:  

  1.  a registered health care aid plus a driver.         
  2. one responsible adult.                
  3. two responsible adults.                
  4. one adult and another child to sit with infant.    

3. two responsible adults.

100

Discharge instructions to a patient following a shoulder arthroscopy with a preoperative interscalene block should include that the:                

  1. surgeon should be notified of any changes in voice quality.            
  2. contralateral pupil will be constricted for 24 hours.            
  3. operative side will have decreased motor function.            
  4. range-of-motion exercises may begin on the operative extremity.            

3. operative side will have decreased motor function.

200

One of the most frequent side effects of ketamine anesthesia is:

  1. hallucination
  2. nausea
  3. muscle fasciculations
  4. bradycardia

1. hallucination


200

A patient who received spinal anesthesia and has postoperative hypothermia is rewarmed by radiant heat and experiences a drop in blood pressure. The etiology of this finding is:

  1. vasodilation
  2. myocardial depression
  3. basal metabolic rate
  4. parasympathetic response

1. vasodilation

200

In the care of a conscious patient who has been admitted to the PACU following a thyroidectomy, the most appropriate position is:

  1. reverse Trendelenburg.                
  2. side lying with head hyperextended.                
  3. prone with knees bent.                
  4. Semi-Fowler's position.              

4. Semi-Fowler's position.

200

According to ASPAN Standards of Perianesthesia Nursing Practice, staffing of perianesthesia units should be based on: 

  1. a standard ratio regardless of acuity.            
  2. vacation schedules and bed availability.            
  3. patient acuity and physical facility.            
  4. the number of staff with ACLS and PALS.       

3. patient acuity and physical facility.  

200

The perianesthesia nurse is aware that discharge instructions for a patient receiving a supraclavicular block should include which of the following?    

  1. Report numbness and hand tingling to surgeon today.                
  2. Start narcotics after full function returns.          
  3. Resume normal activity upon returning home.   
  4. Keep arm elevated in sling until sensation returns.                

4. Keep arm elevated in sling until sensation returns.  

300

On admission to the PACU, the anesthesiologist states that the 3-year-old patient had a laryngospasm upon extubation.  What medication should be immediately available if needed?                

  1. Propofol            
  2. Succinylcholine            
  3. Dexamethasone            
  4. Atropine            

2. Succinylcholine  

300

Q: A postoperative adolescent patient with a recent history of fatigue, headache, and weight loss experiences a delayed awakening and bladder distention. The patient was given general anesthesia with 300 mL of lactated Ringer's solution. The patient is catheterized for 1400 mL of colorless urine.   The perianesthesia nurse assesses the patient for:    

  1. elevated sodium and potassium levels in the urine.            
  2. elevated blood pressure.            
  3. decreased cerebral perfusion pressure.            
  4. elevated sugar and ketones in the urine.

4. elevated sugar and ketones in the urine.

300

A patient is admitted to the PACU following open reduction and internal fixation of a fractured right tibia. The patient now has dyspnea, tachycardia, and a fever.  The perianesthesia nurse suspects:         

  1. fat embolism.                
  2.  lung contusion.                
  3.  pneumonia.                
  4.  hemothorax.                     

 1. fat embolism.

300

According to ASPAN Standards of Perianesthesia Nursing Practice, care in the post anesthesia Phase I focuses on:

  1. preparation of patient and family for home care.
  2. preparation of patient for extended care.           
  3. transition of the patient from an anesthetized state to Phase II or an inpatient setting.            
  4. transition of the patient from the preoperative to the intraoperative phase.                   

3. transition of the patient from an anesthetized state to Phase II or an inpatient setting.  

300

Following maxillomandibular fixation, which of the following should be readily available at the patient's bedside?                    

  1. Wire cutters                
  2. Nasal airway            
  3. Laryngeal mask airway                
  4. Tracheostomy kit                

1. Wire cutters    

400

A patient who received an interscalene block is now experiencing tinnitus, muscle twitching, and confusion. The perianesthesia nurse anticipates treatment with:                    

  1. lipid infusion            
  2. fluid bolus            
  3. lidocaine            
  4. propofol            

1. lipid infusion

400

The perianesthesia nurse is aware that which of the following cardiac rhythms is more clinically ominous and may progress to a lethal dysrhythmia?

  1. Atrial flutter 1:4 response            
  2. Second-degree type II heart block            
  3. Atrial fibrillation            
  4. First-degree AV block     

2. Second-degree type II heart block  

400

In evaluating the care of a patient with vancomycin-resistant enterococci (VRE), the PACU nurse will consider which of the following?           

  1. VRE can live for weeks on surfaces such as bed rails.            
  2. The patient should be placed in a negative-pressure room.                
  3. Transmission-based droplet precautions should be utilized.                
  4. Gloves are a sufficient barrier device.     

1. VRE can live for weeks on surfaces such as bed rails.


400

 According to ASPAN Standards of Perianesthesia Nursing Practice, the perianesthesia nurse administering moderate sedation to a patient makes sure that an emergency cart with a defibrillator is:   

  1. immediately available during the administration.
  2. available on the next floor, near the elevator.    
  3. available only for patients with an ASA score of 2 or less.            
  4. immediately available upon request from the code team.     

1. immediately available during the administration.

                       


   

400

Effective postoperative education is achieved when the nurse:

  1. provides written instructions to the patient
  2. completes the preoperative teaching plan
  3. observes family participation
  4. listens to a return verbalization

4. listens to a return verbalization

500

A patient arrives in the PACU awake and oriented but with difficulty breathing.  The patient received a single dose of succinylcholine in the OR. What is the minimum timeframe for complete muscle recover to occur?                

  1. 15 minutes            
  2. 20 minutes            
  3. 35 minutes            
  4. 40 minutes            

1. 15 minutes

Rational: Administration of 1mg⁄kg of succinylcholine results in complete suppression of neuromuscular activity in approximately 60 seconds, and it takes 9-13 minutes to recover 90% muscle strength in patients with normal pseudocholinesterase activity (also known as plasma cholinesterase or butyrylcholinesterase)

500

While caring for a patient after lumbar posterior nerve root rhizotomy, the perianesthesia nurse notes the patient has no movement or sensation to the lower extremities.  The priority nursing action is to notify the:

  1. anesthesiologist of muscle paralysis.            
  2. operating room of the complications.            
  3. surgeon of the absence of sensation.            
  4. surgeon of lack of motor ability.    

4. surgeon of lack of motor ability.

500

The patient with a pneumonectomy should never be positioned:

  1. on the non-operative side.
  2. on the operative side.
  3. supine.
  4. in semi-Fowler’s position.

1. on the non-operative side

Rational: The optimal position for gas exchange after pneumonectomy is a lateral position, with the remaining lung in the uppermost position

500

In Phase II of the PACU, there are four stable adult patients who are awake, two stable pediatric patients who are awake and under the age of 5 with parents present, and two pediatric patients under the age of 5 with parents present who are ready for discharge. According to the ASPAN Standards of Perianesthesia Nursing Practice, what is the minimum number of nurses needed to staff appropriately?    

  1. 3 nurses          
  2. 4 nurses   
  3. 5 nurses           
  4. 6 nurses          

1. 3 nurses 

Rational: Stable adults: ASPAN recommends a 1:4 nurse-to-patient ratio for stable adult patients in Phase II. With four adult patients, this would require at least one nurse.

Pediatric patients: ASPAN recommends a 1:2 nurse-to-patient ratio for pediatric patients, especially those under the age of 5, when parents are present.

500

It is important for a perianesthesia nurse to understand that a child’s ability to classify and estimate pain normally develops around the age of:  

  1. 4 or 5 years.            
  2. 7 or 8 years.            
  3. 10 or 11 years.            
  4. 13 or 14 years.                           

1. 4 or 5 years.