Nokea
A nurse is working in the PACU. Which of the following would be most important for the nurse to do? Select all that apply.
- A. Checking airway patency
- B. Positioning the client to prevent aspiration of secretions
- C. Reviewing the client's surgical and anesthesia records
- D. Checking the client every 15 to 30 minutes for emergence from anesthesia
- E. Checking the client's vital signs
Correct Answer: A,B,C,E
Rationale: Checking airway patency, positioning the client to prevent aspiration of secretions, reviewing the client's surgical and anesthesia records, checking the client every 5 to 15 minutes for emergence from anesthesia, and checking the client's vital signs, IV lines, catheters, drainage tubes, surgical dressings, and casts represent the nurse's responsibilities to a client in the PACU.
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A client scheduled for surgery has to undergo insertion of an endotracheal tube. The nurse understands that which of the following drugs for general anesthesia would most likely be ordered for this client?
- A. Benzodiazepines
- B. Barbiturates
- C. Opioid analgesics
- D. Skeletal muscle relaxants
Correct Answer: D
Rationale: Skeletal muscle relaxants help produce relaxation of skeletal muscles during certain types of surgeries involving the chest or abdomen and are used to facilitate the insertion of an endotracheal tube. Barbiturates are used for the induction of anesthesia. Benzodiazepines are used to relieve anxiety, induce anesthesia, and consciously sedate the client before minor procedures. Opioid analgesics are used to produce neuroleptanalgesia characterized by general quietness, reduced motor activity, and profound analgesia.
The nurse is reviewing the medical record of a client who has returned from surgery. The client received a volatile liquid that required administration with a special vaporizer because delivery to the client without a vaporizer can result in irritation of the client's respiratory tract. Which of the following would the nurse identify as being administered? Select all that apply.
- A. Sevoflurane
- B. Desflurane
- C. Isoflurane
- D. Methoxyflurane
- E. Halothane
Correct Answer: B
Rationale: Desflurane is a volatile liquid that must be administered with a special vaporizer because delivery to the client without a vaporizer can result in irritation of the client's respiratory tract.
A client admitted to a local health care facility is to undergo surgery with spinal anesthesia. Which of the following is the nurse most likely to observe when caring for this client?
- A. Moderate muscle relaxation
- B. Loss of feeling in the lower abdomen
- C. Hypotension as anesthesia deepens
- D. Increase in the client's heart rate
Correct Answer: B
Rationale: Spinal anesthesia involves the injection of a local anesthetic drug into the subarachnoid space of the spinal cord. There is a loss of feeling (anesthesia) and movement in the lower extremities, lower abdomen, and perineum. Spinal anesthesia is not known to increase a client's heart rate. Spinal anesthesia also does not cause hypotension or moderate muscle relaxation. Enflurane is a volatile liquid anesthetic that causes hypotension once it deepens. Halothane, which is a volatile liquid anesthetic, produces moderate muscle relaxation. Both halothane and enflurane are drugs used for general anesthesia.
For which area on the body would the nurse identify Ambrosia identify that the use of epinephrine with a local injectable drug would be contraindicated? Select all that apply.
- A. Use on a toe
- B. Use on the scalp
- C. Use on the face
- D. Use on the abdomen
- E. Use on a finger
Correct Answer: A,E
Rationale: When the local anesthetic is used on an extremity (such as a toe or finger), the use of epinephrine with a local injectable drug is contraindicated.
When clients receive the rapid-acting general anesthetic ketamine they would exhibit which of the following? Select all that apply.
- A. Analgesia
- B. Cardiovascular stimulation
- C. Reduced skeletal muscle tone
- D. Respiratory depression
- E. Respiratory stimulation
Correct Answer: A,B,E
Rationale: Clients administered the rapid-acting general anesthetic ketamine (Ketalar) will exhibit profound analgesia, cardiovascular stimulation, respiratory stimulation, and enhanced skeletal muscle tone.