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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
Correct Answer: D
Rationale: Elderly patients, like the 82-year-old, are at higher risk for altered anesthesia responses due to age-related declines in hepatic, cardiac, respiratory, and renal function. Younger patients or those with no significant comorbidities are less likely to have altered responses.
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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
Correct Answer: C
Rationale: Propofol is used for both general anesthesia and sedation in ICU settings for mechanically ventilated patients due to its rapid onset and short duration. Ketamine is used for anesthesia and moderate sedation, midazolam for moderate sedation, and sevoflurane is an inhaled anesthetic not typically used for ICU sedation.
The nurse is reviewing the effects of general anesthesia with a group of new nurses. Which effects are expected with the use of general anesthetics? (Select all that apply.)
- A. Increased intracranial pressure
- B. Increased glomerular filtration
- C. Central nervous system depression
- D. Hypotension
- E. Decreased hepatic clearance
- F. Bronchodilation
- G. Respiratory depression
Correct Answer: A,C,D,E
Rationale: General anesthetics cause increased intracranial pressure, central nervous system depression, hypotension, decreased hepatic clearance, and respiratory depression. Glomerular filtration is typically decreased, not increased, and bronchodilation is not a consistent effect.
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
Correct Answer: B
Rationale: Moderate sedation reduces anxiety, pain, and recall while allowing the patient to maintain their airway and respond to commands, ideal for procedures like oral endoscopy. Local and topical anesthesia do not affect recall, and spinal anesthesia is used for lower body procedures.
A patient is to receive midazolam 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is available in a strength of 1 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe for this dose.
Correct Answer: 2 mL
Rationale: To calculate: 1 mg/1 mL = 2 mg/x mL. Cross-multiply: (1 * x) = (1 * 2); x = 2 mL.
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.
Correct Answer: D
Rationale: Neuromuscular blocking drugs paralyze all skeletal muscles, including respiratory muscles, requiring mechanical ventilation. They do not provide sedation or pain relief and are used with, not instead of, general anesthesia.