TEST BANK
Pharmacology and the Nursing Process
9th Edition
Linda Lane Lilley, Shelly Rainforth Collins, Julie S. Snyder
Chapter 11: General and Local Anesthetics
MULTIPLE CHOICE
1. 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?
1. No anesthesia
2. Topical benzocaine spray on the area
3. Topical prilocaine (EMLA) cream around the site
4. Infiltration of the puncture wound with lidocaine
ANS: D
Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the
local anesthetic solution intradermally, subcutaneously, or submucosally across the path of
nerves supplying the area to be anesthetized. The local anesthetic may be administered in a
circular pattern around the operative field. The other types are not appropriate for this injury.
This is a painful procedure; therefore, the option of “no anesthesia” is incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse
notes a sudden elevation in body temperature. This finding may be an indication of which
problem?
1. Tachyphylaxis
2. Postoperative infection
3. Malignant hypertension
4. Malignant hyperthermia
ANS: D
A sudden elevation in body temperature during the postoperative period may indicate the
occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature
does not reflect the other problems listed.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
3. When assessing patients in the preoperative area, the nurse knows that which patient is at a
higher risk for an altered response to anesthesia?
1. The 21-year-old patient who has never had surgery before
2. The 35-year-old patient who stopped smoking 8 years ago
3. The 40-year-old patient who is to have a kidney stone removed
4. The 82-year-old patient who is to have gallbladder removal
ANS: D
Chapter 11: General and Local Anesthetics
57
The elderly patient is more affected by anesthesia than the young or middle-aged adult patient
because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
4. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which
nursing diagnosis would be appropriate for this patient?
1. Anxiety related to the use of an anesthetic
2. Risk for injury related to increased sensorium from general anesthesia
3. Decreased cardiac output related to systemic effects of local anesthesia
4. Impaired gas exchange related to central nervous system depression produced by
general anesthesia
ANS: D
The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety
would not be appropriate while the patient is in surgery. Sensorium would be decreased during
surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When administering a neuromuscular blocking drug, the nurse needs to remember which
principle?
1. It is used instead of general anesthesia during surgery.
2. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
3. It causes sedation and pain relief while allowing for lower doses of anesthetics.
4. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
ANS: D
Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation
because of the resultant paralysis of the respiratory muscles. In addition, they do not cause
sedation or pain relief. They are used along with, not instead of, general anesthesia during
surgery.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. 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?
1. Local anesthesia
2. Moderate sedation
3. Topical anesthesia
4. Spinal anesthesia
Chapter 11: General and Local Anesthetics
58
ANS: B
Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the
medical procedure, yet it preserves a patient’s ability to maintain his or her own airway and
respond to verbal commands. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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?
1. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
2. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
3. An anticholinesterase drug, such as neostigmine
4. Cardiopulmonary resuscitation (CPR) and intubation
ANS: B
Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant
hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart
and lung function as well as with immediate treatment with the skeletal muscle relaxant
dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations.
Naltrexone and anticholinesterase drugs are not appropriate in this situation.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an
appropriate indication for dexmedetomidine? (Select all that apply.)
1. Procedural sedation
2. Surgeries of short duration
3. Surgeries of long duration
4. Postoperative anxiety
5. Sedation of mechanically ventilated patients
ANS: A, B, E
Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration,
and it is also used in the intensive care setting for sedation of mechanically ventilated patients.
The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 11: General and Local Anesthetics
59
COMPLETION
1. A patient is to receive midazolam (Versed) 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. _______
ANS: 2 mL
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 11: General and Local Anesthetics
60
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
MULTIPLE CHOICE
1. A patient who has received some traumatic news is panicking and asks for some medication to
help settle down. The nurse anticipates giving which drug that is most appropriate for this
situation?
1. Diazepam (Valium)
2. Zolpidem (Ambien)
3. Phenobarbital
4. Cyclobenzaprine (Flexeril)
ANS: A
Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a
hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control.
Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells
the nurse that he feels tense and that “the least little thing” bothers him now. Which is the correct
explanation for this problem?
1. These are adverse effects that usually subside after a few weeks.
2. The drug must be stopped immediately because of possible adverse effects.
3. This drug causes the rapid eye movement (REM) sleep period to increase, resulting
in nightmares and restlessness.
4. This drug causes deprivation of REM sleep and may cause the inability to deal
with normal stress.
ANS: D
Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation
and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is
stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in
nightmares. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
3. A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and
unable to walk after eating out for dinner. His wife states that he has no other prescriptions and
that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects
that which of these may have happened?
1. He took a multivitamin.
2. He drank a glass of wine.
3. He took a dose of aspirin.
61
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
d. He developed an allergy to the drug.
ANS: B
Alcohol has an additive effect when combined with barbiturates and causes central nervous
system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this
situation does not illustrate an allergic reaction.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse
to say that when she takes it, she sleeps well, but the next day she feels “so tired.” Which
explanation by the nurse is correct?
1. “Long-term use of this drug results in a sedative effect.”
2. “If you take the drug every night, this hangover effect will be reduced.”
3. “These drugs affect the sleep cycle, resulting in daytime sleepiness.”
4. “These drugs increase the activity of the central nervous system, making you tired
the next day.”
ANS: C
Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and,
thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is
taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a
week. Which nursing diagnosis would be appropriate for him?
1. Risk for injury related to decreased sensorium
2. Risk for addiction related to psychologic dependency
3. Decreased fluid volume related to potential adverse effects
4. Disturbed sleep pattern related to the drug’s interference with REM sleep
ANS: A
Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be
taught the importance of taking measures to minimize self-injury and falls related to decreased
sensorium. “Risk for addiction” is not a NANDA nursing diagnosis. The other nursing diagnoses
are not appropriate for this situation.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
6. A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is
concerned that she cannot get to sleep without taking the medication. What nonpharmacologic
measures should the nurse suggest to promote sleep for this patient?
62
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
1. Providing a quiet environment
2. Exercising before bedtime to become tired
3. Consuming heavy meals in the evening to promote sleepiness
4. Drinking hot tea or coffee just before bedtime
ANS: A
Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding
heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm
decaffeinated drinks, such as warm milk, before bedtime.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
7. A patient is brought to the emergency department for treatment of a suspected overdose. The
patient was found with an empty prescription bottle of a barbiturate by his bedside. He is
lethargic and barely breathing. The nurse would expect which immediate intervention?
1. Starting an intravenous infusion of diluted bicarbonate solution
2. Administering medications to increase blood pressure
3. Implementing measures to maintain the airway and support respirations
4. Administrating naloxone (Narcan) as an antagonist
ANS: C
There are no antagonists/antidotes for barbiturates. Treatment supports respirations and
maintains the airway. The other interventions are not appropriate.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s
medical history, knowing that this medication is contraindicated in which disorder?
1. Coronary artery disease
2. Renal insufficiency
3. Liver disease
4. Anemia
ANS: C
Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not
contraindications.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine
(Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?
a. A musculoskeletal injury
b. Insomnia
63
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
c. d.
Epilepsy Agitation
ANS: A
Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms
following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. A patient has experienced insomnia for months, and the physician has prescribed a
medication to help with this problem. The nurse expects which drug to be used for long-term
treatment of insomnia?
1. Secobarbital (Seconal), a barbiturate
2. Diazepam (Valium), a benzodiazepine
3. Midazolam (Versed), a benzodiazepine
4. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
ANS: D
Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term
use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term
treatment of insomnia; midazolam is used for procedural (moderate) sedation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which
statement by the patient indicates that additional teaching about this herbal product is needed?
1. “I will not drink wine with the kava tea.”
2. “If I notice my skin turning yellow, I will stop taking the tea.”
3. “I will not take sleeping pills if I have this tea in the evening.”
4. “I will be able to drive my car after drinking this tea.”
ANS: D
Patients should not drive after drinking this tea because it may cause sedation. Kava tea may
cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol,
barbiturates, and psychoactive drugs.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
1. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a
contraindication to the use of these drugs? (Select all that apply.)
a. Gout
64
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
2. Pregnancy
3. Epilepsy
4. Severe chronic obstructive pulmonary disease
5. Severe liver disease
6. Diabetes mellitus
ANS: B, D, E
Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and
severe liver disease. The other disorders are not contraindications.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the
patient’s current medications, the nurse recognizes that interactions may occur with which drugs?
(Select all that apply.)
1. Antihistamines
2. Opioids
3. Diuretics
4. Anticoagulants
5. Oral contraceptives
6. Insulin
ANS: A, B, D, E
The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and
tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and
barbiturates can result in decreased anticoagulation response and possible clot formation. Co-
administration of barbiturates and oral contraceptives can result in accelerated metabolism of the
contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics
and insulin.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
65
