Anesthesia

Question 1

Who are the 3 medical professionals that can provide anesthesia services?

Answer 1

1. anesthesiologists
2. certified registered nurse anesthetists
3. anesthesiologist assistants

Question 2

What are the credentials of an anesthesiologist?

Answer 2

1. MD or DO
2. 4 years of graduate education
3. 4 year residency in anesthesiology
4. under the anesthesia care team model, an anesthesiologist supervises the certified registered nurse anesthetist and anesthesiologist assistant

Question 3

What are the credentials of a certified registered nurse anesthetists ?

Answer 3

1. RN with a bachelor’s degree in nursing
2. Min of 1 year of experience in critical care
3. Master’s or doctoral degree from accredited nurse anesthesia ed program
4. passed the national certification exam

Question 4

What are the credentials of an anesthesiologist assistant?

Answer 4

1. Bachelor of Science degree with a pre-med education
2. Accredited AA program
3. passed the national certification exam

Question 5

What are the 8 factors that should be considered before choosing an anesthetic?

Answer 5

1. patient’s age
2. length and type of surgery
3. patient and surgeon preferences
4. patient’s co-existing diseases
5. patient’s mental and psychological status
6. patient’s previous experiences with anesthesia
7. plans and protocols for post pain management
8. position of the patient during surgery

Question 6

What does the American society of Anesthesiologist’s say as NPO guidelines for…clear liquids?

Answer 6

stop 2 hours before surgery

Question 7

What does the American society of Anesthesiologist’s say as NPO guidelines for…breast milk?

Answer 7

stop 4 hours before surgery

Question 8

What does the American society of Anesthesiologist’s say as NPO guidelines for…infant formula?

Answer 8

stop 6 hours before surgery

Question 9

What does the American society of Anesthesiologist’s say as NPO guidelines for…light meal - toast and a clear liquid ?

Answer 9

stop 6 hours before surgery

Question 10

What does the American society of Anesthesiologist’s say as NPO guidelines for…fried foods-fatty foods-mean?

Answer 10

stop 8 hours before surgery

Question 11

According to the ASA’s NPO guidelines, infant formula, nonhuman milk, and a light meal may be consumed 6 hours before surgery? true or false

Answer 11

true

Question 12

Who should be available to assist the anesthesia provider during induction of anesthesia?

Answer 12

perioperative nurse

Question 13

In what way can the perioperative nurse help the anesthesia provider?

Answer 13

1. cricoid pressure application
2. if intubation or ventilation of the patient becomes difficult, the perioperative nurse should retrieve additional equipment and supplies.

Question 14

When is cricoid pressure released?

Answer 14

not until the ET tube cuff is inflated, tube placement is confirmed, and the anesthesia provider has given a verbal confirmation to the nurse that the cricoid pressure can be released.

Question 15

If you are unsure if you should release cricoid pressure, what should you do?

Answer 15

ask the provider

Question 16

What are 6 responsibilities of the perioperative nurse to help anesthesia?

Answer 16

1. Help set up monitoring equipment.
2. obtaining and checking blood products
3. positioning forced-air warming equipment
4. locating and retrieving emergency equipment
5. monitoring the patient according to the preoperative plan of care and making adjustments as needed
6. being at bedside during intubation and emergence

Question 17

What are 3 commonly used anesthesia pieces of equipment?

Answer 17

1. anesthesia machine
2. intravenous infusion pumps
3. warming devices

Question 18

What is the anesthesia machine used for?

Answer 18

for delivering oxygen and inhaled anesthetic gases to the patient

Question 19

What is the IV pump used for?

Answer 19

for administering IV anesthetics and vasoactive meds

Question 20

What are the warming devices used for?

Answer 20

for the patient and for fluids

Question 21

What are 3 pieces of airway equipment used by anesthesia?

Answer 21

1. Laryngoscope
2. oral and nasopharyngeal airways
3. endotracheal tubes

Question 22

What assesses depth of anesthesia?

Answer 22

bispectral index monitor

Question 23

What is general anesthesia?

Answer 23

a drug-induced reversible state of unconsciousness

Question 24

What does general anesthesia result in?

Answer 24

Results in amnesia, analgesia, and loss of responsiveness, decreased stress response, and loss of skeletal muscle
reflexes to a varying degree

Question 25

What is regional anesthesia?

Answer 25

An injection of local anesthetics near nerve fibers that causes reversible loss of sensation over an area of the body

Question 26

What are examples of regional anesthesia?

Answer 26

1. spinal 2. epidural 3. peripheral nerve block

Question 27

What is monitored anesthesia care?

Answer 27

An anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as required.

Question 28

What is moderate sedation?

Answer 28

The administration of sedative, analgesic, and/or anxiolytic agents by a physician or by a nurse under physician supervision

Question 29

What can an RN do depending on state laws and hospital policies?

Answer 29

may administer moderate sedation

Question 30

What is local anesthesia?

Answer 30

The infiltration or topical administration of agents to anesthetize a part of the body

Question 31

What does the RN do with local anesthesia?

Answer 31

provides patient monitoring and supportive care

Question 32

What two types of anesthesia must be administered by an anesthesia provider?

Answer 32

1. general anesthesia | 2. monitored anesthesia care

Question 33

What is phase 1 of general anesthesia?

Answer 33

induction

Question 34

What happens during phase 1 of general anesthesia?

Answer 34

IV medications and inhalational agents are administered by the anesthesia provider.

Question 35

What is phase 2 of general anesthesia?

Answer 35

maintenance

Question 36

What happens during phase 2 of general anesthesia?

Answer 36

Medications and inhaled agents are administered to keep the patient anesthetized

Question 37

What is phase 3 of general anesthesia?

Answer 37

emergence

Question 38

What happens during phase 3 of general anesthesia?

Answer 38

At the end of the procedure, the anesthetic agents are discontinued or reversed to allow the patient to wake up.

Question 39

What are the 3 types of induction for general anesthesia?

Answer 39

1. IV induction - propofol, etomidate, methohexital, ketamine 2. Inhalation induction - sevoflurane 3. muscle relaxant - succinylcholine, cisatracinum, atracurium, rocuronium, and vecuronium, pancuronium

Question 40

What airway maintenance usually requires a muscle relaxant?

Answer 40

endotracheal tube

Question 41

Can succinylcholine be reversed?

Answer 41

no

Question 42

Other relaxants can be reversed with what?

Answer 42

1. neostigmine | 2. edrophonium

Question 43

What is the reversal agent for rocuronium, vecuronium, and pancuronium?

Answer 43

sugammadex

Question 44

What can reverse benzodiazepines (midazolam)?

Answer 44

flumazenil

Question 45

What can reverse narcotics (fentanyl)?

Answer 45

naloxone

Question 46

What happens at the end of the procedure on the anesthesia end?

Answer 46

inhalantional and IV anesthetics are stopped

Question 47

What happens with the Et/laryngeal mask airway during emergence?

Answer 47

the ET or LMA is removed when the patient is conscious and able to maintain their airway

Question 48

What are 4 common local anesthetics used for regional anesthesia?

Answer 48

1. lidocaine 2. bupivacaine 3. ropivacaine 4. tetracaine

Question 49

What are 2 additional meds that might be added to the local anesthetic?

Answer 49

1. epinephrine | 2. bicarbonate

Question 50

what is tetracaine used for?

Answer 50

long-acting spinal anesthesia

Question 51

What is epinephrine used for?

Answer 51

can be added to increase the density and duration of a regional block

Question 52

What is bicarbonate used for?

Answer 52

sometimes added to reduce the acidity of the local anesthetic and speed the onset of the block

Question 53

What are the 2 types of neuraxial anesthesia?

Answer 53

1. spinal anesthesia | 2. epidural anesthesia

Question 54

Describe a spinal block?

Answer 54

local anesthetic is injected into the subarachnoid space

Question 55

Who are 4 patients at increased risk for hypothermia?

Answer 55

1. older adults 2. infants and children 3. women 4. patients with lower-than-normal body weight

Question 56

How does LAST occur slowly?

Answer 56

if local anesthetic is absorbed over time

Question 57

How does LAST occur quickly?

Answer 57

If accidentally injected directly into a blood vessel

Question 58

How can LAST progress?

Answer 58

progresses to seizures and respiratory or cardiac arrest

Question 59

What are 4 s/sx of LAST?

Answer 59

1. ringing in the ear 2. tingling around the lips 3. metallic taste in the mouth 4. dizziness

Question 60

What type of anesthesia does not use sedation?

Answer 60

local

Question 61

What are continuously monitored during a procedure using local anesthesia ?

Answer 61

1. blood pressure 2. ECG 3. Pulse ox 4. Heart rate

Question 62

What is MH triggered by?

Answer 62

inhaled general anesthetic agents and the muscle relaxant succinylocholine

Question 63

What is the most specific sign of MH?

Answer 63

increased end-tidal carbon dioxide

Question 64

What are s/sx of MH?

Answer 64

1. skeletal muscle rigidity 2. ventricular dysrhythmia 3. skin mottling 4. hyperthermia

Question 65

What is the protocol for treatment of MH?

Answer 65

1. stop the surgery 2. Get MH cart and dantrolene 3. Call for Help 4. Hyperventilate with 100% oxygen at a flow of 10 L/min 5. Give dantrolene - 2.5 mg/kg 6. obtain blood gases 7. cool pt. if core temp is greater than 39 degrees celsius, stop cooling if pt.'s temp goes to less than 38 degrees celsius 8. provide appropriate treatment for dysrhythmias and abnormal electrolytes 9. For management of suspected or known MH cases, immediately call the MHAUS hotline: 800.644.9737

Question 66

What are conditions in the OR that put a pt. at risk for hypothermia?

Answer 66

1. patients are required to wear thin gowns 2. Ors are frequently kept cool 3. large amounts of skin are often exposed to the air 4. wet prep solutions are applied to the skin 5. IV and irrigation fluids are usually cooler than body temp. 6. surgery can last hours 7. regional and general anesthesia interfere with the body's ability to regulate temp. vasodilation shifts blood from the body's core to cooler peripheral tissues

Question 67

The RN providing moderate sedation should have what?

Answer 67

1. no competing responsibilities 2. be proficient in airway assessment and ACLS 3. understand indications, contraindications, interactions, adverse reactions and nursing considerations of the drugs being administered 4. have access and the ability to administer reversal meds for the drugs being given

Question 68

Why might cricoid pressure be needed?

Answer 68

1. to prevent aspiration OR 2. to help with visualization of the vocal cords and placement of ET tube OR 3. required for a rapid sequence induction

Question 69

What -- assesses depth of anesthesia?

Answer 69

Bispectral index monitor

Question 70

What is ERAS?

Answer 70

Enhanced Recovery After Surgery

Question 71

What is an airway that is inserted into the mouth and sits above and around the larynx?

Answer 71

supraglottic airway device

Question 72

What is an example of supraglottic airway device?

Answer 72

LMA

Question 73

What is TEE?

Answer 73

Transesophageal echocardiography

Question 74

What is TIVA?

Answer 74

Total intravenous anesthesia