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206 Cards in this Set

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Elevation of maternal temperature which may be the result of receiving an Epidural:

a) Doulas
b) Hypothermia
c) Hyperthermia
d) Pyrexia
Pyrexia
Sometimes hired by women & specalizes in assisting the woman to maintain comfort & control throughout labor & birth:

a) miswife
b) union
c) labor doulas
d) anesthesiologist
c) labor doulas
You will assess the mother & fetus & also evaluate the cxn pattern before administering prescribed systemic medications. Fetal assessment includes all of the following except:

a) short-term & long term variability are present

b) accelerations are present w/fetal movement

c) FHR baseline is between 160 & 181

d) fetus is at term
c) FHR baseline is between 160 & 181

FHR baseline is between 110 & 160 beats/minute
Before you administer medicaton, you will once again ascertain if the woman has a history of drug reactions or allergies & provide info about the medication. After giving the medication you will record the drug name, dose, route, & site on the FHR monitor strip. There are 2 more things you will record on the FHR monitor strip.

What are they?
The womans blood pressure & pulse

You will also assess the FHR for possible adverse affects of the medication
-Narcotic analgesics
-Analgesic potentiators
-Opiate Antagonists

These are classified as:

a) systemic anesthetics
b) regional anesthetics
c) general anesthetics
a) systemic anesthetics

SYSTEMIC DRUGS:

-Narcotic analgesics
-Analgesic potentiators
-Opiate Antagonists
Stadol, Nubain, Phenergan, & Naloxone are:

a) systemic anesthetics
b) regional anesthetics
c) general anesthetics
a) systemic anesthetics
Can be given IM, SQ, IV, & side effects include rspiratory depression, drowsy-dizzy, crying, blurred vision, nausea, diaphoresis, & urinary urgency. This drug may also potentiate drug withdrawal:

a) Stadol
b) Nubain
c) Phenergan
d) Naloxone
b) Nubain

Stadol may also cause drug withdrawal, but is only given IM & IV & may cause urinary retention & bladder distention
Types of regional "local" anesthesetics that rapidly cross the placenta, can be measured in the fetal circulation, & affect the fetus for a prolonged time:

a) Esters
b) Amides
c) Opioids
b) Amides

more powerful & longer acting than esters but readily cross the placenta and can be measured in fetal circulation & affect the fetus for a prolonged period

AMIDES:
lidocaine/xylocaine
carbocaine
marcaine
Both Stadol & Nubain (Systemic-Narcotic Analgesics) can potentiate drug withdrawal, cause respiratory depression, & cross the placenta. Knowing the main difference between them is that Nubain acts more rapidly & lasts longer, what other difference can you think of?
Nubain can be given SQ in addition to IM & IV.

It is noted for causing drowsiness, dizzyness, crying, blurred vision, nausea, diaphoresis & urinary urgency in addition to having a longer duration than Stadol as well as also causing respiratory depression.
All of the following are classified as systemic & analgesic potentiators except:

a) Phenergan
b) Vistaril
c) Largon
d) Narcan
e) Sparine
f) Reglan
g) Aveline
d) Narcan
and...
g) Aveline

-Narcan is an Opiate Antagonist
- Aveline is a works cited
AKA "ataractics" which can decrease anxiety & increase the effectiveness of analgesics when given simultaneously:

a) Narcotic analgesics
b) Nubain
c) Analgesic potentiators
d) Epidural block
c) analgesic potentiators
Type of drug that enables the patient to receive smaller doses of narcotics & also ued to manage N&V:

a) Amides
b) Opioids
c) Butorphanols
d) Analgesic potentiators
d) Analgesic potentiators

AKA: tranqilizers !
-Narcotic analgesics
-Analgesic potentiators
-Opiate Antagonists

These are classified as:

a) systemic anesthetics
b) regional anesthetics
c) general anesthetics
a) systemic anesthetics

systemic drugs used in labor include:

stadol & nubain (narcotics)

phenergan, visaril, lardon, reglan, sparine (potentiators)

narcan/naloxone a antidote for narcotics to reverse respiratory depression
Can be given IM, SQ, IV, & side effects include rspiratory depression, drowsy-dizzy, crying, blurred vision, nausea, diaphoresis, & urinary urgency. This drug may also potentiate drug withdrawal:

a) Stadol
b) Nubain
c) Phenergan
d) Naloxone
b) Nubain

Stadol may also cause drug withdrawal, but is only given IM & IV & may cause urinary retention & bladder distention.
Systemic drugs Stadol & Nubain are also classified as narcotics. When given IV, which has the earliest onset & peak of action, & has the longest duration?

a) Stadol
b) Nubain
b) Nubain

NUBAIN IV:
- onset 2-3 min
- peak 15-20 min
- duration 3-6 hr

STADOL IV:
- onset 10-30 min
- peak 30-1 hr
- duration 3-4 hr
Both Stadol & Nubain (Systemic-Narcotic Analgesics) can potentiate drug withdrawal, cause respiratory depression, cross placenta. Knowing the main difference between them is Nubain acts more rapidly & lasts longer, what other difference can you think of?
Though rare, you should be alert for bladder distention due to urinary retention with Stadol.

Nubain is noted for causing urinary urgency in addition to emotional disturbances, nausea, blurred vision, & diaphoresis.
WHich of the following systemic drugs is (are) classified as tranquilizers?

a) Stadol
b) Nubain
c) Phenergan
d) Naloxone
c) Phenergan

-Stadol & Nubain are narcotics
-Narcan is an Opiate Antagonist
All of the following are classified as systemic & analgesic potentiators except:

a) Phenergan
b) Vistaril
c) Largon
d) Narcan
e) Sparine
f) Reglan
g) Aveline
d) Narcan
and...
g) Aveline

-Narcan is an Opiate Antagonist
- Aveline is a works cited
The main side effect of analgesic potentiators (systemic drug/ataractics)is all of the following except which of these?

a) hyperexcitability
b) sedation
b) sedation
When respiratory depression occurs due to use of Stadol or Nubain, Naloxone/Narcan will not be effective for Nubain.

True or False
False
Naloxone/Narcan may be administered to a newborn to treat respiatory depression.

True or False
True
All of the following are known to potentiate drug withdrawal except:

a) Stadol
b) Nubain
c) Phenergan
d) Reglan
e) Naloxone
f) Vistaril
c) Phenergan
d) Reglan
f) Vistaril

Analgesic potentiators (tranquilizers) are not known to cause withdrawals when a patient is drug dependent on narcotics.
A narcotic (agonist-antagonist) that is 30-40 times more potent than demerol & 7 times more potent than morphine:

a) Stadol
b) Nubain
c) Sparine
d) Fentanyl
a) Stadol

(systemic narcotic)
A synthetic agonist-antagonist that may precipitate drug withdrawal & given IV 10 mg over 3-5 minutes:

a) Stadol
b) Nubain
c) Fentanyl
b) Nubain
A systemic narcotic that revrses the analgesic effect of other opiods, narcotics, & precipitates withdrawal in drug dependent patients. It is administered IV 1-2 mg, has a rapid onset & peaks in 30-60 minutes:

a) Stadol
b) Nubain
c) Fentanyl
a) Stadol

systemic anesthesia
Narcotic analgesics include all of the following except:

a) Stadol
b) Naloxone
c) Xylocaine
d) Nubain
e) Fentanyl
b) Naloxone
and...
c) Xylocaine

NALOXONE -opiate ANTIDOTE
to reverse respiratory depression from opiates)

XYLOCAINE (amide) is a local anesthetic used for an episiotomy (intracutaneous, SQ, IM)
AKA "ataractics" which can decrease anxiety & increase the effectiveness of analgesics when given simultaneously:

a) Narcotic analgesics
b) Nubain
c) Analgesic potentiators
d) Epidural block
c) analgesic potentiators
Type of drug that enables the patient to receive smaller doses of narcotics & also used to manage N&V:

a) Amides
b) Opioids
c) Butorphanols
d) Analgesic potentiators
d) Analgesic potentiators

AKA: tranqilizers !
A systemic narcotic noted for side effects that include maternal resp depression, drowsiness, dizziness, crying,diaphoresis, blurred vision, & urinary urgency:

a) Stadol
b) Nubain
c) Fentanyl
d) Narcan
b) Nubain
The recommended initial dose of Stadol IM is:

a) IM 10 mg q 2-4 hr
b) IM 10 mg q 3-4 hr
c) IM 0.4-2 mg q 2-3 minutes up to 10 mg
d) IM 2 mg q 3-4 hr
d) IM 2 mg q 3-4 hr
Stadol is given IV:

a) IV 1-2 mg
b) IV 10 mg
c) IV 0.4-2 mg
d) IV 0.5-0.8 mg
a) IV 1-2 mg
Nubain is administered:

a) IV 2 mg 3-5 minutes
b) IV 5 mg 3-5 minutes
c) IV 10 mg 3-5 minutes
d) IV 20 mg 3-5 minutes
c) IV 10 mg 3-5 minutes
Narcan. a systemic opiate antagonist used for reversal of mild respiratry depression, sedation, & hypotension is administered:

a) IV 0.1-10 mg q 2-3 minutes
b) IV 0.2-10 mg q 2-3 minutes
c) IV 0.3-10 mg q 2-3 minutes
d) IV 0.4-10 mg q 2-3 minutes
d) IV 0.4-10 mg q 2-3 minutes
Narcotics should not be administered if respirations are:

a) below 24 breaths per minute
b) below 18 breaths per minute
c) below 14 breaths per minute
d) below 12 breaths per minute
d) below 12 breaths per minute
Narcan, an opiate antagonist (systemic) has a short duration and an onset of:

a) 1 hour
b) 30 minutes
c) 10 minutes
d) 2 minutes
d) 2 minutes
Stadol, a narcotic agonist-antagonist, has a duration of:

a) IV 45 min - 6 hrs
b) IV 2-4 hrs
c) IV 3-4 hrs
d) IV 3-6 hrs
c) IV 3-4 hrs
Nubain, a sytemic agonist-antagonist, has a duration of:

a) IV 45 min - 6 hrs
b) IV 2-4 hrs
c) IV 3-4 hrs
d) IV 3-6 hrs
d) IV 3-6 hrs
Narcan, a systemic opiate antagonist, has a duration of:

a) IV 45 min - 6 hrs
b) IV 2-4 hrs
c) IV 3-4 hrs
d) IV 3-6 hrs
a) IV 45 min - 6 hrs
Which of the following are classified as tranquilizers?

a) Stadol
b) Nubain
c) Vistaril
d) Naloxone
c) Vistaril

Analgesic potentiators are classified as tranquilizers.

Have no specific properties that decrease pain but do potentiate effects of narcotic analgesics WITHOUT increasing unwanted side effects

Phenergan
Vistaril
Largon
Sparine
Reglan
The main side effect of analgesic potentiators (tranquilizers) is:

a) nausea
b) anxiety
c) bladder distention
d) withdrawal
e) sedation
e) sedation
Name the main benifit of analgesic potentiators (tranquilers) ?????????
enables the patient to receive smaller doses of narcotics because they potentiate th effects of narcotic anagesics that are administered

sedation is the main side effect & is usually helpful in promoting rest unless rest/sedation is undesired by the patient
Nubain may produce an allergic response in patients with sulfite sensitivity. In addition, before administering you should first:

a) assess blood pressure
b) assess urinary output
c) assess neurological
d) assess respirations
d) assess respirations

CONTACT provider if respirations are LESS THAN 12 breaths per minute
In addition to assessing patients respirations before administering Nubain, the nurse should also assess the patient after administration for:

a) oliguria
b) bladder distention
c) blue eyes
d) alopecia
b) bladder distention
The primary concern for patients who are administered narcotics such as Stadol & Nubain include all of the following except:

a) oliguria
b) maternal respiratory depression
c) fetal distress
d) bladder distention & urgency
e) newborn respiratory depression
a) oliguria
All of the following are classified as systemic methods of anesthesia except:

a) Narcotic analgesics
b) Analgesic potentiators
c) regional anesthesia
d) pudendal block
c) regional anesthesia
and...
d) pudendal block
Accupressure can lessen the pain during the 1st stage of labor but this point should never be stimulated during pregnancy because it stimulates uterine contractions:

a) ear lobe
b) tempal
c) sqeezing between inner ankle bone & achilles tendon
d) webbing between the thumb & index finger
d) webbing between the thumb & index finger

****RUBBIBG stimulates labor
or...
****SQUEEZING to decrease labor pain

Sqeezing between innner ankle bone & achilles tendon for 1 min also reduces labor pain
A method of anesthesia in which agents block the conduction of nerve impulses from the periphery to the central nervous system resulting in a temporary loss of sensation:

a) ataractic anesthesia
b) regional anesthesia
c) systemic anesthesia
d) general anesthesia
b) regional anesthesia

Regional "local" anesthesia is also called a "local"

ATARACTICS is another term used for analgesic potentiators (tranquilizers)

SYSTEMIC is narcotics, analgesic potentiators, & opiate antagonists (Narcan)
Regional anesthesia include all of the following except:

a) epidural
b) spinal
c) general
d) systemic
c) general
and...
d) systemic

these are the other 2 classifications
An intrathecal injection of narcotics is a form of:

a) pudendal block
b) systemic anesthesia
c) regional anesthesia
d) general anesthesia
c) regional "local" anesthesia

Intrathecal is an injection of nacotics into the subarachnoid space of which Fentanyl & preservative free morphine are used
Absorption of local anesthetics depends primarily on:

a) nutritional staus
b) physical condition
c) metabolic rate
d) vasularity of area
d) vasularity of area

The agents themselves contribute to increased blood flow by causing vasodilation
Conditions that can increase the potential for toxic effects for regional anesthesia are all of the following except:

a) malnutrition
b) dehydration
c) electrolyte imbalance
d) cardiovascular problems
e0 pulmonary problems
ALL of THESE
Which of the following delay absorption & prolong anesthetic effects of regional anesthesia?

a) ataractics
b) vasodilators
c) epinepherine
d) esters
c) epinepherine

"Vasoconstrictors"

remember a regional "local" is dependent on vascularity of the area of injection

**Ataractics are tranquiizers (analgesic potentiators)
**Vasodilators would enhance regional anesthesia as most agents used cause vasodilation
** epinepherine is a vasoconstrictor
**esters are a type of agent used in regional anesthesia
Esters, amides & opiates are all agents used primarily in what method of anesthesia:

a) systemic anesthesia
b) regional anesthesia
c) epidurals
d) general anesthesia
b) regional anesthesia

systemic is another method of anesthesia which includes the use of opiates but not esters or amides

epidurals are classified as regional anesthesia

general anesthesia agents are unknown
Esters that are used in regional "local" anesthesia:

a) opiods
b) readily cross the placenta & can be measured in the fetal circulation, & affect the fetus for a prolonged time
c) rapidly metabolized thus toxic maternal levels are not as likely to be reached preventing placental transfer to the fetus
d) include morphine, fentanyl, butorphanol, meperdine
c) rapidly metabolized thus toxic maternal levels are not as likely to be reached preventing placental transfer to the fetus

ESTERS:
procaine/novocaine
nesacaine
tetracaine/pontocaine

AMIDES: readily cross the placenta & can be measured in the fetal circulation, & affect the fetus for a prolonged time

OPIODS:
morphine
fentanyl
butorphanol
meperdine
Mild reactions to regional anesthesia include all of the following except:

a) palpitations
b) tinnitus
c) apprehension
d) muscle twitching
e) confusion
f) metallic taste in mouth
d) muscle twitching

this is not a mild reaction because muscle twitching can progress to convulsions
Types of regional anesthesia include all of the following except:

a) epidural
b) pudendal block
c) intrathecal injection
d) general anesthesia
d) general anesthesia

MY personal FAVORITE!
Severe complications of a "local" (regional anesthesia) are all of the following except:

a) cardiovascular collapse
b) loss of consciousness
c) metallic taste in mouth
d) severe hypotension
e) bradycardia
f) respiratory depression
c) metallic taste in mouth

this is considered a mild reaction of a local (regional)
In the event your patient has mild toxic reactions to a regional "local" anesthesia, the preferred TX is:

a) epinepherine
b) narcan
c) 02
d) IV injection of short acting barbituate
c) 02
and ...
d) IV injection of short acting barbituate (to relieve anxiety)
Cause a temporary loss of sensation produced by injection of an anesthetic into direct contact with nervous tissue (stabilizes cell membranes to prevent initiation & transmission of nerve impulses).

a) Regional Anesthesia
b) General Anesthesia
c) Systemic Analgesics
a) Regional Anesthesia
Types of local anesthesetics that are rapidly metabolized which reduces the chance of toxic levels thus preventing placental transfer to the fetus:

a) Esters
b) Amides
c) Opioids
a) Esters


LOCAL - ESTERS:
- Procaine/Novocaine
- Chloroprocaine/Nesacaine
- Tetracaine/Pontocaine
Types of local anesthesetics that rapidly cross the placenta, can be measured in the fetal circulation, & affect the fetus for a prolonged time:

a) Esters
b) Amides
c) Opioids
b) Amides

LOCAL - AMIDES:

-Lidocaine/Xylocaine
-Mepivacaine/Carbocaine
-Bupivacaine/Marcaine
A type of local anesthetic that is used for epidural blocks and provide less pain relief when used alone than when used with other agentd:

a) Esters
b) Amides
c) Opioids
c) Opioids

Morphine
Fentanyl
Butorphanol
Meperdine

usually administered in combination with low dose of local anesthesia
- Procaine/Novocaine
- Chloroprocaine/Nesacaine
- Tetracaine/Pontocaine

Which type of local anesthetics are these?

a) Esters
b) Amides
c) Opioids
a) Esters
-Lidocaine/Xylocaine
-Mepivacaine/Carbocaine
-Bupivacaine/Marcaine

Which type of local anesthetics are these?

a) Esters
b) Amides
c) Opioids
b) Amides
Esters, Amides, & Opioids are used for:

a) General Anesthesia
b) Local Anesthesia
c) Regional Anetsthesia
b) Local Anesthesia

also known as REGIONAL
Pain RELIEF to a body area:

a) sytemic anesthesia
b) regional anesthesia
c) regional analgesia
d) general anesthesia
c) regional analgesia

Regional ANALGESIA provides pain relief to a body region & uses narcotics such as FENTANYL with only a small amount of anesthetic agent
(anesthetic agents are esters, amides & opiates)

Regional ANESTHESIA "local" produces a temporary loss of sensation (blocks nerve transmissions)with an anesthetic agent injected into nervous tissue; AKA spidural, spinal, combined epidural-spinal block (pudendal block could also be included as regional anesthesia for the perineal area)
Fentanyl & preservative free morphine are the most commonly used drugs injected into the subarachnoid space for:

a) systemic anesthesia
b) general anesthesia
c) intrathecal analgesia
c) intrathecal (regional analgesia)
A laboring patient dilated to 4 cm states " I am in pain, but I'm afraid that medication might harm my baby." Which therapeutic response by the nurse exemplifies understanding of pain medication during labor?

a) Pain medications might affect the baby, but so do pain & stress

b) You are correct in your belief that medication might harm the baby

c) The physician has ordered only a small amount so your baby will be quite safe

d) the new medications are so much safer than the old medications
a) Pain medications might affect the baby, but so do pain & stress

maternal pain & stress can reduce fetal 02 supply because of maternal vasoconstrictgion associated w/metabolic acidosis & the release of catecholamines

udring labor the maternal 02 consumption increases but decreases 02 to the fetus

in safe doses for the fetus, some analgesics provide some pain relief which may effectively increase 02 & nutrients to the fetus
You are planning to administer the 1st dose of butorphanol tartrate (Stadol) to a patient in labor. What should your initial action be before giving this medication?

a) monitor fetal heart rate
b) assess cervical dilation
c) assess for allergies
d) monitor maternal vital signs
a) assess for allergies

YOU MUST assess for allergies before administering any medication

monitoring FHR, cervical dilation, & maternal VS are appropriate interventions but are not the initial action to take

PRIORITIZE to prevent life threatening reactions that could compromise oxygenation of the mother or the fetus
4 clients are asking for pain medication & you know that which of the following is at the most optimal point during labor to achieve good pain control with the least risk of undesired outcomes?

a) The G1P0 w/cervical dilation of 3cm
b) The G3P2 w/cervical dilation of 4cm
c) The G2P0 w/cervical dilation of 9cm
d) The G2P1 w/cervical dilation of 8cm
b) G3P2 patient with cervical dilation of 4 cm

analgesics provide pain relief but also affect the fetus & labor process

opiods too early can prolong labor & can cause fetal depression

giving analgesics too late is of minimal benifit & may cause neonatal resp depression

A useful criteria for giving systemic analgesics is cervical dilation of at least 4-5 cm in the nullipara or 3-4 cm in the multipara

FYI:

G1P0=ist pregnancy
G3P2=3 pregnancies w/2 children & now delivering a 3rd
G2Po=2 pregnancies & 1 one abortion or miscarrage
G2P1 2 pregnancies w/1 live child & one on the way
20 minutes ago your laboring patient received Stadol for cxn pain that she rated as an 8 on scale of 0-10. You would administer Narcan 0.4 STAT for which of the following suide effects?

a) complaint of fatigue
b) suspected opiate dependency
c) respiratory rate of 6
d) contraction pain of 10
respiratory rate of 6

may need to be repeated because it peaks in 15 minutes & duration of narcan is shorter than that of opiods

Narcan should be avoided if client is suspected of or is known for opiate dependency because it could precipitate withdrawal

narcan does not relieve pain or fatigue
Involves the injection of an anesthetic into a potential space between the dura mater & the ligamentum flavum which is accessed through the lumbar area:

a) regional analgesia
b) general anesthesia
c) intrathecal injection
d) epidural block
d) epidural block
It is estimated that what % of women in the united states receive an epidural during labor & birth:

a) 15%
b) 25%
c) 40%
d) 50%
d) 50%
An epidural can be given as soon as active labor is established.

True or False

Describe active labor________.
True

Active labor, contraction pattern has been established
You are evaluating lab values for a woman in labor who requests an epidural. Which value in relation to epidural anesthesia concerns you & would cause you to report to the provider?

a) Platelet count below 100,000
b) serum total protein 6.5
c) Hb 12
d) serum glucose 120
a) Platelet count below 100,000

Low platelet count is an aboslute contraindication for an epidural (below 100,000)

The hemoglobin, total protein, & serum glucose are within normal limits for pregnancy
You are caring for a laboring woman receiving an epidural via a continuous infusion pump. There is a standing order for Benadry & you will administer this to your patient to provide relief from:

a) dry mouth
b) sedation
c) hypotension
d) pruritus
d) pruritis

Benadryl will not treat:

hypotension
N&V
general sedation
You are planning care for a patient scheduled for an epidural block in 30 minutes. Which of the following should be your initial intervention prior to the administration of the epidural?

a) monitor vital signs
b) give 02 5L/minute
c) reposition patient qh
d) infuse bolus 500-1000 mL
d) Infuse IV bolus of 500-1000 mL.

should infuse over 15-39 minutes to prevent hypotensive effect of epidural that can occur w/epidural

giving 02 at 5L/minute is appropriate after hypotension developes

avoid supine position to prevent venal caval syndrome but positioning is not the initial action

taking VS is important to detect hypotension during the epidural
Which of the following would be your most appropraite nursing intervention for a patient who will be receiving an epidural block in 30 minutes?

a) monitor vital signs
b) administer 02 at 5 L/minute
c) reposition patient qhr
d) Infuse IV bolus of 500-1000 mL
Infuse an IV bolus of 500-1000 ml.

500-1000 mL 0.9% NS or LR should infuse over 15-30 minutes to prevent hypotensive effects of an epidural

giving her 02 at 5 l/min is appropriate after hypotension developes

you should avoid the flat supine position to prevent venal caval syndrome but positioning is not the initial action

frequent taking of vital signs promotes detection of hypotension during epidural
A laboring patient has an IV & received an epidural 2 hrs ago & you plan urinary elimination by:

a) a suprapubic catheter
b) intermittant catheter q2h PRN
c) ambulation to bathroom when patient has the urge
d) remind her to void in bed pan q4h
b) intermittant catheterization

patients w/an epidural loose sensation of bladder filling & cannot urinate independently

you should cath q2h PRN

the client would likely fall in an attempt to ambulate

urinary elimination for 4 hrs may result in bladder distention & delay progression of labor

a suprapubic cath is invasive & unecessary during labor
You are assessing your patient who just received an epidural block & you recognize your patient is experiencing possible side effects of the epidural by which of the following?

a) BP 160/110
b) Temp 100.4
c) Pulse 140
d) Blood Pressure 80/56
e) headache
temperature of 100.4
and ...
blood pressure 80/56

the MOST COMMON complication from an epidural is HYPOtension

elevated temperature can be caused by an epidural

HYPERtension is associated w/preeclampsia

headache occurs when spinal block allows penetration of dura mater resulting in a spinal fluid leak

bradyycardia & tachycardia are not common complications of epidurals
The most common complication of an epidural is:

a) hypertension
b) hypotension
c) hypervolemia
d) hypovolemia
b) hypotension
Preventing hypotension in your patient prior to receiving an epidural you will:

a) administer intravenous fluid prior to placement of epidural
b) position her on her side
both !
The disadvantage of epidural anesthesia is all of the following except:

a) decreased labor
b) prolonged labor
c) delayed fetal descent
d) less effective pushing efforts
a) decreased labor
Contraindications for epidurals are all of the following except:

a) client refusal
b) infection at site of needle puncture
c) maternal problems with coagulation
d) drug allergy
e) hypovolemic shock
All of these
When the woman is awaiting an epidural, you should:

a) have her drink 8 oz of water
b) eat chocolate
c) reassure her the injuection will be administerd between contractions
d) habe her eat some green leafy's
c) reassure her the injuection will be administerd between contractions
Prior to receiving an epidural written and informed consent for the proceedure is obtained by:

a) the RN
b) the doctor
c) the anesthesiologist
d) the pediatrician in charge of the newborn after delivery
c) the anesthesiologist
The difference between regional anesthesia & regional analgesia is:

a) regional anesthesia provides pain relief in an area whereas regional analgesia blocks the sensation of pain in an area

b) regional anesthesia blocks sensation of pain in an area & regional analgesia provides pain relief in an area
b) regional anesthesia blocks sensation of pain in an area & regional analgesia provides pain relief in an area
Though regional anesthesia & regional analgesia differ in that anesthesia refers to blocking pain & analgesia rovides pain relief, in what other ways can they be distinguished?

a) regional anesthesia uses primarily esters & amides to block (numb, deaden) pain signals

b) regional anesthesia uses primarily opiods with low doses of esters & amides
a) regional anesthesia injects primarily esters & amides to block (numb, deaden) pain signals


regional analgesia primarily uses narcotics such as fentanyl in combination with low doses of amides

remember "caine blocks" & "narcotic relief" because esters & amides are "caines"
Differentiate between an epidural & a spinal in relation to the methods used for each.

1. - Epidural
2. - Spinal
1. EPIDURAL injects anesthetic agents into the epidural space between the dura mater & the ligamentum flavum (just outside of the spinal column)
Furthermore, the epidural can provide either anesthesia (caine blocks) or analgesia (narcotic relief) or both from active labor through episiotomy repair after delivery

2. -SPINAL is an injection of local anesthetic agents (esters & amides; "caine blocks") directly into the spinal canal
A continuous epidural allows different blocking for each stage of labor allowing the fetus to descend & rotate in the pelvis and preserving the womans urge to bear down.

True or false?
True
The advantage of a spinal block is immediate onset of anesthesia, lower drug volume, & maternal compartmentalization of the drugs used.

or False
True
The most common complication of an epidural and a spinal block are?
hypotension
A combined spinal-epidural block is?
A combined spinal epidural block is the injection of anesthetic agents through the dura mater into the cerebral spinal fluid with subsequent placement of a epidural catheter into the epidural space then secured in place
for additional or continuous administration of drugs

The advantage is both anesthetic & analgesic agents in low doses can be injected into the spinal fluid providing rapid pain relief in early labor and also can allow the woman to ambulate after epidural catheter is placed & additional doses of anesthesics & analgesics can be adminisered when active labor begins
Anesthetic agents should not be used unless:

a) patient has been NPO for 12 hours
b) patient is 18 years of age or older
c) IV line is in place
d) catheter is in place
c) IV line is in place
With an epidural block, labor can be prolonged as much as:

a) 25 minutes
b) 45 minutes
c) 1-2 hrs
d) 2-4 hours
a) 25 minutes
Contraindications for an epidural block include infection at the site of needle puncture, maternal blood coagulation problems, & drug allergy to the specific agents being used. There are 2 other absolute contraindications for use of an epidural. What are they?
client refusal

hypovolemic shock
In preparation for an epidural you should encourage the woman to empty her bladder in addition to assessing maternal blood pressure, pulse, respirations, & FHR for the purpose of:
determining that normal parameters are present & to establish a baseline
Positions that can be used to acheive epidural placement are:

a) standing
b) side lying
c) supine
d) sitting
b) side lying
and...
d) sitting
Anesthetic agents should not be used unless an IV is in place. AN intravenous infusion is usually begun with:

a) bubble gum
b) 12-guage plastic indwelling catheter
c) 16-guage plastic indwelling catheter
d) 18-guage plastic indwelling catheter
d) 18-guage plastic indwelling catheter
The large guage catheter is used in preparation for an epidural because :

a) agents have large particles that cannot be dissolved prior to administration
b) combinations of anesthetic agents & analgesics given in combination may coagulate during administration
c) in the event of hypertension large amounts of fluids can be administered quickly
d) in the event of hypotension large amounts of fluids can be administered quickly
d) in the event of hypotension large amounts of fluids can be administered quickly

Bolus of 500-1000mL of 0.9% NS or LR is administered prior to beginning an epidural block
Place the folloing in the order of penetration for a spinal block:

1. dura mater
5. spinal cord
3. epidural space
4. subarachnoid space
5. ligamentum flavum
ligamentum flavum
epidural space
dura mater
subarachnoid space
spinal cord
In preparation for an epidural your patient elects a side-lying position. You will assist her accordingly:

a) edge of bed, head on small pillow in keeping with alignment of the spine, straight back, shoulders square, legs bent, knees together to prevent rolling forward or twisting

b) edge of bed, chin to chest on small pillow, shoulders rolled forward, knees bent toward chest with pillow at chest to support position & upper arm & to prevent rolling forward or twisting
a) edge of bed, head on small pillow in keeping with alignment of the spine, straight back, shoulders square, legs bent, knees together to prevent rolling forward or twisting
In preparation for an epidural your patient elects a sitting position. You will assist her accordingly:

a)leaning forward with weight supported by arms resting on table, head in alignment with spine, shoulders squared, legs together with feet supported on stool.

b) back arched & feet supported on stool while standing in front of her with your hands on her shoulders, encourage her to push the round of her back towards the anesthesiologists, continue to provide support & try to ensure that she does not move during procedure & assist her into a recling position afterwards.
b) back arched & feet supported on stool while standing in front of her with your hands on her shoulders, encourage her to push the round of her back towards the anesthesiologists, continue to provide support & try to ensure that she does not move during procedure & assist her into a recling position afterwards.
After your patient has received an epidural, maternal vital signs are assessed frequently per protocol until the block wears off & recorded on the:

a) fetal monitor strip
b) client record
c) both
d) neither
according to the text it would be recorded on the fetal monitor strip, the client record or both.
After your patient recieves an epidural from a side lying position you should:

a) encourage her to lay flat to maximize uteroplacental blood flow
b) maintain side lying position to maximize uteroplacental blood flow
c) assist into a reclining position
b) maintain side lying position to maximize uteroplacental blood flow
An important assessment following an epidural, is the location & degree of lost sensation. Dermatomes can be used to measure & document where these levels begin & end. Can you name 4 interventions associated with evaluating where these sensory levels begin & end?
1. - use dermatome level charts

2. - use a coll alcohol prep to check areas & levels of sensation

3. - assess dermatome levels every 30 minutes

4. - evaluate level of of anesthesia.

If too high pt will report numbness in her chest, face, or tongue or difficulty breathing.

Be alert for statements such as "I cant take a full breath" or "my tongue feels funny"
If hypotension the nurse will first:

a) administer ephedrine
b) administer 02 5 L/minute
c) increase IV flow rate
d) verifies left uterine displacement
1st - increase IV flow rate

2nd - insures or verifies left uterine displacemnt to increase circulation

3rd - administer 02 5mL/minute
If your patient experiences hypotension after receiving an epidural & her blood pressure is not restored in 1-2 minutes you will: displacement you will:

a) administer ephedrine 5-10 mg IM
b) administer ephedrine 5-10 mg IV
c) increase IV fluid intake with 500-1000 bolus of crystalloid solution
d) increase 02 levels
b) administer ephedrine 5-10 mg mg IV
If your patient experiences hypotension & you have increased IV flow rate, verified left uterine displacement & administered 02. Afetr giving her 5-10 mg ephedrine IV, you will:

a) begin CPR
b) administer Narcan
c) monitor for bladder distension
d) continually monitor maternal & fetal responses
d) continually monitor maternal & fetal responses
In addition to the primary complication of hypotension associated with administering an epidural, the patient will also experience:

a) decreased anesthetic affects due to contriction of vaculature
b) rebound hypertension
c) urinary retention
d) pyrexia
d) pyrexia
Pyrexia is frequently confused with maternal infxn resulting in additional testing of the newborn to:

a) determine the need for a blood transfusion
b) detect presence of opiates in fetal circulation
c) rule out infection
d) detect the presence of alcohol in maternal circulation
c) rule out infection
Headaches are NOT a side effect of epidural anesthesia. Therefore, lying flat for a number of hours after birth is not necessary.

True or False?
True

The dura mater of the spinal canal has not been penetrated & there is no leakage of spinal fluid.
After birth following an epidural, motor control of the legs is weak but not absent. Therefore assessing for the return of complete sensation & the ability to control legs are essential before ambulation is attempted. Knowing that recovery may take several hours depending on the type and amount of anesthetic agents given, you can assess for sensation by?
**Touching various parts of the legs & abdomen bilaterally to determine if the touch is felt.

**Assessing for motor control can be acheived by asking her to raise her knees, lift her feet one at a time or dorsiflex her foot
Even though you may ave determined that sensation has returned to your patients feet and legs using touch & that she has regained motor control as well by moving knees, legs, & feet, there is one other assessment you should use to determine the safety of ambulation. What is it?
assessing her blood pressure while laying down & while sitting up in bed withut evidence of orthostatic hypotension, you will then assess her blood pressure while standing up.

Nevertheless, you will assist her the 1st time she ambulates to maintain safety.
Benifits of a continuous epidural infusion, with a continuous infusion pump are all of the following except:

a) good to excellent analgesia
b) infrequent nausea
c) minimal sedation
d) decreased anxiety
e) earlier mobilization
f) retained cough reflex
g) decreased risk of deep vein thrombosis
h) decreased myocardial 02 demand
i) ease of administration
These are all benifits !!!
Numerous benefits can be appreciated with a continuous epidural infusion & it is important to remember the ease of administration:

a) does not imply lack of need for close observation
b) malfunctioning equipment with subsequent overdosage is possible
c) the infusion pumps are specially designed for safety in dosage administration
d) should be administered w/the same precautions used for intermittant injections
ALL of THESE !!!
Potential problems of epidural infusions include sedation, nausea, vomiting, & hypotension. There are 2 more potential problems. Can you name them?
1 - breakthrough pain

2 - pruritus
If breakthrough pain occurs with your patient who is receiving a continuous epidural infusion, you should:

a) notify the anesthesiologist immediatly
b) contact your patients provider STAT
c) administer ephedrime 5-10 mg
d) check the integrity of the IV line & notify the anesthesiologist or nurse anesthetist
d) check the integrity of the IV line & notify the anesthesiologist or nurse anesthetist
If your patient experiences breakthrough pain while receiving a continuous epidural infusion and there are standing orders in the event of breakthrough pain, you should:

a) execute the standing orders & monitor the patient
b) check the integrity of the infusion line, execute standing orders & monitor the patient
b) check the integrity of the infusion line, execute standing orders & contact the anesthesiologist
b) check the integrity of the infusion line, execute standing orders & contact the anesthesiologist
(it is always best to inform the anesthesiologists of any problems that occur)
With a continuous epidural infusion, breakthrough pain is often relieved with?
A bolus dose of medication
Because general sedation & resulting respiratory depression can occur from the systemic effects of agents absorbed into circulation, the respiratory rate & quality should be checked no less frequently than:

a) 1 hour
b) 45 minutes
c) 30-45 minutes
d) 15-30 minutes
d) 15-30 minutes

you should contact the anesthesiologists of any significant decreases in respiratory rate or pattern change
Your patient is receiving a continuouos epidural infusion & you have noted respirations have fallen below 14 breaths per minute. With these findings you will anticipate:

a) administering ephedrine
b) administerng naloxone
c) administering increased IV infusion
d) bolus 500-100 mg LR or 0.9% NS
b) administerng naloxone
Your patient is receiving a continuous epidural infusion & is experiencing nausea & vomiting. Which of the following should you do?

a) adninister naloxone per standing order & notify anesthesiologist
b) administer antiemetic per standing order & notify anesthesiologist
c) anticipate need to increase IV infusion rate of the epidural
d) anticipate need to decrease IV infusion rate of epidural
b) administer antiemetic per standing order & notify anesthesiologist

and ...

d) anticipate need to decrease IV infusion rate of epidural
Your patient is receiving a continuous epidural infusion & is beginning to experience pruritus with a rash on the face, neck. Understanding this is a side effect of the agents used in the anesthesia you will anticipate:

a) an order for narcan
b) an order for ephedrine
c) an order for benadryl
d) discontinuance of epidural
c) an order for benadryl

always notify anesthesiologists for any problem arising from anesthesia
If your patient is experiencing hypotension as the result of a continuous epidural infusion or hypovolemia you will anticipate:

a) administeing 02 by mask
b) administering a bolus of a crystalloid solution
c) notifying the anesthesiologist
ALL of these!
If your patient is experiencing hypotension as the result of a continuous epidural infusion or hypovolemia & is not responding to 02 therapy & bolus of crystalloid fluid, you will anticipate:

a) discontinuance of epidural infusion & place patient in semi-fowler position
b) discontinuance of epidural infusion & placing patient in trendelenburg position
c) discontinuance of epidural & place patient in flat supine position
d) discontinuance of epidural & place patient in side-lying position
b) discontinuance of epidural infusion & placing patient in trendelenburg position
Your patient has just given birth & will require analgesia for approximately 24 hours. As her nurse you will anticipate that the anesthesiologist may enject this opiod medication into the epidural space:

a) lidocaine
b) stadol
c) fentanyl
d) duramorph
d) duramorph
The analgesic effect of duramorph(morphine sulphate) begins:

a) 2-4 minutes
b) 5-10 minutes
c) 20-30 minutes
d) 30-60 minutes
d) 30-60 minutes
Side effects of duramorph are pruritus, N&V, & urinary retention. In caring for your patient you know:

a) these side effects will be resolved with narcan
b) mild side effects of amides will resolve within within an hour after administration
c) side effects of duramorph occur early and usually resolve within 14-16 hours
d) these side effects are common and usually resolve with 1-2 hours
c) side effects of duramorph occur early and usually resolve within 14-16 hours
Name 4 primary interventions that you will provide your patient during administration of regional anesthesia:

1.______
2.______
3.______
4.______
1. helping the woman void prior to injection

2. assist with positioning during & after procedure

3. monitoring & assessing vital signs & respiratory status

4. determining fetal well being
Name 4 advantages of an epidural block:

1.______
2.______
3.______
4.______
1. - relieves discomfort during labor & birth

2. - patient is fully awake & a part of the birth process

3. - continuous epidural allows different blocking for each stage of labor so fetus can descend & rotate in the pelvis

4. - often preserves the womans urge to bear down

4. -
Name 4 disadvantages of an epidural:

1._____
2._____
3._____
4._____
1. voiding difficult
2. hypotension
3. often unable to move extremities
4. pushing is difficult
5. fetal distress
6. respiratory depression (fetal & maternal)
If your patient asks where she can expect pain relief in her body from an epidural block, you will tell her all of the following except?

a) uterus
b) cervix
c) perimeum
d) vagina
ALL of these
Complete relief form a lumbar epidural block is reported in:

a) 85% of all women
b) 50% of all women
c) 12% of all women
d) 3% of all women
a) 85% of all women
With an epidural, a fall in systolic pressure or a drop below below 100mmgHg is seen in:

a) 10-20% of patients
b) 20-30% of patients
c) 30-40% of patients
d) 40-60% of patients
b) 20-30% of patients
A spinal block involves a local anesthetic that is injected into the:

a) subarachnoid space
b) ligamnetum flavum
c) dura mater
d) spibal fluid
d) spibal fluid
A spinal block is used priamrily for:

a) vaginal birth
b) cesarian birth
b) cesarian birth
Maternal compartmentalization of the drug used & relative ease of administration are 2 advantages of a spinal block. Can you name 2 other advantages?
1. immediate onset of anesthesia

2. need for smaller smaller drug volume
The primary disadvantage of spinal block is blockade of symathetic nerve fibers resulting in:

a) hemmorhage
b) respiratory depression
c) N&V
d) hypotension
d) hypotension
The primary disadvantage of a spinal block is hypotension which may lead to:

a) hemmorhage
b) fetal hypoxia
c) alterations in FHR
d) stroke
) fetal hypoxia
and...
c) alterations in FHR
Contraindications for a spinal block include client refusal, central nervous system disease, & allergy to agents used. Can you name 3 more contraindications for a spinal block?

1._______
2._______
3._______
1. infxn over the puncture site

2. coagulation problems

3. hypovolemia
AN IV infusion must be in place before a spinal block is administered & a bolus of 500-1000 mL is infused rapidly. The IV infusion is started with a:

a) 16-18 guage plastic catheter
b) 14-16 guage plastic catheter
c) 12-14 guage plastic catheter
d) 10-12 guage plastic catheter
a) 16-18 guage plastic catheter
With a spinal block, the anesthesiologist injects the anesthetic agent between contractions. If the anesthetic agent is injected during a contraction:

a) the level of anesthesia obtained is higher & may compromise respirations

b) the level of anesthesia obtained is lower & may compromise the effectiveness of the anesthesia
a) the level of anesthesia obtained is higher & may compromise respirations
After receiving a spinal block, your patient will remain in a sitting position for:

a) 20-30 minutes
b) 10-20 minutes
c) 5-10 minutes
d) 30 seconds
d) 30 seconds
When assisting your patient into a lying position 30 seconds after receiving a spinal block, your next action will be to:

a) have her drink 6-8 oz of water
b) document the procedure on the Fetal monitor strip
c) assess her vital signs & FHR
d) place a rolled towel under her right hip to displace uterus from the vena cava
d) place a rolled towel under her right hip to displace uterus from the vena cava

then...
momitor maternal bp & pulse frequently per protocol or physicians order & reassessed when moved after birth
A spinal block can be used for both a vaginal or cesarean birth.

True or False
True
If a spinal block is used during a vaginal birth, you will monitor uterine contractions & instruct the woman to:

a) bite on a gag stick
b) tell her husband what she really thinks about his mother
c) get a divorce
d) bear down during a contraction
d) bear down during a contraction
After a spinal block, you will need to exercise caution when moving her from the birthing bed to protect her from injury. You do understand she will remain in bed for:

a) 3-4 hours
b) 4-6 hours
c) 6-12 hours
d) 24 hours
c) 6-12 hours
After a spinal block, your patient will remain in bed for 6-12 hours & may not rgain sensation & control of her bladder for:

a) 3-4 hours
b) 4-6 hours
c) 6-12 hours
d) 8-12 hours
d) 8-12 hours
An indwelling catheter is usually inserted before surgery for women undergoing cesarean birth.

True or False
True
Spinal anesthesia can be combined w/an epidural block & used for:

a) labor analgesia
b) cesarean birth
Both
Another term used for a spinal block is?
Intrathecal anesthesia
With a combined spinal-epidural block small amounts of local anesthetic agents such as esters & amides or ipiates, or both are injected into the spinal fluid. WHat other procedure is accomplished at this time?
AN epidural catheter is placed into the epidural space & secured in place for future drug administration
Can you name 4 advantages of a combined spinal-epidural block?

1) f_ _t o_ _ e _

2) _ _w _o_ _

3) ca_ _ _v_ _ _ e_ _ _ _ l_ _ _r

4) c_ _ _ _ _u_ _ _ _ a_ _ _r p_ _c_ _
1) fast onset

2) low dose

3) can give in early labor

4) can ambulate after placement
A method of regional "local" anesthesia administered transvaginally that can be administered for the latter part of the 1st stage of labor, the 2nd stage, birth, & episiotonmy repair:

a) local infiltration anesthesia

b) pudendal block
c)
b) pudendal block

local infiltration anesthesia is generally used at time of birth for an episiotomy or for episiotomy repair
A method of regional "local" anesthesia administered intracutaneously, subcutaneously, & intramuscularly in areas of the perineum that is generally used at the time of birth & or in preparation for an epsiotomy or episotomy repair:

a) local infiltration anesthesia

b) pudendal block
a) local infiltration anesthesia
A local anesthetic procedure that rerelieves the pain of perineal distention & typiocally relieves pain in the lower vagina, vulva, & perineum. Hopwever, this methiod will not relieve the pain of uterine cxnx:

a) local infiltration anesthesia

b) pudendal block
b) pudendal block
The patient will not reqiure additional assessments in relation to these anesthetic methods b/c they do not alter maternal vital signs or FHR:

a) intrathecal anesthesia
b) pudendal block
c) local infiltration anesthesia
d) general anesthesia
b) pudendal block
and ...
c) local infiltration anesthesia
The disadvantage of this type of local anesthesia is that large amounts of local anesthetic must be used:

a) intrathecal anesthesia
b) pudendal block
c) local infiltration anesthesia
d) combined spinal-epidural
c) local infiltration anesthesia
Nescaine, xylocaine, & carbocaine are the agents of chice with this type of local anesthesia:

a) intrathecal anesthesia
b) pudendal block
c) local infiltration anesthesia
d) combined spinal-epidural
c) local infiltration anesthesia
The disadvantage of this type of local anesthesia include possible broad ligament hematoma, perforation oif the rectum, & trauma to the sciatic nerve:

a) intrathecal anesthesia
b) pudendal block
c) local infiltration anesthesia
d) combined spinal-epidural
b) pudendal block
This type of anesthesia used to relive the pain of perineum distention has minimal ill effects on the course of labor because a moderate dose of anesthetic agent is used. However it may decrease the urge to push:

a) intrathecal anesthesia
b) pudendal block
c) local infiltration anesthesia
d) combined spinal-epidural
b) pudendal block
Can you name 4 advantages of a pudendal block?

1) _ _ _ _ of _ _ _ _ _ _ _ _ _ _ _ _ _ _

2) abscence of _ _ _ _ _ _ _ _ _ _ _

3) decreae pain of _ _w f_ _ _ _ _s or _ _cc_ _ _ a_ _ _ _ _ _ b_ _ _ _

4) does not _ _ _ _ _ m_ _ _ _ _ _ _ v_ _ _ _ _ g_ _ or _ _ R
1) ease of administration

2) abscence of hypotension

3) decrease pain of low forceps or vaccume assisted birth

4) does not alter maternal vital signs or FHR
A type of anesthesia that uses a combination of IV injection & inhalation of anesthetic agents:

a) regional
b) intrathecal
c) combination spinal-epidural block
d) general anesthesia
d) general anesthesia
A type of anesthesia used from which some women may awaken with an awareness of events that occured during cesarean birth:

a) regional
b) intrathecal
c) combination spinal-epidural block
d) general anesthesia
d) general anesthesia
Your patient tells you she is having nightmares following general anesthesia. You encourage her to discuss her dreams & feelings and she becomes at ease & seems to be comforted by your compasion. Following this encounter your 1st action will be:

a) administer benadryl
b) administer narcan
c) call the anesthesiologist
d) call her primary physician
c) call the anesthesiologist

all inceidents related to anesthesia should be reported to the anesthesiologist
The primary danger of general anesthesia is:

a) hypotension
b) cardiac collapse
c) respiratory depression
d) fetal depression
d) fetal depression
WHich of the following methods of anesthesia is not advocated when the fetus is considered to be at high risk & even more so in a preterm birth:

a) systemic
b) regional
c) general
c) general
Infants of women who receive this type of anesthesia suffer more respiratory depression than of other methods commonly used:

a) systemic
b) regional
c) general
c) general
Most general anesthetics used reach the fetus in:

a) 1 hour
b) 30 minutes
c) 10 minutes
d) 2 minutes
d) 2 minutes
The primary danger of general anesthesia is fetal depression. In addition, general anesthetics cause some degree of uterine relaxation. Can you name 2 other complications associated with general anesthesia?
1- vomiting & aspiration

2- decreased gastric motility & onset of labor leave foods eaten hours earlier undigested in the stomach
Because food eaten hours prior to receiving general anesthesia may remain undigested in your patients stomach, you must do which of the following prior to administration:

a) administer an enema
b) administer laxatives
c) administer calcium channel blockers
d) find out what time she last ate & record in chart & on anesthesia record
d) find out what time she last ate & record in chart & on anesthesia record

Even when foods have been withheld, gastric juice produced during fasting is highly acidic & can cause chemical pneumonitis if aspirated
Prophylactic therapy which is common practice for patients who will recieve this type of anesthesia:

a) steroid
b) antihistamine
c) antiacid
d) coagulation
c) antiacid
As the nurse in care of a patient who has been ordered general anesthesia, you will anticipate administering this medication prior to the procedure:

a) Stadol
b) Bicitra
c) Tagamet
d) duramorph
b) Bicitra
c) Tagamet

Preventative measure to decrease potential for chemical pneumomitis from aspiration of highly acidic stomach contents that can occur with general anesthesia is IMPORTANT !!!
Chemical pneumonitis is a greater risk in patients receiving this type of anesthesia than with other methods used:

a) systemic
b) regional
c) spinal
d) general
d) general
Before the induction of general anesthesia, you will:

a) assess DTR, clonus, Homans

b) check patients chart for living will status

c) position client in 15-20 degree trendelenburg position

d) place wedge under right hip
d) place wedge under right hip

to displace uterus to prevent venal caval compression
After positioning your patient with a wedge to prevent venal caval compression prior to administration of general anesthesia, you will:

a) assess DTR, clonus, Homans

b) preoxygenate w/ 3-5 minutes 100% oxygen

c) position client in 15-20 degree trendelenburg position

d) place wedge under right hip
b) preoxygenate w/ 3-5 minutes 100% oxygen
After placement of a wedge under the patients right hip to prevent venal caval compression prior to the induction of general anesthesia, the patient will be placed in what position:

a) 10-20 degree trendelenburg
b) low Fowlers
c) supine
d) prone
Todd? this is your big chance !!!


(supine, hehe)
In preparation of general anesthesia & after recording time of patients last meal, administration of Bicitra or Tagamet, positioning supine with wedge under right hip & preoxygenation with 3-5 minutes 100% oxygen, you will do which of the following during rapid induction of anesthesia:

a) admiister a gravity enema
b) take vitals & record on fetal monitor strip
c) administer bolus of 500-1000 mL NS or LR
d) occlude cricoid cartilage by depressing 2-3 cm posteriorly
d) occlude cricoid cartilage by depressing 2-3 cm posteriorly

cricoid pressure is to be maintained until anesthesiologist has placed endotracheal tube & indicates that the pressure can be released

THIS is a measure to prevent possible aspiration
Name 4 of the major complications of general anesthesia.

1) F_ _ _ _ D_ _ _ _ _ _ _ _ _

2) U_ _ _ _ _ _ R_ _ _ _ _ _ _ _ _

3) V_ _ _ _ _ _ _

4) A_ _ _ _ _ _ _ _ _
1) fetal depression
2) uterine relaxation
3) vomiting
4) aspiration
This drug is cautioned in patients who have received MAO inhibitors within 14 days:

a) fentanyl
b) Stadol
c) narcan
d) morphine
e) nubain
a) fentanyl
Caution is advised for severly obese patients & those with cardiovascular disease:

a) fentanyl
b) Stadol
c) narcan
d) morphine
e) nubain
d) morphine
You should monitor surgical and obstetric patients closely for bleeding with this drug because it has been associated with abnormal coagulation test results:

a) fentanyl
b) Stadol
c) narcan
d) morphine
e) nubain
c) narcan
This drug has an analgesic action that relieves moderate to severe pain with low potential for dependence & is 3-4 times more potent than pentazocine:

a) fentanyl
b) Stadol
c) narcan
d) morphine
e) nubain
e) nubain
This drug is used with caution in patients with a history of drug abuse or dependence; emotionally unstable individuals; head injury, & increased intracranial pressure:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
b) Stadol
and ...
e) nubain
Analgesic doses of this drug may increase pulmonary arterial pressure and cardiac work load. It relieves moderate to severe pain:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
b) Stadol
This drug is used with caution for patients with impaired kidney or liver function, MI, or biliary tract surgery:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
e) Nubain
If your patient has a sensitivity to sulfites you will watch your patient for allergic responses with this drug:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
e) Nubain
This drug is a "pure" narcotic antagonist, essentially free of agonistic (morphine-like) properties. Thus, it produces no significant analgesia:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
c) Narcan
This drug controls severe pain & is also used as an adjunct to anesthesia:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
e) Nubain
d) Morphine
Kava-kava, valerian, & St. John's wort may increase sedation with this drug:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Morphine
Monitor vital signs and observe patient for signs of skeletal and thoracic muscle (depressed respirations) rigidity and weakness when administered this drug:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
a) Fentanyl
This drug reverses the effects of opiates, including respiratory depression, sedation, and hypotension.

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
c) Narcan
Administer this drug with caution to patients with hepatic or renal impairment:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Nubain
and ...
b) Stadol
This drug may dull perception of bladder stimuli. Therefore, encourage the patients to void at least q4h. Palpate lower abdomen to detect bladder distention:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Morphine
This drug should be used with caution in patients with bronchial asthma:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
b) Stadol
The action of this drug is similar to those of morphine and meperidine, but action is more prompt and less prolonged. Used primarily for analgesia and sedation.

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
a) Fentanyl
It is important to monitor for respiratory depression which can be severe for as long as 24 h after epidural or intrathecal administration.

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Morphine
If this drug is used used during labor or delivery, observe neonate for signs of respiratory depression:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
b) Stadol

and...

d) Nubain
It is important to monitor urinary output and assess bladder for distention with this drug & patient may need assistance to void:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Nubain
This drug can induce acute withdrawal symptoms in opiate-dependent patients.

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
b) Stadol
and ...
c) Narcan
Duration of respiratory depressant effect may be considerably longer than its narcotic analgesic effect. Have immediately available oxygen, resuscitative and intubation equipment, and an opioid antagonist such as naloxone available when this drug is administered:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
a) Fentanyl
Avoid abrupt termination of this drug following prolonged use which may result in symptoms similar to narcotic withdrawal such as nausea, vomiting, abdominal cramps, lacrimation, nasal congestion, piloerection, fever, restlessness, & anxiety:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Nubain
It is important to monitor for respiratory depression with this drug;

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
monitor for respiratory depression with ALL of these drugs.

EVEN with Narcan because it's duration of action will be less than narcotics & additional doses may be required
In contrast to morphine, doses >30 mg of this drug does not produce further respiratory depression:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
d) Nubain
You should watch carefully for movements of various groups of skeletal muscle in extremities, external eye, and neck during postoperative period when this drug has been administered. These movements may present patient management problems & should be reported promptly:

a) Fentanyl
b) Stadol
c) Narcan
d) Morphine
d) Nubain
a) Fentanyl