8-1. During the anesthesia stage of delirium, the patient is at risk for:

8-2. While completing a Phase I PACU admission assessment, the nurse notes that the patient’s respirations are irregular, RR 8, and difficult to count because they are shallow; the pupils are dilated and are not moving; the patient does not respond to verbal command; and the patient’s general muscle tone appears to be slack. The nurse is concerned because it appears the patient is in which stage of anesthesia?

8-3. During the preanesthesia nursing assessment, the nurse knows that malignant hyperthermia (MH) is an inherited disorder that affects:

8-4. As the perianesthesia nurse is performing an admission assessment on a patient after general anesthesia, the patient states, “I am having trouble breathing.” The BP is 180/70, RR 8, and the SpO₂ is 100%. During respiration, the chest wall and abdominal muscles are not working together in a coordinated effort. Considering this assessment, the nurse recognizes that the first drug the patient may need is a/an:

8-5. In the absence of a peripheral nerve stimulator, the best indication of a patient’s readiness for extubation in the Phase I PACU is the ability to:

8-6. The injection of a local anesthetic in the immediate vicinity of a major nerve plexus is termed a:

8-7. The primary role of the perianesthesia nurse when assisting the anesthesia provider during the placement of a regional anesthetic is to:

8-8. It is important to instruct a patient in the use of slings or braces after partial motor blockade in order to:

8-9. In the same-day surgery unit, a patient expresses anxiety about the choice of anesthetics for a total knee replacement. The anesthesia provider has recommended a spinal block with sedation. The patient is concerned about being awake during the operation. The preadmission nurse offers reassurance and explains that there are medications commonly used for sedation. Drugs commonly used include all of the following EXCEPT:

8-10. The Malignant Hyperthermia Association of the United States (MHAUS) recommends core temperature monitoring for all patients undergoing general anesthesia lasting more than _________ minutes.

8-11. A patient is resting with the eyes closed but responds easily to verbal commands. You would give the patient a Ramsay score of:

8-12. A 45-year-old male patient arrives in the Phase I PACU with weak peripheral reflexes and decreased ventilatory effort. The perianesthesia nurse notes that the RR is 8 and breath sounds are distant. What medications are most likely indicated for this patient?

    Consider this scenario for questions 8-13 and 8-14.

    An 18-year-old patient with a history of advanced Duchenne muscular dystrophy arrived into the Phase I PACU after a brief anesthetic for a right myringotomy and tube. He has severe lower extremity contractures and has an indwelling suprapubic catheter. Anesthesia reports that the procedure was well tolerated after inhalation anesthesia using only sevoflurane.

8-13. The perianesthesia nurse completes an initial assessment noting that the patient’s urine is the color of a cola beverage. This is a potential sign of:

8-14. While calling for immediate anesthesia support to reassess the patient, the perianesthesia nurse begins to consider applying a urimeter to the suprapubic tube for more accurate urine output assessment. The renal goals for treating a patient with a malignant hyperthermia (MH) event include ensuring a urinary output of:

8-15. Assessment of temperature is essential in the patient recovering from inhalation anesthesia because inhalation agents:

8-16. A patient with known susceptibility to malignant hyperthermia (MH) has just undergone a surgical procedure using “safe” anesthetics. The patient should be monitored in the Phase II PACU for at least:

8-17. Rhabdomyolysis is an indication of:

8-18. Although a malignant hyperthermia (MH) event can be triggered at the first exposure of a patient to anesthesia, the average patient will demonstrate the first signs of MH after ___________ anesthetics.

8-19. The three states with a high incidence of malignant hyperthermia (MH) are:

8-20. An _____ attaches to a specific receptor to block the neurotransmitter from stimulating the receptor.

8-21. Signs that a malignant hyperthermia (MH) crisis is resolving include declining end-tidal carbon dioxide (ETCO₂), declining temperature, and:

8-22. The goals of therapy for a patient experiencing malignant hyperthermia (MH) include prompt administration of dantrolene, treatment of hyperkalemia, rapid cooling, and:

8-23. A malignant hyperthermia cart must be available wherever anesthesia is administered. Kits stored in the cart include all of the following EXCEPT:

8-24. A patient with a history of myasthenia gravis presents in the Phase I PACU after administration of a general anesthetic with a muscle relaxant. The primary symptom that the nurse will be monitoring for is:

8-25. Given that malignant hyperthermia (MH) is a high-risk, low-frequency event, perianesthesia nurses should take advantage of several methods available for ongoing competency training. The Malignant Hyperthermia Association of the United States (MHAUS) recommends:

8-26. Agents known to be safely administered to patients with malignant hyperthermia susceptibility (MHS) include:

8-27. Sevoflurane is known to cause:

8-28. A 45-year-old male patient is transferred from the operating room to the Phase I PACU after open rotator cuff repair. During the preanesthesia assessment, the patient reported a history of emergence delirium related to posttraumatic stress disorder. The anesthesia provider has initiated a dexmedetomidine infusion to provide sedation to allow a slower, calmer emergence. The MOST concerning side effect that the perianesthesia nurse must monitor the patient for is:

8-29. A 16-year-old field hockey player is recovering from an open reduction of a fractured ankle. Ten minutes earlier she was given a popliteal nerve block to support a multimodal approach to pain management. The young patient begins to complain of tinnitus and dizziness. The perianesthesia nurse anticipates the following recommended treatment for this patient:

8-30. Dantrolene belongs to the drug class:

8-31. An example of a long-acting nondepolarizing neuromuscular blocking agent (NMBA) is:

8-32. After flat foot reconstruction surgery on a 42-year-old middle-school teacher, the anesthesia provider orders a continuous infusion of ropivacaine via popliteal nerve block and catheter. The perianesthesia nurse understands that ropivacaine:

8-33. A 24-year-old adopted male patient engaged to be married in the fall has been told that he is at risk for malignant hyperthermia (MH). He is understandably anxious about the possibility of passing on this susceptibility to any offspring. The nurse interviewing this patient knows that the most definitive test for MH is:

8-34. Inhalation agents disrupt the regulation of body temperature by depressing the effect of the:

8-35. A 35-year-old patient has been in the Phase I PACU for 90 minutes after general anesthesia. Although the plan was to extubate her immediately after surgery, she remains intubated and on a ventilator. Respiratory parameters are measured; her tidal volume is 100 mL and inspiratory force is negative 20 cm H₂O. Reversal agents were given twice. Which genetic disorder is the patient suspected to have?

8-36. An 82-year-old patient is reintubated in the Phase I PACU. A propofol infusion is initiated. Understanding the pharmacology of propofol, the nurse closely monitors the patient for a:

8-37. Upon arrival to the Phase I PACU after a total hip replacement with spinal anesthesia, the patient tells the nurse, “I don’t feel well. I feel like I am going to vomit. My arms feel funny and I can’t feel myself breathe.” The nurse suspects:

8-38. Midazolam should be administered with caution in patients with myocardial ischemia because midazolam produces:

8-39. A patient experiences chest wall rigidity during the administration of moderate sedation. The agent most likely associated with this incident is:

8-40. Dantrolene sodium requires dilution. The most appropriate diluent is:

8-41. Immediate nursing interventions for a patient experiencing a high spinal block may include:

8-42. What is the peak action of hydromorphone?

8-43. Common signs of malignant hyperthermia that follow an increase in end-tidal carbon dioxide (ETCO₂) include tachycardia, tachypnea, and:

8-44. A patient becomes obtunded with RR of 6 after intravenous administration of 50 mcg of fentanyl. The most appropriate reversal agent for this patient would be:

8-45. Complications after an acute malignant hyperthermia (MH) crisis include:

8-46. A patient experiences fixed chest syndrome after the administration of fentanyl. The FIRST thing that the nurse should do is:

8-47. Temperature elevation associated with malignant hyperthermia (MH):

a. Often occurs immediately

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