AORN PERIOP 101 Exam Review:

Correct Answers

All the following professionals are qualified to provide anesthesia to a patient EXCEPT: a) anesthesiologist

1. CRNA
2. anesthesiology assistant
3. operating surgeon -Answer- d) operating surgeon

Of the following, which is not used to secure airway: a) ET tube

1. LMA
2. nasal cannula
3. oral airway -Answer- c) nasal cannula

The perioperative team should know the location of equipment stored in the OR and in the department. Equipment that the anesthesia provider may request includes:

a) video laryngoscopy devices b) fiberoptic bronchoscopes c) suction tips and devices

d) all of the above -Answer- d) all of the above

General Anesthesia -Answer- a drug-induced reversible state of unconsciousness, it includes amnesia, analgesia, loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to varying degree

Regional Anesthesia -Answer- an injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body, common examples include spinal, epidural, and peripheral nerve blocks

Monitored Anesthesia Care (MAC) -Answer- when an anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as needed

Moderate Sedation -Answer- the administration of sedative, analgesic, and/or anxiolytic agents by a physician or under physician supervision. Depending on state laws and hospital policies, a perioperative nurse may be able to administer this type of anesthesia

Local Anesthesia -Answer- The infiltration or topical administration of agents to anesthetize a part of the body. It is typically used for minor procedures, does not involve an anesthesia provider, and does not involve sedation. A perioperative nurse monitors the patient and provides supportive care if needed.

The phases of general anesthesia, in order, are:

a) induction, maintenance, emergence b) emergence, maintenance, induction c) maintenance, emergence, induction

d) induction, emergence, maintenance -Answer- a) induction, maintenance, emergence

Propofol -Answer- IV induction agent

etomidate -Answer- IV induction agent

methohexitol -Answer- IV induction agent

IV induction agent -Answer- ketamine

sevoflurane with or without nitric oxide -Answer- inhaled induction agent

Succinylcholine -Answer- short-acting muscle relaxant

cisatracurium -Answer- intermediate-acting muscle relaxant

atracurium -Answer- intermediate-acting muscle relaxant

rocuronium -Answer- intermediate-acting muscle relaxant

vecuronium -Answer- intermediate-acting muscle relaxant

pancuronium -Answer- long-acting muscle relaxant

isoflurane -Answer- used for inhalation maintenance

desflurane -Answer- used for inhalation maintenance

total iv anesthesia (TIVA) -Answer- a technique for maintaining anesthesia using infusions of short-acting IV agents without inhalation anesthetics. Propofol and remifentanil are often used for TIVA.

Reversal agent for succinylcholine -Answer- none!

neostigmine -Answer- reversal for muscle relaxant (except succinylcholine)

edrophonium -Answer- reversal for muscle relaxant (except succinylcholine)

sugammadex -Answer- reversal agent for rocuronium, vecuronium, and pancuronium

flumazenil -Answer- reversal agent for benzos (midazolam)

naloxone -Answer- reversal agent for narcotics (fentanyl)

which of the following type of airway maintenance usually requires muscle relazants? a) spontaneous respiration

1. mask ventilation
2. laryngeal mask airway
3. endotracheal intubation -Answer- d) endotracheal intubation

When should cricoid pressure be released? a) if the patient coughs

1. when the patient loses consciousness
2. if the anesthesia provider cannot see the vocal cords
3. after the cuff of the ET tube is inflated and the position is confirmed -Answer- d) after the cuff of the ET tube is inflated and the position is confirmed

lidocaine -Answer- local anesthetic

bupivacaine -Answer- local anesthetic

ropivacaine -Answer- local anesthetic

tetracaine -Answer- for long-acting spinal anesthesia

epinephrine (anesthesia) -Answer- added to increase density and duration of a regional block

bicarbonate (anesthesia) -Answer- sometimes added to reduce the acidity of the local anesthetic and speed the onset of the block

Spinal Anesthesia -Answer- the subarachnoid space is entered and local anesthetic is injected directly into the spinal canal, pt sitting or lateral

Epidural Anesthesia -Answer- the anesthesia care provider finds the space between the ligamentum flavum and dura, this space is identified by a loss of resistance as the needle is advanced, a single dose of anesthetic can be injected, or a catheter can be placed

IV regional anesthesia (Bier Block) -Answer- used for procedures on hand, wrist, or forearm (double tourniquet method)

Local Anesthetic System Toxicity (LAST) -Answer- can occur if unsafe amount of local anesthetic enters bloodstream, can occur slowly as med is absorbed over time, or quickly if accidentally injected into blood vessel

CAN PROGRESS TO SEIZURES AND CARDIAC OR RESP ARREST

Symptoms of LAST -Answer- -ringing in ears

-tingling lips

-metallic taste in mouth

-dizziness

Sedation can be used with any of the following types of anesthesia except: a) regional anesthesia

b) monitored anesthesia care c) general anesthesia

d) local anesthesia -Answer- d) local anesthesia

Malignant Hyperthermia (MH) -Answer- a rare but potentially life-threatening complication of anesthesia, triggered by inhaled general anesthetic agents and the muscle relaxant succinylcholine

Complications of MH -Answer- it can lead to cardiac arrest, brain damage, organ failure, and death

increased end-tidal CO2 -Answer- most specific sign of MH

Dantrolene -Answer- drug used to treat MH

Hypothermia -Answer- a core body temperature <36c (<96.8F)

Which of the following is associated with increased risk for hypothermia? a) female sex

b) higher than normal body weight c) hyperthyroid

d) hypertension -Answer- a) female sex

Identify the active warming devices a) circulating water garments

1. cotton blankets
2. forced-air warming devices
3. increased ambient room temperature e) surgical drapes

d) warmed IV fluids -Answer- a) circulating water garments c) forced-air warming devices

d) increased ambient room temperature f) warmed IV fluids

Which of the following would be an appropriate action for the perioperative nurse when assisting with anesthesia?

a) administer the muscle relaxant reversal agent if needed? b) apply cricoid pressure if needed during intubation

1. document anesthetic agents used, dose, route, and time
2. extubate the patient -Answer- b) apply cricoid pressure if needed during intubation

Which of the following is NOT included in basic monitoring of the patient for anesthesia? a) pulse oximetry

1. ECG
2. arterial line
3. blood pressure -Answer- c) arterial line

Which drug is used to reverse valium and midazolam? a) neostigmine

b) pancuronium c) flumazenil

d) succinylcholine -Answer- c) flumazenil

Which method is used to prevent aspiration during endotracheal intubation? a) applying cricoid pressure

b) inserting a nasal/oral airway c) laryngoscopy

d) invasive techniques -Answer- a) applying cricoid pressure

How can the perioperative nurse assist the anesthesia provider with placement of a spinal or epidural block?

1. inject local anesthetic
2. thread the catheter through the needle c) calm the patient

d) identify landmarks for insertion of the needle -Answer- c) calm the patient

During IV regional anesthesia the tourniquet should be deflated slowly to prevent which of the following from entering the bloodstream?

1. bacteria
2. lymphatic fluids c) thrombus

d) bolus of anestheitc -Answer- d) bolus of anesthetic

Depending on state laws and hospital policies, which of the following can be performed without a professional anesthesia provider?

a) general anesthesia b) regional anesthesia

1. monitored anesthesia care
2. moderate sedation -Answer- d) moderate sedation

Which assessment factor is important to include when screening patients for MH? a) family history of problems related to anesthesia

1. patients age
2. patients use of herbal and vitamin supplements
3. patients use of OTC meds -Answer- a) family history of problems related to anesthesia