Test Bank for Pharmacology for the Surgical Technologist 6E by Tiffany Howe & Angela Burton

TEST BANK

TEST BANK

UNIT I Introduction to Pharmacology Chapter

1 Basic Pharmacology

Chapter

2 Medication Development, Regulation, and Resources

Chapter

3 Pharmacology Mathematics

Chapter

4 Medication Administration

UNIT II Applied Surgical Pharmacology Chapter

5 Antibiotics

Chapter

6 Diagnostic Agents

Chapter

7 Diuretics

Chapter

8 Hormones

Chapter

9 Medications That Affect Coagulation

Chapter

10 Ophthalmic Agents

Chapter

11 Fluids and Irrigation Solutions

UNIT III Anesthesia Chapter

12 Preoperative Medications

Chapter

13 Patient Monitoring and Local and Regional Anesthesia

Chapter

14 General Anesthesia

Chapter

15 Emergency Situations

Chapter 01: Basic Pharmacology

Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. A drug that binds to a receptor and stimulates its function is said to be a(n) a. agonist b. antagonist c. idiosyncratic d. pharmacokinetic

drug.

ANS: A Agonist drugs bind to or have an affinity (attraction) for a receptor and cause a particular response.

DIF:

1

REF: 14

TOP: AST Core Curriculum X:B:1:b, agonist

2. Which factor is not used for the classification of drugs? a. Therapeutic action b. Physiological action c. Affected body system d. Source of origin ANS: D Drugs are classified by what they do, what they affect, what they are not, and what they are.

DIF:

1

REF: 4

TOP: AST Core Curriculum X:B:2, therapeutic actions

3. An anticoagulant drug is classified by its a. chemical type. b. source of origin. c. physiologic action. d. therapeutic action.

ANS: D Therapeutic action describes what the drug does for a patient; in this example, it works against coagulation.

DIF:

1

REF: 4

TOP: AST Core Curriculum X:B:2:a, indications

4. Prescriptions must include all of the following information except a. name of the drug. b. patient’s social security number. c. drug dosage. d. route of administration of the drug.

ANS: B Prescriptions must include the date, name of the patient, name of the drug, dosage, route of administration, and frequency or time of administration. The patient’s social security number will be in the chart but not on a prescription.

DIF: 1 REF: 5 TOP: AST Core Curriculum XI:B:2, prescription medications 5. An order for a drug to be given as needed is called a

order.

1

a. standing b. oral c. stat d. PRN

ANS: D PRN stands for pro re nata, which means that the drug may be given as needed.

DIF:

1

REF: 5

TOP: AST Core Curriculum XI:D:3:d, PRN

6. What does the abbreviation sos mean on a prescription? a. One half b. Once, if necessary c. Without d. As desired ANS: B sos means once, if necessary (see Table 1.3).

DIF: 1 REF: 5 TOP: AST Core Curriculum XI:B:2, prescription medications

7. How is an order for a drug to be taken every 4 hours indicated on a prescription? a. q4h b. qid c. qod d. qs ANS: A The q means every; the actual number of hours is inserted before the h, which means hours (see Table 1.4).

DIF: 3 REF: 7 TOP: AST Core Curriculum XI:B:2, prescription medications 8. How is an order for a drug to be given three times a day indicated on a prescription? a. q3h b. hs c. qh d. tid ANS: D tid means three times a day (see Table 1.4).

DIF: 1 REF: 7 TOP: AST Core Curriculum XI:B:2, prescription medications 9. Which form of drug preparation tends to act more quickly? a. Solid b. Semisolid c. Liquid d. Gas ANS: D Absorption of drugs given by inhalation is rapid, especially gases such as inhalation anesthetics, because of the huge numbers of capillaries in the alveoli of the lungs.

2

DIF:

2

REF: 7

TOP: AST Core Curriculum XI:G:1, gas

10. Which abbreviation indicates an ointment form of a given drug? a. gtts b. ung c. susp d. soln ANS: B ung means ointment (see Table 1.5).

DIF:

1

REF: 7

TOP: AST Core Curriculum XI:G:4, semisolid

11. Which abbreviation indicates that a drug is to be given orally? a. IM b. PO c. IV d. SC ANS: B PO means per os or by mouth.

DIF:

1

REF: 8

TOP: AST Core Curriculum XI:H:4, PO

12. How is a medication administered by any route except the mouth? a. Systemically b. Sublingually c. Parenterally d. Subcutaneously ANS: C The term parenteral indicates any route other than the digestive tract.

DIF: 13.

3

REF: 9

TOP: AST Core Curriculum XI:H:1, injection/parenteral

is the study of the four basic processes of absorption, distribution, metabolism, and excretion in response to drugs. a. Pharmacokinetics b. Pharmacodynamics c. Biotransformation d. Sympathomimetics ANS: A The study of pharmacokinetics focuses on how the body processes drugs.

DIF:

1

REF: 11

TOP: AST Core Curriculum X:A:2, pharmacokinetics

14. Distribution of drugs within the body is carried out through which body system? a. Respiratory b. Circulatory c. Integumentary d. Urinary ANS: B Once a drug has been absorbed into the bloodstream, it is transported throughout the body by the circulatory system. Drug molecules eventually diffuse out of the 3

bloodstream to the site of action in the process called distribution.

DIF:

2

REF: 12

TOP: AST Core Curriculum X:A:2:b, distribution

15. The time between the administration of a drug and the first appearance of its effects is called a. peak effect. b. onset. c. duration. d. reaction time.

ANS: B The time between the administration of a drug and the first appearance of effects is called the onset.

DIF:

1

REF: 15

TOP: AST Core Curriculum X:A:3:a, onset

16. Which group of drugs is known as receptor blockers? a. Antagonists b. Agonists c. Antipyretics d. Analgesics ANS: A Drugs that bind to a receptor and prevent a response are called antagonists (Fig. 1.17). Antagonists are also called receptor blockers.

DIF:

2

REF: 14

TOP: AST Core Curriculum X:B:1:c, antagonist

17. An expected but unintended effect of a drug is termed a(n) effect. a. idiosyncratic b. adverse c. synergic d. side ANS: D A side effect is a predictable but unintended effect of a drug.

DIF:

1

REF: 15

TOP: AST Core Curriculum X:B:3:a, side effects

18. Malignant hyperthermia is a(n) effect to certain drugs. a. idiosyncratic b. adverse c. local d. side ANS: A Most idiosyncratic drug reactions are thought to occur in people with some genetic abnormality, causing either an excessive or an inadequate response to a drug. For example, malignant hyperthermia (see Chapter 16) is a life-threatening response to certain drugs and is attributable to a genetic defect.

DIF:

3

REF: 15

TOP: AST Core Curriculum X:B:3:b, adverse effects

19. Which drug form is used the least in the surgical department?

4

a. Semisolid b. Solid c. Liquid d. Gas

ANS: B Solids such as capsules and tablets, are rarely used in surgery, because oral administration is required.

DIF:

2

REF: 7

TOP: AST Core Curriculum XI:G:3, solid

20. When a drug travels from the site of administration into the bloodstream, it is called a. absorption. b. distribution. c. metabolism. d. excretion.

ANS: A Absorption is the process by which a drug is taken into the body and moves from the site of administration into the blood.

DIF:

2

REF: 11

TOP: AST Core Curriculum X:A:2:a, absorption

21. Drugs are chemically altered via a process called metabolism in the a. lungs. b. colon. c. kidney. d. liver.

ANS: D The chemical composition of a drug is changed in the liver by a process called metabolism or biotransformation.

DIF:

1

REF: 12

TOP: AST Core Curriculum X:A:2:c, metabolism

22. Most drugs are excreted and eliminated by the a. lungs b. colon c. kidney d. liver ANS: C Some drug molecules are eliminated in the bile, feces, or skin, but most unchanged drugs and metabolites are excreted by the kidneys and eliminated in urine (Fig. 1.16).

DIF:

1

REF: 14

TOP: AST Core Curriculum X:A:2:d, excretion

23. A drug that enhances the effect of another drug is called a(n) a. agonist. b. synergist. c. antagonist. d. receptor blocker.

ANS: B A drug that enhances the effect of another drug is called a synergist.

DIF:

1

REF: 14

TOP: AST Core Curriculum X:B:1:a, synergist 5

24. Which type of drug binds to receptor site proteins and then inhibits a response? a. Agonist b. Synergist c. Antagonist d. Electrolyte ANS: C Drugs that bind to a receptor and prevent a response are called antagonists.

DIF:

2

REF: 14

TOP: AST Core Curriculum X:B:1:c, antagonist

25. What is the considered the purpose for giving a medication? a. Duration b. Biotransformation c. Indication d. Distribution ANS: C The reason or purpose for giving a medication is called an indication.

DIF:

1

REF: 15

TOP: AST Core Curriculum X:B:2:a, indications

26. The abbreviation bid represents a. twice a day. b. three times a day. c. four times a day. d. immediately.

ANS: A bid means twice a day.

DIF: 1 REF: 7 TOP: AST Core Curriculum XI:B:2, prescription medications 27. The abbreviation NPO represents a. discontinue. b. immediately. c. keep vein open. d. nothing by mouth.

ANS: D NPO means nothing by mouth.

DIF: 1 REF: 7 TOP: AST Core Curriculum XI:B:2, prescription medications

28. A surgical patient is given a drug during surgery and suspects he or she is having a delayed allergic reaction to the drug, several days later. Which symptom indicates that the patient may be having a delayed drug reaction? a. Drowsiness b. Circulatory collapse c. Joint swelling d. Excessive anticoagulation ANS: C Delayed drug reactions occur days or weeks after a drug is taken and can include fever 6

and joint swelling.

DIF:

2

REF: 15

TOP: AST Core Curriculum X:B:3:a, side effects

29. All are terms used to describe the body’s response or reaction to medications, except a. idiosyncratic. b. contraindication. c. side effect. d. hypersensitivity.

ANS: B A contraindication is a reason against giving a particular drug.

DIF:

1

REF: 15

TOP: AST Core Curriculum X:B:2:b, contraindication

30. What drug is given as an antidote to warfarin? a. Vitamin K b. Amoxicillin c. Mannitol d. Succinylcholine ANS: A Vitamin K is given as an antidote for warfarin if the patient has been overanticoagulated because vitamin K cancels out the effect of warfarin.

DIF: 2 REF: 14 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 31. Volatile anesthetic agents are eliminated from the body via a. the kidneys. b. the skin. c. the circulatory system. d. the lungs.

ANS: D Notable exceptions to urinary excretion are the volatile anesthetic agents, which are excreted by the lungs.

DIF: 2 REF: 13 TOP: AST Core Curriculum V:I:1:c, isoflurane | AST Core Curriculum V:I:1:d, desflurane | AST Core Curriculum V:I:1:e, sevoflurane 32. Which drug administration route causes many drugs to undergo the “first-pass effect”? a. Sublingual b. Oral c. Transdermal d. Inhalation ANS: B Since oral drugs enter the liver through the hepatic portal system, many undergo the first-pass effect, which means they may be altered or nearly inactivated when passing through the liver, potentially reducing the drug’s effectiveness.

DIF: 3 REF: 13 TOP: AST Core Curriculum X:A:2:a, absorption | AST Core Curriculum XI:H:4, oral route 33. Why would a local anesthetic, injected into an infected wound, not produce the intended 7

effect? a. Because the local anesthetic was not strong enough b. Because the local anesthetic was not absorbed c. Because the local anesthetic could not reach the site of action d. Because the local anesthetic could not bind to proteins

ANS: C When a local anesthetic is injected into an infected wound, the local becomes ionized and cannot enter the lipid membrane of the nerves to reach the site of action. See Insight 1.3.

DIF: 3 REF: 12 TOP: AST Core Curriculum VI:A:1, injection | AST Core Curriculum VI:B:1:a, lidocaine | AST Core Curriculum VI:B:1:b, bupivacaine | AST Core Curriculum VI:B:1:c, mepivacaine

34. How is antibiotic irrigation applied during surgery? a. Parenteral b. Topical c. Inhalation d. Emulsion ANS: B Topical antibiotic irrigation is common in surgery, in which case an antibiotic solution is poured or squirted into the surgical site.

DIF: 2 REF: 9 TOP: AST Core Curriculum XIII:A:20, irrigation solutions 35. Many antibiotics used in surgery come in a. liquid b. gas c. ointment d. powder

form and must be reconstituted.

ANS: D Some drugs come in powder form and are contained in glass vials. Such powders must be mixed with a liquid (reconstituted) with sterile water or sodium chloride.

DIF:

1

REF: 7

TOP: AST Core Curriculum IX:D:1, combining

36. The study of drugs derived from natural sources is called a. pharmacology. b. biotechnology. c. pharmacokinetics. d. pharmacognosy.

ANS: D The study of drugs derived from natural sources is called pharmacognosy.

DIF: 1 REF: 2 TOP: AST Core Curriculum XI:F:1, Plants | AST Core Curriculum XI:F:2, animals | AST Core Curriculum XI:F:3, minerals

37. Demerol is an example of a 8

a. synthetic drug. b. hormone. c. semisynthetic. d. natural drug.

ANS: A Meperidine (Demerol) is an example of a synthetic drug; it is made from chemicals.

DIF:

1

REF: 3

TOP: AST Core Curriculum XI:F:4, laboratory synthesis

MATCHING Match the following terms with the correct definitions. a. Adverse effect b. Bioavailability c. Biotechnology d. Biotransformation e. Side effect 1. Amount of unbound drug molecules able to cause the desired effect 2. Expected but unintended action or effect of a drug 3. Artificial manipulation of segments of DNA (genetic material) 4. Metabolism or breaking down of drug molecules in the liver 5. Undesired, potentially harmful effect of a medication 1. ANS: B

DIF: 1 REF: 12 TOP: AST Core Curriculum X:B:3, effects 2. ANS: E DIF: 1 REF: 15 TOP: AST Core Curriculum X:B:3:a, side effects 3. ANS: C DIF: 1 REF: 3 TOP: AST Core Curriculum XI:F:5, biotechnology 4. ANS: D DIF: 1 REF: 12 TOP: AST Core Curriculum X:A:2:c, metabolism 5. ANS: A DIF: 1 REF: 15 TOP: AST Core Curriculum X:B:3:b, adverse effects

9

Chapter 02: Medication Development, Regulation, and Resources Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Which federal action sets the standards for quality and requires proper medication labeling for preparations containing morphine? a. Durham-Humphrey Amendments b. Food, Drug, and Cosmetic Act c. Pure Food and Drug Act d. Controlled Substances Act ANS: C The Pure Food and Drug Act of 1906 requires all drugs marketed in the United States to meet minimal standards of uniform strength, purity, and quality. This Act requires all preparations containing morphine to be labeled as such.

DIF: 1 REF: 21 TOP: AST Core Curriculum XI:D:2, state and federal laws 2. Drugs that are listed with a C-I are considered to a. have a high-abuse potential with no medical use. b. be appropriate for postoperative pain control. c. have a low-abuse potential (e.g., steroids). d. be available over the counter.

ANS: A The Schedules of Controlled Substances established drugs with high abuse potential as C-I. DIF: 1 REF: 22 TOP: AST Core Curriculum XI:B:1, controlled substance (Schedule I-V) 3. Which government agency was established to enforce the Controlled Substances Act? a. Occupational Safety and Health Administration (OSHA) b. The U.S. Food and Drug Administration (FDA) c. The Drug Enforcement Agency (DEA) d. The Joint Commission ANS: C The Controlled Substances Act established the DEA to enforce its requirements and controls.

DIF: 1 REF: 22 TOP: AST Core Curriculum XI:D:2, state and federal laws 4. All of the following items are on the “Do Not Use” list of abbreviations except a. U for unit. b. the trailing zero. c. QD for once daily. d. zero before the decimal point.

ANS: D The Joint Commission established a “Do Not Use” list of abbreviations that includes U for unit, the trailing zero, and the abbreviation, QD. The use of a zero before the decimal point is a recommended practice 10

(see Table 2.2).

DIF: 1 REF: 25 TOP: AST Core Curriculum XI:D:1, health care facility policies and procedures 5. Nonprescription medications are also known as a. addictive medications. b. over-the-counter medications. c. controlled substances. d. Schedule C-II medications.

ANS: B Medications that do not require prescriptions are called over-the-counter medications.

DIF: 1 REF: 21 TOP: AST Core Curriculum XI:B:3, nonprescription medications - over the counter 6. All of the following factors are disadvantages to pharmacogenetics except a. its use to target specific diseases. b. the complexity of its development. c. the cost of genetic research. d. educating health care providers to its use.

ANS: A Pharmacogenetics can be used to target specific diseases. This technologic advantage makes pharmacogenetics important.

DIF:

2

REF: 26

TOP: AST Core Curriculum X:A:1, pharmacology

7. Who assigns a brand name to a new medication? a. The FDA b. Manufacturer c. Pharmacist d. Drug reference publishers ANS: B The manufacturer’s name for a medication is called the brand or trade name.

DIF:

1

REF: 27

TOP: AST Core Curriculum XI:A:3, trade or brand name

8. A medication’s generic name is a. never capitalized on the label. b. followed by the registered trademark (®) symbol. c. its formula. d. its proprietary name.

ANS: A The generic name is not owned by any one company and is not capitalized.

DIF:

1

REF: 27

TOP: AST Core Curriculum XI:A:2, generic name

9. On some medication labels, the generic name is a. placed inside parentheses. b. capitalized. c. not required. d. most prominent.

11

ANS: A The generic name may be placed directly under the brand name or in parentheses.

DIF:

1

REF: 27

TOP: AST Core Curriculum XI:A:2, generic name

10. The full quantity contained in a medication bottle is its a. control number. b. administration route. c. total volume. d. supply dosage.

ANS: C The full quantity of a medication in the bottle is known as its total volume.

DIF:

1

REF: 27

TOP: AST Core Curriculum XII:A:5, amount

11. The organization that internationally regulates medications is a. The Joint Commission. b. FDA. c. OSHA. d. The World Health Organization.

ANS: D The World Health Organization is a specialized agency of the United Nations and is the international regulatory agency for medications.

DIF: 1 REF: 21 TOP: AST Core Curriculum XI:D:2, state and federal laws 12. The identifying number on every prescription that is required by federal law is called the a. National Drug Code. b. label alert. c. barcode symbol. d. lot number.

ANS: A The identifying number on every prescription that is required by federal law is the National Drug Code.

DIF: 1 REF: 28 TOP: AST Core Curriculum XI:D:2, state and federal laws 13. Coordination of research about drug abuse in another country is regulated by the a. CDC b. WHO c. FDA d. DEA ANS: B The WHO acts as the coordinating authority on international public health, providing technical assistance in the drug field, and promoting research on drug abuse.

DIF:

2

REF: 21

TOP: AST Core Curriculum XI:C:1, narcotic precautions

12

14. Which drug law established classifications, known as schedules, of medications that had potential for abuse? a. Controlled Substances Act b. Pure Food and Drug Act c. Federal Food, Drug, and Cosmetic Act d. Drug Enforcement Administration ANS: A The Controlled Substances Act of 1970 established classifications, known as schedules, of medications that had potential for abuse.

DIF: 1 REF: 22 TOP: AST Core Curriculum XI:B:1, controlled substance (Schedule I-V) 15. Drugs that have an accepted use in the surgical setting are on the schedule. a. C-I b. C-II c. C-III d. C-IV ANS: B Controlled substances from the C-II schedule have high abuse potential but also have accepted medical uses, as in the surgical setting. Alfentanil, Cocaine, and morphine are frequently used in surgery.

DIF: 2 REF: 22 TOP: AST Core Curriculum XI:B:1, controlled substance (Schedule I-V) 16. How does a surgical technologist know if he or she can handle and administer medications in his or her state? a. By asking the surgeon b. By asking the facility’s risk management c. By researching the state’s policy online d. By contacting the AORN ANS: C As a surgical technologist, you should be knowledgeable about the medication handling and administration laws in your state. State practice acts are public information; this means you can read these acts yourself in order to be correctly informed.

DIF: 2 REF: 24 TOP: AST Core Curriculum XI:D:2, state and federal laws 17. Which factor is an advantage of pharmacogenomics? a. Complexity of the genetic research b. Cost of the genetic research c. Education in the use of this technology d. Facilitate the medication approval process ANS: D Facilitating the medication approval process is an advantage of pharmacogenomics.

DIF:

1

REF: 26

TOP: AST Core Curriculum X:A:1, pharmacology

13

18. What should be done to an otic suspension medication to dilute the particles before it is administered to the patient? a. It must be liquefied. b. It must be concentrated. c. It must be shaken. d. It must be sterilized.

ANS: C The word suspension tells us the solution must be shaken to dilute the particles before it is administered to the patient.

DIF:

3

REF: 27

TOP: AST Core Curriculum XI:G:2:b, suspension

19. How should an outdated multiuse vial of a local anesthetic be handled? a. By finishing the vial b. By returning it to pharmacy c. By giving it to anesthesia team d. By discarding the vial ANS: B Outdated medications should be returned to the pharmacy and another obtained with a date that is not passed.

DIF:

2

REF: 28

TOP: AST Core Curriculum XII:A:6, expiration date

20. All are found on medication labels, except a. supply dosage. b. control number. c. label alert. d. PDR number.

ANS: D PDR (Physician’s Desk Reference) is a resource used to access information on thousands of medications used in medical and surgical practice; however, a PDR number would not be found on a medication label.

DIF:

1

REF: 29

TOP: AST Core Curriculum XII:A:1, label information

21. Which medication reference is published annually and updated quarterly by the American Society of Health-System Pharmacists? a. AHFS b. USP-NF c. PDR d. WHO ANS: A The American Hospital Formulary Service (AHFS) is published annually and updated quarterly by the American Society of Health-System Pharmacists, in Bethesda, MD. DIF: 1 REF: 30 TOP: AST Core Curriculum XI:E:4, American Hospital Formulary Service Index

14

22. Which source is the most reliable way to check that medication information is accurate online? a. Searching the Internet b. Using a government website c. Asking a clinical coordinator d. Calling the FDA ANS: B Using a governmental website to verify information would be the best method.

DIF: 1 REF: 31 TOP: AST Core Curriculum XI:E, Medication publications 23. Which categories of medications under the FDA’s pregnancy categories are considered to be within safe limits for use during pregnancy? a. Categories B and C b. Categories A and B c. Categories C and D d. Categories A and X ANS: B The FDA’s Pregnancy Categories list A and B as either “no risk” (category A) or “little to no risk” (category B), respectively.

DIF: 1 REF: 25 TOP: AST Core Curriculum XI:B:2, prescription medications 24. In the phases of human medication testing, what is the last phase? a. Phase 0 b. Clinical investigation c. Clinical trials d. Postmarking study ANS: D The last phase in medication testing on humans is phase IV or postmarketing study, which occurs after the medication is released for use in the treatment of a specified condition.

DIF:

1

REF: 26

TOP: AST Core Curriculum X:A:1, pharmacology

25. Drugs that are used for diseases and disorders that affect fewer than 200,000 people in the United States are considered a. Phase 0 drugs. b. Category A drugs. c. C-III drugs. d. orphan drugs.

ANS: D The Orphan Drug Designation program assigns this status to drugs and biologics that are for the effective and safe treatment, diagnosis, or prevention of diseases or disorders that affect fewer than 200,000 people in the United States. This designation can also be applied to drugs that affect more than 200,000 people but are not expected to recover the costs for developing and marketing within 7 years following FDA approval.

DIF:

1

REF: 25

TOP: AST Core Curriculum X:A:1, pharmacology 15

16

Chapter 03: Pharmacology Mathematics Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Seven o’clock in the morning, military time, would be written as

a. b. c. d.

0007.

0070.

0700.

7000.

ANS: C Seven o’clock in the morning, written in military time, is 0700 without the need for the AM designation.

DIF:

1

REF: 33

TOP: AST Core Curriculum IX:A:2:b, conversions

2. The equivalent fraction to 3/4 is

a. b. c. d.

50/100 60/100 75/100 85/100

ANS: C If you multiply or divide the numerator and denominator of a fraction by the same nonzero number, the result is an equivalent fraction: 3 25 = 75 and 4 25 = 100.

DIF:

3

REF: 35

TOP: AST Core Curriculum IX:B:1, fractions

3. 3 5/8 written as an improper fraction is

a. b. c. d.

29/8 29/5 29/3 29/1

ANS: A To convert a fraction into an improper fraction, multiply the whole number by the denominator and then add the numerator. This new number becomes the numerator and the denominator stays the same: 3 would be 8 3 + 5 = 29. Place this new number over the old denominator as for the improper fraction.

DIF:

3

REF: 35

TOP: AST Core Curriculum IX:B:1, fractions

4. In the number 123.45678, which digit is in the ten thousandths place? a. b. c. d.

5 6 7 8

ANS: C The ten thousandth place is located in the fourth place value slot to the right of the decimal point. The number 7 is in this place value in the decimal 123.45678.

DIF:

1

REF: 37

TOP: AST Core Curriculum IX:B:2, decimals

17

5. Your surgery supervisor asks you to report to work by seven thirty in the morning. How

would this be written in military time? a. 730 b. 0730 c. 7:30 d. 7300 ANS: B In military time, seven thirty in the morning would be written as 0730.

DIF:

1

REF: 34

TOP: AST Core Curriculum IX:A:2:b, conversions

6. Which fraction is in its lowest terms?

a. 3/4 b. 10/12 c. 2/2 d. 6/8 ANS: A A fraction is in its lowest terms when no nonzero number except 1 can be evenly divided into both the numerator and the denominator.

DIF:

2

REF: 35

TOP: AST Core Curriculum IX:B:1, fractions

7. What is the decimal form of the fraction 1/8?

a. 8.0 b. 0.8 c. 1.25 d. 0.125 ANS: D To convert fractions to decimals, divide the numerator by the denominator resulting in 8 ÷ 1 = 0.125.

DIF:

2

REF: 40

TOP: AST Core Curriculum IX:B:2, decimals

8. 0.25% is expressed as a fraction as

a. b. c. d.

0.25/100.

0.25/25.

25/100.

100/25.

ANS: C When you drop the percent sign, you either replace it with a denominator of 100 or a decimal place of hundredths.

DIF:

1

REF: 40

TOP: AST Core Curriculum IX:B:5, percentages

9. What is 25% of 50?

10 b. 12.5 c. 10.5 d. 12

a.

ANS: B To find the percent of a number, change the percent to a decimal or fraction, replace the “of” with the times sign and multiply.

18

DIF:

1

REF: 40

TOP: AST Core Curriculum IX:B:5, percentages

10. 8 is what percent of 12?

a. 66.6% b. 150% c. 6.7% d. 33.3% ANS: A 8/12 is reduced using the number 4 to equal 2/3; 2 ÷ 3 = 0.666 or 66.6%.

DIF:

1

REF: 45

TOP: AST Core Curriculum IX:B:5, percentages

11. Your surgeon is using a medication that is given according to the surgical patient’s

weight in kilograms. The patient weighs 6 pounds. How many kilograms is this? a. 0.367 b. 36.7 c. 27.3 d. 2.73 ANS: D 1 kg/2.2 lbs = X kg/6 lbs; 1 x 6 = 2.2X; 6 = 2.2X; 2.2 ÷ 2.2 = X; 6 ÷ 2.2 = 2.727 or 2.73.

DIF:

2

REF: 45

TOP: AST Core Curriculum IX:A:4:e, Kg

12. The surgeon’s preference card asks for a 1:1:3 solution of polymyxin B sulfate,

bacitracin, and saline mixture on the sterile field. What percentage of the solution does each ingredient represent? a. 80%, 10%, 10% b. 20%, 20%, 60% c. 10%, 40%, 50% d. 20%, 30%, 50% ANS: B 1:1:3 = 1 + 1 + 3 = 5; 1/5 = 1 ÷ 5 = 0.2, move decimal two places to the right = 20%; another 1/5 = 0.2 or 20%; 3/5 = 3 ÷ 5 = 0.6, move decimal two places to the right = 60% DIF:

2

REF: 41

TOP: AST Core Curriculum IX:B:4, proportions

13. For an infant surgical procedure, the operating room temperature must be warm.

Your surgeon wants to know the current temperature in Fahrenheit, but you know the temperature is 38 degrees Celsius. What is the Fahrenheit temperature? a. 100.4 b. 33.2 c. 32 d. 98.6 ANS: A The formula to convert Celsius to Fahrenheit is: F = (9/5C) + 32. 9/5 reduce: 9/1 7.6/1; 7.6 9 = 68.4; 68.4 + 32 = 100.4.

38/1. Cross

DIF: 2 REF: 42 TOP: AST Core Curriculum IX:A:3:b, Celsius to Fahrenheit 19

14. 1 gram of an antibiotic is equal to a. b. c. d.

mL of fluid.

1 2 5 10

ANS: A 1 cc or 1 mL is equal to 1 gram of weight.

DIF:

1

REF: 45

TOP: AST Core Curriculum IX:A:1:b, conversions

COMPLETION 1. Meter ANS: m The accepted abbreviation for meter is m.

DIF: 1

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

2. Liter ANS: L The accepted abbreviation for liter is L. DIF:

1

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

3. Cubic centimeter ANS: cc The accepted abbreviation for cubic centimeter is cc.

DIF: 1

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

4. Centimeter ANS: cm The accepted abbreviation for centimeter is cm.

DIF: 1

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

5. Drop ANS: gtt The accepted abbreviation for drop is gtt.

DIF: 1

REF: 46

TOP: AST Core Curriculum 20

IX:A:4:d, Gtt 6. Gram ANS: g The accepted abbreviation for gram is g.

DIF:

1

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

7. Milliequivalent ANS: mEq The accepted abbreviation for milliequivalent is mEq. DIF:

1

8. 1/2

1/6

REF: 46

TOP: AST Core Curriculum IX:A:1:a, terminology

ANS: 1/12 To multiply two fractions, multiply the numerators together and then the denominators together: 1 1 = 1 and 2 6 = 12. The result is the new fraction.

Note: Always reduce fractions to their lowest terms.

DIF:

3

REF: 36

TOP: AST Core Curriculum

9. 2/3 ÷ 1/3 = ANS: 2 To divide two fractions, invert the divisor and then multiply: 2/3 Note: Always reduce to lowest terms.

DIF:

3

REF: 37

3/1 = 6/3 = 2.

TOP: AST Core Curriculum

10. 1/12 + 5/12 = ANS: 1/2 To add two fractions whose denominators are the same, add the numerators and retain the same denominator: 1 + 5 = 6/12.

Note: Always reduce fractions to their lowest terms.

DIF:

3

REF: 36

TOP: AST Core Curriculum

11. 7.05 + 3.221 = ANS: 10.271 21

To add two decimal numbers, line up the decimal points and carry out the calculations.

7.050 + 3.221 = 10.271.

Note: Adding zeros to the right of a number on the right side of the decimal point does not change its value.

DIF:

3

REF: 38

TOP: AST Core Curriculum

IX:B:2, decimals 12. 6.6 – 4.4452 = ANS: 2.1548 To subtract two decimal numbers, line up the decimal points and carry out the calculations. 6.6000 – 4.4452 = 2.1548.

Note: Adding zeros to the right of a number on the right side of the decimal point does not change its value.

DIF:

3

REF: 38

IX:B:2, decimals 13. 16 5/6

TOP: AST Core Curriculum 5 2/5=

ANS: 11 13/30 To subtract two fractions with different denominators, first convert the fractions to equivalent fractions with the lowest common denominators, then subtract the numerators. The least common denominator of these two fractions is 30. Therefore 16 5/6 can be written as 16 25/30, and 5 2/5 can be written as 5 12/30. Now the fractions can be subtracted as 16 25/30 5 12/30. 16 5 = 11 and 25/30 12/30 = 13/30. The answer is 11 13/30, which is in the lowest terms.

DIF:

3

14. 1/5

REF: 36

TOP: AST Core Curriculum

100 =

ANS: 20 To multiply two fractions (100 is the same as the fraction 100/1), multiply the numerators together and then the denominators together. The result is the new fraction: 1/5 100/1 = 100/5.

Note: Always reduce to lowest terms.

DIF:

15. 8.3

3

REF: 37

TOP: AST Core Curriculum IX:B:1, fractions

0.9 =

ANS: 7.47 To multiply two decimals, carry out the multiplication and then add the number of decimal places from the right of the decimal point in the original two numbers. This total is the number of decimal places from the right of the decimal point in the product (answer). 8.3 0.9 when multiplied is 7.47. There is one decimal place in 22

8.3 and one in 0.9 for a total of two decimal places in both decimals; therefore two decimal places are in the answer 7.47 DIF:

3

16. 0.003

REF: 38

TOP: AST Core Curriculum

1.25 =

ANS: 0.00375 The rationale is the same as in problem 22; 0.003 has three decimal places, and 1.25 has two decimal places for a total of five. Add zeros to the left of the answer (3 125 = 375) to obtain the correct number of decimal places needed. By adding two zeros to the left of 375, the correct number is 0.00375.

DIF:

3

REF: 38

TOP: AST Core Curriculum IX:B:2, decimals

17. 20 is what percent of 50?

ANS: 40 To find the percent of one number to another, change the percent to a decimal or fraction and then to a percent. The fraction is 20/50. A percent’s denominator is always 100; therefore multiply the numerator and denominator of the fraction by 2 to make the denominator 100: 20 2 = 40 and 50 2 = 100; it can be written as 40%.

DIF:

3

REF: 40

TOP: AST Core Curriculum IX:B:5, percentages

18. In the decimals 0.0000332 and 0.0000035, which has the larger value?

ANS: 0.0000332 To compare the values of two decimals, look to the right of the decimal point and find the first numbers that are different. In these two numbers, the fifth place over shows a 3 in the first number and a 0 in the second. Because 3 is larger than 0, the larger value is 0.0000332.

DIF:

3

REF: 37

TOP: AST Core Curriculum

IX:B:2, decimals 19. 15° C = ° F. ANS: 59° To convert degrees Celsius to Fahrenheit, use the formula F = C + 32. Note: Remember to perform the multiplication step before the addition. F = (15) + 32; F = 27 + 32; F = 59° DIF: 3 REF: 42 TOP: AST Core Curriculum IX:A:3:b, Celsius to Fahrenheit 20. 50° 23

C=

° F.

ANS: 122 Using the rationale from the previous example, substitute the degrees Celsius into the formula F = C + 32°.

F = (50) + 32; F = 90 + 32; F = 122° DIF: 3 REF: 42 TOP: AST Core Curriculum 21. 32° Celsius to Fahrenheit F =

°C

ANS: 0 To convert degrees Fahrenheit to Celsius, use the formula C = 5/9 (F-32).

Note: Remember to perform the calculations in the parentheses first. In addition, when a number (in this case a fraction) is next to a parenthesis, it means to multiply that number times the number within the parentheses.

C= 5/9 (32-32); C= 5/9(0); C=0 Note: Any number times 0 is equal to 0.

DIF: 3 REF: 42 TOP: AST Core Curriculum IX:A:3:a, Fahrenheit to Celsius

22. 50° F = ° C ANS: 10 Using the same rationale from the previous example, substitute the degrees Fahrenheit into the formula: C = (F 32): C = (50 32); C = (18); C = 10.

DIF: 3 REF: 42 TOP: AST Core Curriculum IX:A:3:a, Fahrenheit to Celsius MATCHING Match the following equivalents and prefixes with their correct meaning. a. 1000 milliliters b. 1000 c. 1 cubic centimeter d. one tenth e. 2.54 centimeters f. 5 cubic centimeters g. one millionth h. 1 kilogram 1. 1 milliliter 2. 1 liter 3. 2.2 pounds 4. micro 24

5. 1 teaspoon 6. deci 7. 1 inch 8. kilo 1. ANS: C

DIF: 1 REF: 44 TOP: AST Core Curriculum IX:A:4:b, mL or ml 2. ANS: A DIF: 2 REF: 44 TOP: AST Core Curriculum IX:A:4:b, mL or ml 3. ANS: H DIF: 1 REF: 45 TOP: AST Core Curriculum IX:A:4:e, Kg 4. ANS: G DIF: 1 REF: 43 TOP: AST Core Curriculum IX:A:1:a, terminology 5. ANS: F DIF: 1 REF: 45 TOP: AST Core Curriculum IX:A:2:b, conversions 6. ANS: D DIF: 1 REF: 43 TOP: AST Core Curriculum IX:A:1:a, terminology 7. ANS: E DIF: 1 REF: 45 TOP: AST Core Curriculum IX:A:2:b, conversions 8. ANS: B DIF: 1 REF: 43 TOP: AST Core Curriculum IX:A:1:a, terminology

25

Chapter 04: Medication Administration Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Which member of the surgical team must document the medications that are used at the surgical field? a. Surgeon b. Circulator c. Surgical first assistant d. Surgical technologist in the scrub role ANS: B The circulator is responsible for documenting all medications used from the sterile field according to institutional policy.

DIF: 2 REF: 49 TOP: AST Core Curriculum XII:C:2:a, circulator responsibility and role 2. When changing shifts, the incoming surgical technologist notices one of the medications on the sterile field is not accurately labeled. What should he or she do? a. Discard the medication and ask the circulator for a new dose. b. Ask the scrub person to label the medication before leaving. c. Ask the circulator to show him or her the empty vial and then label it properly. d. Ask the surgeon what to do.

ANS: A Occasionally, the scrubbed surgical technologist may be replaced during a procedure (e.g., shift change, lunch break). All medications must be plainly labeled and reported to the new scrub person. If any doubt remains as to the identity of a solution, then it must be discarded and a new medication must be obtained.

DIF: 3 REF: 57 TOP: AST Core Curriculum XII:C:2:b, surgical technologist responsibility and role 3. The five rights of medication administration include all of the following except a. right drug. b. right dose. c. right patient. d. right physician. e. right time.

ANS: D Team members must work together to ensure that the right drug is given in the right dose, by the right route, to the right patient, and at the right time.

DIF:

2

REF: 50

TOP: AST Core Curriculum XII:C:3:c, six rights

4. Which statement does not apply to the required steps for proper medication identification? a. Read the label on the container. b. Check the integrity of the container. c. Check the expiration date. d. Show the label to the surgeon.

26

ANS: D Both the scrub person and the circulator are responsible for correctly identifying the medications delivered to and used from the sterile field. This dual responsibility minimizes the potential for errors in medication administration, as does following a logical series of steps (Box 4.3) to identify drugs properly.

DIF:

2

REF: 53

TOP: AST Core Curriculum XII:C:3:d, verification

5. Medication labels must contain all of the following information except a. generic and trade names. b. contraindications. c. strength of medications. d. amount of medication.

ANS: B The medication label contains important information about the drug (Table 4.1). The most crucial information is the drug name (both generic and trade), the strength, the amount, and the expiration date. Special handling instructions (e.g., refrigeration, keeping medication from direct light), the drug form, and its intended administration route are also key pieces of drug information contained on the label. (For more details, see Chapter 2.)

DIF:

2

REF: 54

TOP: AST Core Curriculum XII:A:1, label information

6. When handling medications in the surgical department, which statement does not apply? a. Both the scrub person and the circulator must follow aseptic technique. b. Multidose vials may be recapped aseptically and dated to enable the remaining portions to be used at a later time. c. Medications in a powder form must be reconstituted by the circulator before delivery to the sterile field. d. When the circulator is delivering solutions to the sterile field, the scrub person should hold the receiving container away from the sterile table.

ANS: B Unused portions should not be saved for later use; sterility cannot be ensured.

DIF: 3 REF: 56 TOP: AST Core Curriculum XII:A:8:a, handling precautions 7. Improper or inadequate labeling of medications may be considered a. malpractice. b. tort. c. materia medica. d. negligence.

ANS: D No excuse is acceptable for the presence of unlabeled (unidentified) medications on the sterile back table. Improper or inadequate labeling of drugs may be considered negligent.

DIF: 3 REF: 57 TOP: AST Core Curriculum XII:C:2:b, surgical technologist responsibility and role 27

8. Which step does not apply once a medication error has occurred? a. Notify the surgeon immediately. b. Notify the unit supervisor. c. Follow institutional policy. d. Do not complete an incident report.

ANS: D If a medication error is made, it must be immediately acknowledged to ensure that corrective measures are taken. The surgeon is notified immediately; then institutional policy is followed. Usually, when a medication error occurs, the unit supervisor is notified and an incident or occurrence report is completed. Above all, immediate action is taken to correct the error.

DIF: 2 REF: 57 TOP: AST Core Curriculum XI:C:2, personnel negligence 9. Before medications are delivered into the sterile field, they must be identified by a. scrub person and circulator. b. two scrub personnel. c. physician and circulator. d. nurse anesthetist and circulator.

ANS: A The drug should be delivered to the sterile field only after the steps to identify the medication have been completed.

DIF: 2 REF: 59 TOP: AST Core Curriculum XII:C:1:a, draw up medication into syringe 10. All of the following items must be read aloud when identifying a drug except a. drug name. b. manufacturer. c. strength. d. expiration date.

ANS: B The most crucial information is the drug name (both generic and trade), the strength, the amount, and the expiration date. The circulator reads vital label information aloud just before delivery to the sterile field and shows the label to the scrub person (Fig. 4.6). Finally, the scrub person repeats the label information aloud to confirm the correct drug. Alternately, both the scrub person and the circulator may read the information aloud together before delivering the medication to the sterile field.

DIF: 2 REF: 54 TOP: AST Core Curriculum XII:C:2:b, surgical technologist responsibility and role 11. The scrub person may receive medications into the sterile field in all of the following ways except a. circulator places the bottle on the corner of the back table. b. circulator pours the medication into a sterile container. c. scrub person draws up the medication from the bottle held by the circulator. d. circulator reconstitutes powder medication and the liquid is withdrawn with a syringe.

28

ANS: A The circulator (a nonsterile team member) cannot place anything directly on the back table. In addition, a medication container is not sterile; therefore it cannot be placed directly on the sterile back table.

DIF: 2 REF: 54 TOP: AST Core Curriculum XII:C:2:b, surgical technologist responsibility and role

12. The most common type of syringe used in surgery is the a. plain tip. b. Luer-loc. c. tuberculin. d. insulin.

ANS: B The most common type of syringe tip used in surgery is the Luer-loc tip, which has a screw-type locking mechanism used to attach a hypodermic needle securely.

DIF: 3 REF: 55 TOP: AST Core Curriculum XII:C:2:c, methods of transfer 13. When recapping a needle, you should a. throw the needle into the trash. b. use the two-handed method. c. use the one-handed method. d. hand the uncapped needle to the circulator.

ANS: C Standard precautions state that used needles must never be recapped, because most needle puncture injuries are the result of attempting to recap a used needle. However, leaving an unsheathed hypodermic needle exposed on the sterile table during a surgical procedure is also dangerous. If a needle must be recapped for protection between repeated uses during a surgical procedure, a one-handed technique (Fig. 4.18) should be used or a recapping device intended for that purpose can be used.

DIF:

2

REF: 58

TOP: AST Core Curriculum XII:B:1:b, Luer-loc

14. Who is responsible for passing a medication to the surgeon for administration during the surgical procedure? a. Anesthesiologist b. Scrubbed surgical technologist c. Circulating nurse d. Another scrubbed surgeon ANS: B The surgical technologist is responsible for passing the medication to the surgeon.

DIF: 3 REF: 59 TOP: AST Core Curriculum XII:C:1:a, draw up medication into syringe 15. Which of these is not one of the “five rights” but is crucial in medication administration? a. Right documentation b. Right patient c. Right route d. Right time 29

ANS: A It is crucial that medications given from the sterile table be accurately recorded in the operative record.

DIF: 1 REF: 50 TOP: AST Core Curriculum III:A, Health care facility policy 16. Why should the scrubbed surgical technologist repeat the medication label information aloud? a. To ensure that he or she can read b. So that he or she can be heard c. To confirm the correct drug d. So that the surgical team will know ANS: C The scrub should repeat the label information to confirm the drug.

DIF:

2

REF: 53

TOP: AST Core Curriculum XII:C:3:c, six rights

17. What is the first action that should be taken by the scrubbed surgical technologist when withdrawing medication from an inverted vial held by the circulator? a. Puncture the rubber stopper. b. Remove the rubber stopper. c. Remove the syringe plunger. d. Draw air into the syringe.

ANS: D Alternatively, the circulator may hold the vial in an inverted position while the scrub withdraws the drug from the vial with a syringe and needle (Fig. 4.8). The scrubbed surgical technologist should first draw some air into the syringe, then puncture the rubber stopper with the needle and inject air into the vial, which will allow the contents of the vial to enter the syringe rapidly.

DIF: 1 REF: 50 TOP: AST Core Curriculum XII:C:2:b, surgical technologist responsibility and role

18. A recapped bottle of sterile saline is considered a. sterile. b. unsterile. c. expired. d. none of these.

ANS: B A bottle that is recapped is considered unsterile.

DIF: 2 REF: 55 TOP: AST Core Curriculum XII:C:2:c, methods of transfer 19. All of the following are containers acceptable for storing medication on the sterile table, except a. pitchers. b. opened ampules. c. medicine cups. d. basins.

30

ANS: B Opened ampules can be hazard because of the risk of broken glass in the medication from opening it.

DIF: 1 REF: 56 TOP: AST Core Curriculum XII:A:8:a, handling precautions 20. All of the following pieces are basic parts of a syringe, except a. hub. b. barrel. c. plunger. d. tip.

ANS: A The hub is a basic part of a hypodermic needle.

DIF:

2

REF: 56

TOP: AST Core Curriculum XII:B:4, ampule

21. A surgeon requests the use of an embolectomy catheter that has a 3mL balloon.

Which of these syringes is the BEST choice for inflating this balloon? a. 1 mL TB syringe b. 5 mL syringe c. 10 cc syringe d. A Tubex syringe ANS: B The 5 mL or cc syringe would be the best choice for inflating the tiny 3 mL balloon of the embolectomy catheter.

DIF:

1

REF: 59

TOP: AST Core Curriculum XII:B:1, syringes

22. Which hypodermic needle has the smallest lumen? a. 18-gauge b. 21-gauge c. 25-gauge d. 27-gauge ANS: D The larger the gauge of the needle, the smaller the diameter of the lumen.

DIF:

2

REF: 58

TOP: AST Core Curriculum XII:B:1, syringes

23. What is the length of a spinal needle? a. 1 1/2 inches b. 2 1/2 inches c. 3 inches d. 1/3 inches ANS: C Longer needles (3-inch) are called spinal needles.

DIF: 1 REF: 59 TOP: AST Core Curriculum XII:C:2:c, methods of transfer MATCHING Match the following terms with the correct definitions.

31

a. b. c. d. e.

Asepsis Carpule Contamination Diluent Reconstitute

Glass tube containing a medication 2. Liquid such as saline or water used to reduce the concentration of an agent 3. Turning a solid medication into a liquid by adding water or saline 4. Transmission of microorganisms to a sterile field or item 1.

5.

Without infection

ANS: B DIF: 2 REF: 59 TOP: AST Core Curriculum II:G:2:a, spinal | AST Core Curriculum III:B:2, spinal/epidural anesthesia 2. ANS: D DIF: 1 REF: 59 TOP: AST Core Curriculum XII:B:4, ampule 3. ANS: E DIF: 2 REF: 58 TOP: AST Core Curriculum IX:D:3, diluting 4. ANS: C DIF: 3 REF: 55 TOP: AST Core Curriculum IX:D:3, diluting 5. ANS: A DIF: 3 REF: 56 TOP: AST Core Curriculum XII:A:8:a, handling precautions 1.

TRUE/FALSE 1. A 30-gauge hypodermic needle is larger in diameter than an 18-gauge needle.

ANS: F The larger the gauge of a needle, the smaller the diameter of the lumen (inside channel). Therefore an 18-gauge needle has a significantly larger lumen than does a 25-gauge needle.

DIF: 3 REF: 55 TOP: AST Core Curriculum XII:A:8:a, handling precautions

32

Chapter 05: Antibiotics Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Disease-causing microorganisms are called a. broad spectrum. b. bacteriostatic. c. pathogens. d. ototoxic.

ANS: C The definition of pathogens is disease-causing microbes.

DIF:

1

REF: 66

TOP: AST Core Curriculum XIII:A:6, anti-infectives

2. A series of tests used to identify disease-causing microorganisms and to determine their susceptibility to various antibiotics is called a. hemoglobin and hematocrit. b. culture and sensitivity. c. antibiotic resistance. d. Gram stain.

ANS: B Culture and sensitivity testing is the process of growing microbes in culture to determine the infecting microorganism and its exposure to various antibiotics to determine which agent would best inhibit its growth.

DIF:

1

REF: 69

TOP: AST Core Curriculum XIII:A:6, anti-infectives

3. Prophylactic antibiotics are prescribed to a. treat surgical site infections (SSIs). b. prevent infections. c. identify pathogens. d. produce chemicals in the body.

ANS: B Prophylactic antibiotics are administered before an SSI occurs as a preventive measure.

DIF:

2

REF: 82

TOP: AST Core Curriculum XIII:A:6, anti-infectives

4. Endogenous infection occurs from a. outside the patient’s body. b. the patient’s own bacteria. c. a tear in the surgeon’s glove. d. contaminated surgical supplies.

ANS: B Endogenous infections come from the patient’s own bacteria; examples include microorganisms on the patient’s skin being carried into a surgical wound.

DIF:

3

REF: 68

TOP: AST Core Curriculum XIII:A:6, anti-infectives

33

5. Eukaryotes are known to a. have an early or pre nucleus. b. have smaller ribosomes than prokaryotes. c. be multicellular organisms. d. have a plasma membrane, whereas prokaryotes do not.

ANS: C Eukaryotes have a true nucleus and are multicellular organisms.

DIF:

2

REF: 69

TOP: AST Core Curriculum XIII:A:6, anti-infectives

6. Which function is not how antimicrobial agents may work against pathogenic microorganisms? a. Inhibiting cell-wall synthesis b. Altering cell-wall membrane c. Interfering with cell metabolism d. Interfering with reabsorption of sodium ANS: D Diuretics, not antimicrobial agents, interfere with the reabsorption of sodium in the body.

DIF:

2

REF: 69

TOP: AST Core Curriculum XIII:A:6, anti-infectives

7. When a microorganism’s DNA sequence is altered to prevent destruction by an agent, the microorganism is said to have developed a(n) a. antibiotic resistance. b. broad-spectrum coverage. c. plasma membrane. d. bacteriostatic effect.

ANS: A Bacteria obtain antibiotic resistance by mutation or changes in the DNA sequence of the microorganism.

DIF:

2

REF: 70

TOP: AST Core Curriculum XIII:A:6, anti-infectives

8. Among the most common causative agents of SSI are bacteria known as a. Bacillus subtilis. b. Streptococcus pneumoniae. c. Staphylococcus epidermidis. d. Staphylococcus aureus.

ANS: D Staphylococcus aureus, normally present on the patient’s skin, may be carried into the surgical wound and is considered among the most common causative agents for SSIs. DIF:

1

REF: 71

TOP: AST Core Curriculum XIII:A:6, anti-infectives

9. Preoperative and intraoperative antibiotics may be administered by any one of the following methods except a. orally. b. intravenously. c. topically to the incision. d. in irrigation solutions.

34

ANS: A Surgical patients usually do not eat or drink anything by mouth (PO or orally) for a specific period before surgery or during surgery because of the risk of aspiration with the administration of general anesthesia.

DIF:

3

REF: 82

TOP: AST Core Curriculum XIII:A:6, anti-infectives

10. An antimicrobial agent used to inhibit bacterial growth is called a. bactericidal. b. bacteriogenic. c. bacteriophagic. d. bacteriostatic.

ANS: D The definition of bacteriostatic is an agent that inhibits the growth of bacteria.

DIF:

1

REF: 70

TOP: AST Core Curriculum XIII:A:6, anti-infectives

11. Which category of antibiotics is known to be ototoxic and nephrotoxic? a. Cephalosporins b. Macrolides c. Aminoglycosides d. Penicillins ANS: C Aminoglycosides interfere with protein synthesis of the pathogen, are bactericidal, and are relatively narrow-spectrum agents. Among the major adverse effects are nephrotoxicity and ototoxicity.

DIF:

1

REF: 75

TOP: AST Core Curriculum XIII:A:6:a, aminoglycoside

12. Which antibiotic is available only in topical form because it is too toxic for systemic use? a. Neomycin b. Tobramycin c. Kanamycin d. Streptomycin ANS: A Neomycin is very toxic when used systemically (i.e., as when given intravenously); therefore it is used topically (as in an ointment).

DIF:

1

REF: 75

TOP: AST Core Curriculum XIII:A:6:a, aminoglycoside

13. Which major group of antibiotics is classified into five generations on the basis of the spectrum of its activity? a. Cephalosporins b. Macrolides c. Tetracyclines d. Penicillins ANS: A Cephalosporins are classified into five generations based on different ranges of activity. Each newer generation requires doses being required less frequently.

DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 35

14. Erythromycin belongs to which group of antibiotics? a. Cephalosporins b. Macrolides c. Aminoglycosides d. Penicillins ANS: B Macrolides are a group of broad-spectrum agents that include erythromycin.

DIF:

1

REF: 76

TOP: AST Core Curriculum XIII:A:6:c, antimicrobial

15. Who discovered penicillin? a. Edward Jenner b. Louis Pasteur c. Robert Koch d. Alexander Fleming ANS: D Alexander Fleming discovered penicillin in 1928 while working on the development of vaccines.

DIF: 1 REF: 73 TOP: AST Core Curriculum XIII:A:6, anti-infective agents 16. Which combination agent contains an antibiotic, an anti-inflammatory, and must be shaken before using? a. Coly-mycin S Otic b. Neosporin GU Irrigant c. Cortisporin Otic d. Bacitracin with polymyxin B ANS: C Cortisporin Otic is an antibiotic with an anti-inflammatory agent. It is in suspension, which means it must be shaken before using to distribute the drug particles evenly.

DIF: 2 REF: 78 TOP: AST Core Curriculum XIII:A:6, anti-infective agents 17. Antibiotics are natural chemicals, which are produced by a. microorganisms. b. metabolites. c. human cells. d. sulfa drugs.

ANS: A Antibiotics are derived from natural chemicals produced by microorganisms and include fungi and bacteria.

DIF: 1 REF: 67 TOP: AST Core Curriculum XIII:A:6, anti-infective agents 18. Antibiotics assist the surgical patient’s own defenses to prevent or diminish a. venereal diseases. b. lack of aseptic technique. c. growth of bacteria.

36

d. surgical site infections.

ANS: D Antibiotics are adjuncts that assist the patient’s own defenses to prevent or diminish the severity of a surgical site infection.

DIF: 1 REF: 66 TOP: AST Core Curriculum XIII:A:6, anti-infective agents 19. The Surgical Patient Checklist is a tool to help with compliance for antibiotic administration and was developed by a. the CDC. b. the WHO. c. CMS. d. AORN. ANS: B The Surgical Patient Checklist was developed by the World Health Organization (WHO).

DIF:

2

REF: 67

TOP: AST Core Curriculum XII:C:3:c, six rights

20. A sulfonamide is an antimicrobial chemical and is further classified as a. a fluoroquinolone. b. a synthetic antibacterial. c. a semisynthetic antibacterial. d. a bacteriocidal microbe.

ANS: B Sulfonamides are developed in the lab by chemical synthesis and these are classified as synthetic antibacterial agents.

DIF:

2

REF: 67

TOP: AST Core Curriculum XIII:A:6:c, antimicrobial

21. To cause an infection, a pathogen must have a(n) a. source. b. bacteria. c. unclean environment. d. S. aureus.

ANS: A A pathogen must have a source, a means of transmission, and a susceptible host to cause an infection.

DIF:

2

REF: 68

TOP: AST Core Curriculum XIII:A:6, anti-infectives

22. Surgical instruments that are improperly cleaned prior to sterilization are an example of a(n) a. endogenous source. b. exogenous source. c. bactericidal source. d. resistant source.

ANS: B The microbes of an improperly cleaned instrument will carry into the surgical wound and can cause infection.

37

DIF:

1

REF: 68

TOP: AST Core Curriculum XIII:A:6, anti-infectives

23. A way of distinguishing between two types of bacteria is called a. culture and sensitivity. b. morphology. c. selective toxicity. d. Gram staining.

ANS: D Gram staining is a differential staining procedure, which means it is used to distinguish between two types of bacteria.

DIF:

2

REF: 68

TOP: AST Core Curriculum XIII:A:6, anti-infectives

24. Which agent is bactericidal? a. Macrolides b. Penicillins c. Tetracyclines d. Fluoroquinolones ANS: B Bactericidal agents include aminoglycosides, cephalosporins, and penicillins.

DIF:

1

REF: 70

TOP: AST Core Curriculum XIII:A:6, anti-infectives

25. Which is the correct group of antibiotics that belong to the beta-lactam class? a. Penicillins, cephalosporins, carbapenems b. Cephalosporins. carbapenems, aminoglycosides c. Monobactams, aminoglycosides, macrolides d. Fluoroquinolones, aminoglycosides, penicillins ANS: A The beta-lactam class includes three major groups of antibiotics—penicillins, cephalosporins, and carbapenems. It also includes the monobactams.

DIF: 1 REF: 71 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 26. A sulfonamide cream that is used as a topical dressing for burn patients is called a. bacitracin cream. b. silvadene cream. c. Chloromycetin. d. Cubicin.

ANS: B Silver sulfadiazine (silvadene cream) is a topical antimicrobial agent containing sulfa and silver salts that is used to treat burn patients.

DIF:

1

REF: 76

TOP: AST Core Curriculum XIII:A:6:f, sulfonamides

27. Which ointment is a naturally occurring antibiotic produced by fermentation and used as an intranasal packing? a. Bactroban b. Bacitracin c. Synercid d. Cleocin ANS: A 38

Bactroban Nasal or Mupirocin 2% is a natural occurring antibiotic produced by fermentation using the organism Pseudomonas fluorescens.

DIF:

2

REF: 78

TOP: AST Core Curriculum XIII:A:6, anti-infectives

MATCHING Match the following medications with the correct categories.

Amikacin (Amikin) b. Cefazolin (Ancef) c. Ceftriaxone (Rocephin) d. Methicillin (Staphcillin) e. Ampicillin (Omnipen) f. Piperacillin (Pipracil) g. Minocycline (Minocin) h. Silver sulfadiazine (Silvadene) a.

First-generation cephalosporins 2. Third-generation cephalosporins 3. Aminoglycoside 4. Aminopenicillin 5. Broad-spectrum penicillin 6. Penicillinase-resistant penicillin 7. Sulfonamide 8. Tetracycline 1.

1. ANS: B

DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 2. ANS: C DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 3. ANS: A DIF: 1 REF: 75 TOP: AST Core Curriculum XIII:A:6:a, aminoglycoside 4. ANS: E DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 5. ANS: F DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 6. ANS: D DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6:d, penicillins and cephalosporins 7. ANS: H DIF: 1 REF: 76 TOP: AST Core Curriculum XIII:A:6:f, sulfonamides 8. ANS: G DIF: 1 REF: 76 TOP: AST Core Curriculum XIII:A:6:g, tetracyclines Match the following terms with their correct definitions.

Antibiotic resistance b. Bactericidal c. Bacteriostatic d. Endogenous e. Eukaryotes f. Exogenous a.

39

g. h. i. j.

Morphology Polymicrobial infection Prokaryotes Selective toxicity

9. Characteristic of antibiotics in which the agent is toxic to the infecting microorganism

without harming the host 10. Characteristic of some strains of pathogenic microorganisms able to prevent or

overcome the activity of antibiotic agents 11. Destructive to bacteria 12. Infection caused by more than one microorganism 13. Inhibiting the growth of bacteria 14. Multicellular organisms 15. Single-celled organisms 16. Source from outside the patient 17. Source from inside the patient 18. Study of shapes 9. ANS: J

DIF: 1 REF: 69 TOP: AST Core Curriculum XIII:A:6, anti-infectives 10. ANS: A DIF: 1 REF: 70 TOP: AST Core Curriculum XIII:A:6, anti-infectives 11. ANS: B DIF: 1 REF: 70 TOP: AST Core Curriculum XIII:A:6, anti-infectives 12. ANS: H DIF: 1 REF: 74 TOP: AST Core Curriculum XIII:A:6, anti-infectives 13. ANS: C DIF: 1 REF: 70 TOP: AST Core Curriculum XIII:A:6, anti-infectives 14. ANS: E DIF: 1 REF: 69 TOP: AST Core Curriculum XIII:A:6, anti-infectives 15. ANS: I DIF: 1 REF: 69 TOP: AST Core Curriculum XIII:A:6, anti-infectives 16. ANS: F DIF: 1 REF: 68 TOP: AST Core Curriculum XIII:A:6, anti-infectives 17. ANS: D DIF: 1 REF: 68 TOP: AST Core Curriculum XIII:A:6, anti-infectives 18. ANS: G DIF: 1 REF: 68 TOP: AST Core Curriculum XIII:A:6, anti-infectives

40

Chapter 06: Diagnostic Agents Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Pharmacologic agents used in diagnostic radiographic testing are considered a. dyes. b. steroids. c. contrast media. d. staining agents.

ANS: C Agents used in diagnostic radiographic testing are called radiopaque contrast media (ROCM).

DIF:

1

REF: 85

TOP: AST Core Curriculum XIII:A:13, contrast media

2. All of the following statements are true of contrast media except a. they are sensitive to light. b. they are clear in color. c. most contain iodine. d. most are radiotransparent.

ANS: D Contrast media are radiopaque, which means they do not allow x-rays to pass through; as a result, they are visible on the file. Radiotransparent material would be the opposite.

DIF:

2

REF: 85

TOP: AST Core Curriculum XIII:A:13, contrast media

3. The pharmacologic agent used to delineate lymph nodes is a. Lymphazurin b. Indigo carmine c. Lugol solution d. Omnipaque ANS: A Lymphazurin 1% is selectively picked up by lymphatic vessels, making them bright blue in color.

DIF:

1

REF: 89

TOP: AST Core Curriculum XIII:A:15, dyes

4. Acetic acid is used to a. remove small skin lesions. b. enhance radiographic studies. c. identify cervical dysplasia. d. reveal corneal abrasions.

ANS: C Acetic acid causes abnormal tissue on the cervix (dysplasia) to appear whiter than the surrounding healthy tissue.

DIF:

1

REF: 91

TOP: AST Core Curriculum XIII:A:27, staining agents

41

5. Dyes can be administered by all of the following methods except a. injected into the bloodstream. b. ingested into the digestive system. c. applied topically to tissue. d. instilled into cavities.

ANS: B Dyes are administered intravenously, topically, and by instilling them into body cavities.

DIF:

2

REF: 85

TOP: AST Core Curriculum XIII:A:15, dyes

6. Staining agents are used surgically to a. identify abnormal cells. b. mark normal tissue planes. c. enhance visualization of body cavities. d. visualize stones or blockages in body structures.

ANS: A Staining agents are used in surgery to identify abnormal cells. Dyes are used to mark normal tissue planes, enhance visualization of body cavities, and identify stones or blockages.

DIF:

1

REF: 85

TOP: AST Core Curriculum XIII:A:27, staining agents

7. During an operative cholangiogram, saline is injected to a. dilute the contrast media. b. verify catheter placement. c. enhance the structures on x-ray film. d. remove the contrast media after the x-ray study is complete.

ANS: B Saline is injected first to verify the correct placement of the catheter; then the contrast media is injected through the catheter and an x-ray film is taken.

DIF:

2

REF: 87

TOP: AST Core Curriculum XIII:A:13, contrast media

8. All of the following dyes are blue except a. methylene blue. b. indigo carmine. c. Lymphazurin. d. Lugol solution.

ANS: D All of the dyes are blue in color except Lugol solution, which is an iodine mixture and is brown in color.

DIF:

2

REF: 90

TOP: AST Core Curriculum XIII:A:15, dyes

9. Which agent is used to mark skin incisions? a. Staining agents b. Contrast media c. Dyes d. Diuretics ANS: C Dyes are used to mark/color tissue, including the skin, by applying topically.

42

DIF:

1

REF: 88

TOP: AST Core Curriculum XIII:A:15, dyes

10. To perform a Schiller test of the cervix, which agent is applied topically? a. Acetic acid b. Monsel solution c. Gentian violet d. Lugol solution ANS: D Lugol solution is applied topically to the cervix with a sponge stick or cotton-tipped applicator.

DIF:

1

REF: 90

TOP: AST Core Curriculum XIII:A:27, staining agents

11. A chemical agent is brought into the OR suite by the circulating nurse, during a laser procedure of the cervix. It smells like vinegar—what do you suspect the chemical agent is? a. Monsel solution b. Acetic acid c. Lugol solution d. Methylene blue ANS: B Acetic acid is commonly known as vinegar.

DIF:

2

REF: 91

TOP: AST Core Curriculum XIII:A:27, staining agents

12. Which dye is administered intravenously so that it can be excreted by the kidneys to show immediate damage to bladder or ureters? a. Indigo carmine b. Methylene blue c. Gentian violet d. Isosulfan blue ANS: A Indigo carmine is a blue dye that is usually given via IV; the dye is excreted within 10 minutes of the IV injection.

DIF:

2

REF: 89

TOP: AST Core Curriculum XIII:A:15, dyes

13. Which procedure uses methylene blue in order to verify patent tubes? a. Lymph node biopsy b. Cystoscopy c. Z-plasty d. Chromotubation ANS: D During chromotubation, or tubal dye study, methylene blue is administered into the uterus; the dye enters the fallopian tubes and is observed exiting into the pelvic cavity.

DIF:

2

REF: 88

TOP: AST Core Curriculum XIII:A:15, dyes

43

14. Which contrast media is approved for intrathecal use? a. Hypaque-76 b. Omnipaque-240 c. Omnipaque-350 d. Visipaque-270 ANS: B Omnipaque is currently one of only a few ROCM that are FDA-approved for intrathecal use, but only in concentrations of 180, 240, and 300.

DIF:

2

REF: 86

TOP: AST Core Curriculum XIII:A:13, contrast media

15. During an operative cholangiogram, the surgeon incorrectly asks for a dye to determine the presence of biliary stones. What should the surgical technologist do? a. Ask the circulating nurse to bring a selection of dyes. b. Ask the surgeon to clarify what is being requested. c. Break scrub and look at the patient’s medical record. d. The surgical technologist should do nothing.

ANS: B In surgery, contrast media are often referred to incorrectly as “dyes.” Dyes and contrast media are different diagnostic agents used for different purposes.

DIF:

3

REF: 85

TOP: AST Core Curriculum XIII:A:13, contrast media

16. Many radiopaque contrast media contain barium or a. saline. b. vinegar. c. sodium. d. iodine.

ANS: D Many contrast media contain barium or iodine, which makes them opaque—does not allow the x-ray to pass through.

DIF:

1

REF: 85

TOP: AST Core Curriculum XIII:A:13, contrast media

17. How is Lymphazurin blue 1% used to find a sentinel node? a. It is used to mark the skin at the site of the node. b. The surgeon follows its path to the node. c. The agent makes the nodes appear lighter. d. The agent is injected at the sentinel node.

ANS: B The surgeon follows the Lymphazurin blue path to excise the node, which is then sent to pathology.

DIF:

1

REF: 89

TOP: AST Core Curriculum XIII:A:15, dyes

44

Chapter 07: Diuretics Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. The definition of a diuretic medication is an agent that prevents the reabsorption of sodium and water by the a. lungs. b. colon. c. kidneys. d. small intestines.

ANS: C The definition of a diuretic medication is an agent that prevents the reabsorption of sodium and water by the kidneys.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

2. Which term indicates an abnormally high concentration of potassium in the blood? a. Hypernatremia b. Creatinine c. Homeostasis d. Hyperkalemia ANS: D The definition of hyperkalemia is an abnormally high potassium concentration in the blood.

DIF:

1

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

3. When too much potassium is excreted, the resulting condition is called a. hypocalemia. b. hypokalemia. c. hypernatremia. d. hyperemia.

ANS: B The definition of hypokalemia is low serum potassium levels.

DIF:

1

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

4. What is the normal range for serum potassium? a. 5 to 5.2 mEq/L b. 12 to 23.3 mEq/L c. 42 to 43.5 mEq/L d. 3.5 to 5.0 mEq/L ANS: D The normal range of serum potassium is 3.5 to 5.0 mEq/L. DIF:

1

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

45

5. Which condition is not a result of hypokalemia? a. Cardiac arrest b. Cardiac dysrhythmias c. Muscle weakness d. Increased intracranial pressure ANS: D Low serum potassium does not cause increased intracranial pressure.

DIF:

2

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

6. The diuretic medication that draws fluid out of tissues and into the circulatory system is called a. osmotic. b. high ceiling. c. loop. d. thiazide.

ANS: A The definition of an osmotic diuretic is an agent that draws fluid out of tissues and into the circulatory system. The result is an increase of blood pressure and volume levels.

DIF:

1

REF: 98

TOP: AST Core Curriculum XIII:A:14, diuretics

7. The trade, or brand name, for mannitol is a. Osmitrol. b. Diamox. c. Lasix. d. Diuril.

ANS: A The brand name for mannitol is Osmitrol.

DIF:

1

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

8. The trade, or brand name, for furosemide is a. Mannitol. b. Osmitrol. c. Diamox. d. Lasix.

ANS: D The brand name for furosemide is Lasix.

DIF:

1

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

9. Which drug is classified as a loop diuretic medication and is used to decrease intracranial pressure? a. Aldactone b. Osmitrol c. Esidrix d. Lasix

46

ANS: D Lasix decreases intracranial pressure by quickly removing fluid that accumulates in response to the trauma of intracranial procedures or injuries. It works by decreasing the reabsorption of sodium and chloride ions along the renal tubule.

DIF:

2

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

10. What cardiac condition requires treatment with diuretics? a. Congestive heart failure b. Bradycardia c. Tachycardia d. Cardiac arrhythmia ANS: A Congestive heart failure is the result of the heart’s inability to pump blood and the resultant back pressure of blood that slows the venous blood. When the right ventricle fails, congestion of the organs and extremities will result. Diuretic medications assist the body in removing the excess fluid, which helps decrease this congestion.

DIF:

3

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

11. Which type of diuretic medications is prescribed in the treatment of glaucoma? a. Thiazide b. Potassium sparing c. Carbonic anhydrase inhibitor d. Lloop ANS: C Carbonic anhydrase inhibitors are active in the formation of aqueous humor in the eye. By inhibiting the production of aqueous humor, these drugs lower the intraocular pressure that causes glaucoma.

DIF:

2

REF: 98

TOP: AST Core Curriculum XIII:A:14, diuretics

12. Which diuretic is contraindicated in patients with hypertension? a. Potassium sparing b. Osmotic c. Carbonic anhydrase inhibitor d. Loop ANS: B Osmotic diuretics actually increase blood pressure by drawing fluids from tissues and into the circulatory system.

DIF:

2

REF: 98

TOP: AST Core Curriculum XIII:A:14, diuretics

13. Which electrolyte may be seriously depleted in patients taking certain diuretics? a. Sodium (Na+) b. Chloride (Cl-) c. Calcium (Ca) d. Potassium (K+) ANS: D Most diuretics cause the excretion of electrolytes other than sodium, including potassium. Because normal serum potassium levels are narrow (3.5 to 5.0 mEq/L), a depletion of potassium levels can result.

47

DIF:

2

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

14. Diuretics cause the elimination of excess fluid by preventing the reabsorption of a. sodium. b. chloride. c. potassium. d. calcium.

ANS: A The mechanism of a diuretic medication is to prevent the reabsorption of sodium and, consequently, water by the kidneys; thus, the increased elimination of fluids results.

DIF:

2

REF: 98

TOP: AST Core Curriculum XIII:A:14, diuretics

15. Potassium-sparing diuretics are commonly used to treat a. edema. b. congestive heart failure. c. intracranial pressure. d. intraocular pressure.

ANS: A An indication for potassium-sparing diuretics, which are low in potency, is to treat edema.

DIF:

1

REF: 98

TOP: AST Core Curriculum XIII:A:14, diuretics

16. Which medication is a loop diuretic? a. HydroDIURIL b. Aldactone c. Lasix d. Osmitrol ANS: C Lasix is classified as a loop diuretic.

DIF:

1

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

17. Hydrochlorothiazide (HydroDIURIL) is which type of diuretic medication? a. Potassium sparing b. Thiazide c. Osmotic d. Carbonic anhydrase inhibitor ANS: B Hydrochlorothiazide (HydroDIURIL) is classified as a thiazide diuretic.

DIF:

1

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

18. The only diuretic administered from the sterile back table is a. furosemide. b. hydrochlorothiazide. c. mannitol. d. acetazolamide.

48

ANS: C Mannitol, which is contained in the ophthalmic medication Miochol-E, is given from the back table.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

19. Minerals made up of electrically charged particles held together by ionic bonds in the body are called a. urine. b. electrolytes. c. water. d. hormones.

ANS: B Electrolytes are minerals made up of electrically charged particles held together by ionic bonds.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

20. How are electrolytes acquired? a. Through supplements and food b. Through food and water c. Through fluids and supplements d. Through hormones and food ANS: B Electrolytes are obtained through food and water.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

21. Diuretics help to lower blood pressure by a. lowering blood volume. b. lowering blood pH. c. raising blood volume. d. raising blood pH. ANS: A Diuretics help lower blood pressure by decreasing the blood volume.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

22. How many nephrons are present within the kidneys? a. Two b. Four c. Millions d. Hundreds ANS: C There are millions of nephrons present within the kidneys.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

49

23. A process of forcing fluids and solutes through a membrane by pressure is called a. homeostasis. b. hemostasis. c. metabolism. d. filtration.

ANS: D Filtration is the process of forcing fluids and solutes through a membrane by pressure.

DIF:

1

REF: 95

TOP: AST Core Curriculum XIII:A:14, diuretics

24. What substance undergoes tubular reabsorption in the proximal convoluted tubule? a. Urea b. Filtrate c. Creatinine d. Water ANS: B Filtrate undergoes tubular reabsorption and takes place in the proximal convoluted tubule and the ascending and descending limbs of the loop of Henle.

DIF:

1

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

25. What is the primary concern for nonemergency surgical patients with low potassium? a. Hypokalemia b. Delayed surgery c. Cardiac arrest d. Muscle weakness ANS: C Low potassium may cause arrhythmias, which can increase the chance for cardiac arrest.

DIF:

2

REF: 96

TOP: AST Core Curriculum XIII:A:14, diuretics

26. Anesthesia care providers may administer diuretics for short-term therapy for all of the following reasons, except a. reduce intraocular pressure. b. reduce liver failure. c. reduce intracranial pressure. d. protect kidney function.

ANS: B Diuretics are not administered to reduce liver failure intraoperatively.

DIF:

2

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

27. Why is it necessary to place a urinary catheter in a surgical patient undergoing a procedure during which diuretics will be administered? a. Because of large amounts of urine excreted b. Because of large amounts of electrolytes reduced c. Because of blood volume decrease d. Because of swelling ANS: A Because diuretics reduce fluid by causing the excretion of large amounts of dilute urine, it is necessary to insert an indwelling urinary catheter in the patient before surgery.

50

DIF:

2

REF: 97

TOP: AST Core Curriculum XIII:A:14, diuretics

51

Chapter 08: Hormones Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Steroidal hormones that promote male characteristics are a. hypogonadists. b. recombinants. c. catecholamines. d. androgens.

ANS: D Androgens, primarily testosterone, are critical for the development of the male sex organs and for the maintenance of secondary sex characteristics.

DIF:

2

REF: 109

TOP: AST Core Curriculum XIII:A:18, hormones

2. Which mechanism is not a function of hormones? a. Regulation of internal chemical balance and volume b. Response to environmental changes c. Production of histamine (H2) receptor antagonists to bind to target cells d. Reproduction ANS: C Hormonal effects are many and varied, but actions on the body may be categorized into four main groups: • Regulation of internal chemical balance and volume • Response to environmental changes, including stress, trauma, and temperature changes • Growth and development • Reproduction DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

3. Steroidal hormones are derived from a. cholesterol. b. amino acids. c. proteins. d. glucose.

ANS: A Steroidal hormones are derived from cholesterol. In cellular mitochondria, enzymes convert cholesterol into pregnenolone, which is not a hormone, but pregnenolone is the immediate precursor molecule to the synthesis of all steroidal hormones.

DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

4. Nonsteroidal hormones are synthesized from a. cholesterol. b. amino acids. c. aldosterone. d. glucose.

ANS: B Nonsteroidal hormones are synthesized from amino acids. The simplest hormones are amines, derived from a single amino acid. Amine hormones include epinephrine, norepinephrine, thyroxine, and triiodothyronine. Hormones made of short chains of 52

amino acids are called peptide hormones.

DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

5. Which hormone is not a steroidal hormone? a. Cortisol b. Estrogen c. Testosterone d. Epinephrine ANS: D Steroidal hormones are classified as glucocorticoids (primarily cortisol), mineralocorticoids (primarily aldosterone), estrogens, progestogens (progesterone), and androgens (male sex hormones, primarily testosterone). Nonsteroidal hormones are synthesized from amino acids. The simplest hormones are amines, derived from a single amino acid. Amine hormones include epinephrine, norepinephrine, thyroxine, and triiodothyronine.

DIF:

2

6.

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

are considered the simplest form of hormones. a. Steroids b. Nonsteroids c. Antidiuretics d. Amines

ANS: D The simplest hormones are amines, derived from a single amino acid. Amine hormones include epinephrine, norepinephrine, thyroxine, and triiodothyronine.

DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

7. Hormones made of short chains of amino acids are called hormones. a. peptide b. amine c. antidiuretic d. protein ANS: A Hormones made of short chains of amino acids are called peptide hormones.

DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

8. Which gland is called the master gland? a. Pituitary b. Adrenal c. Pancreas d. Parathyroid ANS: A The pituitary gland, also known as the master gland, has a vital role in reproduction and growth, and it regulates the function of the renal system and thyroid gland.

DIF:

1

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

53

9. The pituitary gland has a role in all of the following body functions except a. reproduction. b. regulation of renal system. c. production of insulin. d. regulation of thyroid gland.

ANS: C The pituitary gland, known as the master gland, has a vital role in reproduction and growth, and it regulates the function of the renal system and thyroid gland. The pancreas produces insulin.

DIF:

2

REF: 102

TOP: AST Core Curriculum XIII:A:18, hormones

10. Which gland has both endocrine and exocrine functions? a. Pituitary b. Thyroid c. Pancreas d. Adrenal ANS: C A unique feature of the pancreas is that it functions as an exocrine gland for digestion and as an endocrine gland for the release of hormones.

DIF:

2

REF: 108

TOP: AST Core Curriculum XIII:A:18, hormones

11. Adenohypophysis is associated with which gland? a. Pituitary b. Adrenal c. Parathyroid d. Testes ANS: A The pituitary gland is connected to the hypothalamus by a stalk called the infundibulum. It is divided into two lobes—the anterior or adenohypophysis and the posterior or neurohypophysis. The adenohypophysis communicates with the hypothalamus via factors released into the blood supply.

DIF:

2

REF: 103

TOP: AST Core Curriculum XIII:A:18, hormones

12. What part of the endocrine system secretes oxytocin? a. Adenohypophysis b. Neurohypophysis c. Adrenal cortex d. Ovaries ANS: B The hypothalamus synthesizes oxytocin and vasopressin (also known as antidiuretic hormone [ADH]) and transports these hormones to the neurohypophysis where they are released.

DIF:

2

REF: 103

TOP: AST Core Curriculum XIII:A:18, hormones

54

13. Which hormone is necessary for the stimulation of uterine contractions during labor and delivery? a. Thyroxine b. Oxytocin c. Pitressin d. Norepinephrine ANS: B Oxytocin stimulates the uterine contractions necessary for normal labor and delivery.

DIF:

2

REF: 103

TOP: AST Core Curriculum XIII:A:18, hormones

14. Oxytocin is available under which trade name? a. Pitocin b. Vasopressin c. Pitressin d. Celestone ANS: A Oxytocin is available as Pitocin and Syntocinon.

DIF:

1

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

15. An adult patient who complains of being sleepy and less alert and having slow heart rate and reduced endurance may be suffering from a. hyperthyroidism b. Graves disease c. hypothyroidism d. Cushing syndrome ANS: C The lack of thyroid hormones slows metabolism. An adult with hypothyroidism is sleepy, tires easily, is less mentally alert, has reduced endurance, and has a slow heart rate (bradycardia).

DIF:

3

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

16. Thyroid-stimulating hormone (TSH) is produced by which gland? a. Adrenal b. Parathyroid c. Thyroid d. Pituitary ANS: D Hormones secreted by the adenohypophysis of the pituitary gland include growth hormone (GH) (see Insight 8.1), TSH, adrenocorticotropic hormone (ACTH), prolactin (PRL), dopamine, and gonadotropic hormones, which include follicle-stimulating hormones (FSH) and luteinizing hormones (LH).

DIF:

2

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

55

17. Natural thyroid hormones that are extracted from pig thyroid glands are made available under what trade name? a. Thyroid USP b. Cytomel c. Levothroid d. Thyrolar ANS: A Naturally occurring thyroid hormone has been extracted from the thyroid gland of pigs (porcine) and is labeled as desiccated thyroid (Thyroid USP).

DIF:

2

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

18. Which one of the following is not a thyroid hormone? a. Thyroxine (T4) b. Triiodothyronine (T3) c. Thyroid-stimulating hormone (TSH) d. Calcitonin ANS: C TSH is secreted by the anterior lobe of the pituitary gland, not the thyroid gland.

DIF:

2

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

19. Which hormone helps control calcium and phosphate levels in the blood? a. Thyroxine (T4) b. Triiodothyronine (T3) c. Thyroid-stimulating hormone (TSH) d. Calcitonin ANS: D Hormones secreted by the adenohypophysis of the pituitary gland include TSH. DIF:

2

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

20. Hormones produced by the cortex of adrenal glands are collectively called a. steroids. b. nonsteroids. c. catecholamines. d. vasoconstrictors.

ANS: A Adrenal cortex hormones are classified in two major groups—glucocorticoids and mineralocorticoids—collectively known as steroids.

DIF:

2

REF: 107

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids

21. Hormones produced by the medulla of the adrenal glands are collectively called a. steroids. b. nonsteroids. c. catecholamines. d. vasoconstrictors.

56

ANS: C The adrenal medulla produces, stores, and secretes the hormones epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine, collectively called catecholamines.

DIF:

2

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

22. Which classification of hormones is sympathomimetic? a. Steroids b. Nonsteroids c. Catecholamines d. Vasoconstrictors ANS: C The catecholamines are sympathomimetic, meaning they mimic the effects of the sympathetic portion of the autonomic nervous system.

DIF:

3

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

23. Which hormone is not a catecholamine? a. Epinephrine b. Norepinephrine c. Adrenaline d. Aldosterone ANS: D Aldosterone is mineralocorticoid. Glucocorticoids and mineralocorticoids are collectively known as steroids. The hormones epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine, are collectively called catecholamines.

DIF:

2

REF: 107

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids

24. The “fight-or-flight” response to stress is initiated by a. catecholamines. b. steroids. c. glucocorticoids. d. mineralocorticoids.

ANS: A Epinephrine and norepinephrine (catecholamines) work with the sympathetic nervous system to prepare the body for the “fight-or-flight” response to stress.

DIF:

2

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

25. Which concentration of epinephrine is for topical use only? a. 1:1000 b. 1:100,000 c. 1:200,000 d. 1:500,000 ANS: A Concentrated epinephrine (1:1000) may be applied topically for hemostasis in limited areas. In ear surgery, epinephrine 1:1000 is used only for topical application—never injection.

57

DIF:

2

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

26. Epinephrine is combined with local anesthetics to a. prolong the effects of local anesthesia. b. inhibit the postoperative inflammatory response. c. induce amnesia. d. prevent blood clot formation.

ANS: A Epinephrine is often used in combination with local anesthetics such as lidocaine to prolong the effects of anesthesia.

DIF:

1

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

27. What will happen if epinephrine 1:1000 is injected? a. Bradycardia and hypotension b. Bradycardia and hypertension c. Tachycardia and hypertension d. Tachycardia and hypotension ANS: C If epinephrine 1:1000 is mistakenly injected, deadly tachycardia and hypertension may result (see Insight 4.1).

DIF:

3

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

28. Which mineralocorticoid maintains hemostatic levels of sodium in the blood? a. Epinephrine b. Norepinephrine c. Aldosterone d. Deoxycorticosterone ANS: C The most important mineralocorticoid is aldosterone, which maintains homeostatic levels of sodium and potassium in the blood.

DIF:

2

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

29. Which group of hormones is used to reduce the postoperative inflammatory response? a. Catecholamines b. Glucocorticoids c. Mineralocorticoids d. Nonsteroids ANS: B Glucocorticoids are used alone or in combination to reduce or inhibit the inflammatory response after surgical procedures.

DIF:

1

REF: 107

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids

30. Drugs that relieve symptoms of a condition but do not cure it are a. palliative. b. recombinant. c. androgen. d. asymptomatic.

ANS: A 58

Palliative drugs relieve symptoms, but they do not cure the condition or disease.

DIF:

1

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

31. A condition in which the skeletal system loses mineralized bone volume is a. osteomalacia. b. osteoporosis. c. Addison disease. d. Graves disease.

ANS: B Osteoporosis is a disorder in which the skeletal system loses too much mineralized bone volume. Without proper levels of estrogen in the body, the amount of calcium stored in the bones is diminished and bones become more porous—that is, osteoporotic (see Insight 8.5) DIF:

2

REF: 109

TOP: AST Core Curriculum XIII:A:18, hormones

32. What is the generic name for Decadron? a. Dexamethasone b. Prednisone c. Triamcinolone acetonide d. Betamethasone ANS: A The generic name for Decadron is dexamethasone.

DIF:

1

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

33. What is the generic name for Solu-Medrol? a. Dexamethasone b. Methylprednisolone c. Triamcinolone acetonide d. Betamethasone ANS: B The generic name for Solu-Medrol is methylprednisolone.

DIF:

1

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

34. The exocrine pancreas is the primary source for all of the following digestive enzymes except a. glucagon. b. amylase. c. lipase. d. proteinase.

ANS: A The exocrine pancreas is the primary source for the vital digestive enzymes amylase, lipase, and proteinase. Glucagon is a hormone that stimulates the liver to break down glycogen into glucose.

DIF:

2

REF: 108

TOP: AST Core Curriculum XIII:A:18, hormones

59

35. The pancreatic duct transports all of the following into the duodenum except a. insulin. b. amylase. c. lipase. d. proteinase.

ANS: A The exocrine pancreas is the primary source for the vital digestive enzymes amylase, lipase, and proteinase. Insulin is a hormone that is secreted into the bloodstream, not the duodenum.

DIF:

2

REF: 108

TOP: AST Core Curriculum XIII:A:18, hormones

36. Which pancreatic hormone stimulates the liver to break down glycogen into glucose to increase the blood sugar level? a. Proteinase b. Glucagon c. Amylase d. Insulin ANS: B Glucagon is a hormone that stimulates the liver to break down glycogen into glucose.

DIF: 2 REF: 108 TOP: AST Core Curriculum XIII:A:18:b, insulin/glucagon 37. Which pancreatic hormone stimulates the liver to form glycogen from glucose to lower the blood sugar level? a. Amylase b. Insulin c. Glucagon d. Lipase ANS: B Glucagon is a hormone that stimulates the liver to break down glycogen into glucose.

DIF: 2 REF: 108 TOP: AST Core Curriculum XIII:A:18:b, insulin/glucagon 38. Human insulin produced through recombinant DNA technology is a. DiaBeta. b. Diabinese. c. Tolinase. d. Humulin.

ANS: D Insulin was first obtained from animals, but human insulin (Humulin) is now produced via biotechnology.

DIF: 1 REF: 105 TOP: AST Core Curriculum XIII:A:18:b, insulin/glucagon 39. The body’s failure to respond to the action of insulin on target cells results in a. hyperglycemia. b. hypoglycemia. c. Type 1 diabetes. d. Type 2 diabetes.

60

ANS: D In type 2 diabetes, the body’s tissues fail to respond to the action of insulin on target cells.

DIF: 2 REF: 108 TOP: AST Core Curriculum XIII:A:18:b, insulin/glucagon 40.

is an ovarian hormone? a. Cortisone b. Estrogen c. Testosterone d. Thyroxine ANS: B The ovaries, located in the pelvic cavity, are paired glands that produce estrogen and progesterone.

DIF:

2

REF: 108

TOP: AST Core Curriculum XIII:A:18:d, sex hormones

41. Which one of the following hormones is given for palliative treatment of metastatic breast cancer and androgen-dependent prostate cancer? a. Testosterone b. Estrogen c. Progesterone d. Androgen ANS: B Estrogens are also used for palliative treatment of metastatic breast cancer and advanced androgen-dependent prostate cancer.

DIF:

2

REF: 109

TOP: AST Core Curriculum XIII:A:18:d, sex hormones

42. Delatestryl may be prescribed for a diagnosis of a. hypergonadism. b. hypogonadism. c. endometriosis. d. fibrocystic disease.

ANS: B Androgens, especially testosterone (Depo-Testosterone, Delatestryl), are administered if replacement therapy is indicated, as in hypogonadism.

DIF:

2

REF: 110

TOP: AST Core Curriculum XIII:A:18:d, sex hormones

43. Which one of the following is prescribed preoperatively for patients scheduled for endometrial ablation? a. Danocrine b. Depo-Testosterone c. Delatestryl d. Transarterial chemoembolization (TACE) ANS: A The androgen danazol (Danocrine) may be used to treat diseases such as endometriosis in women. In addition, patients scheduled for an endometrial ablation may be placed on danazol therapy a few weeks before surgery to reduce the volume of the endometrial layer.

61

DIF:

2

REF: 110

TOP: AST Core Curriculum XIII:A:18:d, sex hormones

44. Which hormone is responsible for the development of male sex organs and secondary sex characteristics? a. Testosterone b. Estrogen c. Insulin d. Glucagon ANS: A Androgens, especially testosterone, are critical for the development of male sex hormones and secondary sex characteristics.

DIF:

1

REF: 110

TOP: AST Core Curriculum XIII:A:18:d, sex hormones

45. Premarin cream might be used in the surgical setting for what procedure? a. Organ transplant b. Cataract extraction c. Shoulder arthroscopy d. Vaginal hysterectomy ANS: D A cream form of estrogen may be used on a vaginal packing after vaginal hysterectomy.

DIF:

3

REF: 109

TOP: AST Core Curriculum XIII:A:18, hormones

46. A condition in which endometrial tissue is found outside the uterus is called a. menopause. b. endometriosis. c. dysmenorrhea. d. amenorrhea.

ANS: B Endometriosis is an abnormal condition in which functional endometrial tissue is found situated outside of the uterus, such as in the pelvic cavity.

DIF:

1

REF: 108

TOP: AST Core Curriculum XIII:A:18, hormones

47. All are parts of the pancreas except a. peritoneum. b. head. c. tail. d. body.

ANS: A The anatomic areas of the pancreas are: head, body, and tail. The pancreas lies behind the parietal peritoneum.

DIF:

1

REF: 108

TOP: AST Core Curriculum XIII:A:18, hormones

48. After a traumatic accident involving the head, which hormone may be given to help reduce cerebral edema? a. Oxytocin b. Insulin c. Betamethasone d. Epinephrine 62

ANS: C Betamethasone, a glucocorticoid, could be used to help alleviate cerebral edema.

DIF:

3

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones

49. Which is a major function of the parathyroid gland? a. Mimics the effects of the sympathetic portion of the ANS b. Helps transport iodine salts for use in hormone production c. Enhances the reabsorption of calcium at the kidneys d. Stimulates uterine contractions for normal labor and delivery ANS: C The parathyroid glands have four major functions: to stimulate osteoclasts, accelerating mineral turnover and the release of calcium from bone; to inhibit osteoblasts, reducing the rate of calcium deposit in the bone; to enhance the reabsorption of calcium at the kidneys, reducing its loss via urine; and to stimulate the formation and secretion of calcitriol at the kidneys DIF:

2

REF: 106

TOP: AST Core Curriculum XIII:A:18, hormones

50. Which hormone is an example of a protein hormone? a. Oxytocin b. Insulin c. Dopamine d. Prolactin ANS: B Protein hormones include growth hormone (GH), parathyroid hormone (PTH), insulin, and glucagon (Box 8.1).

DIF:

1

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

51. After natural delivery of an infant, what else would oxytocin help to accomplish? a. Increase calcium and phosphate b. Stop postpartum bleeding c. Cause vasoconstriction d. Cause decreased swelling ANS: B Oxytocin also helps with contracting the uterus after delivery, expelling the placenta and stopping postpartum bleeding from the placental attachment site.

DIF:

2

REF: 104

TOP: AST Core Curriculum XIII:A:18, hormones

52. The most common cause of Addison disease today is a. tumors. b. hemorrhage of adrenal glands. c. tuberculosis. d. autoimmune disease.

ANS: D Autoimmune disease is currently the most common cause of Addison disease (see Insight 8.4).

DIF:

1

REF: 107

TOP: AST Core Curriculum XIII:A:18, hormones 63

53. The first indication of osteoporosis is seen as or in a a. weak skeleton. b. radiograph. c. DEXA scan. d. fracture.

ANS: D The first indication of osteoporosis is a fracture—in the femur at the hip, in the radius near the wrist, or as a compression fracture of the vertebrae (Insight 8.5).

DIF:

2

REF: 109

TOP: AST Core Curriculum XIII:A:18, hormones

64

Chapter 09: Medications That Affect Coagulation Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Agents that inhibit the process of blood clot formation are called a. coagulants. b. anticoagulants. c. hemostatics. d. thrombolytics.

ANS: B Anticoagulants inhibit clotting.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 2. Agents that dissolve already formed clots are called a. coagulants. b. anticoagulants. c. hemostatics. d. thrombolytics.

ANS: D Thrombolytics are agents used to help speed the breakdown of existing blood clots as observed in conditions such as deep-vein thrombosis (DVT), pulmonary embolism (PE), coronary artery thrombosis, and myocardial infarction.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 3. The formation or presence of a blood clot within the vascular system is termed a. hemostasis. b. thrombosis. c. coagulation. d. aggregation.

ANS: B Thrombosis means an abnormal condition of a blood clot.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 4. During the first stage of blood clot formation, a. thromboplastin b. prothrombin c. thrombin d. fibrin

is formed.

ANS: A In Stage 1 of the clotting cascade, thromboplastin (also known as prothrombin activator) is formed.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 65

5. During the second stage of blood clot formation, a. thromboplastin b. prothrombin c. thrombin d. fibrinogen

is formed.

ANS: C In Stage 2 of the clotting cascade, thromboplastin converts prothrombin (known as factor II) into thrombin.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 6. During the third stage of blood clot formation, a. thromboplastin b. prothrombin c. thrombin d. fibrin

is formed.

ANS: D In Stage 3 of the clotting cascade, thrombin converts fibrinogen (known as factor I) to fibrin.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

7.

is a natural clot-dissolving enzyme in the blood? a. Fibrin b. Fibrinogen c. Fibrinolysin d. Fibrin stabilizing factor

ANS: C Blood clots may dissolve naturally, because blood normally contains the clot-dissolving enzyme, fibrinolysin.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 8. If a blood clot is formed in an artery, a(n) a. cholecystectomy b. arterial embolectomy c. venous ablation d. phlebectomy

may be required.

ANS: B Arterial embolectomy may be necessary when blood clots form in the femoral, popliteal, or tibial artery. If a blood clot forms in a vein, medical treatment may be sufficient. With bed rest and the administration of a thrombolytic agent, such a clot may dissolve.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

66

9. A medical plan of treatment for thrombosis usually indicates that a clot has formed in a(n) a. vein. b. artery.

ANS: A If a blood clot forms in a vein, then medical treatment may be sufficient. With bed rest and the administration of a thrombolytic agent, such a clot may dissolve.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 10. Drugs that promote clot formation are termed a. coagulants. b. anticoagulants. c. hemostatics. d. fibrinolytics.

ANS: A Coagulants are drugs that promote, accelerate, or make possible blood coagulation.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 11. Which product is not a form of absorbable gelatin? a. Gelfilm b. Gelfoam powder c. Gelfoam sponge d. Thrombogen ANS: D Examples of gelatin hemostatics include Gelfilm, Gelfoam powder and sponges (Fig. 9.3), and Surgifoam.

DIF: 1 REF: 118-119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 12. Which product is a form of oxidized regenerated cellulose? a. Avitene microfibrillar collagen hemostat (MCH) b. Surgifoam c. Surgicel Fibrillar d. Thrombi-Gel ANS: C Examples of oxidized regenerated cellulose include Surgicel gauze, Surgicel NuKnit (a knitted fabric), Surgicel Fibrillar, and Surgicel SNoW (structured non-woven material).

DIF: 1 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 13.

is brand of absorbable collagen sponge. a. FloSeal b. Helistat c. Oxycel d. Surgiflo 67

ANS: B Examples of absorbable collagen sponges are Helistat and Heliene.

DIF: 1 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

14.

is a brand of microfibrillar collagen hemostat. a. Oxycel b. Surgicel c. Avitene d. NuKnit

ANS: C Avitene Microfibrillar Collagen Hemostat (MCH) is a dry, fibrous preparation of purified bovine corium collagen.

DIF: 1 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 15. Which material is not a topical hemostatic? a. Bone wax b. Tannic acid c. Silver nitrate d. Calcium salts ANS: D Calcium salts are systemic coagulants used to replace deficiencies in the natural clotting mechanism.

DIF: 1 REF: 122 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 16. Which hemostatic agent may be used dry or moist and is available in film, powder, and sponge forms? a. Chemical hemostatics b. Oxidized cellulose c. Avitene Microfibrillar Collagen Hemostat (MCH) d. Absorbable gelatin ANS: D Gelatin hemostatics may be used dry or moistened with saline and are available in Gelfilm, Gelfoam powder and sponges, Surgifoam, and Gelita-Spon.

DIF: 3 REF: 118 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 17. Which hemostatic agent promotes platelet aggregation leading to clot formation? a. Surgicel b. Avitene c. Thrombin d. NuKnit ANS: B Avitene directly applied to bleeding surfaces attracts platelets to the substance, thus triggering further platelet aggregation leading to the formation of a fibrin clot.

68

DIF: 3 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 18. Which hemostatic agent causes adhesion formation if it comes in contact with nonbleeding tissues? a. Surgicel b. Avitene c. Gelfoam d. NuKnit ANS: B Avitene contact with nonbleeding surfaces must be avoided because adhesions may result.

DIF: 3 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 19. Avitene Microfibrillar Collagen Hemostat (MCH) is derived from a. bovine corium collagen. b. purified pork skin. c. purified beeswax. d. an astringent plant.

ANS: A Avitene MCH is a dry, fibrous preparation of purified bovine corium collagen.

DIF: 2 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

20. Which hemostatic agent should be used immediately after it is reconstituted? a. Avitene b. Instat MCH c. Thrombostat d. Helistat ANS: C Thrombin (Thrombostat) should be used immediately after preparation, or it should be refrigerated and used immediately after reconstituting.

DIF: 2 REF: 120 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 21. Which hemostatic agent creates a mechanical barrier to control bleeding? a. Tannic acid b. Silver nitrate c. Collastat d. Bone wax ANS: D Bone wax acts as a mechanical barrier rather than as a matrix for clotting.

DIF: 2 REF: 121 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

69

22. Which hemostatic agent causes a chemical burn to stop capillary bleeding? a. Silver nitrate b. Konakion c. Helistat d. Heparin ANS: A Some hemostatic agents, such as tannic acid and silver nitrate, chemically cauterize bleeding surfaces.

DIF: 2 REF: 122 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 23. Which type of agent is used to correct deficiencies in the natural clotting mechanism and may be administered preoperatively or intraoperatively? a. Systemic coagulants b. Chemical hemostatics c. Thrombin d. Collagen hemostatics ANS: A Systemic coagulants are agents that replace deficiencies in the natural clotting mechanism. If needed, systemic coagulants are usually administered preoperatively.

Occasionally, the anesthesia provider may administer a systemic coagulant intraoperatively.

DIF: 2 REF: 122 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 24. Which one of the following is not a systemic coagulant? a. Vitamin K b. Protamine sulfate c. Calcium salts d. Hemofil-M ANS: B The antidote for heparin is protamine sulfate, a parenteral anticoagulant that binds with and inactivates heparin. (See Box 9.2 for a summary of systemic coagulants.)

DIF: 1 REF: 125 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 25. Which systemic coagulant is contraindicated in patients with a history of malignant hyperthermia? a. Calcium salts b. Vitamin K c. Hemofil-M d. Factor VIII ANS: A Calcium salts are not given to patients with a history of malignant hyperthermia (MH) because one aspect of MH is increased calcium release from muscle cells.

DIF: 3 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

70

26. Intravenous administration of is associated with anaphylactic reactions and should not be attempted unless no other venue is available. a. calcium salts b. vitamin K c. anti-hemophilic factor (AHF) d. factor IX ANS: B When surgery is needed urgently, vitamin K may be administered intravenously, but there is an increased risk of anaphylaxis and it takes approximately 6 hours to produce an acceptable effect.

DIF: 3 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 27. Anticoagulants are used for any of the following reasons except a. to prevent pulmonary embolism. b. to prevent venous thrombosis. c. to dissolve blood clots causing a myocardial infarction. d. postoperative prophylactic therapy for patients with a history of arterial stasis.

ANS: C Anticoagulants do not dissolve existing clots; rather, they help prevent new clots from forming.

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 28. Which parenteral anticoagulant is used most often? a. Protamine sulfate b. Calcium chloride c. Enoxaparin sodium d. Heparin sodium ANS: D Heparin sodium is the most commonly used parenteral anticoagulant; it is used in both medical and surgical settings.

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 29. Heparin is measured in a. milliliters. b. milligrams. c. units. d. drams.

ANS: C Heparin is measured in units rather than milligrams.

DIF: 2 REF: 124 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

71

30. Which one of the following is not a function of heparin? a. Inhibition of factor X b. Breakdown of fibrin c. Interfering with prothrombin-to-thrombin conversion d. Interference with platelet aggregation ANS: B Heparin acts by binding to antithrombin III (AT III, a protein), which greatly increases AT III’s ability to inhibit the action of coagulation factors thrombin, Xa, and IXa. Binding with AT III enables heparin to work at several points in the clotting cascade by inhibiting factor X, interfering with prothrombin-to-thrombin conversion, and inactivating thrombin, thus preventing of fibrinogen-to-fibrin conversion. Heparin also interferes with platelet aggregation and the formation of a stable fibrin clot.

DIF: 3 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 31. What is the onset of heparin (in minutes)? a. 5 b. 10 c. 15 d. 20 ANS: A The onset of action is rapid, usually within 5 minutes.

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 32. What is the duration of heparin (in hours)? a. 1 to 2 b. 2 to 4 c. 6 to 12 d. 12 to 24 ANS: B Heparin has a duration of 2 to 4 hours.

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 33. Heparin is available in vials of solutions in each of the following concentrations (in units/mL) to be used at the sterile field except a. 150. b. 1000. c. 5000. d. 10,000.

ANS: A Heparin injection is available in 1 mL single-dose vials containing 1000, 5000, or 10,000 units/mL (Table 9.5). Hep-Lock catheter flush heparin is supplied in 10 units/mL and 100 units/mL. DIF: 2 REF: 124 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 72

34. Which solution may be used as an irrigation solution at the sterile field during an atrioventricular (AV) fistula insertion? a. 100 units heparin in 3000 mL saline b. 1000 units heparin in 100 mL saline c. 5000 units heparin in 1000 mL saline d. 10,000 units heparin in 100 mL saline ANS: C Heparin is also frequently used from the sterile back table during peripheral and cardiovascular procedures. A dilute solution, such as 5000 units heparin in 1000 mL normal saline, is commonly used as a topical arterial irrigant.

DIF: 3 REF: 124 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 35. Which drug is used to reverse the effect of heparin? a. Enoxaparin sodium b. Lovenox c. Calcium chloride d. Protamine sulfate ANS: D The antidote for heparin is protamine sulfate, a parenteral anticoagulant that binds with and inactivates heparin.

DIF: 1 REF: 130 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 36. Which form of anticoagulant is used for long-term management of deep vein thrombosis (DVT)? a. Parenteral b. Oral c. Thrombolytics d. Factor XIII ANS: B Oral anticoagulants are used for long-term medical management of thromboembolic disease such as DVT or pulmonary embolism (PE).

DIF: 3 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 37. What is the generic name for Coumadin? a. Warfarin sodium b. Vitamin K c. Anistreplase d. Urokinase ANS: A Warfarin sodium (Coumadin), a coumarin derivative, is a widely prescribed oral anticoagulant.

DIF: 1 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

73

38. What is the onset of Coumadin? a. 2 or more days b. 8 to 12 days c. 16 to 24 hours d. 12 to 72 hours ANS: A The onset of action of warfarin is prolonged, usually more than 2 days; its duration is 2.5 to 5 days after discontinuation.

DIF: 3 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 39. What is the duration of Coumadin? a. 8 to 12 days b. 16 to 24 hours c. 2.5 to 5 days d. 12 to 72 hours ANS: C The onset of action of warfarin is prolonged, usually more than 2 days; its duration is 2.5 to 5 days after discontinuation.

DIF: 3 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 40. Which medication is not an oral anticoagulant? a. Aspirin b. Coumadin c. Streptokinase d. Acetylsalicylic acid ANS: C Streptokinase is a thrombolytic medication.

DIF: 1 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 41. Which group of drugs is given intravenously to dissolve existing blood clots? a. Parenteral anticoagulants b. Oral anticoagulants c. Thrombolytics d. Factor XIII inhibitors ANS: C Thrombolytics are agents given intravenously to dissolve existing blood clots.

DIF: 1 REF: 126 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 42. Which medication is not a thrombolytic drug? a. Streptokinase b. Warfarin c. Urokinase d. Alteplase ANS: B Warfarin is an oral anticoagulant.

74

DIF: 2 REF: 126 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 43. What types of hemostatics are used on areas of capillary bleeding? a. Subcutaneous b. Intravenous c. Intramuscular d. Topical ANS: D Topical hemostatics are coagulants used on areas of capillary bleeding as an adjunct to natural hemostasis DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 44. Which agent is a systemic anticoagulant? a. Gelfoam b. Heparin c. Vitamin K d. Avitene ANS: B Heparin is a systemic anticoagulant.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

45. Thrombolytic medications are used to treat all of the following conditions except a. deep vein thrombosis (DVT). b. pulmonary embolism (PE). c. myocardial infarction. d. hemorrhage.

ANS: D Thrombolytics dissolve existing blood clots and would be contraindicated in hemorrhage.

DIF: 3 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 46. Which vitamin serves a vital role in coagulation? a. K b. D c. A d. C ANS: A Vitamin K is a fat-soluble vitamin; it promotes blood clotting by increasing synthesis of coagulation factors. Vitamin K is necessary to synthesize prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX), and the Stuart-Prower factor (X).

DIF: 1 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 75

47. Which procedure is performed to remove a blood clot? a. Carotid endarterectomy b. Arterial embolectomy c. Venous endarterectomy d. Open heart surgery ANS: B During a arterial embolectomy, heparin is administered directly into the affected artery (intra-arterial) through an arterial irrigating catheter to clear the artery of remaining clot or embolic debris.

DIF: 1 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 48. All of the following materials are topical hemostatics except a. Gelfoam. b. Surgicel. c. bone wax. d. vitamin K. ANS: D Vitamin K is a fat-soluble vitamin; it promotes blood clotting by increasing synthesis of coagulation factors.

DIF: 1 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 49. Avitene must be applied with a a. large b. wet c. dry d. warm

instrument.

ANS: C Avitene should be applied with dry instruments only, because it will adhere to wet surfaces.

DIF: 3 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 50. Bone wax is used primarily in which surgical specialty? a. General surgery b. Gynecology c. Neurosurgery d. Otorhinolaryngology ANS: C Bone wax is used primarily in orthopedics and neurosurgery to control bleeding on bone surfaces.

DIF: 3 REF: 121 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

51. Vitamin K is available as a. phytonadione.

76

b. protamine sulfate. c. heparin sodium. d. Warfarin.

ANS: A Vitamin K is available as phytonadione (Mephyton) for oral administration or as phytonadione (AquaMEPHYTON, Vitamin K) for injection.

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 52. Which naturally occurring mechanism is the most dominant in blood? a. Coagulants b. Vitamin K c. Anticoagulants d. Calcium ANS: C Anticoagulants are the most dominant because they keep the blood in liquid form and not clotted (dried up).

DIF: 2 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 53. A blood clot within an intact blood vessel is called a(n) a. embolus. b. thrombus. c. thrombosis. d. coagulant.

ANS: B When a blood clot, or thrombus, forms within an intact blood vessel, a mechanism in the blood acts to dissolve the clot naturally.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 54. Damage to small blood vessels causes a series of reactions that produce a protein called a. thrombin. b. thromboplastin. c. plasma. d. fibrin.

ANS: D Damage to a small blood vessel results in spasm and tissue damage, which causes a series of reactions; these reactions produce a protein called fibrin.

DIF: 1 REF: 116 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 55. A “net” that traps blood cells to form a clot is called a. fibrin. b. thrombin. c. platelets. d. plasma.

ANS: A Fibrin is a mesh of protein threads—a net that traps blood cells to form a clot (Fig. 9.2).

77

DIF: 1 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 56. How long does the intrinsic pathway take to form a clot? a. Seconds b. Minutes c. Hours d. Days ANS: B The intrinsic pathway is initiated by substances contained in the blood; it is more complex and takes several minutes.

DIF: 1 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

57. If a venous clot breaks off and travels to the heart, it is called a(n) a. thrombus. b. coagulant. c. embolus. d. thrombosis.

ANS: C A venous clot can break off and become an embolus—traveling to the heart, brain, or lungs.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 58. Which hemostatic agent was developed to treat severe traumatic bleeding on the battlefield? a. Gelfoam b. Bone wax c. QuikClot d. Silver nitrate ANS: C QuikClot was developed to treat severe traumatic bleeding on the battlefield, in trauma situations by emergency responders, and by law enforcement; it is not intended for use in the surgical setting.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 59. A tiny piece of Gelfoam used during a tympanoplasty procedure is called a a. pledget. b. platelet. c. gelfilm. d. floseal.

ANS: A Gelfoam can be cut into tiny pieces called pledgets, which can be used to pack the area around the tympanic graft.

DIF:

2

REF: 118 78

TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 60.

is an example of a flowable form of absorbable gelatin. a. Gelfoam b. Gelfilm c. Tisseel d. Floseal

ANS: D Floseal is an example of a flowable form of absorbable gelatin.

DIF: 1 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 61. Which hemostatic agent can be used in the presence of a gram-positive microorganism? a. Surgicel b. Gelfoam c. Avitene d. Bone wax ANS: A Surgicel absorbable hemostat is also bactericidal and effective against a wide range of gram-positive and gram-negative microorganisms.

DIF: 2 REF: 119-120 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics MATCHING Match the following medications with the correct categories. a. Alteplase (Activase) b. Heparin c. Monsel solution d. Oxidized regenerated cellulose (Surgicel) e. Vitamin K f. Warfarin (Coumadin) 1. Chemical hemostatic 2. Hemostatic 3. Oral anticoagulant 4. Parenteral anticoagulant 5. Systemic coagulant 6. Thrombolytic 1. ANS: C

DIF: 1 REF: 122 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 2. ANS: D DIF: 1 REF: 119 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics

3. ANS: F

DIF: 1 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 4. ANS: B DIF: 1 REF: 123 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 5. ANS: E DIF: 1 REF: 123 TOP: AST Core Curriculum XIII:A:12, coagulants and hemostatics 79

6. ANS: A

DIF: 1 REF: 126 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

TRUE/FALSE 1. Calcium and vitamin K play vital roles in the process of clot formation.

ANS: T The clotting cascade requires calcium at all stages—that is, calcium enables many of the steps. Vitamin K also plays a vital role in coagulation.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics 2. Hemostatic agents are effective against major arterial or venous bleeding.

ANS: F These agents serve as adjuncts to natural coagulation, which controls minor capillary bleeding. Thus, traditional hemostatic medications are not effective against arterial or major venous bleeding.

DIF: 2 REF: 117 TOP: AST Core Curriculum XIII:A:3, anticoagulants and fibrinolytics

80

Chapter 10: Ophthalmic Agents Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Increased intraocular pressure is a characteristic of a. glaucoma. b. pterygium. c. miosis. d. mydriasis.

ANS: A Glaucoma is a group of diseases characterized by increased intraocular pressure.

DIF: 1 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 2. The mucous membrane layer that covers the inside of the eyelids, as well as the anterior surface of the globe of the eye, is known as the a. sclera. b. retina. c. cornea. d. conjunctiva.

ANS: D A thin, transparent mucous membrane called the conjunctiva lines the inside of the eyelids and the anterior surface of the eyeball (globe).

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 3. The dense, white, fibrous connective tissue that coats the entire globe of the eye is called the a. sclera. b. retina. c. choroids. d. conjunctiva.

ANS: A The fibrous outer coat of the eye is composed of dense, white connective tissue and is called the sclera.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 4. The clear, nonvascular fibrous tissue that covers the front of the eye to allow light into the eye is known as the a. sclera. b. retina. c. cornea. d. aqueous humor.

81

ANS: C The anterior covering of the eye is made of clear, nonvascular fibrous tissue called the cornea.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 5. The area where the cornea and sclera meet is named a. limbus. b. choroids. c. canal of Schlemm. d. anterior cavity.

ANS: A The area where the cornea and sclera meet is called the limbus.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 6. The posterior cavity of the globe is filled with a. aqueous humor. b. choroids. c. ciliary body. d. vitreous humor.

ANS: D The posterior cavity, which is between the lens and retina, is filled with a thick substance called vitreous humor.

DIF: 1 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 7. The anterior cavity of the eye is filled with a. aqueous humor. b. choroids. c. lens. d. vitreous humor.

ANS: A The entire anterior cavity is filled with aqueous humor (fluid) secreted by the ciliary processes.

DIF: 1 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 8. The vascular layer of the globe of the eye is the a. sclera. b. retina. c. choroid. d. conjunctiva.

ANS: C The vascular layer of the eye is called the choroid.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 82

9. The is the nervous layer of the eye a. sclera b. retina c. choroid d. conjunctiva ANS: B The nervous layer of the eye, called the retina, is present only posteriorly and covers the choroid.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 10. The focuses the image onto the retina. a. pupil b. lens c. cornea d. iris ANS: B The lens is positioned just behind the iris and serves to focus images onto the retina.

DIF: 1 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 11. Anterior and posterior cavities of the eye are separated by the a. lens. b. iris. c. optic nerve. d. sclera.

ANS: A The interior portion of the globe contains two cavities, anterior and posterior, and is separated by the lens.

DIF: 2 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 12. Anterior and posterior chambers of the anterior cavity are separated by the a. lens. b. iris. c. optic nerve. d. retina.

ANS: B The anterior chamber of the anterior cavity is posterior to the cornea and anterior to the iris. The posterior chamber is behind the iris and anterior to the lens.

DIF: 2 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 13. Aqueous humor is a fluid secreted by the a. vitreous humor. b. ciliary processes. c. trabecular meshwork. d. sclera.

83

ANS: B The entire anterior cavity is filled with aqueous humor (fluid) secreted by the ciliary processes.

DIF: 2 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications

14. Chronic open-angle glaucoma results from a blockage of the a. ciliary processes. b. trabecular meshwork. c. canal of Schlemm. d. zonula.

ANS: B If a blockage occurs in the trabecular meshwork, intraocular pressure builds, causing glaucoma.

DIF: 2 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 15. The vitreous humor of the eye does not a. give the globe of the eye its shape. b. contain a gelatinous substance. c. keep the retina in position. d. replenish itself.

ANS: D Vitreous humor gives the globe its shape, keeps the retina in position, and contributes to intraocular pressure. Unlike aqueous humor, vitreous humor is not replaced.

DIF: 2 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 16. Why is topical application the most common method of administering anesthesia for eye surgery? a. Blood-eye barrier prevents effective absorption of most systemic drugs. b. Eye procedures do not require systemic anesthesia. c. Eyes do not have deep pain receptors; therefore deep anesthesia is not needed. d. Topical anesthesia administered through the conjunctiva remains in the eye for an extended time.

ANS: A The blood-eye barrier prevents effective absorption of most systemically administered medications. For this reason, the most common administration route for ophthalmic medications is topical application, such as drops, suspensions, ointments, and medicated disks or pledgets inserted onto the eye.

DIF: 3 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications

84

17. Which statement is not true about topical ophthalmic anesthesia administration? a. They enter the systemic circulation through conjunctival vessels. b. They enter the nasolacrimal system, then drain into the stomach where they are absorbed. c. After administering a drug, the lacrimal sac must be compressed to prevent the drug from draining into the lacrimal system. d. 0.75% Marcaine is commonly used.

ANS: D Ophthalmic agents administered topically enter systemic circulation through the conjunctival vessels and the nasolacrimal system. Approximately 80% of eye drops enter the nasolacrimal system and then drain from nose to mouth and enter the stomach where absorption takes place. Figure 10.2 illustrates the proper steps for administering topical ophthalmic solutions. After administering a medication, compression of the lacrimal sac prevents rapid drainage of the medication into the lacrimal system where it is carried away from the eye.

DIF: 3 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 18. What prep solution is acceptable for eyes, including the eyelids, brows, and cheeks? a. Lacri-lube b. Balanced salt solution c. Viscoat d. Betadine Ophthalmic ANS: D Betadine Ophthalmic 5% is used in the region of the ocular region that also includes the eyelids, brows, and cheeks.

DIF: 1 REF: 136 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 19. Which product is mixed with injectable local anesthetic agents to increase its rate of diffusion through tissues? a. Vitrase b. Pilocarpine c. Healon d. BSS ANS: A Mixed with injectable local anesthetic agents, hyaluronidase (Vitrase) increases the rate and extent of anesthetic diffusion through tissue for nerve block.

DIF: 3 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts 20. Which product is used in the treatment of blepharitis? a. Ocusert Pilo b. Durasite c. Ultracell Pledgets d. BSS ANS: B Durasite extends the length of time the antibiotic is in contact with the ocular surface and is used in the treatment of blepharitis.

85

DIF:

1

REF: 135

TOP: AST Core Curriculum XIII:A:25:a, antibiotics

21. Which product is used to treat glaucoma by producing miosis? a. Ocusert Pilo b. Durasite c. Ultracell Pledgets d. BSS ANS: A Pilocarpine ophthalmic (Ocusert Pilo) is a wafer-thin disk used to produce miosis and decrease IOP for the treatment of glaucoma.

DIF:

1

REF: 135

TOP: AST Core Curriculum XIII:A:25:g, miotics

22. Which product is placed in the conjunctival cul-de-sac after the eye has been anesthetized? a. Ocusert Pilo b. Durasite c. Ultracell Pledgets d. BSS ANS: C Medication soaked pledgets, such as Ultracell Ophthalmic Pledgets, are placed in the conjunctival cul-de-sac after the eye has been anesthetized with local anesthetic drops.

DIF: 1 REF: 135 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 23. BSS is an example of which ophthalmic drug category? a. Anesthesia b. Lubricants c. Anti-inflammatory agents d. Irrigating solution ANS: D BSS is an irrigating solution.

DIF: 1 REF: 136 TOP: AST Core Curriculum XIII:A:25:d, irrigating solutions 24. Thick, gelatinous substances that are injected into the eye to keep the chamber expanded or to replace vitreous humor are a. viscoelastic agents. b. enzymes. c. cycloplegics. d. mydriatics.

ANS: A Viscoelastic agents are thick, jellylike substances injected into the eye during certain ophthalmic procedures. These agents are often injected into the anterior chamber during cataract extraction (phacoemulsification) to keep the chamber expanded, prevent injury to surrounding tissue, and protect the cornea. Viscoelastic agents may also be used as a vitreous substitute or tamponade (compression).

DIF:

2

REF: 137

TOP: AST Core Curriculum XIII:A:25:i, viscoelastics

86

25. Which one of the following is not a viscoelastic agent? a. Vitrax b. Miochol c. Viscoat d. Occucoat ANS: B Examples of viscoelastic agents include sodium hyaluronate (Amvisc-Plus, Vitrax, Provisc), 2% hydroxypropyl methylcellulose (Ocucoat), and a combination of sodium chondroitin sulfate 4% and sodium hyaluronate 3% (Viscoat). Miochol is a miotic agent.

DIF:

1

REF: 137

TOP: AST Core Curriculum XIII:A:25:i, viscoelastics

26. Drugs that constrict the pupil by stimulating the iris muscle are called a. viscoelastic agents. b. miotics. c. mydriatics. d. cycloplegics.

ANS: B Miotics constrict the pupil by stimulating the sphincter muscle of the iris.

DIF:

1

REF: 141

TOP: AST Core Curriculum XIII:A:25:g, miotics

27. Constriction of the pupil results in a. increased intraocular pressure. b. decreased intraocular pressure. c. increased blood pressure. d. decreased blood pressure.

ANS: B Because constriction of the pupil (miosis) reduces intraocular pressure, miotics are frequently used in the short-term treatment of glaucoma.

DIF:

3

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

28. Which group of ophthalmic drugs is used in the short-term treatment of glaucoma? a. Lubricants b. Miotics c. Mydriatics d. Cycloplegics ANS: B Because constriction of the pupil (miosis) reduces intraocular pressure, miotics are frequently used in short-term treatment of glaucoma.

DIF:

3

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

29. Blurred vision; abdominal cramps and diarrhea; and eye, eyebrow, and eyelid pain are side effects of which group of ophthalmic drugs? a. Anesthetic agents b. Miotics c. Viscoelastic agents d. Cycloplegics

87

ANS: B Miotics may be administered by injection or topical application. Side effects include eye, eyebrow, or eyelid pain; blurred vision; and abdominal cramps and diarrhea.

DIF:

3

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

30. Acetylcholine chloride in a solution of mannitol is marketed under which one of the following trade names? a. Miochol-E b. Miostat c. Pilocar d. IsoptoCarpine ANS: A Acetylcholine chloride is a miotic agent available in a solution of mannitol marketed as Miochol-E. DIF:

2

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

31. Which one of the following medications should be reconstituted immediately before use? a. Miochol-E b. Miostat c. Pilocar d. IsoptoCarpine ANS: A Miochol-E should be reconstituted immediately before use.

DIF:

2

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

32. Which one of the following drugs is not a topical miotic? a. Miostat b. Pilocar c. IsoptoCarpine d. IsoptoCarbachol ANS: A Carbachol (IsoptoCarbachol) is used topically to reduce intraocular pressure in glaucoma and by injection (Miostat) into the anterior chamber as needed intraoperatively. Pilocarpine hydrochloride (Pilocar, IsoptoCarpine) in 1% and 4% ophthalmic solutions is another topical miotic.

DIF:

3

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

33. Which group of ophthalmic drugs dilates the pupil? a. Mydriatics b. Miotics c. Viscoelastic agents d. Dyes ANS: A Mydriatics dilate the pupil.

DIF:

1

REF: 137

TOP: AST Core Curriculum XIII:A:25:h, mydriatics

88

34. What is the effect of cycloplegic drugs? a. Miosis b. Mydriasis c. Proteolysis d. Diuresis ANS: B Both mydriatics and cycloplegics are paralytic agents used to dilate the pupil before ophthalmoscopy. Both kinds of agents cause mydriasis—dilation of the pupil—by paralyzing the sphincter muscle of the iris.

DIF:

3

REF: 137

TOP: AST Core Curriculum XIII:A:25:h, mydriatics

35. Which drug is considered a cycloplegic agent? a. Mydriacyl b. Neo-Synephrine c. Atropine d. Atropisol ANS: A Cycloplegic agents include cyclopentolate HCL (Cyclogyl, AK-Pentolate, Pentolair) available in 0.5% to 2% solutions and tropicamide (Mydral, Mydriacyl, Opticyl) available in 0.5% and 1% solutions.

DIF:

2

REF: 137

TOP: AST Core Curriculum XIII:A:25:h, mydriatics

36. Phenylephrine is the generic name for a. Mydriacyl. b. Neo-Synephrine. c. Atropine. d. Atropisol.

ANS: B Phenylephrine (Neo-Synephrine, AK-Dilate) is available in solutions of 2.5% and 10% for topical ophthalmic use.

DIF: 2 REF: 137 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 37. Neomycin combined with polymyxin and bacitracin is marketed as a. Neosporin. b. A-K Tracin. c. Ilotycin. d. Garamycin.

ANS: A Neomycin is also available as Neosporin and Mycitracin, combined with polymyxin and bacitracin (commonly referred to as triple antibiotic).

DIF:

2

REF: 137

TOP: AST Core Curriculum XIII:A:25:a, antibiotics

38. 0.5% ointment of erythromycin is marketed as a. Neosporin. b. A-K Tracin. c. Ilotycin. d. Sulamyd.

89

ANS: C Erythromycin (Ilotycin) 0.5% ointment.

DIF:

2

REF: 139

TOP: AST Core Curriculum XIII:A:25:a, antibiotics

39. Ophthalmic lubricants are generally used to a. prevent corneal abrasions while the patient is under general anesthesia. b. maintain the corneal reflex during eye surgery. c. decrease tissue irritation as suture material moves through tissue layers. d. enhance the effect of topical anesthesia.

ANS: A Ophthalmic lubricants may be used when a general anesthetic is administered for any surgical procedure. With patients under general anesthesia, eyelids are relaxed, and the corneal reflex is absent. To prevent corneal drying or damage and maintain integrity of the epithelial surface, a nonionic ointment or lubricant, such as lanolin alcohol (LacriLube) or polyvinyl alcohol (Liquifilm, Lubrifresh), is applied to each eye. Then the eyelids are taped closed or special foam eye masks with plastic shields are used.

DIF:

3

REF: 136

TOP: AST Core Curriculum XIII:A:25:f, lubricants

40. An anti-inflammatory ophthalmic ointment that is composed of neomycin, polymyxin B, and dexamethasone is marketed under what trade name? a. Miochol b. Wydase c. Sulamyd d. Maxitrol ANS: D Maxitrol ointment combines the antibiotics neomycin and polymyxin B with dexamethasone.

DIF:

2

REF: 140

TOP: AST Core Curriculum XIII:A:25:a, antibiotics

41. An anti-inflammatory ophthalmic ointment that is made of tobramycin and dexamethasone is marketed under what trade name? a. TobraDex b. Tobrex c. Timolol d. Activase ANS: A TobraDex combines the anti-inflammatory action of dexamethasone 0.1% with the antibiotic tobramycin 0.3%.

DIF:

2

REF: 140

TOP: AST Core Curriculum XIII:A:25:a, antibiotics

42. Which group of drugs interferes with the transmission of pain impulses to the brain? a. Cycloplegics b. Viscoelastic agents c. Anesthetic agents d. Anti-inflammatory agents ANS: C Anesthetics are medications that interfere with normal transmission of pain impulses to the brain.

90

DIF: 1 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts 43. Which medication is rarely used as a topical ophthalmic anesthetic agent? a. Tetracaine b. Cocaine c. Proparacaine d. Pontocaine ANS: B Cocaine solution (1% and 4%) was the initial topical anesthetic agent used in ophthalmology; however, it is currently used predominantly in otolaryngology.

DIF: 2 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts 44. 0.5% ophthalmic solution of tetracaine is known by which trade name? a. Pontocaine b. Alcaine c. Ophthaine d. Xylocaine ANS: A Tetracaine hydrochloride (Pontocaine) is available in a 0.5% ophthalmic solution.

DIF: 2 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts 45. 0.5% ophthalmic solution of proparacaine is known by which trade name? a. Pontocaine b. Alcaine c. Bupivacaine d. Xylocaine ANS: B Proparacaine hydrochloride (Alcaine, Ophthaine) is available in a 0.5% ophthalmic solution.

DIF: 2 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts 46. Which one of the following anesthetic agents may be used for a retrobulbar block? a. 5% Ophthaine b. 4% Xylocaine c. 4% Cocaine d. 0.5% Pontocaine ANS: B Ophthalmic procedures requiring an extensive area of anesthesia are performed under a regional, retrobulbar or peribulbar block (see Chapter 14). This type of anesthesia, which provides both sensory and motor (movement) block, is performed with a local anesthetic, such as lidocaine (Xylocaine 4% MPF) or bupivacaine (0.75%).

DIF: 3 REF: 139 TOP: AST Core Curriculum XIII:A:25:e, local anesthesia adjuncts

91

47. Long-term treatment of glaucoma may include any one of the following groups of drugs except a. miotic agents. b. carbonic anhydrase inhibitors. c. mydriatic agents. d. beta-adrenergic blockers ANS: C Long-term management of increased intraocular pressure may be accomplished with several different types of agents including prostaglandin analogues, miotics, ® adrenergic blockers, -adrenergic agonists, and diuretics(see Chapter 7), particularly carbonic anhydrase inhibitors (Box 10.2).

DIF:

3

REF: 140

TOP: AST Core Curriculum XIII:A:25:h, mydriatics

48. What is the effect of carbonic anhydrase inhibitors in the treatment of glaucoma? a. Draws fluid out of the eye b. Interferes with the production of aqueous humor c. Causes papillary constriction d. Increases outflow of aqueous humor ANS: B A carbonic anhydrase inhibitor such as acetazolamide (Diamox) interferes with production of carbonic anhydrase; thus it reduces production of aqueous humor and decreases intraocular pressure.

DIF: 2 REF: 140 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 49. The effect of osmotic diuretics in the treatment of glaucoma is to a. draw fluid out of the eye. b. interfere with production of aqueous humor. c. cause papillary constriction. d. increase outflow of aqueous humor.

ANS: A Osmotic diuretics cause fluid to be drawn out of the eye, lowering intraocular pressure.

DIF:

2

REF: 140

TOP: AST Core Curriculum XIII:A:14, diuretics

50. Which drug is a carbonic anhydrase inhibitor? a. Miochol b. Osmitrol c. Timoptic d. Diamox ANS: D Acetazolamide (Diamox) is a carbonic anhydrase inhibitor.

DIF: 2 REF: 140 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 51. Which drug is an osmotic diuretic? a. Miochol b. Osmitrol c. Timoptic d. Trusopt 92

ANS: B The most common osmotic diuretic used in ophthalmic surgery is mannitol (Osmitrol).

DIF:

1

REF: 140

TOP: AST Core Curriculum XIII:A:14, diuretics

52. What is the generic name for Osmitrol? a. Mannitol b. Timolol c. Carbachol d. Carteolol ANS: A Mannitol is the generic name for Osmitrol.

DIF:

2

REF: 140

TOP: AST Core Curriculum XIII:A:14, diuretics

53. Which one of the following antiglaucoma agents is only administered topically? a. Acetazolamide b. Mannitol c. Timolol d. Glycerine ANS: C Timolol, in 0.25% or 0.5% ophthalmic solution, is administered in a dosage of one drop in the affected eye twice daily.

DIF: 3 REF: 140 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications

54. Which medication, if administered preoperatively, will necessitate the placement of an indwelling urinary catheter? a. Timoptic b. Betagan c. Occupress d. Osmitrol ANS: D When mannitol (Osmitrol) is administered preoperatively, an indwelling urinary catheter is usually inserted into the patient’s bladder to accommodate resulting diuresis (increased excretion of urine).

DIF:

3

REF: 140

TOP: AST Core Curriculum XIII:A:14, diuretics

55. Steroid anti-inflammatory drugs are used in ophthalmology to a. prevent the rejection of a corneal transplant. b. suppress inflammatory response to trauma. c. inhibit intraoperative miosis. d. diagnose corneal abrasions.

ANS: B Steroids are hormones (see Chapter 8) with a wide range of effects; they are used in ophthalmology to decrease ocular inflammatory response to trauma, decrease corneal inflammation, protect the eye from scarring, and to decrease postoperative swelling.

DIF:

3

REF: 140

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids 93

56. Which medication is classified as a nonsteroidal anti-inflammatory drug (NSAID)? a. Betamethasone b. Decadron c. Prednisolone d. Flurbiprofen ANS: D Nonsteroidal anti-inflammatory drugs may also be used to inhibit intraoperative miosis, particularly flurbiprofen 0.03% (Ocufen) and suprofen 0.1% (Profenal).

Betamethasone, decadron, and prednisolone are steroids.

DIF:

3

REF: 141

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids

57. Which drug is used intraoperatively to inhibit miosis? a. Dexamethasone b. Flurbiprofen 0.03% c. Ketorolac 0.5% d. Diclofenac 0.1% ANS: B Nonsteroidal anti-inflammatory drugs may also be used to inhibit intraoperative miosis, particularly flurbiprofen 0.03% (Ocufen) and suprofen 0.1% (Profenal).

DIF:

3

REF: 141

TOP: AST Core Curriculum XIII:A:25:g, miotics

58. Which drug is given postoperatively to reduce inflammation? a. Dexamethasone b. Flurbiprofen 0.03% c. Ketorolac 0.5% d. Prednisolone ANS: C Ocular NSAIDs are used to prevent or treat cystoid macular edema, iritis, and conjunctivitis. They are also used to reduce postoperative inflammation after cataract surgery. Ophthalmic solutions of ketorolac 0.5% (Acular), diclofenac sodium 0.1%, nepafenac 0.1% (Nevanac), and bromfenac 0.09% (Xibrom, Bromday) are available.

DIF:

3

REF: 141

TOP: AST Core Curriculum XIII:A:18:a, corticosteroids

59. Ophthalmic staining agents are used to accomplish each of the following except a. diagnose corneal and conjunctival epithelium abnormalities. b. locate a foreign body. c. observe flow of vitreous humor. d. verify lacrimal system blockage.

ANS: C Staining agents are instilled topically to diagnose abnormalities of the cornea and conjunctival epithelium or to locate foreign bodies. They may also be used to observe the flow of aqueous humor (not the vitreous humor) or to demonstrate lacrimal system function.

DIF:

3

REF: 141

TOP: AST Core Curriculum XIII:A:25:b, dyes and stains

94

60. Which dye is primarily used for diagnosis of “dry eye syndrome”? a. Methylene blue b. Ful-Glo c. Fluorescein sodium d. Rose bengal 1% ANS: D Rose bengal and lissamine green in 1% solutions stain devitalized cells better than fluorescein sodium. These agents are primarily used for demarcation of devitalized conjunctival epithelium seen in “dry eye” syndrome (keratoconjunctivitis sicca [KCS]).

DIF:

3

REF: 141

TOP: AST Core Curriculum XIII:A:25:b, dyes and stains

61. The eye receives stimuli and transmits signals to the brain via which nerve? a. Olfactory b. Optic c. Oculomotor d. Trochlear ANS: B The optic nerve transmits signals to the brain for the eye.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 62. How many ocular muscles control the movement of the eye? a. One b. Two c. Four d. Six ANS: D The six extraocular muscles that control movement of the eye are the medial, lateral, superior and inferior rectus, and the inferior and superior oblique.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 63. Which is considered an accessory structure of the eye? a. Eyelids b. Cornea c. Optic nerve d. Ciliary body ANS: A The accessory structures include the eyebrows, eyelids, eyelashes, and the lacrimal system.

DIF: 1 REF: 134 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications

95

64. If the tip of a sterile medication applicator should touch the surgical patient’s tissue, what should happen next? a. Keep the medication on the sterile field b. Should be sent back to the pharmacy c. Should be refrigerated d. Should be discarded immediately after use ANS: D It is considered contaminated and should be discarded immediately after use.

DIF: 2 REF: 135 TOP: AST Core Curriculum XII:A:8:a, handling precautions 65. During most ophthalmic procedures, who will periodically moisten the eye? a. Surgeon b. Circulator c. Scrubbed surgical technologist d. Scrubbed anesthesia care provider ANS: C The scrubbed ST will irrigate the cornea with BSS during most ophthalmic procedures.

DIF: 2 REF: 136 TOP: AST Core Curriculum XIII:A:25:d, irrigating solutions 66. When Miochol-E is used, how long does miosis last? a. 1 hour b. 10 minutes c. 10 seconds d. 24 hours ANS: B Miosis lasts 10 minutes when Miochol-E is used.

DIF:

1

REF: 137

TOP: AST Core Curriculum XIII:A:25:g, miotics

67. An IOP pressure greater than 25 mm Hg may cause a. deafness. b. nerve damage. c. high blood pressure. d. infection.

ANS: B An IOP greater than 25 mm Hg is considered abnormal. This pressure damages the optic nerve and may cause blindness.

DIF: 2 REF: 139 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 68. The most common form of glaucoma is a. narrow-angle glaucoma. b. open-angle glaucoma. c. angle-closure glaucoma. d. closed-angle glaucoma.

96

ANS: B Chronic open-angle glaucoma is the most common form of glaucoma.

DIF: 1 REF: 139 TOP: AST Core Curriculum XIII:A:25, ophthalmic medications 69. When will the most urine output be noted in a surgical patient with an indwelling urinary catheter after receiving mannitol? a. 1 hour after administration b. 1 day after the procedure c. 30 minutes after the procedure d. 4 hours after administration ANS: A The maximum effect is noted approximately 1 hour after administration.

DIF:

3

REF: 140

TOP: AST Core Curriculum XIII:A:14, diuretics

97

Chapter 11: Fluids and Irrigation Solutions Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Major electrolytes found in body fluids are sodium, chloride, calcium, and a. glucose. b. potassium. c. creatinine. d. urea.

ANS: B The body fluid’s major electrolytes are sodium, chloride, calcium, and potassium.

Glucose, urea, and creatinine are present in body fluids but are considered nonelectrolytes.

DIF:

1

REF: 146

TOP: AST Core Curriculum XIII:A:21, IV fluids

2. Food and fluid restrictions preoperatively can result in the surgical patient needing a. food. b. IV fluids. c. blood replacement. d. oral medications.

ANS: B Most surgical patients will have preoperative fluid and food restrictions prior to surgery, so fluid replacement is usually indicated by administering intravenous (IV) fluids.

DIF:

1

REF: 146

TOP: AST Core Curriculum XIII:A:21, IV fluids

3. The electrolyte that controls the distribution of water in the body and maintains fluid and

electrolyte balance is a. sodium. b. potassium. c. magnesium. d. calcium.

ANS: A Sodium controls the distribution of water in the body and maintains fluid and electrolyte balance.

DIF:

1

REF: 147

TOP: AST Core Curriculum XIII:A:21, IV fluids

4. The intravenous (IV) solution used during blood transfusion is a. water. b. lactated Ringer solution. c. normal saline. d. plasmaLyte.

ANS: C Normal saline is the agent of choice during blood transfusion because it does not hemolyze the blood cells.

DIF:

2

REF: 148

TOP: AST Core Curriculum XIII:A:9:a:1:b, techniques 98

5. Which IV solution increases insulin requirements for the patient with diabetes? a. Sterile water b. Dextrose c. Normal saline d. Ionosol B

ANS: B Dextrose is a natural sugar and, consequently, would increase the insulin requirements for the patient with diabetes.

DIF:

2

REF: 148

TOP: AST Core Curriculum XIII:A:21, IV fluids

6. Another name for Hartmann solution is a. physiologic saline. b. dextrose in water. c. lactated Ringer solution. d. isolyte E.

ANS: C Hartmann solution is similar to lactated Ringer solution and is often referred to as such.

DIF:

1

REF: 148

TOP: AST Core Curriculum XIII:A:21, IV fluids

7. Proteins responsible for transporting oxygen to cells are a. leukocytes. b. platelets. c. antigens. d. hemoglobin.

ANS: D Hemoglobin is the protein responsible for transporting oxygen to the cells.

DIF:

1

REF: 151

TOP: AST Core Curriculum XIII:A:21, IV fluids

8. The volume of erythrocytes in a given volume of blood is called a. hemoglobin. b. hematocrit. c. plasma. d. white blood cell count.

ANS: B The definition of hematocrit is the volume of erythrocytes in a given volume of blood as expressed as a percentage.

DIF: 1 REF: 151 TOP: AST Core Curriculum XIII:A:9, blood replacement interventions 9. Another name for donor blood is a. homologous. b. autologous. c. autotransfusion. d. synthetic.

ANS: A Donor blood is referred to as homologous and includes donor blood from friends or family.

99

DIF: 1 REF: 153 TOP: AST Core Curriculum XIII:A:9:b, donated blood products 10. Most transfusions involve packed red blood cells (RBCs) given with a. volume expander. b. dextrose solution. c. plasma. d. normal saline.

ANS: A Rather than give whole blood, transfusions use packed RBCs and a volume expander to achieve the same results with less risk of transfusion reactions.

DIF: 1 REF: 153 TOP: AST Core Curriculum XIII:A:9:a:1, autotransfusion 11. What blood product is given when clotting factors are required? a. Whole blood b. Packed cells c. Plasma d. Erythrocytes

ANS: C Plasma is stored as fresh-frozen plasma to preserve clotting factors; plasma is then given when needed in addition to circulating blood volume.

DIF: 1 REF: 154 TOP: AST Core Curriculum XIII:A:9:d, plasma expanders 12. Dextran is an example of a a. blood substitute. b. volume expander. c. cryoprecipitate. d. plasma protein.

ANS: B Dextran expands plasma volume by drawing fluid from the interstitial space to the intravascular fluid space and thus is a volume expander.

DIF: 2 REF: 155 TOP: AST Core Curriculum XIII:A:9:d, plasma expanders 13. Testing the temperature of irrigation solution is important, because if too hot, it can a. disrupt the electrosurgical unit (ESU). b. fog the endoscopes. c. cause tissue damage. d. rust instrumentation.

ANS: C Any solution applied to the body would cause tissue damage if it were too hot.

DIF: 2 REF: 157 TOP: AST Core Curriculum XIII:A:20, irrigation solutions

100

14. The irrigation solution that is conductive and is used with caution in the presence of the

ESU is a. sterile water. b. physiosol. c. sobrital. d. saline.

ANS: D Saline is sodium chloride and conductive, which means it can transfer heat and current from the ESU to adjacent tissues and cause damage.

DIF: 2 REF: 157 TOP: AST Core Curriculum XIII:A:20, irrigation solutions 15. One of the most common IV solutions used in the surgical setting is a. sterile water. b. 0.9% sodium chloride. c. dextrose. d. dextran.

ANS: B Sterile water is not used for IV solutions. Dextrose is used for patients who require easily metabolized source of calories, and Dextran is used as a volume expander.

Thus 0.9% sodium chloride is the best answer.

DIF:

2

REF: 147

TOP: AST Core Curriculum XIII:A:21, IV fluids

16. Which function is not a reason that IV fluids may be ordered? a. Maintain acid-base balance b. Replacement of lost fluids c. Maintain fluid and electrolyte balance d. To administer IV medications

ANS: A Maintaining acid-base balance is a purpose for electrolytes in hemostasis.

DIF:

2

REF: 146

TOP: AST Core Curriculum XIII:A:21, IV fluids

17. 60% of the total body weight in a healthy adult is made up of a. food. b. fat. c. muscle. d. fluid.

ANS: D In a healthy adult, approximately 60% of the total body weight is made up of fluids, electrolytes and nonelectrolytes.

DIF:

1

REF: 146

TOP: AST Core Curriculum XIII:A:21, IV fluids

18. Which electrolyte is present in normal body fluid? a. Urea b. Magnesium c. Creatinine d. Glucose

ANS: B Magnesium is an electrolyte; the others are nonelectrolytes.

101

DIF:

1

REF: 146

TOP: AST Core Curriculum XIII:A:21, IV fluids

19. Which form of potassium is not preferable for the patient undergoing surgery? a. Liquid b. Oral c. Capsule d. IV

ANS: D IV potassium can cause severe and potentially fatal cardiac rhythm disturbances; when possible, the patient should be given oral potassium in liquid, tablet, or capsule form.

DIF:

2

REF: 147

TOP: AST Core Curriculum XIII:A:21, IV fluids

20. Which common IV fluid is used in the presence of hypovolemia? a. Sodium chloride b. Dextrose in saline c. Dextrose in water d. Lactated ringer

ANS: B Dextrose in saline is used for temporary treatment of circulatory insufficiency and shock due to hypovolemia, in the absence of a plasma extender and for early treatment with plasma for loss of fluid due to burns.

DIF:

2

REF: 148

TOP: AST Core Curriculum XIII:A:21, IV fluids

21. If a surgical patient has liver disease, which IV fluid should not be given? a. Sodium chloride b. Normosol-R c. Lactated Ringer d. Isolyte-E

ANS: C Patients at high risk from lactated Ringer use are those with liver disease, Addison’s disease, severe pH imbalances, shock, or cardiac failure.

DIF:

3

REF: 148

TOP: AST Core Curriculum XIII:A:21, IV fluids

22. Why is the secondary tubing hung higher than the primary tubing when establishing an

IV on a surgical patient? a. Because it is placed in an electronic infusion pump system b. Because the secondary medication should infuse first c. So that the medication can drip into the vein d. So that the medication can move slower than the rest ANS: B The secondary IV tubing is hung higher than the primary IV so that the secondary medication infuses first.

DIF:

2

REF: 150

TOP: AST Core Curriculum XIII:A:21, IV fluids

102

23. Which reading is a low hemoglobin level for an adult female? a. 10 g/100 mL of blood b. 13 g/100 mL of blood c. 14 g/100 mL of blood d. 18 g/100 mL of blood

ANS: A The normal hemoglobin level is 12 to 16 g/100 mL of blood in the adult female.

DIF:

3

REF: 151

TOP: AST Core Curriculum XIII:A:21, IV fluids

24. A surgical patient with blood type AB has a blood type that contains a. both A and B antigens. b. contains no antigens. c. contains O antigens. d. contains only A antigens.

ANS: A Type AB contains both A antigen and B antigen.

DIF: 1 REF: 151 TOP: AST Core Curriculum XIII:A:9:b:1, type-and-cross matching 25. A component of blood that is used when several units of blood have been used and

should be thawed in water prior to use is called a. platelets. b. packed red cells. c. cryoprecipitate. d. plasma.

ANS: D Plasma is stored as fresh-frozen plasma (FFP) and thawed in a water bath prior to use; it is used when several units of blood have been replaced, because of clotting factors that have been removed from donor blood.

DIF:

2

REF: 154

TOP: AST Core Curriculum XIII:A:9:b:2:a, principles

26. The largest group of anticancer agents is a. alkylating medications. b. antimetabolites. c. mitotic inhibitors. d. hormones.

ANS: A Alkylating drugs are the largest group of anticancer agents and include the first antineoplastic drug, nitrogen mustard.

DIF: 1 REF: 167 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 27. The anticancer agents that include androgens are a. antineoplastic antibiotics. b. mitotic inhibitors. c. hormones. d. biologic response modifiers.

ANS: C Androgens are classified as hormones.

103

DIF: 1 REF: 168 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 28. The exact cause of cancer is a. genetic. b. environmental. c. medical. d. unknown.

ANS: D Many theories have been stated and many studies have been conducted to answer this question; presently, however, the exact cause of cancer is unknown.

DIF: 2 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 29. If a tumor resembles normal tissue, grows slowly, and does not spread to surrounding

tissues, it is considered a. metastatic. b. benign. c. malignant. d. cancerous.

ANS: B The definition of benign is a tumor that resembles normal tissue, does not spread to surrounding tissues, and grows slowly.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 30. Antineoplastic agents are not contraindicated in a. metastatic disease. b. pregnancy. c. patients with renal disorders. d. patients with hepatic disorders.

ANS: A Contraindicated is defined as not indicated for use. Antineoplastic agents are used to fight metastatic disease.

DIF: 2 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 31. The antineoplastic agent used in ectopic pregnancy is a. Fluorouracil. b. Cytoxan. c. Methotrexate. d. Nitrogen mustard.

ANS: C Methotrexate is injected into the muscle and reaches the embryo via the bloodstream.

It kills the rapidly developing cells developing in the placenta.

DIF: 2 REF: 167 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 104

32. The second leading cause of death in the United States is a. heart disease. b. trauma. c. cancer. d. pregnancy.

ANS: C In the United States, cancer is the second leading cause of death.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 33. If a neoplasm is found in a surgical patient and is said to be malignant, it is a. benign. b. noncancerous. c. cancerous. d. normal.

ANS: C A malignant neoplasm is cancerous.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 34. Antineoplastic agents are not be used for a. patients in remission. b. weight loss. c. prolonging patient life. d. palliative effects.

ANS: B Weight loss is not a use for antineoplastic agents; remission, palliative effects, and prolonging life are uses for antineoplastic agents.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 35. Which newer alkylating agent can be used to treat brain tumors? a. Cytoxan b. Temodar c. Folex d. Methotrexate

ANS: B The newer alkylating agents are called nitrosoureas and are unique because they cross the blood-brain barrier and are used to treat brain tumors—Temodar and carmustine are examples of these agents.

DIF: 1 REF: 167 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 36. Which cancer medications are derived from the European yew tree? a. Cytoxan b. Methotrexate c. Adrucil d. Taxol 105

ANS: D Taxol and Taxotere are derived from the bark and needles of the European yew tree.

DIF: 2 REF: 167 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 37. To prevent recurrence of a pterygium eye growth, which agent would most likely be

used? a. Taxol b. Toposar c. Blenoxane d. Mutamycin ANS: D Mutamycin is an anti-tumor antibiotic that is used to prevent the recurrence of an eye growth called a pterygium.

DIF: 2 REF: 168 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 38. What does the term “precision medicine” mean? a. Medicine that prevents cell growth signaling b. Medicine that is molecularly targeted c. Medicine that focuses on cellular changes specific to cancer cells d. Medicine that uses information about the patient’s genetic makeup

ANS: D Precision medicine is medicine that uses information about the patient’s genetic makeup and proteins to prevent, diagnose, and treat a disease.

DIF:

2

REF: 168

TOP: AST Core Curriculum XI:F:5, biotechnology

39. Neupogen, an agent used to stimulate the growth of neutrophils in bone marrow, is

considered to be a(n) a. targeted therapy. b. biologic response modifier. c. antimetabolite. d. antitumor antibiotic.

ANS: B Two agents used to treat chemotherapy side effects by stimulating specific bone marrow production of blood cells are erythropoietin (epogen, Procrit) and filgrastim (Neupogen), which are both biologic response modifiers.

DIF:

2

REF: 168

TOP: AST Core Curriculum XI:F:5, biotechnology

40. The use of genes to treat or prevent disease is called a. targeted therapy. b. gene therapy. c. nanotechnology. d. epidemiology.

ANS: B Gene therapy is an experimental technique that uses genes to treat or prevent disease.

DIF:

1

REF: 169

TOP: AST Core Curriculum XI:F:5, biotechnology 106

41. The use of nanotechnology to create and match medicinal compounds to a patient is

called a. nanopharmacology. b. nanomedicine. c. nanoshells. d. nanorobotic.

ANS: A Nanopharmacology is the use of nanotechnology for pharmaceutical applications such as creating and then matching medicinal compounds to the patient for maximum effect.

DIF:

2

REF: 169

TOP: AST Core Curriculum XI:F:5, biotechnology

COMPLETION 1.

Malignant cells that spread to other areas of the body form a tumor called a

.

ANS: metastasis Metastasis is defined as malignant cells that have spread to other areas of the body.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 2.

An abnormal growth of body cells is called a

.

ANS: neoplasm A neoplasm is defined as an abnormal growth of body cells.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy 3.

The term that means harmful to cells is

.

ANS: cytotoxic Cytotoxic is defined as harmful to cells, both normal and malignant cells.

DIF: 1 REF: 166 TOP: AST Core Curriculum XIII:A:7, antineoplastic chemotherapy

107

COMPLETION 1. The four major blood types are

.

ANS: A, B, AB, O The four major blood types are A, B, AB, and O. DIF: 1 REF: 152 TOP: AST Core Curriculum XIII:A:9:b:1, type-and-cross matching 2. The process of collecting, processing, and reinfusing the patient’s own blood is called

.

ANS: autotransfusion The definition of autotransfusion is reinfusing the patient’s own blood.

DIF: 1 REF: 154 TOP: AST Core Curriculum XIII:A:9:a:1, autotransfusion

3. An example of a solution used in hysteroscopy is

.

ANS: Hyskon Hyskon is used in hysteroscopy to distend the uterus and irrigate blood and tissue debris from the surgical site.

DIF: 1 REF: 158 TOP: AST Core Curriculum XIII:A:20, irrigation solutions

108

Chapter 12: Preoperative Medications Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. Which type of drug blocks parasympathetic nervous impulses? a. Analgesic b. Narcotic c. Sedative d. Anticholinergic ANS: D Anticholinergics are agents that block the action of the neurotransmitter, acetylcholine, inhibiting the transmission of parasympathetic nerve impulses.

DIF: 1 REF: 179 TOP: AST Core Curriculum IV:C, anti-cholinergics | AST Core Curriculum XIII:A:8:d, cholinergic blockers 2. Which type of drug provides relief of pain without loss of consciousness? a. Analgesic b. Narcotic c. Sedative d. Anticholinergic ANS: A Analgesia means pain relief; literally “without pain.”

DIF: 1 REF: 179 TOP: AST Core Curriculum IV:B, analgesics | AST Core Curriculum XIII:A:1, analgesics 3. Preoperative assessment of the surgical patient is conducted by any one of the following individuals except a. anesthesiologist. b. certified registered nurse anesthetist (CRNA). c. anesthesiologist assistant (AA). d. surgeon.

ANS: D A preoperative anesthesia evaluation or assessment is performed on all surgical patients and is conducted by the anesthesia provider. The anesthesia provider may be an anesthesiologist, an AA, or a CRNA. DIF:

2

REF: 176

TOP: AST Core Curriculum II:B, patient factors

4. Preoperative assessment of the surgical patient is meant to gather information for all of the following purposes except to a. confirm the patient’s surgical diagnosis. b. assess other medical conditions. c. determine the patient’s physical status. d. determine whether the procedure is necessary.

ANS: D The purpose of a preoperative anesthesia evaluation is to gather pertinent patient information to determine the optimal anesthetic plan. The preoperative anesthesia evaluation is used to confirm the patient’s surgical diagnosis and to assess concurrent 109

medical conditions that might increase the risk of anesthesia-related complications.

DIF:

2

REF: 176

TOP: AST Core Curriculum II:B, patient factors

5. The American Society of Anesthesiologists (ASA) has established the criteria for classifying the patient’s a. physical status. b. degree of wound contamination. c. stage of disease. d. preoperative respiratory status.

ANS: A The patient’s preoperative physical status is classified according to criteria established by the American Society of Anesthesiologists (Table 13.1).

DIF:

2

REF: 176

TOP: AST Core Curriculum II:B, patient factors

6. Which type of medication is given to relieve a patient’s preoperative anxiety? a. Sedative b. Anticholinergic c. Antimuscarinic d. Narcotic ANS: A Sedatives are given to relieve anxiety, which is common in surgical patients.

DIF: 1 REF: 176 TOP: AST Core Curriculum IV:A, sedative-hypnotic agents | AST Core Curriculum XIII:A:26, sedative-hypnotic agents

7. Which type of medication is given to relieve pain and reduce the amount of anesthesia needed during surgery? a. Sedative b. Antiemetic c. Antimuscarinic d. Analgesic ANS: D Opioids cause analgesia and mild sedation in usual doses and may reduce the amount of anesthesia needed for the surgical procedure.

DIF: 1 REF: 179 TOP: AST Core Curriculum IV:B, analgesics | AST Core Curriculum XIII:A:1, analgesics 8. Medications used to inhibit mucous secretions of the respiratory system and digestive tract are termed a. antacids. b. antiemetics. c. anticholinergics. d. tranquilizers.

110

ANS: C Anticholinergics are not routinely used preoperatively but may be indicated in specific instances to inhibit mucous secretions of the respiratory system and digestive tract (antisialagogue effect).

DIF: 1 REF: 179 TOP: AST Core Curriculum IV:C, anti-cholinergics | AST Core Curriculum XIII:A:8:d, cholinergic blockers 9. Medications used to reduce nausea and the possibility of vomiting are called a. antacids. b. antiemetics. c. anticholinergics. d. antimuscarinics.

ANS: B Antiemetics are agents administered preoperatively to reduce nausea and to minimize the possibility of postoperative nausea and vomiting (PONV) in at-risk patients.

DIF: 1 REF: 181 TOP: AST Core Curriculum XIII:A:5, antiemetics and antihistamines | AST Core Curriculum IV:E, antiemetics 10. Which group of preoperative sedatives is most often used? a. Benzodiazepines b. Phenothiazines c. Diphenhydramine d. Droperidol ANS: A The most common sedatives used preoperatively are benzodiazepines.

DIF: 1 REF: 176 TOP: AST Core Curriculum IV:A, sedative-hypnotic agents | AST Core Curriculum XIII:A:26, sedative-hypnotic agents 11. Which drug is not in the benzodiazepine family? a. Diazepam b. Lorazepam c. Midazolam d. Promethazine ANS: D The benzodiazepine family of drugs includes diazepam (Valium), lorazepam (Ativan), and midazolam (Versed). Promethazine is an antihistimine.

DIF: 1 REF: 178 TOP: AST Core Curriculum IV:A, sedative-hypnotic agents | AST Core Curriculum XIII:A:26, sedative-hypnotic agents 12. The ratio of the amount of medication in milligrams per kilogram of patient’s weight is demonstrated by a. mg/kg. b. g/kg.

ANS: A Benzodiazepines are administered intravenously in weight-dependent dosages (mg/kg) 111

for preoperative sedation (see also Chapter 3); mg means milligrams and kg means kilograms.

DIF:

1

REF: 179

TOP: AST Core Curriculum IX:A:4:f, mg

13. Diazepam is the generic name of a. Ativan. b. Versed. c. Valium. d. Phenergan.

ANS: C The benzodiazepine family of drugs includes diazepam (Valium).

DIF: 2 REF: 178 TOP: AST Core Curriculum IV:A:1, diazepam | AST Core Curriculum XIII:A:26, sedative-hypnotic agents 14. What is the trade name for midazolam? a. Ativan b. Versed c. Valium d. Phenergan ANS: B The benzodiazepine family of drugs includes midazolam (Versed).

DIF: 2 REF: 178 TOP: AST Core Curriculum IV:A:3, midazolam | AST Core Curriculum XIII:A:26, sedative-hypnotic agents 15. What is the trade name for lorazepam? a. Ativan b. Versed c. Valium d. Phenergan ANS: A The benzodiazepine family of drugs includes lorazepam (Ativan).

DIF: 2 REF: 178 TOP: AST Core Curriculum IV:A:2, lorazepam | AST Core Curriculum XIII:A:26, sedative-hypnotic agents 16. Opiates are a subgroup of: ? a. analgesics. b. sedatives. c. tranquilizers. d. amnesiacs.

ANS: A The term opioid refers to all drugs—natural, semisynthetic, or synthetic—having morphinelike actions.

DIF: 2 REF: 179 TOP: AST Core Curriculum IV:B, analgesics | AST Core Curriculum XIII:A:1, analgesics 112

17. Astramorph is a trade name for which generic drug? a. Morphine b. Meperidine c. Fentanyl d. Phenergan ANS: A Morphine (Astramorph, Duramorph) is a natural opioid that may be used preoperatively.

DIF: 2 REF: 179 TOP: AST Core Curriculum IV:B:1:a, morphine | AST Core Curriculum XIII:A:1, analgesics 18. Duramorph is a trade name for a. morphine. b. meperidine. c. fentanyl. d. valium.

ANS: A Morphine (Astramorph, Duramorph) is a natural opioid that may be used preoperatively.

DIF: 2 REF: 179 TOP: AST Core Curriculum IV:B:1:a, morphine | AST Core Curriculum XIII:A:1, analgesics 19. Demerol is a trade name for a. morphine. b. meperidine. c. fentanyl. d. phenergan.

ANS: B The most common synthetic opioid used in surgery are meperidine (Demerol).

DIF: 2 REF: 179 TOP: AST Core Curriculum IV:B:2:a, meperidine | AST Core Curriculum XIII:A:1, analgesics

20. Stimuli, such as stretching the peritoneum or retracting the eye muscles, can produce a(n) a. decrease in heart rate. b. increase in heart rate. c. blockage of the production of gastric acids. d. increase in the production of gastric acids.

ANS: A Anticholinergics may also be used intraoperatively to block the vagal response (called reflex bradycardia) to certain stimuli, such as stretching the peritoneum during open abdominal procedures, bowel manipulation, cervical traction in gynecologic cases, carotid artery dissection, or stretching eye muscles during retinal procedures.

DIF: 3 REF: 180 TOP: AST Core Curriculum IV:C, anti-cholinergics | AST Core Curriculum XIII:A:8:d, cholinergic blockers 113

21. What is the trade name for glycopyrrolate? a. Robinul b. Inapsine c. Morphine d. Atropine ANS: A Anticholinergics are most frequently used preoperatively and include atropine and glycopyrrolate (Robinul).

DIF: 2 REF: 179-180 TOP: AST Core Curriculum IV:C:2, glycopyrrolate | AST Core Curriculum XIII:A:8:d, cholinergic blockers 22. How long is the onset of atropine (in minutes)? a. Immediate b. 1 to 2 c. 1 to 5 d. 3 to 5 ANS: A Atropine is administered intravenously in doses of 0.4 to 1.0 mg; onset is almost immediate, and duration is 15 to 30 minutes.

DIF: 3 REF: 180 TOP: AST Core Curriculum IV:C:1, atropine | AST Core Curriculum XIII:A:8:d, cholinergic blockers 23. How long is the duration of Robinul (in hours)? a. 1 to 1.5 b. 2 to 3 c. 4 to 6 d. 8 to 24 ANS: B Glycopyrrolate is administered intravenously in doses of 0.1 to 2 mg; onset occurs within 1 minute and lasts 2 to 3 hours.

DIF: 3 REF: 180 TOP: AST Core Curriculum IV:C:2, glycopyrrolate | AST Core Curriculum XIII:A:8:d, cholinergic blockers 24. What is the normal pH of gastric acid? a. 2 b. 4 c. 6 d. 8 ANS: A Gastric acid normally has an acidity or pH of 2 to 3.

DIF: 2 REF: 181 TOP: AST Core Curriculum IV:C, anti-cholinergics | AST Core Curriculum XIII:A:8:d, cholinergic blockers

114

25. To minimize the damage caused by aspiration of gastric contents during surgery, which drug may be given preoperatively? a. Zofran b. Reglan c. Bicitra d. Inapsine ANS: C Preoperative administration of an antacid is intended to minimize damage to the lungs from gastric acid should aspiration occur. Sodium citrate with citric acid (Bicitra) is a nonparticulate liquid antacid that may be administered preoperatively to neutralize the acidity of stomach contents.

DIF: 2 REF: 180-181 TOP: AST Core Curriculum IV:D:1, sodium citrate with citric acid | AST Core Curriculum XIII:A:17, gastric medication

26. Famotidine is marketed under what trade name? a. Zantac b. Pepcid c. Tagamet d. Zofran ANS: B The most common H2 blockers given preoperatively are cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac).

DIF: 2 REF: 181 TOP: AST Core Curriculum IV:D:2, cimetidine | AST Core Curriculum XIII:A:17, gastric medications 27. Gastroesophageal reflux may occur when the lower esophageal sphincter and thorax muscles a. flex. b. tighten. c. reflux. d. relax.

ANS: D The lower esophageal sphincter may relax to an extent that a reflux of gastric contents may occur.

DIF: 2 REF: 180 TOP: AST Core Curriculum IV:D, antacid/H2-receptor blocking agents | AST Core Curriculum XIII:A:17, gastric medication 28. A preoperative antacid administered orally is a. Cimetidine (Tagamet) b. H2 blocker c. sodium citrate d. Zantac ANS: C Sodium citrate is given orally in a dose of 15 to 30 mL. DIF:

3

REF: 181 115

TOP: AST Core Curriculum IV:D:1, sodium citrate with citric acid | AST Core Curriculum XIII:A:17, gastric medication 29. Which agent is an H2 blocker? a. Droperidol b. Ondansetron c. Sodium citrate d. Ranitidine ANS: D The most common H2 blockers given preoperatively are cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac).

DIF: 1 REF: 181 TOP: AST Core Curriculum IV:D:4, ranitidine | AST Core Curriculum XIII:A:17, gastric medication 30. The purpose of a preoperative H2 blocker is to a. inhibit the production of gastric acid. b. neutralize gastric acid. c. produce chyme. d. limit chyme production.

ANS: A By blocking H2 receptors, these agents temporarily interfere with the production of gastric acid by parietal cells.

DIF: 2 REF: 181 TOP: AST Core Curriculum IV:D, antacid/H2-receptor blocking agents | AST Core Curriculum XIII:A:17, gastric medication 31. A preoperative assessment places special emphasis on all of the following conditions except a. atherosclerosis. b. chronic obstructive pulmonary disease. c. diabetes. d. melanoma.

ANS: D The preanesthesia physical examination is a complete assessment of the patient’s physical status. Special emphasis is placed on assessment of diabetes and diseases of the cardiovascular and respiratory systems.

DIF:

3

REF: 176

TOP: AST Core Curriculum II:B, patient factors

32. Which agent neutralizes gastric acid? a. Cimetidine (Tagamet) b. Ranitidine (Zantac) c. Sodium bicarbonate d. Sodium citrate ANS: D Sodium citrate is metabolized to sodium bicarbonate—a base that chemically neutralizes gastric acid.

DIF: 1 REF: 181 TOP: AST Core Curriculum IV:D:1, sodium citrate with citric acid | AST Core Curriculum 116

XIII:A:17, gastric medication

33. The action of metoclopramide (Reglan) is to a. block production of gastric acid. b. decrease mucous secretions. c. increase gastrointestinal motility. d. neutralize gastric acid.

ANS: C Metoclopramide (Reglan) is classified as a gastrokinetic agent, and it is used to reduce gastric fluid volume in at-risk patients, such as those with delayed gastric emptying (most associated with diabetes), pregnant patients, those with anticipated difficult airway, and emergency patients who have not been NPO. It stimulates motility of the upper GI tract (and thus gastric emptying) without stimulating gastric acid secretion, but administration of metoclopramide does not ensure complete emptying of the stomach.

DIF: 2 REF: 182 TOP: AST Core Curriculum XIII:A:5, antiemetics and antihistamines | AST Core Curriculum IV:E:3, metoclopramide 34. Atropine is an anticholinergic that a. blocks the production of gastric acid. b. decreases mucous secretions. c. increases gastrointestinal motility. d. neutralizes gastric acid.

ANS: B Anticholinergics are not routinely used preoperatively but may be indicated in specific instances to inhibit mucous secretions of the respiratory system and digestive tract (antisialagogue effect).

DIF: 2 REF: 179 TOP: AST Core Curriculum IV:C:1, atropine | AST Core Curriculum XIII:A:8:d, cholinergic blockers 35. A trauma patient having an indwelling urinary catheter inserted prior to surgery may need to receive a(n) a. anticholinergic. b. sedative. c. analgesic. d. antiemetic.

ANS: C Analgesics are given preoperatively to relieve the pain for patients receiving invasive monitors, such as trauma patients.

DIF:

3

REF: 179

TOP: AST Core Curriculum IV:B, analgesics

36. Which physical status classification would be assigned to a surgical patient with cancer of the uterus who is undergoing a hysterectomy? a. P1 b. P2 c. P3 d. P4 117

ANS: C The patient with a severe systemic disease, such as cancer of the uterus, would be classified as a P3 by the anesthesia care provider.

DIF: 3 REF: 179 TOP: AST Core Curriculum II:B:5, co-morbid conditions 37. The most common benzodiazepine administered preoperatively is a. Versed. b. Valium. c. Ativan. d. Demerol.

ANS: A Midazolam (Versed) is the most common benzodiazepine administered preoperatively.

DIF:

1

REF: 179

TOP: AST Core Curriculum IV:A:3, midazolam

38. If a surgical patient is exhibiting significant pain after surgery and will be admitted as an inpatient, which medication may be given for pain? a. Morphine b. Meperidine c. Midazolam d. Lorazepam ANS: A Morphine may be used preoperatively for pain and may be indicated for patients experiencing significant pain who are expected to be admitted as inpatients after surgery.

DIF:

3

REF: 179

TOP: AST Core Curriculum IV:B:1:a, morphine

39. Scopolamine is classified as all of the following, except a. antiemetic. b. analgesic. c. sedative. d. antisialagogue.

ANS: B Scopolamine is classified as an antisialagogue, a sedative, and an antiemetic.

DIF:

1

40.

REF: 180

TOP: AST Core Curriculum IV:C:3, scopalomine

is a proton-pump inhibitor. a. Pepcid b. Bicitra c. Reglan d. Nexium

ANS: D Esomeprazole (Nexium) is a drug in the proton-pump inhibitor category.

DIF: 1 REF: 181 TOP: AST Core Curriculum IV:D, antacid/H2-receptor blocking agents

118

41. Which antiemetic medication has an FDA Black Box warning? a. Inapsine b. Reglan c. Zofran d. Kytril ANS: A The U.S. Food and Drug Administration requires a Black Box warning on droperidol (Inapsine) because of fatal cardiac arrhythmias.

DIF:

1

REF: 182

TOP: AST Core Curriculum IV:E, antiemetics

42. The commonly used antiemetic used preoperatively is a. Versed. b. Pepcid. c. Zofran. d. Reglan.

ANS: C Ondansetron (Zofran) is the most commonly used antiemetic given preoperatively.

DIF:

1

REF: 182

TOP: AST Core Curriculum IV:E:2 ondansetron

43. Why is gum chewing not allowed preoperatively for the patient who has been NPO? a. Because it may be swallowed b. Because it is not a clear fluid c. Because it is a solid food d. Because it increases gastric fluid ANS: D Gum chewing is not allowed preoperatively due to resulting increases in gastric fluid volume.

DIF: 2 REF: 181 TOP: AST Core Curriculum II:A, American Society of Anesthesiologists determination 44. Which category of preoperative medication has an effect on the vagus nerve? a. Sedatives b. Anticholinergics c. Analgesics d. Antiemetics ANS: B Anticholinergics may be administered preoperatively to block certain receptors on the vagus nerve (vagolysis).

DIF: 2 REF: 179 TOP: AST Core Curriculum V:C, anti-cholinergics | AST Core Curriculum XIII:A:8:d, cholinergic

119

MATCHING Match the following medications with the correct categories. a. Antacid b. Anticholinergic c. Antiemetic d. Opioid analgesic e. Sedative 1. Atropine (Atropine) B 2. Diazepam (Valium) E 3. Meperidine (Demerol) D 4. Metoclopramide (Reglan) C

5. Sodium citrate (Bicitra) A 1. ANS: B

DIF: 1 REF: 179 TOP: AST Core Curriculum IV:C, anti-cholinergics 2. ANS: E DIF: 1 REF: 178 TOP: AST Core Curriculum IV:A, sedative-hypnotic agents 3. ANS: D DIF: 1 REF: 179 TOP: AST Core Curriculum IV:B:2:a, meperidine 4. ANS: C DIF: 1 REF: 182 TOP: AST Core Curriculum XIII:A:5, antiemetics and antihistamines 5. ANS: A DIF: 1 REF: 181 TOP: AST Core Curriculum IV:D:1, sodium citrate with citric acid Match the following medications with the correct categories. a. Antacid b. Anticholinergic c. Antiemetic d. Opioid analgesic e. Sedative 6. Glycopyrrolate (Robinul) B 7. Midazolam (Versed) E 8. Morphine (Astramorph) D 9. Ondansetron (Zofran) C 10. Ranitidine (Zantac) A

6. ANS: B DIF: 1 REF: 179-180 TOP: AST Core Curriculum IV:C, anti-cholinergics 7. ANS: E DIF: 1 REF: 178 TOP: AST Core Curriculum IV:A:3, midazolam 8. ANS: D DIF: 1 REF: 179 TOP: AST Core Curriculum IV:B, analgesics 9. ANS: C DIF: 1 REF: 182 TOP: AST Core Curriculum IV:E:2 ondansetron 10. ANS: A DIF: 1 REF: 181 TOP: AST Core Curriculum IV:D:4, ranitidine | AST Core Curriculum XIII:A:17, gastric medication

120

TRUE/FALSE 1. Preoperative assessment of the surgical patient includes a questionnaire to be completed by the patient, as well as an interview conducted by the anesthesia provider.

ANS: T The evaluation usually consists of a questionnaire (Fig. 13.1) to be completed by the patient and a follow-up interview with the anesthesia provider (Fig. 13.2).

DIF:

1

REF: 177-178 TOP: AST Core Curriculum II:B, patient factors

121

Chapter 13: Patient Monitoring and Local and Regional Anesthesia Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. The brand name for lidocaine is a. Carbocaine. b. Marcaine. c. Sensorcaine. d. Xylocaine.

ANS: D The most common local anesthetic agents used in surgery are aminoamides; lidocaine (Xylocaine) is one of those agents.

DIF:

2

REF: 192

TOP: AST Core Curriculum VI:B:1:a, lidocaine

2. The brand name for bupivacaine is a. Carbocaine. b. Marcaine. c. Novocaine. d. Xylocaine.

ANS: B The most common local anesthetic agents used in surgery are aminoamides; bupivacaine (Marcaine) is one of those agents.

DIF:

2

REF: 193

TOP: AST Core Curriculum VI:B:1:b, bupivacaine

3. The brand name for mepivacaine is a. Carbocaine. b. Marcaine. c. Sensorcaine. d. Xylocaine.

ANS: A A less commonly used local anesthetic agent is mepivacaine (Carbocaine).

DIF:

2

REF: 193

TOP: AST Core Curriculum VI:B:1:c, mepivacaine

4. Which agent is not an amide anesthetic? a. Bupivacaine b. Cocaine c. Lidocaine d. Mepivacaine ANS: B The most common local anesthetic agents used in surgery are aminoamides—lidocaine (Xylocaine), bupivacaine (Marcaine), and ropivacaine (Naropin). A less commonly used local anesthetic agent is mepivacaine (Carbocaine). The first local anesthetic agents, topical cocaine and injectable procaine (Novocaine), were aminoesters.

DIF:

3

REF: 193

TOP: AST Core Curriculum VI:B:2:a, cocaine

5. The generic name for Sensorcaine is 122

a. bupivacaine. b. cocaine. c. lidocaine. d. mepivacaine.

ANS: A Bupivacaine (Marcaine, Sensorcaine) is an aminoamide anesthetic agent.

DIF:

2

REF: 193

TOP: AST Core Curriculum VI:B:1:b, bupivacaine

6. Anesthesia that is administered at the surgical site is a a. block b. general c. local d. regional

anesthetic.

ANS: C A local anesthetic is administered to the immediate surgical site. Whether injected (infiltrated) into tissue or applied topically to mucosal membranes, it affects a small, circumscribed area.

DIF:

1

REF: 191

TOP: AST Core Curriculum II:G:2:e, nerve block (local)

7. Topical administration of 4% cocaine solution for a septoplasty is an example of a anesthetic. a. block b. general c. local d. regional ANS: C A local anesthetic is administered to the immediate surgical site. Whether injected (infiltrated) into tissue or applied topically to mucosal membranes, it affects a small, circumscribed area.

DIF:

3

REF: 192

TOP: AST Core Curriculum II:G:2:e:(2), topical

8. A healthy 32-year-old woman is scheduled for elective excision of a nevus from her right shoulder. Which method of anesthesia is likely to be used? a. Block b. General c. Local d. Regional ANS: C Local injections are appropriate for excision or biopsy of small soft-tissue masses such as lipomas, nevi, or other skin lesions.

DIF:

3

REF: 191

TOP: AST Core Curriculum II:G:2:e, nerve block (local)

9. The most common approach for a brachial plexus block is a. axillary. b. interscalene. c. supraclavicular. d. infraclavicular.

ANS: A 123

A brachial plexus block may be administered in several different locations including interscalene, supraclavicular, infraclavicular, but the most common approach is axillary.

DIF:

1

REF: 197

TOP: AST Core Curriculum II:G:2:e, nerve block (local)

10. Which method of anesthesia will most likely be used for an elective cystoscopy on an adult? a. Block b. General c. Local d. Regional ANS: C In urology, cystoscopy may be performed with a topical anesthetic agent.

DIF:

3

REF: 191

TOP: AST Core Curriculum II:G:2:e:(2), topical

11. Which local anesthetic is only used topically? a. Carbocaine b. Cocaine c. Mepivacaine d. Sensorcaine ANS: B Cocaine is for topical use only; it is never injected.

DIF:

2

REF: 192

TOP: AST Core Curriculum VI:B:2:a, cocaine

12. Which statement is not true of cocaine used in surgery? a. Available in 4% and 10% solutions. b. 4% solution may be administered intravenously. c. May be sprayed on the mucous membrane. d. May be placed topically on nasal packing.

ANS: B Cocaine is for topical use only; it is never injected.

DIF:

2

REF: 192

TOP: AST Core Curriculum VI:B:2:a, cocaine

13. Which drug is not a vasoconstrictor? a. Cocaine b. Epinephrine c. Lidocaine d. Norepinephrine ANS: C Most local anesthetics, like lidocaine and bupivacaine cause some vasodilation, which speeds absorption. (Ropivacaine is the exception.)

DIF:

3

REF: 193

TOP: AST Core Curriculum VI:B:1:a, lidocaine

14. Lidocaine is available for injection in each of the following concentrations except 124

a. b. c. d.

0.5%.

1%.

2%.

4%.

ANS: D Lidocaine is available for injection in solutions of 0.5%, 1%, 1.5%, and 2%.

DIF:

2

REF: 193

TOP: AST Core Curriculum VI:B:1:a, lidocaine

15. Which statement does not apply to lidocaine? a. Lidocaine is an amide compound. b. Lidocaine is available with epinephrine. c. Lidocaine is fast acting. d. Lidocaine lasts longer than bupivacaine.

ANS: D Bupivacaine (Marcaine, Sensorcaine) is an aminoamide anesthetic, which is approximately four times more potent than lidocaine and has a longer duration, from 3 to 7 hours.

DIF:

3

REF: 193

TOP: AST Core Curriculum VI:B:1:a, lidocaine

16. Which local anesthetic has the longest duration? a. Bupivacaine b. Cocaine c. Lidocaine with epinephrine d. Mepivacaine ANS: A Bupivacaine (Marcaine, Sensorcaine) is an aminoamide anesthetic, which is approximately four times more potent than lidocaine and has a longer duration, from 3 to 7 hours.

DIF:

3

REF: 193

TOP: AST Core Curriculum VI:B:1:b, bupivacaine

17. Marcaine is available in each of the following concentrations except a. 0.25%. b. 0.5%. c. 0.75%. d. 1%.

ANS: D Bupivacaine is available in solutions of 0.25%, 0.5%, and 0.75%.

DIF:

2

REF: 193

TOP: AST Core Curriculum VI:B:1:b, bupivacaine

18. Which is not a correct concentration for epinephrine? a. 1:1000 b. 1:50,000 c. 1:100,000 d. 1:200,000 ANS: B Epinephrine is available in 100,000 or 200,000 parts solvent. Epinephrine is also available in a very high concentration of 1:1000.

DIF:

2

REF: 193 125

TOP: AST Core Curriculum VI:B, local and topical agents 19. Which response is not associated with the inadvertent injection of high-concentration epinephrine? a. Cardiac arrest b. Hypertension c. Nausea and vomiting d. Severe tachycardia ANS: C If the high 1:1000 concentration of epinephrine is inadvertently injected, then severe tachycardia (rapid heart rate) and hypertension will result, increasing the potential for cardiac arrest.

DIF: 3 REF: 193 TOP: AST Core Curriculum VI:B, local and topical agents 20. Which local anesthetic has the shortest duration? a. Carbocaine b. Marcaine c. Sensorcaine d. Xylocaine ANS: D Xylocaine (lidocaine) has the shortest duration of the above options. See Table 14.1 for comparison.

DIF:

3

REF: 194

TOP: AST Core Curriculum VI:B:1:a, lidocaine

21. An 82-year-old patient is scheduled for colonoscopy. What form of anesthesia is most likely to be planned? a. Local b. Regional block c. Monitored anesthesia care (MAC) d. General ANS: C Indications for MAC include the nature of the procedure, the patient’s clinical condition, or the potential need to convert to a general or regional anesthetic. There are many diagnostic or therapeutic procedures that are conducted with MAC, including colonoscopy and esophagogastroduodenoscopy (EGD).

DIF: 3 REF: 191 TOP: AST Core Curriculum II:G:3:d, monitored anesthesia care (MAC) 22. Injection of local anesthetic into the nerve plexus that supplies the operative area is generally termed a. local anesthesia b. a regional block c. MAC d. intravenous regional anesthesia (IVRA) (Bier block) ANS: B Regional anesthesia blocks nerves (not just nerve endings) or groups of nerves (called a plexus) at specific locations. Regional blocks can affect sympathetic, sensory, and motor nerve supply, so an anesthetized limb may be immobile as well 126

as numb.

DIF:

1

REF: 195

TOP: AST Core Curriculum II:G:2, regional

23. Which statement does not apply to regional blocks? a. Sensory nerve supply is affected. b. Motor nerve supply is affected. c. Epidural anesthesia is one example. d. They may be used for all types of surgical procedures.

ANS: D Regional blocks can affect sympathetic, sensory, and motor nerve supply; consequently, an anesthetized limb may be immobile, as well as numb. Regional blocks are effective for many (but not all) types of surgical procedures.

DIF:

2

REF: 195

TOP: AST Core Curriculum II:G:2, regional

24. For which type of regional block is the anesthetic agent injected into the subarachnoid space? a. Spinal b. Epidural c. Caudal d. Bier block ANS: A For spinal anesthesia, agents are injected through the dura mater into the subarachnoid space and cerebrospinal fluid (CSF) in the lumbar area of the spine (Fig. 14.9); this is called the intrathecal route. Injection is at the end of the spinal cord, usually not higher than L3 to L4.

DIF:

3

REF: 195

TOP: AST Core Curriculum II:G:2:a, spinal

25. Which type of regional block requires a needle to be inserted between the vertebral bodies and through the dura mater? a. Spinal b. Epidural c. Caudal d. Bier block ANS: A For spinal anesthesia, agents are injected through the dura mater into the subarachnoid space and cerebrospinal fluid (CSF) in the lumbar area of the spine (Fig. 14.9); this is called the intrathecal route. Injection is at the end of the spinal cord, usually not higher than L3 to L4.

DIF:

3

REF: 195

TOP: AST Core Curriculum II:G:2:a, spinal

26. Spinal anesthesia may be used for any of the following surgical procedures except a. cesarean section. b. embolectomy of the lower extremity. c. intestinal resection. d. transurethral resection of prostate.

ANS: C Spinal anesthesia is used for procedures of the lower abdomen, perineum, and lower extremities. It is often used for transurethral resection of the prostate gland or bladder tumors, for lower leg vascular procedures such as embolectomy, select orthopedic 127

procedures such as total knee arthroplasty, and for cesarean sections.

DIF:

2

REF: 196

TOP: AST Core Curriculum II:G:2:a, spinal

27. An epidural block is used for all of the following reasons except a. providing anesthesia for cesarean section. b. managing postoperative pain. c. managing pain during labor and vaginal childbirth/ d. providing anesthesia for suprapubic resection of a bladder tumor.

ANS: D Epidural anesthesia is used to relieve the pain of labor and vaginal delivery, as well as provide anesthesia for a cesarean section. Epidural blocks may also be used as an adjunct to general anesthesia in select patients to minimize the amount of agents needed; it may also be used for postoperative pain control after such procedures as thoracotomy.

DIF:

2

REF: 196

TOP: AST Core Curriculum II:G:2:b, epidural

28. Which regional block requires the anesthetic agent to be injected into the space that surrounds the dura mater via the sacral canal? a. Spinal b. Epidural c. Caudal d. Bier block ANS: C Caudal anesthesia is a type of epidural block injected into the epidural space via the sacral canal (Fig. 14.12).

DIF:

3

REF: 196

TOP: AST Core Curriculum II:G:2:c, caudal

29. Caudal blocks are primarily used for a. cesarean section b. embolectomy of the lower extremity c. vaginal childbirth d. postoperative pain management ANS: D Although less common now, caudal blocks may be used for vaginal childbirth, but they are administered in the obstetrical unit rather than in the surgical suite. Caudal blocks are primarily used in conjunction with general anesthesia for urologic and lower-extremity surgical procedures in children and for postoperative pain management.

DIF:

2

REF: 196-197 TOP: AST Core Curriculum II:G:2:c, caudal

30. Which regional block requires that the anesthetic agent be injected into the muscle cone behind the eye? a. Retrobulbar b. Bier c. Intrathecal d. MAC

128

ANS: A Retrobulbar blocks are injected behind the eye into the muscle cone (see Fig. 10.6) to block branches of the oculomotor nerve.

DIF:

1

REF: 198

TOP: AST Core Curriculum II:G:2, regional

31. Extremity blocks for the arm may be established at any of the following nerves’ locations except a. obturator. b. median. c. radial. d. ulnar.

ANS: A The arm may be blocked at several locations, including the brachial plexus and the median, radial, and ulnar nerves.

DIF:

2

REF: 197

TOP: AST Core Curriculum II:G:2:f, Bier block

32. Extremity blocks for the leg may be established at any of the following nerves’ locations except a. obturator. b. brachial. c. femoral. d. sciatic.

ANS: B The leg may be blocked at the femoral, obturator, or sciatic nerves.

DIF:

2

REF: 197

TOP: AST Core Curriculum II:G:2:f, Bier block

33. An axillary approach for arm block requires the injection of local anesthetic agents at which nerve network? a. Brachial plexus b. Pampiniform plexus c. Pectoralis bundle d. Obturator bundle ANS: A A brachial plexus block may be used for procedures on the hand, forearm, or elbow.

A brachial plexus block may be administered in several different sites including interscalene, supraclavicular, and infraclavicular locations, but the most common approach is axillary (Fig. 14.13).

DIF:

2

REF: 197

TOP: AST Core Curriculum II:G:2:e:(1), intramuscular

34. Which statement does not apply to axillary blocks? a. The arm must first be exsanguinated. b. 30 to 40 mL of local is injected. c. They make the entire arm numb. d. They may be used for procedures from elbow to fingers.

129

ANS: A The arm is exsanguinated before administering an IVRA (Bier block), not an axillary block. For an axillary block, approximately 30 to 40 mL of local anesthetic is injected around the nerves that are adjacent to the axillary artery, which makes the entire arm both numb and immobile. This type of block is used for procedures from elbow to fingers.

DIF:

3

REF: 197

TOP: AST Core Curriculum II:G:2:e:(1), intramuscular

35. Which type of block is an intravenous block? a. Axillary b. Bier c. Retrobulbar d. Caudal ANS: B One of the most common extremity blocks is IVRA (also called Bier block).

DIF:

2

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

36. To render an extremity bloodless by elevation and constriction is termed a. fasciculation. b. vasoconstriction. c. exsanguination. d. tourniquet application.

ANS: C An intravenous catheter is inserted in a dorsal vein of the hand, and blood is forced from the distal limb (exsanguination) by elevating the arm and wrapping it tightly with an Esmarch rubber bandage.

DIF:

1

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

37. Which nerve block requires exsanguination of the affected extremity? a. Axillary b. Bier c. Intrathecal d. Caudal ANS: B In a Bier block, an intravenous catheter is inserted in a dorsal vein of the hand, and blood is forced from the distal limb (exsanguination) by elevating the arm and wrapping it tightly with an Esmarch rubber bandage).

DIF:

2

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

38. An IVRA (Bier block) may be used for procedures such as a. excision of a nevus on the shoulder. b. removal of a groin nodule. c. carpal tunnel release. d. inferior rectus release.

ANS: C An IVRA (Bier block) can be used for procedures on the upper and lower distal extremities, although it is most frequently used for procedures on the hands. An IVRA is particularly useful for soft tissue procedures lasting 1 hour or less (e.g., release of carpal tunnel or trigger finger, moderate Dupuytren contracture).

130

DIF:

2

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

39. Which piece of equipment is essential to perform an IVRA (Bier block) for a carpal tunnel release? a. Nerve stimulator b. Consciousness monitor c. Tourniquet d. Pulse oximeter ANS: C In IVRA for a procedure on the hand, for example, a pneumatic or electric doublecuffed tourniquet is placed around the patient’s proximal (upper) arm.

DIF:

3

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

40. Which statement does not apply to Bier blocks? a. They are a fast and effective method of anesthesia for reduction of fractures. b. An intravenous (IV) line is established in the affected extremity. c. A pneumatic tourniquet is applied to the affected extremity. d. A local anesthetic agent is introduced through the IV line after the tourniquet has been inflated.

ANS: A IVRA is not usually the technique of choice for fracture reduction because of the discomfort caused by exsanguination and because IVRA does not provide postoperative analgesia.

DIF:

3

REF: 198

TOP: AST Core Curriculum II:G:2:f, Bier block

41. The surgical patient’s heart rate and rhythm are continually assessed using a. a pulse oximeter. b. a blood pressure cuff. c. a capnometer. d. electrocardiography.

ANS: D Electrocardiography is the process of recording the electrical impulses of the heart.

DIF:

1

REF: 188

TOP: AST Core Curriculum V:B:1:a, principles

42. The precordial stethoscope is taped to the surgical patient’s a. shoulder. b. esophagus. c. chest. d. arm.

ANS: C The precordial stethoscope is taped to the patient’s chest at the left sternal border or in the suprasternal notch.

DIF: 2 REF: 188 TOP: AST Core Curriculum V:C, related patient care devices

131

43.

is not considered a dysrhythmia. a. Sinus rhythm b. Bradycardia c. Asystole d. Tachycardia

ANS: A Sinus rhythm is considered a normal rhythm. The surgical technologist should be able to appreciate the various types of dysrhythmias, including bradycardia, tachycardia, and asystole.

DIF:

2

REF: 188

TOP: AST Core Curriculum III:D, monitoring

44. All are areas where a pulse oximeter can be placed, except a. finger. b. tongue. c. earlobe. d. toe.

ANS: B The pulse oximeter can be attached to a finger, toe, or earlobe.

DIF:

1

REF: 189

TOP: AST Core Curriculum V:B:3:c:2, pulse oximeter

45. An accurate reading of a surgical patient’s core temperature may be taken from which location? a. Forehead b. Mouth c. Esophagus d. Axilla ANS: C More precise measurements of core temperature are indicated in some patients and for some types of surgical procedures. In such cases a lower esophageal probe may be used because it offers more accurate reading of core temperature with the least risk of patient injury.

DIF:

2

REF: 189

TOP: AST Core Curriculum V:B:6:d, sites

46. Capnometry can serve as a valuable tool in the early detection of a. high blood pressure. b. consciousness. c. hypothermia. d. malignant hyperthermia.

ANS: D Capnometry is an extremely valuable tool in the assessment of respiratory function and can serve a critical role in early detection of problems such as an esophageal intubation, compromised ventilation, or malignant hyperthermia.

DIF:

2

REF: 190

TOP: AST Core Curriculum V:B:8, capnography

132

47. During open heart surgery, which advanced monitoring technique is used to assess cardiac function? a. CVP line b. Swan-Ganz catheter c. TEE d. ECG ANS: C During heart surgery, transesophageal echocardiography (TEE) may be used to assess cardiac function.

DIF: 2 REF: 190 TOP: AST Core Curriculum V:C, related patient care devices 48. Which patient would be the best candidate for monitoring by a registered nurse under local anesthesia? a. Mentally challenged patient b. 10-month-old infant for circumcision c. 25 year old with pacemaker d. 82 year old for total knee repair ANS: B The registered nurse may administer sedatives as ordered by the surgeon. Only physically healthy and psychologically stable patients undergoing brief, uncomplicated surgical procedures are appropriate candidates for local anesthesia without monitoring by an anesthesia care provider.

DIF: 3 REF: 191 TOP: AST Core Curriculum II:A, American Society of Anesthesiologists determination 49. How is cocaine 4% administered to the mucosal surface during nasal surgery? a. Injection b. Spray c. Irrigation d. IV ANS: B Cocaine may be administered on cotton applicators or nasal packing, or it may be sprayed directly on the mucosal surface.

DIF:

2

REF: 192

TOP: AST Core Curriculum VI:B:2:a, cocaine

50. Which local anesthetic is not recommended for use for obstetrical epidural anesthesia? a. Lidocaine 1% b. Bupivacaine 0.75% c. Ropivacaine 0.5% d. Mepivacaine 1.5% ANS: B The product package insert contains a warning that the use of 0.75% bupivacaine is not recommended for obstetrical epidural anesthesia. Cardiac arrest with difficult resuscitation or death has been reported in patients receiving bupivacaine (generally the 0.75% concentration) for obstetrical epidural anesthesia.

DIF:

2

REF: 194

TOP: AST Core Curriculum VI:B:1:b, bupivacaine

133

MATCHING Match the following terms with the correct definitions. a. Asystole b. Auscultation c. Blood pressure d. Bradycardia e. Capnometry f. Dysrhythmia g. Electrocardiography h. Electroencephalogram i. Exsanguination j. Precordial 1. Abnormal cardiac rhythm 2. Absence of heart beat 3. Listening to the sounds of the heart and lungs 4. Measure of expired carbon dioxide 5. Measure of the force of blood against the arterial walls 6. Pertaining to the anterior surface of the body overlying the heart 7. Process of recording electrical activity of the heart 8. Record of electrical activity of the brain 9. Render bloodless 10. Slow heart rate 1. ANS: F DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:1:a, principles 2. ANS: A DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:1:a, principles 3. ANS: TOP: B DIF: 1 REF: AST Core Curriculum V:B:1:a, principles 4. ANS: E

DIF: 1 REF: 189 TOP: AST Core Curriculum V:B:8, capnography 5. ANS: C DIF: 1 REF: 189 TOP: AST Core Curriculum V:B:2, blood pressure 6. ANS: J DIF: 2 REF: 188 TOP: AST Core Curriculum V:B:1:a, principles 7. ANS: G DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:1, electrocardiogram (ECG) 8. ANS: H DIF: 1 REF: 190 TOP: AST Core Curriculum V:B, patient monitoring devices 9. ANS: I DIF: 1 REF: 198 TOP: AST Core Curriculum II:G:2:f, Bier block 10. ANS: D DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:3:f:(2), abnormal Match the following types of patient monitoring to the parameters they measure. a. Auscultation b. Blood pressure c. Capnometry d. Electrocardiography e. Pulse oximetry 11. Expired carbon dioxide 12. Force of blood against vessel walls 13. Heart rate and rhythm 14. Oxygen saturation of blood 15. Sounds of the chest 134

ANS: C DIF: 1 REF: 189 TOP: AST Core Curriculum V:B:8, capnography 12. ANS: B DIF: 1 REF: 189 TOP: AST Core Curriculum V:B:2, blood pressure 13. ANS: D DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:1, electrocardiogram (ECG) 14. ANS: E DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:7:a, principles 15. ANS: A DIF: 1 REF: 188 TOP: AST Core Curriculum V:B:1:b, equipment 11.

TRUE/FALSE 1. Local anesthesia blocks the transmission of pain impulses to the brain; as a result, the

patient cannot feel pain but is able to move and feel pressure.

ANS: F Because local anesthesia blocks sensory nerve endings only at the site of injection or application, the patient cannot feel pain in that area but is still able to move muscles and feel pressure.

DIF:

2

REF: 192

TOP: AST Core Curriculum II:G:2:e, nerve block (local)

2. Cocaine is a controlled substance and when used in the surgical unit must never be left

unattended.

ANS: T Cocaine is a controlled substance. It should never be left unattended in the surgical unit, and any cocaine solution dispensed but unused should be returned to the pharmacy or destroyed. At least two people should witness the destruction of unused cocaine to verify that it has not been used for illicit purposes (see Chapter 2).

DIF:

1

REF: 192

TOP: AST Core Curriculum VI:B:2:a, cocaine

135

Chapter 14: General Anesthesia Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. The term anesthesia means without a. consciousness. b. memory. c. sensation. d. pain.

ANS: C The term anesthesia is literally defined as an absence of sensation.

DIF:

1

REF: 203

TOP: AST Core Curriculum V:G:1, induction

2. Which statement is not a primary objective of general anesthesia? a. Patient remains unresponsive during surgery. b. Patient retains no memory of the surgery. c. Patient’s cardiovascular function remains stable. d. Patient retains muscle tone during surgery.

ANS: D The goals, or components, of general anesthesia are unconsciousness (a state of being unaware), analgesia (painlessness), amnesia (memory impairment), and immobility (skeletal muscle relaxation) (Box 15.1).

DIF:

2

REF: 204-205 TOP: AST Core Curriculum V:G:1, induction

3. What are the five phases of general anesthesia in the correct sequence? a. Emergence, preinduction, induction, maintenance, recovery b. Induction, postinduction, emergence, maintenance, recovery c. Induction, postinduction, maintenance, emergence, recovery d. Preinduction, induction, maintenance, emergence, recovery ANS: D The five phases of general anesthesia in the correct sequence are preinduction, induction, maintenance, emergence, and recovery (Box 15.2).

DIF: 2 REF: 205 TOP: AST Core Curriculum V:G, phases of general anesthesia 4. Which phase of general anesthesia includes preoxygenation of the patient? a. Emergence b. Preinduction c. Recovery d. Induction ANS: B An anesthesia mask is usually placed over the patient’s nose and mouth and 100% oxygen is administered, a process known as preoxygenation. This practice is performed to bring the oxygen saturation of the patient’s blood to the highest possible level before induction.

136

DIF: 3 REF: 205 TOP: AST Core Curriculum V:G, phases of general anesthesia 5. Which phase of general anesthesia includes administration of anesthetic agents? a. Emergence b. Preinduction c. Recovery d. Induction ANS: D The induction phase begins when medications are administered to initiate general anesthesia.

DIF:

1

REF: 206

TOP: AST Core Curriculum V:G:1, induction

6. Which phase of general anesthesia includes the administration of muscle relaxants? a. Emergence b. Preinduction c. Recovery d. Induction ANS: D The induction phase begins when medications are administered to initiate general anesthesia. The placement of an endotracheal (ET) tube, called intubation, begins after induction agents and muscle relaxants are administered to render the patient unconscious and immobile.

DIF:

2

REF: 206

TOP: AST Core Curriculum V:G:1, induction

7. Preoperative patient assessment and evaluation are performed during which phase of general anesthesia? a. Emergence b. Preinduction c. Recovery d. Induction e. Maintenance ANS: B The preinduction phase begins as the patient is admitted to the preoperative holding area and continues up to the point of administering the anesthetic agents. In this phase, the patient is assessed and prepared for anesthesia and surgery.

DIF:

2

REF: 205

TOP: AST Core Curriculum V:G:1, induction

8. Patient intubation is performed during which phase of general anesthesia? a. Emergence b. Preinduction c. Recovery d. Induction ANS: D The induction phase begins when medications are administered to initiate general anesthesia. The placement of an ET tube, called intubation, begins after induction agents and muscle relaxants are administered to render the patient unconscious and immobile.

DIF:

2

REF: 206

TOP: AST Core Curriculum V:G:1, induction 137

9. The surgical procedure is performed during which phase of general anesthesia? a. Emergence b. Preinduction c. Recovery d. Maintenance ANS: D The maintenance phase begins as the patient’s airway is established and secured and continues until the surgical procedure has been completed.

DIF:

1

REF: 209

TOP: AST Core Curriculum V:G:2, maintenance

10. Anesthetic agents are reversed or discontinued, or both, during which phase of general anesthesia? a. Emergence b. Preinduction c. Recovery d. Induction ANS: A As the procedure is completed, the emergence phase begins, during which anesthetic agents are discontinued and allowed to wear off.

DIF:

1

REF: 210

TOP: AST Core Curriculum V:G:3, emergence

11. Which is the postoperative phase of general anesthesia? a. Emergence b. Preinduction c. Recovery d. Induction ANS: C When vital signs are stable, the patient is carefully moved to a transport stretcher and taken to postanesthesia care unit (PACU) for the recovery phase. The anesthesia provider provides a detailed report to the PACU staff nurses, who closely monitor the patient during the recovery phase.

DIF:

2

REF: 211

TOP: AST Core Curriculum V:G:4, recovery

12. Which statement does not apply to endotracheal intubation? a. The patient’s vocal cords are visualized using a laryngoscope. b. The circulator assists the anesthesia provider by applying pressure on the cricoid cartilage. c. An ET tube is placed in the trachea. d. The ET tube is connected to a pulse oximeter.

ANS: D Once intubation is accomplished, the ET tube is connected to a breathing circuit leading to the ventilator.

DIF: 2 REF: 209 TOP: AST Core Curriculum V:E:3, endotracheal intubation

13. Which statement is not true about cricoid pressure? a. It is used in rapid sequence induction.

138

b. It reduces the risk of laryngeal spasm. c. It compresses the esophagus. d. It reduces the risk of aspiration.

ANS: B Cricoid pressure (also known as the Sellick maneuver) (Fig. 15.8) is applied with the thumb and index finger to the cricoid cartilage, gently compressing the esophagus downward against the cervical vertebrae in an effort to prevent gastric contents from entering the trachea and lungs.

DIF: 3 REF: 206 TOP: AST Core Curriculum V:E:3, endotracheal intubation 14. Which statement is not true of laryngeal masked airway (LMA)? a. Administering muscle relaxants is required. b. It is a reusable airway. c. It is contraindicated for patients with history of gastroesophageal reflux disease (GERD). d. It may be used for certain ambulatory procedures.

ANS: A The LMA, which does not require laryngoscopy or muscle relaxation, is particularly useful for ambulatory surgical procedures.

DIF: 2 REF: 210 TOP: AST Core Curriculum V:E:2, laryngeal masked airway 15. Where does the recovery phase take place? a. Surgical unit b. PACU c. Patient’s room d. Patient’s home ANS: B When vital signs are stable, the patient is carefully moved to a transport stretcher and taken to the PACU for the recovery phase. The anesthesia provider provides a detailed report to the PACU staff nurses, who closely monitor the patient during the recovery phase.

DIF:

1

REF: 211

TOP: AST Core Curriculum V:G:4, recovery

16. The patient is most prone to agitation and excitement in which phase of anesthesia? a. Preinduction b. Induction c. Maintenance d. Recovery ANS: B The patient may experience a period of agitation or excitement during induction.

DIF:

3

REF: 206

TOP: AST Core Curriculum V:G:1, induction

17. The anesthesia technique that uses both inhalation and intravenous agents is called a. monitored anesthesia care (MAC). b. LMA. c. combination anesthesia. d. balanced anesthesia.

139

ANS: D The term balanced anesthesia refers to the technique that uses a combination of inhalation and intravenous agents to accomplish general anesthesia.

DIF:

1

REF: 211

TOP: AST Core Curriculum V:G:1, induction

18. Ultra–short-acting intravenous anesthesia agents administered during the induction phase are a. analgesics. b. barbiturates. c. desflurane. d. neuromuscular blocking agents.

ANS: B Barbiturates are ultra–short-acting hypnotic agents derived from barbituric acid.

Before the development of propofol (Diprivan), the most frequently used induction agents were barbiturates.

DIF:

2

REF: 211

TOP: AST Core Curriculum V:I:2:d, propofol

19. Which statement is not true of Pentothal? a. It is the most commonly used barbiturate. b. It is rapidly processed by the brain. c. It is an effective analgesic. d. The generic form is thiopental.

ANS: C Barbiturates induce anesthesia, but they have no analgesic effect.

DIF:

2

REF: 211

TOP: AST Core Curriculum V:I:2:b, thiopental

20. Which statement is not true of benzodiazepines? a. The most commonly used benzodiazepine in surgery is midazolam. b. They are exclusively used in surgery. c. They have both sedative and amnesiac effects. d. They provide no analgesic effect.

ANS: B Benzodiazepines, which have both sedative and amnesiac effects, are used preoperatively and occasionally as induction agents in combination with other agents.

Benzodiazepines include midazolam (Versed), diazepam (Valium), and lorazepam (Ativan), and lorazepam is used to treat anxiety.

DIF:

2

REF: 211

TOP: AST Core Curriculum V:I:2:a, benzodiazepines

21. Which statement is not true of ketamine? a. It is chemically related to phencyclidine (PCP). b. It is an effective analgesic and amnesiac agent. c. It is available under the trade name Ketalar. d. It is best used for procedures of long duration.

ANS: D Ketamine is not commonly used for maintenance of anesthesia but may be used for superficial procedures of short duration, such as painful dressing changes, debridement, or skin grafts.

140

DIF:

2

REF: 211

TOP: AST Core Curriculum V:I:2:f:(1), ketamine

22. Which drug is a barbiturate? a. Versed b. Valium c. Brevital d. Ativan ANS: C Barbiturates include 2.5% thiopental (Pentothal) and 1% methohexital (Brevital).

DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:b, thiopental | AST Core Curriculum V:I:2:c, methohexital 23. Which drug is a not a benzodiazepine? a. Pentothal b. Versed c. Valium d. Ativan ANS: A Benzodiazepines include midazolam (Versed), diazepam (Valium), and lorazepam (Ativan).

DIF:

1

REF: 211

TOP: AST Core Curriculum V:I:2:b, thiopental

24. Which drug is best used for superficial procedures of short duration such as skin grafts? a. Versed b. Brevital c. Ativan d. Ketalar ANS: D Ketamine (Ketalar) is not commonly used for maintenance of anesthesia but may be used for superficial procedures of short duration, such as painful dressing changes, debridement, or skin grafts.

DIF:

3

REF: 211

TOP: AST Core Curriculum V:I:2:f:(1), ketamine

25. Which drug is used for patients with hypovolemic trauma or short procedures on patients with compromised cardiac function, or both? a. Diprivan b. Amidate c. Ativan d. Ketalar ANS: B Etomidate (Amidate) is a hypnotic agent that is often used for patients with compromised myocardial contractility who cannot tolerate the myocardial depression often observed with other induction agents. It is particularly useful for induction in patients with trauma who may be hypovolemic and therefore unable to tolerate any additional hypotension.

DIF:

3

REF: 211

TOP: AST Core Curriculum V:I:2:e, etomidate

141

26. Which class of drugs is used for its analgesic effect? a. Opioids b. Barbiturates c. Neuromuscular blocking agents d. Induction agents ANS: A The most common analgesic agents administered for anesthesia are classified as opioids.

DIF:

2

REF: 212

TOP: AST Core Curriculum IV:B, analgesics

27. Analgesics are administered during which phase of general anesthesia? a. Emergence b. Recovery c. Maintenance d. Induction ANS: C Analgesic agents are given during the maintenance phase of general anesthesia to prevent pain during surgery.

DIF:

3

REF: 212

TOP: AST Core Curriculum V:G:2, maintenance

28. Which statement is not true of propofol? a. It is a hypnotic agent. b. It has a milky color and must be handled using aseptic technique because it has no antimicrobial preservatives. c. It is available under the trade name Diprivan. d. Patients may experience hallucinations through the emergence phase of anesthesia.

ANS: D Propofol (Diprivan) is a hypnotic agent with a characteristic milky white appearance.

Strict aseptic technique must be maintained when handling propofol because it contains no antimicrobial preservatives and can support rapid growth of microorganisms.

DIF:

2

REF: 211-212 TOP: AST Core Curriculum V:I:2:d, propofol

29. Which drug is not an opioid? a. Fentanyl b. Morphine c. Propofol d. Sublimaze ANS: C Natural opioids are morphine and codeine. Synthetic opioids used for anesthesia are fentanyl (Sublimaze), alfentanil (Alfenta), sufentanil (Sufenta), and remifentanil (Ultiva). Propofol is chemically unrelated to any other anesthetic agent and is not an opioid.

DIF:

2

REF: 212

TOP: AST Core Curriculum V:I:2:d, propofol

30. Fentanyl is available under what trade name? a. Alfenta b. Sufenta c. Fluothane 142

d. Sublimaze

ANS: D Synthetic opioids used for anesthesia include fentanyl (Sublimaze).

DIF:

2

REF: 212

TOP: AST Core Curriculum IV:B:2:b, fentanyl

31. Which statement is not true of fentanyl? a. It is 100 times more potent than morphine. b. It can only be used in combination with other anesthetic agents. c. It is 5 to 10 times less potent than Sufenta. d. It has a rapid onset of approximately 30 seconds.

ANS: B Fentanyl can be used alone. Fentanyl is 100 times more potent than morphine. This drug has a rapid onset, approximately 30 seconds, with a duration of 20 to 40 minutes. Fentanyl provides analgesia plus some sedation. When used as the sole induction agent, the dose is 30 to 100 g/kg of body weight. When used in addition to other agents, the dose is 1 to 10 g/kg. Sufentanil is 5 to 10 times more potent than fentanyl.

DIF:

3

REF: 213

TOP: AST Core Curriculum IV:B:2:b, fentanyl

32. Which opioid has an onset time greater than 30 seconds? a. Alfenta b. Sufenta c. Ultiva d. Sublimaze ANS: C Remifentanil (Ultiva) is the newest ultra–short-acting opioid and is 20 to 40 times more potent than alfentanil. Onset of effects occurs in 1 to 3 minutes, but duration is only 5 to 10 minutes.

DIF:

3

REF: 213

TOP: AST Core Curriculum IV:B:2:e, remifentanyl

33. Of the following early inhalation agents, which one is still in use? a. Ether b. Chloroform c. Cyclopropane d. Nitrous oxide ANS: D The first inhalation anesthetics used were ether, chloroform, nitrous oxide, and cyclopropane. Of these, only nitrous oxide gas is in use currently.

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1:b, nitrous oxide

34. Which statement does not apply to inhalation agents? a. They are difficult to control. b. They are eliminated easily from the body. c. They have the potential for cardiovascular depression. d. They are easy to administer.

ANS: A Inhalation anesthetics are quickly eliminated from the body, most through the 143

pulmonary, hepatic, and renal systems. The disadvantages of inhalation agents include an increased potential for cardiovascular depression and a lack of postoperative analgesia. The vaporizer turns the liquid agent into a gas that is relatively easy to administer via a breathing mask, an LMA, or an ET tube.

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1, inhalation

35. Sevoflurane is marketed under what trade name? a. Fluothane b. Forane c. Suprane d. Ultane ANS: D The three most common volatile liquid anesthetics are isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane).

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1:e, sevoflurane

36. Isoflurane is marketed under what trade name? a. Fluothane b. Forane c. Suprane d. Sevoflurane ANS: B The three most common volatile liquid anesthetics are isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane).

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1:c, isoflurane

37. Desflurane is marketed under what trade name? a. Sevoflurane b. Forane c. Suprane d. Ethrane ANS: C The three most common volatile liquid anesthetics are isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane).

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1:d, desflurane

38. Each one of the following inhalation agents, either alone or in combination with succinylcholine, is considered a triggering agent for malignant hyperthermia except a. sevoflurane. b. isoflurane. c. nitrous oxide. d. desflurane.

ANS: C Inhalation anesthetic agents (except for nitrous oxide), either alone or in combination with succinylcholine (Anectine)), have been identified as triggering agents of a rare but life-threatening condition called malignant hyperthermia (see Chapter 16).

DIF:

2

REF: 214

TOP: AST Core Curriculum V:I:1:b, nitrous oxide 144

39. Which inhalation agent is a gas, not a vapor? a. Enflurane b. Isoflurane c. Desflurane d. Nitrous oxide ANS: D Nitrous oxide is a colorless, odorless, tasteless gas and one of the most widely used inhalation anesthetics in clinical practice.

DIF:

1

REF: 214

TOP: AST Core Curriculum V:I:1:b, nitrous oxide

40. Which group of drugs is given to facilitate intubation, as well as provide better surgical exposure during abdominal procedures? a. Opioids b. Muscle relaxants c. Tranquilizers d. Analgesics ANS: B Agents categorized as neuromuscular blockers are administered to relax skeletal muscles for intubation and surgery. Patients under general anesthesia may be unconscious, pain free, and memory free, but their skeletal muscles continue to respond to stimuli. To receive an ET tube, the patient must be adequately relaxed—that is, the muscles must be relaxed. During some surgical procedures, especially in the abdomen, the patient’s muscles must be relaxed to facilitate exposure of the surgical site.

DIF: 2 REF: 214 TOP: AST Core Curriculum V:I:3, neuromuscular blocking agents 41. What was the first muscle relaxant used in surgery? a. Cocaine b. Opium c. Purple foxglove d. Curare ANS: D The first muscle relaxant, tubocurarine chloride (Curare) is also nondepolarizing (see Insight 15.7).

DIF:

3

REF: 215

TOP: AST Core Curriculum V:I:3:b, non-depolarizing

42. What is the neurotransmitter that is released at neuromuscular synapses to stimulate the release of calcium ions? a. Acetylcholine antagonists b. Acetylcholinesterase c. Acetylcholine d. Succinylcholine ANS: C The neurotransmitter at the neuromuscular junction is acetylcholine (ACH). When ACh is released from the axon, it diffuses across the synapse (synaptic cleft) and binds to receptor sites on the cell membrane of the muscle fiber (sarcolemma). Acetylcholine causes a wave of depolarization to spread across the muscle fiber to T-tubules, which conduct the wave of depolarization deep into the muscle fibers. As a result of the spreading wave of depolarization, calcium is released from its storage sites within the 145

sarcoplasmic reticulum.

DIF: 3 REF: 214 TOP: AST Core Curriculum V:I:3, neuromuscular blocking agents 43. Depolarization means a. muscle contraction. b. muscle relaxation. c. fasciculation. d. prevention of muscle contraction.

ANS: A Depolarizing muscle relaxants act similar to ACh; they bind with receptor sites and initiate a contraction (depolarization).

DIF:

1

REF: 214

TOP: AST Core Curriculum V:I:3:a, depolarizing

44. Small, involuntary muscle twitches just under the skin are known as a. minimum alveolar concentrations. b. fasciculations. c. depolarization. d. nondepolarization.

ANS: B Fasciculations are small involuntary muscle twitches just under the skin.

DIF:

1

REF: 214

TOP: AST Core Curriculum V:I:3:a, depolarizing

45. Which agent is the only depolarizing muscle relaxant presently in use? a. Pancuronium b. Atracurium c. Mivacurium d. Succinylcholine ANS: D Succinylcholine (Anectine) is the only depolarizing muscle relaxant in use.

DIF:

2

REF: 214

TOP: AST Core Curriculum V:I:3:a:(1), succinylcholine

46. Which muscle relaxant produces fasciculations, followed by flaccidity? a. Pancuronium b. Atracurium c. Mivacurium d. Succinylcholine ANS: D Succinylcholine causes persistent depolarization and produces fasciculations, followed by flaccidity.

DIF:

2

REF: 214

TOP: AST Core Curriculum V:I:3:a:(1), succinylcholine

47. Which is not an adverse effect associated with succinylcholine? a. Increased intragastric pressure b. Increased potential for regurgitation and aspiration c. Decreased intracranial pressure d. Postoperative muscle pain 146

ANS: C Some adverse effects associated with the administration of succinylcholine include increased intracranial pressure, increased intraocular pressure, increased intragastric pressure (which increases the potential for regurgitation), and postoperative muscle soreness.

DIF:

3

REF: 214

TOP: AST Core Curriculum V:I:3:a:(1), succinylcholine

48. Which condition is not an adverse effect associated with nondepolarizing muscle relaxants? a. Tachycardia or bradycardia b. Cardiac arrhythmias c. Elevated serum potassium in burn patients d. Hypertension or hypotension ANS: C Adverse effects of nondepolarizing muscle relaxants on the cardiovascular system include hypotension or hypertension, tachycardia, bradycardia, and arrhythmias.

DIF:

3

REF: 216

TOP: AST Core Curriculum V:I:3:b, non-depolarizing

49. Which muscle relaxant has no reversal agent and must be allowed to wear off? a. Anectine b. Pavulon c. Norcuron d. Tracrium ANS: A Because no antagonist or reversal agent is currently available, succinylcholine (Anectine) must be allowed to wear off.

DIF:

2

REF: 214

TOP: AST Core Curriculum V:I:3:a:(1), succinylcholine

50. The effect of nondepolarizing muscle relaxants can be reversed by using a. Anectine. b. Prostigmin. c. Mivacron. d. Tracrium.

ANS: B Nondepolarizing muscle relaxants may be reversed if necessary with an antagonist such as neostigmine (Prostigmin).

DIF:

3

REF: 216

TOP: AST Core Curriculum V:I:4:b, neostigmine

51. What is the trade name for pancuronium bromide? a. Pavulon b. Norcuron c. Prostigmin d. Anectine ANS: A Several nondepolarizing muscle relaxants are categorized as long, intermediate, and short acting. These agents include pancuronium bromide (Pavulon).

DIF:

2

REF: 215

TOP: AST Core Curriculum V:I:3:b:(4), pancuronium 147

52. What is the trade name for naloxone? a. Mazicon b. Norcuron c. Narcan d. Mivacron ANS: C Naloxone (Narcan), nalmefene (Revex), and naltrexone (ReVia, Trexan) are used to reverse opioid analgesics, if necessary.

DIF:

2

REF: 216

TOP: AST Core Curriculum V:I:6:a:(1), naloxone

53. Opioids are reversed using a. Mazicon. b. Norcuron. c. Narcan. d. Prostigmin.

ANS: C Naloxone (Narcan), nalmefene (Revex), and naltrexone (ReVia, Trexan) are used to reverse opioid analgesics, if necessary.

DIF:

3

REF: 216

TOP: AST Core Curriculum V:I:6:a:(1), naloxone

54. Benzodiazepines are reversed using a. Mazicon. b. Norcuron. c. Narcan. d. Prostigmin.

ANS: A Benzodiazepines may be reversed with flumazenil (Mazicon).

DIF:

3

REF: 216

TOP: AST Core Curriculum V:I:6:b:(1), flumazenil

55. What patient factor does not influence the selection of general anesthesia? a. Patient age b. Patient preference c. Cognitive ability d. Length of hospital stay ANS: D Patient factors that influence the selection of general anesthesia include patient age, cognitive ability, mental or emotional state, and patient preference.

DIF:

1

REF: 203

TOP: AST Core Curriculum II:B, patient factors

56. Which age group is never a candidate for regional or local anesthesia? a. Geriatric b. Pediatric c. Adult d. Adolescent ANS: B Patient age is a primary consideration in that children are almost never candidates for regional or local anesthesia, regardless of the surgical procedure being performed.

148

DIF:

2

REF: 203

TOP: AST Core Curriculum II:B:1, age

57. In the preanesthesia era, surgery was based on a. speed. b. luck. c. skill. d. shock.

ANS: A In the preanesthesia era, surgery was based on speed.

DIF: 2 REF: 204 TOP: AST Core Curriculum II:A, American Society of Anesthesiologists determination 58. What equipment is a part of the anesthesia workstation? a. Back table b. OR table c. Vaporizer d. Kick bucket ANS: C Components of an anesthesia workstation include manual and automatic ventilation systems, breathing circuits, oxygen and nitrous oxide (N2O) central pipeline hoses and backup tanks, vaporizers (for volatile gases), pressure regulators and gas-mixing components, and gas-scavenging systems.

DIF:

1

REF: 204

TOP: AST Core Curriculum V:D:1, vaporizer

59. A supraglottic airway is also known as a(n) a. ET tube. b. LMA. c. McGill Forcep. d. mask.

ANS: B In select patients, the airway may be managed with a laryngeal masked airway (LMA) also known as a supraglottic airway.

DIF: 1 REF: 206 TOP: AST Core Curriculum V:E:2, laryngeal masked airway

60. Which structure is encountered when placing an ET tube? a. Trachea b. Esophagus c. Stomach d. Lung ANS: A When the patient is adequately relaxed to suppress the laryngeal reflex, an ET tube is inserted past the epiglottis, through the vocal cords, and into the trachea under direct visualization with an intubating laryngoscope.

DIF: 2 REF: 207 TOP: AST Core Curriculum V:E:3, endotracheal intubation 149

61. Which is an example of a video laryngoscope? a. Macintosh b. Miller c. McGrath d. McGill ANS: C Examples of video laryngoscopes include the GlideScope, C-MAC, and McGrath.

DIF:

2

REF: 208

TOP: AST Core Curriculum V:F:1, laryngoscope

62. Nasal intubation may be useful for a(n) procedure. a. abdominal b. oral c. orthopedic d. thoracic ANS: B Nasal intubation may be used for particular surgical procedures performed in the oral cavity, such as repair of mandibular fractures, when the presence of the ET tube in the mouth may not be desirable.

DIF:

2

REF: 208

TOP: AST Core Curriculum V:F:5, nasal airway

63. A surgical patient, who is morbidly obese and has a history of GERD, may be intubated by using a. fiberoptic endotracheal intubation. b. nasal intubation. c. a laryngeal masked airway. d. an endotracheal tube.

ANS: A If the preoperative evaluation indicates a potential significant problem for ventilation and intubation (difficult airway), the patient may be intubated prior to induction using fiberoptic endotracheal intubation. This technique is reserved for patients with specific conditions such as morbid obesity, a history of difficult intubation, facial deformities, laryngeal cancer, unstable cervical spine fractures, or other conditions that may compromise the airway.

DIF: 3 REF: 208 TOP: AST Core Curriculum V:E:3, endotracheal intubation 64. Which type of surgical patient is at risk for being aware under anesthesia? a. Patients with acute pain b. Trauma patients c. Mentally challenged patients d. Patients with allergies ANS: B Patients who are hemodynamically unstable (such as trauma patients) are also at greater risk for awareness under anesthesia, as well as those undergoing cardiac and emergency obstetric procedures.

DIF:

2

REF: 209

TOP: AST Core Curriculum V:G:2, maintenance

MATCHING 150

Match the following medications with the correct categories.

Barbiturate b. Depolarizing muscle relaxant c. Hypnotic agent d. Inhalation anesthetic e. Nondepolarizing muscle relaxant f. Opioid analgesic g. Reversal agent h. Sedative a.

Alfentanil (Alfenta) 2. Atracurium besylate (Tracrium) 3. Desflurane (Suprane) 4. Diazepam (Valium) 5. Edrophonium (Tensilon) 6. Etomidate (Amidate) 7. Succinylcholine (Anectine) 1.

8.

Thiopental (Pentothal)

ANS: F DIF: 1 REF: 212 TOP: AST Core Curriculum IV:B:2:d, alfentanil 2. ANS: E DIF: 1 REF: 215 TOP: AST Core Curriculum V:I:3:b, non-depolarizing 3. ANS: D DIF: 1 REF: 213 TOP: AST Core Curriculum V:I:1:d, desflurane 4. ANS: H DIF: 1 REF: 211 TOP: AST Core Curriculum IV:A:1, diazepam 5. ANS: G DIF: 1 REF: 216 TOP: AST Core Curriculum V:I:4:a, edrophonium 6. ANS: C DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:e, etomidate 7. ANS: B DIF: 1 REF: 214 TOP: AST Core Curriculum V:I:3:a:(1), succinylcholine 8. ANS: A DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:b, thiopental 1.

Match the following medications with the correct categories.

Barbiturate b. Hypnotic agent c. Inhalation anesthetic d. Nondepolarizing muscle relaxant e. Opioid analgesic f. Reversal agent g. Sedative a.

151

Flumazenil (Mazicon) Isoflurane (Forane) 11. Ketamine (Ketalar) 12. Methohexital (Brevital) 13. Midazolam (Versed) 14. Mivacurium chloride (Mivacron) 15. Fentanyl (Sublimaze) 9.

10.

9. ANS: F

DIF: 1 REF: 216 TOP: AST Core Curriculum V:I:6:b:(1), flumazenil 10. ANS: C DIF: 1 REF: 213 TOP: AST Core Curriculum V:I:1:c, isoflurane 11. ANS: B DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:f:(1), ketamine 12. ANS: A DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:c, methohexital 13. ANS: G DIF: 1 REF: 211 TOP: AST Core Curriculum IV:A:3, midazolam 14. ANS: D DIF: 1 REF: 215 TOP: AST Core Curriculum V:I:3:b, non-depolarizing 15. ANS: E DIF: 1 REF: 212 TOP: AST Core Curriculum IV:B:2:b, fentanyl Match the following medications with the correct categories. a. Hypnotic agent b. Inhalation anesthetic c. Nondepolarizing muscle relaxant d. Reversal agent e. Sedative 16. Naloxone (Narcan) 17. Pancuronium bromide (Pavulon) 18. Propofol (Diprivan) 19. Sevoflurane (Ultane) 20. Lorazepam (Ativan) 16. ANS: D

DIF: 1 REF: 216 TOP: AST Core Curriculum V:I:6:a:(1), naloxone 17. ANS: C DIF: 1 REF: 215 TOP: AST Core Curriculum V:I:3:b:(4), pancuronium 18. ANS: A DIF: 1 REF: 211 TOP: AST Core Curriculum V:I:2:d, propofol 19. ANS: B DIF: 1 REF: 214 TOP: AST Core Curriculum V:I:1:e, sevoflurane 20. ANS: E DIF: 1 REF: 211 TOP: AST Core Curriculum IV:A:2, lorazepam 152

TRUE/FALSE 1. General anesthesia may be accomplished by administering inhalation or intravenous

drugs, or both.

ANS: T Two methods, or routes, are used to administer general anesthetic agents: inhalation and intravenous injection. The term balanced anesthesia refers to the technique that uses a combination of inhalation and intravenous agents to accomplish general anesthesia.

DIF:

2

REF: 211

TOP: AST Core Curriculum V:G:1, induction

2. Analgesics are used in surgery to reduce the necessary amount of anesthesia drugs.

ANS: T Analgesic agents are given during maintenance of general anesthesia to prevent pain during surgery. If adequate pain control is achieved, the amount of other anesthetic agents required may be reduced.

DIF:

2

REF: 212

TOP: AST Core Curriculum IV:B, analgesics

3. Inhalation agents enter the bloodstream from the inhaled air through the alveoli in the

lungs.

ANS: T Inhalation agents, which are measured by the percentage of vapor present in the mixture the patient inhales, diffuse into the blood from the air in the alveoli and then rapidly diffuse out of the blood and into the brain—the site of action.

DIF:

2

REF: 213

TOP: AST Core Curriculum V:I:1, inhalation

153

Chapter 15: Emergency Situations Howe: Pharmacology for the Surgical Technologist, 6th Edition MULTIPLE CHOICE 1. A severe and potentially lethal allergic reaction to a medication marked by hives, dyspnea, circulatory collapse, and severe bronchospasm is known as a. chronic obstructive pulmonary disease. b. cyanosis. c. anaphylaxis. d. fulminant hypermetabolic crisis.

ANS: C Allergic reactions range from mild signs such as urticaria (hives or raised skin patches) to severe cardiovascular and respiratory problems indicating anaphylaxis. Respiratory symptoms include bronchospasm, dyspnea (labored breathing), tachypnea (rapid breathing), respiratory obstruction, and laryngeal edema. Anaphylactic shock is a complete cardiovascular collapse, which occurs rapidly and may include cardiac and respiratory arrest.

DIF:

2

REF: 220

TOP: AST Core Curriculum VII:F:2, cardiogenic

2. Which medication is administered intravenously as soon as allergic reaction is confirmed? a. Benadryl b. Epinephrine c. Anectine d. Digoxin ANS: B If early signs of a mild allergic reaction appear, potentially triggering medications being administered are discontinued, 100% oxygen is administered, infusions of IV fluids are increased, and a dose of epinephrine may be administered.

DIF:

2

REF: 220

TOP: AST Core Curriculum VII:A, allergic reaction

3. Which medication(s) is(are) given to treat a febrile nonhemolytic transfusion reaction to incompatible blood? a. Epinephrine hydrochloride b. Antipyretics c. Succinylcholine d. Xylocaine and Levophed ANS: B Febrile nonhemolytic reaction is caused by antibodies binding to donor white blood cells (WBCs) or platelets and is rarely seen during surgery. It is characterized by a temperature increase of 1° C and is usually treated with antipyretic agents, such as acetaminophen.

DIF: 3 REF: 222 TOP: AST Core Curriculum XIII:A:2, analgesic antipyretic agents

154

4. Why might lidocaine be administered in the management of cardiac arrest? a. To treat metabolic acidosis b. To reverse bronchospasm c. To treat ventricular arrhythmias d. To treat angina ANS: C Additional medications that may be administered during cardiac arrest, including antidysrhythmic agents amiodarone (Cordarone) and lidocaine (Xylocaine). These agents are used in an effort to restore normal cardiac rhythm in patients with ventricular tachycardia or ventricular fibrillation.

DIF:

3

REF: 225

TOP: AST Core Curriculum VII:H, cardiac arrest

5. Which statement does not apply to malignant hyperthermia (MH)? a. MH is triggered by succinylcholine and nitrous oxide. b. Increase in end-tidal carbon dioxide is an early sign. c. Pyrexia is a late sign of MH. d. Patient may die within 15 minutes if not promptly treated.

ANS: A Agents known to trigger this disease are succinylcholine (Anectine) and all inhalation anesthetics except nitrous oxide.

DIF: 2 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia 6. Which intervention is not one of the treatment steps for MH? a. Slow ventilation b. Administration of Dantrolene c. Intravenous (IV) administration of sodium bicarbonate d. Application of ice packs ANS: A The patient is hyperventilated with 100% oxygen to help eliminate the excess carbon dioxide that accumulates in the blood.

DIF: 3 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia

7. Measurement of inspired and expired carbon dioxide concentrations is a. urticaria. b. capnography. c. pyrexia. d. desaturation.

ANS: B Capnography is used to measure carbon dioxide (review from Chapter 14).

DIF:

1

REF: 224

TOP: AST Core Curriculum V:B:8, capnography

155

8. Rapid IV administration of a concentrated dose of medication is known as a a. bolus. b. shot. c. rush. d. push.

ANS: A The term bolus is used to describe a rapid IV dose of a medication.

DIF:

1

REF: 221

TOP: AST Core Curriculum XI:H:1:a, IV

9. Cardiac arrhythmias are often observed in surgical patients with imbalances of a. sodium. b. potassium. c. calcium. d. phosphate.

ANS: B Cardiac arrest may be attributed to several causes. For example, some anesthetic agents can cause cardiac irritability or arrhythmias; in other cases, the patient may have an existing condition, such as cardiac disease, low-serum potassium, or hypovolemia that might precipitate a cardiac arrest.

DIF:

3

REF: 223

TOP: AST Core Curriculum VII:G, cardiac dysrhythmias

10. Which medication is administered intravenously for anaphylaxis when it occurs under general anesthesia? a. Albuterol b. Sodium bicarbonate c. Benadryl d. Dopamine ANS: D Under general anesthesia, however, hypotension is the first sign of anaphylaxis usually noted. Hypotension is treated with IV fluids, and medications used to raise blood pressure (vasopressor or inotropic agents) are administered as needed.

Vasopressor agents include dopamine (Intropin) and dobutamine (Dobutrex).

DIF:

3

REF: 221

TOP: AST Core Curriculum VII:F, shock

11. Which agent may be used as a bronchodilator? a. Epinephrine (Adrenalin) b. Dantrolene sodium (Dantrium) c. Digoxin (Lanoxin) d. Lidocaine (Xylocaine) ANS: A Epinephrine (Adrenalin) is a hormone (see Chapter 8) that may be aerosolized through the endotracheal tube (ET) or given subcutaneously for bronchospasm.

DIF:

2

REF: 222

TOP: AST Core Curriculum VII:D, bronchospasm

12. Which condition is a late sign of MH? a. Muscle rigidity b. Pyrexia c. Tachycardia d. Tachypnea 156

ANS: B Contrary to popular belief, pyrexia (rapid increase in body temperature) is not an early indicator of MH (Box 16.2) – it is a late sign. A significant rise in patient temperature indicates that a full crisis is in effect.

DIF: 2 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia

13. Which medication must be reconstituted before using? a. Epinephrine (Adrenalin) b. Dantrolene sodium (Dantrium) c. Digoxin (Lanoxin) d. Lidocaine (Xylocaine) ANS: B Dantrolene is packaged and freeze-dried in vials of 20 mg with 3 g of mannitol and must be reconstituted with 60 mL of sterile water.

DIF: 2 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia 14. Which medication would be used to manage laryngospasm with oxygen desaturation after extubation? a. Benadryl b. Potassium c. Albuterol d. Succinylcholine ANS: D If the spasm does not respond to positive pressure ventilation, and pulse oximetry shows oxygen desaturation, a 0.1 to 2 mg/kg dose of the depolarizing muscle relaxant succinylcholine will be administered intravenously.

DIF:

3

REF: 223

TOP: AST Core Curriculum VII:C, laryngospasm

15. Which task is the primary responsibility of the surgical technologist in the scrub role during an intraoperative cardiac arrest that occurs on the day shift? a. Obtain crash cart. b. Close the wound. c. Maintain the sterile field. d. Activate internal defibrillator paddles.

ANS: C In the scrub role, the surgical technologist may remain sterile to cover the wound if necessary or prepare the internal defibrillator paddles for use.

DIF:

3

REF: 224

TOP: AST Core Curriculum VII:H, cardiac arrest

16. During an MH crisis, the surgical technologist might perform each one of the following tasks except a. administer Dantrium. b. obtain the MH cart. c. notify the supervising anesthesiologist. d. send for ice.

ANS: A 157

If additional help is not available (as seen when performing emergency on-call procedures), it may become necessary for the scrubbed surgical technologist to break scrub and help reconstitute dantrolene as directed by the anesthesia provider, but surgical technologists are not authorized to administer medications.

DIF: 2 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia 17. All of the following medications may be the cause to frequent allergic reactions, except a. succinylcholine. b. penicillin. c. morphine. d. epinephrine.

ANS: D Medications that cause the most frequent allergic reactions include neuromuscular blockers such as succinylcholine, antibiotics such as penicillin and cephalosporins, iodine-based contrast media, morphine, and meperidine.

DIF:

1

REF: 221

TOP: AST Core Curriculum VII:A, allergic reaction

18. In a hemolytic transfusion reaction, which agent would be used to treat hypotension? a. Mannitol b. Benadryl c. Epinephrine d. Dopamine ANS: D Hemolytic transfusion reactions are first treated by discontinuation of blood products, followed by control of hypotension. Medications used to raise blood pressure (vasopressors and/or inotropic agents) are administered as needed.

Vasopressor agents include dopamine and phenylephrine.

DIF: 2 REF: 22 TOP: AST Core Curriculum XIII:A:9:b, donated blood products

19. Impaired breathing due to constriction and inflammation of the bronchi is known as a. bronchospasm. b. laryngospasm. c. anaphylaxis. d. malignant hyperthermia.

ANS: A Bronchospasm is defined as impaired breathing from constriction and inflammation of the bronchi.

DIF:

1

REF: 222

TOP: AST Core Curriculum VII:D, bronchospasm

20. The most common cause of mechanical bronchospasm is a. irritation due to intubation. b. loss of cardiac function. c. receiving succinylcholine. d. dyspnea.

158

ANS: A Acute bronchospasm can be triggered by chemical or mechanical irritation, the most common of which is tracheal irritation caused during intubation (also known as reflex bronchospasm).

DIF:

1

REF: 222

TOP: AST Core Curriculum VII:D, bronchospasm

21. Which drug is useful in treating bronchospasm? a. Dantrolene b. Lidocaine c. Albuterol d. Atropine ANS: C Several different categories of medications may be used to treat bronchospasm. A group of drugs called -adrenergic agonists are particularly effective. Albuterol may be aerosolized (nebulized) and administered via the ET tube.

DIF:

1

REF: 222

TOP: AST Core Curriculum VII:D, bronchospasm

22. Which level of CPR should a surgical technologist be certified in? a. Healthcare provider b. Heartsaver c. Family and friends d. ACLS ANS: A All surgical technologists must be certified in American Heart Association Basic Life Support (BLS) at the healthcare provider level.

DIF:

2

REF: 223

TOP: AST Core Curriculum VII:H, cardiac arrest

23. If an operation is in process, who may not administer cardiac compressions from the sterile field? a. Surgeon b. Anesthesia provider c. Surgical tech d. First assistant ANS: B If the operation is in progress, the surgeon, surgical first assistant, or surgical technologist may administer cardiac compressions from the sterile field. The anesthesia provider may not.

DIF:

2

REF: 223

TOP: AST Core Curriculum VII:H, cardiac arrest

24. Who can place the internal defibrillator paddles in direct contact with the heart during cardiac arrest? a. Anesthesia provider b. Surgical technologist c. Surgeon d. First assistant ANS: C If the thoracic cavity is open, sterile internal defibrillator paddles are opened, connected to the defibrillator, and placed by the surgeon into direct contact with the heart muscle.

159

DIF:

1

REF: 224

TOP: AST Core Curriculum VII:H, cardiac arrest

25. The first-line medications used to treat cardiac arrest are a. vasopressin and milrinone. b. dopamine and vasopressin. c. amiodarone and epinephrine. d. epinephrine and inotrope.

ANS: D The first-line pharmacologic treatment for cardiac arrest (also known as asystole— the absence of a heart beat) is epinephrine. Epinephrine is a hormone (see Chapter 8) that acts as a vasopressor (causes vasoconstriction and raises blood pressure) and inotrope to strengthen the force and rate of myocardial contractions (to improve coronary perfusion pressure and myocardial blood flow).

DIF: 1 REF: 224 TOP: AST Core Curriculum VII:H, cardiac arrest | AST Core Curriculum XIII:A:10:a, antiarrhythmics | AST Core Curriculum XIII:A:10:c, inotropic agents 26. The first-line treatment for ventricular fibrillation is a. epinephrine and vasopressin. b. epinephrine and amiodarone. c. epinephrine and inotrope. d. lidocaine and amiodarone.

ANS: A The first-line treatment for ventricular fibrillation and/or ventricular tachycardia (called V-fib/V-tach) is epinephrine and vasopressin.

DIF: 1 REF: 225 TOP: AST Core Curriculum XIII:A:10:a, antiarrhythmics MATCHING Match the following terms with the correct definitions. a. Abnormally rapid heart rate b. Bluish discoloration of the skin c. Cardiac standstill or arrest d. Concentrated amount of IV medication administered rapidly e. Febrile condition f. Increased metabolism g. Involuntary contraction of the smooth muscle of the bronchi h. Measurement of expired carbon dioxide i. Presence of free hemoglobin in the urine j. Profuse perspiration k. Reduction of oxygen saturation in the blood l. Slow heart rate m. Unusual or exaggerated allergic reaction n. Very rapid respirations 1. Anaphylaxis 2. Asystole 3. Bolus 4. Bradycardia 160

5. Bronchospasm 6. Capnography 7. Cyanosis 8. Desaturation 9. Diaphoresis 10. Hemoglobinuria 11. Pyrexia 12. Tachycardia 13. Tachypnea 1. ANS: M

DIF: 1 REF: 220 TOP: AST Core Curriculum VII:F, shock 2. ANS: C DIF: 1 REF: 224 TOP: AST Core Curriculum VII:H, cardiac arrest 3. ANS: D DIF: 1 REF: 227 TOP: AST Core Curriculum XI:H:1:a, IV 4. ANS: L DIF: 1 REF: 225 TOP: AST Core Curriculum V:B:7:d:(2), abnormal 5. ANS: G DIF: 1 REF: 222 TOP: AST Core Curriculum VII:D, bronchospasm 6. ANS: H DIF: 1 REF: 224 TOP: AST Core Curriculum V:B:8, capnography 7. ANS: B DIF: 1 REF: 227 TOP: AST Core Curriculum VII:H, cardiac arrest 8. ANS: K DIF: 1 REF: 222 TOP: AST Core Curriculum V:B:7:d:(2), abnormal 9. ANS: J DIF: 1 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia 10. ANS: I DIF: 1 REF: 222 TOP: AST Core Curriculum XIII:A:14, diuretics 11. ANS: E DIF: 1 REF: 227 TOP: AST Core Curriculum VII:E, malignant hyperthermia 12. ANS: A DIF: 1 REF: 225 TOP: AST Core Curriculum V:B:7:d:(2), abnormal 13. ANS: N DIF: 1 REF: 220 TOP: AST Core Curriculum V:B:9:d:(2), abnormal Match the following medications with the correct categories. a. Adrenergic agonist b. Alpha-adrenergic agonist c. Antiarrhythmic agent d. Anticholinergic e. Antihistamine f. Beta-adrenergic agonist g. Beta-adrenergic antagonist h. Calcium channel blocker i. Depolarizing muscle relaxant j. Hormone k. Inotropic agent l. Nitrovasodilator m. Skeletal muscle relaxant 14. Albuterol (Proventil, Ventolin) 15. Atropine (Atropine) 161

16. Dantrolene (Dantrium) 17. Digoxin (Lanoxin) 18. Diphenhydramine (Benadryl) 19. Dopamine (Intropin) 20. Epinephrine (Adrenalin) 21. Ipratropium (Atrovent) 22. Isoproterenol (Isuprel) 23. Labetalol (Normodyne) 24. Lidocaine (Xylocaine) 25. Nitroprusside (Nipride) 26. Phenylephrine (Neo-Synephrine) 27. Procainamide (Pronestyl) 28. Succinylcholine (Anectine) 29. Verapamil (Isoptin) 14. ANS: F

DIF: 2 REF: 226 TOP: AST Core Curriculum X:B:1:b, agonist 15. ANS: D DIF: 2 REF: 225 TOP: AST Core Curriculum IV:C, anti-cholinergics 16. ANS: M DIF: 2 REF: 227 TOP: AST Core Curriculum XIII:A:16:a, malignant hyperthermia 17. ANS: K DIF: 2 REF: 227 TOP: AST Core Curriculum XIII:A:10:c, inotropic agents 18. ANS: E DIF: 2 REF: 220 TOP: AST Core Curriculum XIII:A:5, antiemetics and antihistamines 19. ANS: A DIF: 2 REF: 225 TOP: AST Core Curriculum XIII:A:8:a, adrenergics (alpha and beta) 20. ANS: J DIF: 2 REF: 225 TOP: AST Core Curriculum XIII:A:18:a, corticosteroids 21. ANS: D DIF: 2 REF: 222 TOP: AST Core Curriculum IV:C, anti-cholinergics 22. ANS: F DIF: 2 REF: 225 TOP: AST Core Curriculum XIII:A:8:a, adrenergics (alpha and beta) 23. ANS: G DIF: 2 REF: 225 TOP: AST Core Curriculum XIII:A:8:b, adrenergic blockers 24. ANS: C DIF: 2 REF: 226 TOP: AST Core Curriculum XIII:A:10:a, antiarrhythmics 25. ANS: L DIF: 2 REF: 226 TOP: AST Core Curriculum XIII:A:10:b, coronary dilators 26. ANS: B DIF: 2 REF: 226 TOP: AST Core Curriculum XIII:A:8:a, adrenergics (alpha and beta) 27. ANS: C DIF: 2 REF: 226 TOP: AST Core Curriculum XIII:A:10:a, antiarrhythmics 28. ANS: I DIF: 2 REF: 221 TOP: AST Core Curriculum XIII:A:16:a, malignant hyperthermia 29. ANS: H DIF: 2 REF: 226 TOP: AST Core Curriculum XIII:A:10, cardiac medication

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