Chapter 4 Review Questions

1) Shivering can lead to ALL BUT ONE of the following. Indicate the exception:
a) Myocardial ischemia
b) Increased oxygen consumption
c) Decreased carbon dioxide production
d) Interference with monitor signal interpretation

2) Which ONE of the following statements about shivering is correct?
a) Shivering is a response controlled by the brainstem.
b) Shivering can occur in the absence of hypothermia.
c) Shivering is effectively treated with small doses of naloxone.
d) Shivering is an uncomfortable, though harmless, effect of anesthesia.

3) ALL BUT ONE of the following are used as intravenous antiemetics. Indicate the exception:
a) Prochlorperazine
b) Ranitidine
c) Dimenhydrinate
d) Dexamethasone

4) Which of the following is a risk factor for PONV?
a) History of gastroesophageal reflux
b) Smoking
c) Diabetes mellitus
d) Female gender

5) Which ONE of the following is part of a rational approach to post-operative nausea and vomiting?
a) All patients should receive pharmacologic prophylaxis.
b) Avoidance of anti-emetic anesthetic agents is an effective management strategy.
c) Prophylaxis must be given prior to induction of anesthesia for maximal effectiveness.
d) Dimenhydrinate remains the mainstay of PONV prevention and treatment.

6) Which ONE of the following is least likely to be the cause of hypertension in the PACU?
a) Pain
b) Airway obstruction
c) Prolonged spinal blockade
d) Full bladder

7) Which ONE of the following is a criteria that the patient must meet prior to transfer from the post-anesthetic care unit (PACU) to the ward?
a) Normal cognitive function
b) Adequate pain control
c) Ability to hold down food
d) Ability to weight-bear

8) You see a patient in the preoperative assessment clinic prior to her laparotomy for colon cancer. If the patient has an epidural inserted for post-operative pain, she is likely to experience ALL BUT ONE of the following. Indicate the exception.
a) Reduced adrenal activation
b) Hypertension
c) Improved respiratory function
d) Excellent post-operative pain control

9) Your patient’s most recent surgery was thirty years ago after which she received “conventional” nurse-administered opioid analgesia. For her upcoming lumbar spinal decompression and instrumentation, she will be receiving PCA (patient-controlled analgesia). The comparative advantages of PCA morphine include ALL BUT ONE of the following. Indicate the exception:
a) Less labor intensive for nurses
b) More opioid delivered to the patient
c) Improved patient satisfaction
d) Small doses at frequent intervals minimizing the pharmacokinetic “peaks” and “valleys”

10) ALL BUT ONE of the following is a relative contraindication to post-operative epidural analgesia. Indicate the exception:
a) Multiple sclerosis
b) Lumbar disc disease
c) Hypertrophic obstructive cardiomyopathy
d) Myasthenia gravis

Answers: 1c, 2b, 3c, 4d, 5b, 6c, 7b, 8b, 9b, 10b