NCLEX Practice Exam for Pharmacology: Anesthetic and Narcotic Medications

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. During surgery, there is an increased potential for arrhythmias when catecholamines are given with:

1. halothane (Fluothane)
2. digoxin (Lanoxin)
3. bupivacaine (Marcaine)
4. lidocaine (Xylocaine)

2. General anesthetics potentiate the effects of which of the following drugs?

1. Depolarizing agents
2. Skeletal muscle relaxants
3. Volatile liquids
4. Inhalation anesthetics

3. The most dangerous metabolic side effect of general anesthesia that can occur during surgery is:

1. Hyperglycemia
2. Hyperthermia
3. Hypoglycemia
4. Hypothermia

4. Mr. Baltazar will be undergoing surgery with general anesthesia. The client should be given which of the following instructions preoperatively?

1. Eat big breakfast
2. Expect to be incontinent of urine postoperatively
3. Double your medication doses
4. Expect nausea, vomiting, shivering, and pain postoperatively.

5. Geneva is reviewing for her upcoming quiz in Pharmacology. She should be aware that local and regional anesthesia act by:

1. Inhibiting depolarization.
2. Increasing depolarization.
3. Producing a semiconscious state.
4. Inhibiting motor movement.

6. Which of the following statements about shivering is correct?

1. Shivering is a response controlled by the brainstem.
2. Shivering can occur in the absence of hypothermia.
3. Shivering is effectively treated with small doses of naloxone.
4. Shivering is an uncomfortable, though harmless, effect of anesthesia.

7. Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the following. Indicate the exception:

1. Tinnitus
2. Perioral numbness
3. Dizziness
4. Hypertension

8. A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent:

1. anxiety.
2. bradycardia.
3. dry mouth.
4. hypertension.

9. The nurse teaching a client who will receive thiopental (Pentothal) as an anesthetic explains that what common adverse effects might occur?

1. Headache
2. Emergence delirium
3. Nausea and vomiting
4. Paralysis

10. A client received lidocaine viscous before a gastroscopy was performed. Following the procedure, the nurse places priority on what assessment?

1. Return of the gag reflex
2. Ability to urinate
3. Abdominal pain
4. Ability to stand

11. The nurse observes a co-worker preparing to administer a solution of lidocaine and epinephrine to a client with multiple premature ventricular contractions. The appropriate action by the nurse is to:

1. Offer to monitor the client’s heart rhythm.
2. Notify the supervisor of the error.
3. Do nothing; the drug choice is correct.
4. Prevent the administration, and give a plain lidocaine solution.

12. During induction of anesthesia, the nurse notes the client becomes hyperactive and physically resists the treatment. The nurse concludes what interventions are needed?

1. Anesthesia must be discontinued.
2. An intravenous drug will be given to calm the client.
3. Anesthesia must be discontinued.
4. The surgery will need to be rescheduled.

13. The nurse receives the client in the postanesthesia care unit (PACU) following a procedure requiring general anesthesia. The most important assessment made by the nurse relates to the client’s:

1. Level of consciousness.
2. Pain.
3. Vital signs.
4. Respiratory status.

14. Nurse Gretchen is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?

1. “Anesthetic effects develop slowly and persist for several hours.”
2. “Cocaine is a local anesthetic administered by injection.”
3. “Vasoconstrictors should not be used as adjunct agents with this drug.”
4. “When abused, cocaine causes physical dependence.”

15. The client asks the nurse to explain the action of infiltration anesthesia. The nurse’s response is based on the knowledge that infiltration anesthesia:

1.  Is applied only to mucous membranes to provide local anesthesia.
2. Blocks a specific group of nerves in tissues close to the operative area.
3. Blocks sensation to an entire limb, or a large area of the face.
4. Produces numbing to large, regional areas such as the lower abdomen and legs.

16. All narcotics, regardless of their origin, reduce pain by:

1. Stimulating opiate receptors
2. Promoting the release of excitatory transmitters
3. Releasing large quantities of endorphin
4. Blocking the mu receptors

17. In addition to analgesia, narcotic effects include:

1. Euphoria, diarrhea, increased respirations
2. Euphoria, miosis, nausea and vomiting
3. Respiratory depression, increased blood pressure
4. Dependence, seizures, muscle spasms

18. The half-life of morphine is:

1. 4 to 6 hours
2. 2 to 4 hours
3. 6 to 8 hours
4. 30 minutes to 1 hour

19. Which of the following statements about morphine is correct?

1. Morphine is contraindicated in pain relief caused by head injury.
2. Morphine’s withdrawal symptoms cannot be relieved by methadone.
3. Morphine is most effective by parenteral administration.
4. Morphine quickly enters all body tissues.

20. When administering codeine, the nurse should be aware that:

1. Codeine produces more sedation than other opiates.
2. Codeine causes diarrhea, so the client must take an additional drug to prevent this.
3. Codeine is very constipating.
4. Codeine is an antitussive in high doses.

Answers and Rationales

1. Answer: A. halothane (Fluothane). Arrhythmias are a result of an interaction that can occur with halothane and catecholamines. Other choices do not interact with halothane to cause arrhythmias.
2. Answer: B. Skeletal muscle relaxants. The effects of skeletal muscle relaxants are potentiated with the use of the general anesthetics. Depolarizing agents do not interact with general anesthetics. C and D are general anesthetics.
3. Answer: B. Hyperthermia. Malignant hyperthermia is the most dangerous metabolic side effect of general anesthesia.
4. Answer: D. Expect nausea, vomiting, shivering, and pain postoperatively. These responses should be expected, and the client should be prepared for them. Food is contraindicated before surgery. Urinary retention, not incontinence is likely. Medication is more likely to be held on the day of surgery.
5. Answer: A. Inhibiting depolarization. When local anesthesia is used, sensation is removed and the area anesthetized by inhibition of depolarization. Choice B is incorrect because the opposite is true. Choices C and D do not occur with local anesthesia.
6. Answer: B. Shivering can occur in the absence of hypothermia. Shivering can also appear after surgery. This is known as postanesthetic shivering.
7. Answer: D. Hypertension. Manifestations of local anesthetic toxicity typically appear 1-5 minutes after the injection, but onset may range from 30 seconds to as long as 60 minutes. Initial manifestations may also vary widely. Classically, patients experience symptoms of central nervous system (CNS) excitement such as the following: Circumoral and/or tongue numbness, metallic taste, lightheadedness, dizziness, visual and auditory disturbances (difficulty focusing and tinnitus), disorientation and drowsiness.
8. Answer: B. bradycardia. Atropine, an anticholinergic drug, is used as an adjunct to anesthesia to counter the effects of vagal stimulation, which is caused by surgical manipulations that trigger parasympathetic reflexes, resulting in bradycardia. Atropine is not an anxiolytic. Atropine causes dry mouth and sometimes is used to minimize bronchial secretions.
9. Answer: B. Emergence delirium. Emergence delirium could occur postoperatively, and is characterized by hallucinations, confusion, and excitability.
10. Answer: A. Return of the gag reflex. Because the throat is anesthetized, monitor the client for return of the gag reflex before drinking or eating.
11. Answer: D. Prevent the administration, and give a plain lidocaine solution. Solutions of lidocaine containing preservatives or epinephrine are intended for local anesthesia only, and must never be given IV for dysrhythmias.
12. Answer: B. An intravenous drug will be given to calm the client. Stage 2 is the stage of excitement and hyperactivity. Medications may be given IV to calm the client.
13. Answer: D. Respiratory status. General anesthesia causes relaxation of all muscles, including respiratory muscles, requiring mechanical ventilation. The client’s respiratory status must be monitored closely following general anesthesia.
14. Answer: C. “Vasoconstrictors should not be used as adjunct agents with this drug.” Cocaine should not be combined with epinephrine or other vasoconstrictors, because it causes vasoconstriction itself, and the combination could precipitate severe hypertension. Cocaine has a rapid onset of effects, which last about 1 hour. It is used only topically for anesthesia. Although subject to widespread abuse with profound psychological dependence, it does not cause substantial physical dependence.
15. Answer: B. Blocks a specific group of nerves in tissues close to the operative area. Infiltration anesthesia blocks a specific group of nerves close to the operative area by diffusion of a drug into the tissues. It is used to anesthetize small areas. Topical anesthetics are applied to mucous membranes. Nerve blocks provide anesthesia to a large surface area. Spinal anesthesia affects large, regional areas.
16. Answer: A. Stimulating opiate receptors. It is the stimulation of cerebral opiate receptors that reduces pain. Excitatory transmitters are not released during administration of morphine. Endorphin release is not associated with narcotic pain relief. The mu receptors mediate analgesia and are not blocked during narcotic administration.
17. Answer: B. Euphoria, miosis, nausea and vomiting. These are the effects that often occur with administration of narcotics. Constipation (not diarrhea) and decreased respirations (not increased) are noted during administration of narcotics. Decreased blood pressure results from narcotic administration. Narcotics do not cause the effects in choice D at all.
18. Answer: B. 2 to 4 hours. The half-life of morphine is 2 to 4 hours. Other choices are incorrect because they are either longer or shorter than the true half-life of morphine.
19. Answer: D. Morphine quickly enters all body tissues. Morphine quickly enters all body tissues. Morphine is not contraindicated for head-injured clients, and withdrawal symptoms can be relieved by methadone. Morphine is equally effective by all routes when the proper dose is prescribed.
20. Answer: C. Codeine is very constipating. Codeine is very constipating, so the client’s diet should include foods that fight constipation, such as water, fruits, and vegetables.