Principles II- Exam 3

71 Questions | Total Attempts: 225

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School Quizzes & Trivia

A review of the material for Exam 3 in Principles covering OB anesthesia.


Questions and Answers
  • 1. 
    If intubation should fail, as an anesthetist you should be most concerned with saving the life of the….
    • A. 

      Fetus

    • B. 

      Mother

    • C. 

      Neither is more important than the other

    • D. 

      Myself!!!

  • 2. 
    You are the SRNA for Mrs. Gitz who is coming to you for an elective C-section today. She has refused epidural anesthesia, so will have to undergo general anesthesia today. You begin a rapid sequence induction and are unable to intubate. You able to ventilate the pt with cricioid pressure, but can’t seem to get a tube in. What do you do?
    • A. 

      Perform retrograde intubation

    • B. 

      Insert LMA and then proceed with case

    • C. 

      Wake pt up, then do an awake fiberoptic intubation

    • D. 

      Maintain ventilation with cricoid pressure and proceed with surgery

  • 3. 
    You are the SRNA for Ms. Tiyarah who is coming down for an emergent c-section due to fetal distress. She does not have an epidural, so must undergo general anesthesia since there is no time to insert one. You do a rapid sequence induction and are unable to intubate the pt. You are able to maintain ventilation with cricoids pressure but can’t get a tube in. What do you do?
    • A. 

      Perform retrograde intubation

    • B. 

      Perform Transtracheal Jet Ventilation

    • C. 

      Wake pt up, then do an awake fiberoptic intubation

    • D. 

      Maintain ventilation with cricoid pressure and proceed with surgery

  • 4. 
    Which of the following is not an indication for general anesthesia?
    • A. 

      Precipitous labor

    • B. 

      Fetal Distress

    • C. 

      Pt hemorrhaging

    • D. 

      Failed regional block

  • 5. 
    Which nonparticulate antacid is commonly given to pregnant pts undergoing general anesthesia?
    • A. 

      Metaclopromide

    • B. 

      Bicitra

    • C. 

      Calcium Carbonate

    • D. 

      Pepcid

  • 6. 
    How should the pregnant pt be extubated upon emergence from general anesthesia?
    • A. 

      Deep extubation

    • B. 

      All pregnant pts should remain intubated until cleared by OB/GYN

    • C. 

      Awake extubation

    • D. 

      Extubate of jet stylet so re-intubation easier if necessary

  • 7. 
    In the obese patient in labor, it is of particular importance to…
    • A. 

      Avoid regional blocks due to difficulty in locating anatomical landmarks

    • B. 

      Administer anxiolytic and opioids as soon as possible to initiate pain control

    • C. 

      Talk to them about how to lose the baby weight (and then some) after birth

    • D. 

      Make every effort to initiate early regional anesthetic

  • 8. 
    You are doing general anesthesia on Mrs. Maritt who is having a lap chole today. She is also 7 months pregnant and morbidly obese. Which of the following would not be an airway consideration with this patient?
    • A. 

      More anterior larynx

    • B. 

      Limited flexion

    • C. 

      Narrowed view of pharyngeal opening

    • D. 

      Limited mouth opening

  • 9. 
    Which of the following is not an indication for cesarean section?
    • A. 

      Fetal Distress

    • B. 

      Failed regional block

    • C. 

      Dystocia

    • D. 

      Cephalopelvic disproportion

  • 10. 
    For cesarean section with epidural in place, you want to achieve a sensory blockade at what level?
    • A. 

      T6

    • B. 

      T2

    • C. 

      T4

    • D. 

      T8

  • 11. 
    Duty, Breach, Injury, and Proximate cause are all elements that are necessary to establish what?
    • A. 

      Sentinel Event

    • B. 

      Obstetric risk

    • C. 

      Culpability

    • D. 

      Medical Malpractice

  • 12. 
    What are the most common precipitating events leading to adverse outcome in obstetric anesthesia?
    • A. 

      Respiratory Events

    • B. 

      Cardiac Events

    • C. 

      Fetal Distress

    • D. 

      Abnormal fetal presentation

  • 13. 
    What is the preferred anesthetic method for the obstetric patient?
    • A. 

      MAC sedation

    • B. 

      Regional Anesthesia

    • C. 

      General Anesthesia

    • D. 

      All the above are equally good options

  • 14. 
    All OB patients going for a c-section are considered to have full stomachs regardless of how long they have been NPO.  
    • A. 

      True

    • B. 

      False

  • 15. 
    Minimum NPO status for an elective C-section is ____ hours.
    • A. 

      4

    • B. 

      8

    • C. 

      6

    • D. 

      10

  • 16. 
    Which of the following does not contribute to increases risk of aspiration during anesthesia for pregnant patients?
    • A. 

      Increased intragastric pressure

    • B. 

      Lower esophageal sphincter tone

    • C. 

      Delayed Gastric emptying

    • D. 

      All the above contribute.

  • 17. 
    Aspiration is more likely to occur for all of the following pregnant patients except?
    • A. 

      Pt who is overdue by 2 weeks

    • B. 

      Emergent c-section

    • C. 

      Eclamptic pt

    • D. 

      Difficult intubation

  • 18. 
    When does organogenesis occur?
    • A. 

      First 4 months of pregnancy

    • B. 

      3rd – 5th months of pregnancy

    • C. 

      First two months of pregnancy

    • D. 

      Throughout the entire pregnancy

  • 19. 
    Which of the following is considered unsafe to give during pregnancy?
    • A. 

      Vecuronium

    • B. 

      Ephedrine

    • C. 

      Sevoflurane

    • D. 

      Versed

  • 20. 
    Which of the following is not true regarding surgical considerations of pregnant pts?
    • A. 

      They have a greater sensitivity to anesthetics

    • B. 

      Optimal positioning for 2nd – 3rd trimester pts is supine

    • C. 

      Pts have a greater circulating blood volume

    • D. 

      Pts are more susceptible to thromboembolic problems

  • 21. 
    During the first and second trimesters, pregnant pts are not considered to be at an increased aspiration risk.
    • A. 

      True

    • B. 

      False

  • 22. 
    Why must nitrous oxide be avoided during pregnancy?
    • A. 

      N2O diffuses into and expands uterus, increasing risk for uterine rupture

    • B. 

      Nitrous oxide causes fetal bradycardia and increasing risk of spontaneous abortion

    • C. 

      N2O interferes with folic acid metabolism, thus impairing DNA synthesis

    • D. 

      All the above

  • 23. 
    Success in outcome of pregnancy following surgery is determined by all of the following except…
    • A. 

      Maternal well-being

    • B. 

      Timing of surgery

    • C. 

      Choice of anesthetic agents

    • D. 

      Maternal age

  • 24. 
    How will pregnancy affect the MAC of anesthetics?
    • A. 

      Decrease MAC

    • B. 

      Increase MAC

    • C. 

      No effect on MAC

  • 25. 
    You are performing an epidural on a patient in labor. As you begin to administer your test dose you see pts heart rate go up. She is now breathing deeply and rubbing her stomach. Is it OK to proceed?
    • A. 

      No, elevated HR is a sign of intravascular injection. Stop injection.

    • B. 

      Elevated HR is an expected side effect and It is OK to proceed.

    • C. 

      This is a sign of accidental dural puncture, just give a smaller dose.

    • D. 

      She is probably having a contraction, wait a few minutes and see.

  • 26. 
    You are giving a test dose of lido with epi to a patient receiving an epidural. Within 3 minutes of injection the pt complains of numbness in their lower extremities. Is it OK to proceed with the injection?
    • A. 

      This is a sign of accidental dural puncture, you will need to adjust your dose.

    • B. 

      The epidural is *supposed* to produce numbess, continue with injection

    • C. 

      This is a sign of intravascular injection, stop injection.

    • D. 

      None of above

  • 27. 
    You are giving an epidural to a pt up on the OB floor. As you insert the catheter the patient complains of feeling an electric shock sensation. What do you do?
    • A. 

      Pull the catheter back then reinsert

    • B. 

      This is to be expected when inserting the catheter

    • C. 

      Stop the catheter, you have gone too far

    • D. 

      You have inserted the catheter intravascularly, pull out needle and cather.

  • 28. 
    Which of the following is not a good candidate for Spinal anesthesia?
    • A. 

      Pt with a known difficult airway

    • B. 

      Pt with Aortic stenosis

    • C. 

      Pt with history of asthma and bronchitis

    • D. 

      Pt who is terrified of general anesthesia

  • 29. 
    Which of the following is not an appropriate treatment for Post dural Puncture headache?
    • A. 

      Blood Patch, at same interspace prior epidural was performed

    • B. 

      Oral/IV hydration

    • C. 

      IV Caffeine

    • D. 

      Maintaining pt in upright position, on bedrest

  • 30. 
    How far should your epidural catheter be inserted?
    • A. 

      Until pt begins to feel an ‘electric shock’ sensation

    • B. 

      3-5 cm

    • C. 

      1-2 cm

    • D. 

      5-10 cm

  • 31. 
    Which of the following will not help to decrease the incidence of PDPH?
    • A. 

      Use of rounded point needle

    • B. 

      Use of smaller gauge needle

    • C. 

      Making sure the point of the needle used to puncture the dura is oriented PARALLEL rather than perpendicular to the meningeal fibers

    • D. 

      Placing pt in lateral position during administration of epidural

  • 32. 
    How much volume would you inject for a blood patch to treat PDPH?
    • A. 

      10-20 cc’s

    • B. 

      5-10 cc’s

    • C. 

      25-30 cc’s

    • D. 

      Depends upon size of pt and severity of headache

  • 33. 
    Where would you place your epidural catheter for a labor epidural?
    • A. 

      L2

    • B. 

      T12

    • C. 

      L3

    • D. 

      L5

  • 34. 
    Which of the following is not true of CV changes that occur during pregnancy?
    • A. 

      Increase in intravascular volume

    • B. 

      Decrease in SVR

    • C. 

      Increase in HR

    • D. 

      Largest increase in CO is during third trimester

  • 35. 
    Which of the following is not true of respiratory changes during pregnancy?
    • A. 

      Pts will need larger ETT’s

    • B. 

      O2 dissociation curve shifts to right

    • C. 

      Decrease in FRC

    • D. 

      Respiratory Alkalosis may be normal

  • 36. 
    Which of the following patients is an Absolute contraindication to spinal anesthesia?
    • A. 

      Mrs. A what has severe mitral stenosis.

    • B. 

      Mr. B who has advanced HIV disease

    • C. 

      Mrs. C who weighs 350 pounds.

    • D. 

      Mr. D who suffers from chronic back pain.

  • 37. 
    Which of the following is not true regarding anesthetic requirements during pregnancy?
    • A. 

      Decreased epidural space

    • B. 

      Plasma cholinesterase activity increased

    • C. 

      Increased response to LA’s

    • D. 

      Decreased MAC requirements

  • 38. 
    What happens to coagulation factors during pregnancy?
    • A. 

      Decreased plasma concentration

    • B. 

      No change in plasma concentration

    • C. 

      Increase in plasma concentration

    • D. 

      Look.... Honestly I am sooooooo not motivated to study right now.

  • 39. 
    Which of the following is not true regarding GI changes during pregnancy?
    • A. 

      Gastric fluid volume increase

    • B. 

      Insulin secretion increases

    • C. 

      Gastroesophageal tone decreases

    • D. 

      Gastric pH increases

  • 40. 
    Uterine Blood flow is autoregulated. 
    • A. 

      True

    • B. 

      False

  • 41. 
    What percentage of cardiac output goes to the uterus?
    • A. 

      10%

    • B. 

      20%

    • C. 

      30%

    • D. 

      5%

  • 42. 
    Spinal and Epidural anesthesia are known to decrease uterine blood flow.
    • A. 

      True

    • B. 

      False

  • 43. 
    Placental exchange occurs primarily via ….
    • A. 

      Active Transport

    • B. 

      Diffusion

    • C. 

      Osmosis

    • D. 

      Forced Filtration

  • 44. 
    What is the optimal surgical position for a pt undergoing c-section to prevent hypotension?
    • A. 

      Reverse trendelenburg

    • B. 

      Lithotomy

    • C. 

      Supine and slightly lateral

    • D. 

      Trendelenburg

  • 45. 
    Which of the following fetal shunts directs blood from the umbilical vein to the inferior vena cava?
    • A. 

      Foramen Ovale

    • B. 

      Hepatic shunt

    • C. 

      Ductuc Arteriosus

    • D. 

      Ductuc Venosus

  • 46. 
    During the first stage of labor, the pain felt is visceral in origin and derived from nerve fibers originating where?
    • A. 

      T10-L1

    • B. 

      L3-L5

    • C. 

      S1-S4

    • D. 

      T6-T8

  • 47. 
    During vaginal delivery of the baby, pain is somatic in origin and mainly derived from nerve fibers originating where?
    • A. 

      L3-L5

    • B. 

      S1-S4

    • C. 

      T10-L1

    • D. 

      T6-T8

  • 48. 
    You are caring for Mrs. Lincinia who is in active labor. While looking at the fetal HR tracing you notice fetal HR decelerations. There doesn’t appear to be any pattern in regards to onset, in fact most seem to be short and vary in the magnitude.  However, when it does occur the descents in fetal HR are steep. Is this baby in distress?
    • A. 

      Yes!! We should prepare for c-section

    • B. 

      This is a sign Mom must be fully dilated and ready to push, totally normal.

    • C. 

      No, just change Mom’s position and make sure decelerations do not become prolonged

  • 49. 
    Which of the following scenarios would indicate fetal distress?
    • A. 

      Fetal deceleration that are short, and variable in nature with steep descent in FHR

    • B. 

      Fetal deceleration that occur with onset of uterine contractions

    • C. 

      FHR that varies by 15 beats each minute

    • D. 

      Fetal deceleration that occur 30 seconds after onset of uterine contraction

  • 50. 
    The incidence of maternal aspiration is higher for emergent c-sections. 
    • A. 

      True

    • B. 

      False

  • 51. 
    What is the leading cause of maternal death under general anesthesia?
    • A. 

      Aspiration

    • B. 

      Amniotic Fluid Embolism

    • C. 

      Uterine rupture and Hemorrhage

    • D. 

      Myocardial Infarction

  • 52. 
    At what point during labor is an epidural usually performed?
    • A. 

      Whenever Mom asks

    • B. 

      When pt is 3-4 cm dilated

    • C. 

      When pt is 8-9 cm dilated

    • D. 

      As soon as pt admitted, regardless of dilation

  • 53. 
    Primary dysfunctional labor occurs when the patient is completely effaced but not dilated and has been laboring for more than _____ hours.
    • A. 

      12

    • B. 

      48

    • C. 

      4

    • D. 

      20

  • 54. 
    Which of the following is not a cause of antepartum hemorrhage?
    • A. 

      Amniotic Fluid Embolism

    • B. 

      Placenta Previa

    • C. 

      Uterine Rupture

    • D. 

      Abruptio Placentae

  • 55. 
    You are caring for Mrs. Berri who is fully dilated and about to deliver her baby. She has a past history of gestational diabetes, and 2 prior deliveries. Her first child delivered vaginally and her second child born via c-section.  As Mrs. Berri is pushing she suddenly screams and start to complain of a very severe pain. She says ‘something’s wrong’ and that it doesn’t feel like labor pain.  You look at the FHR monitor and notice the baby’s HR going down. What is happening?
    • A. 

      Amniotic Fluid Embolism

    • B. 

      Uterine Rupture

    • C. 

      Umbilical Cord prolapsed

    • D. 

      Abruptio Placentae

  • 56. 
    You are now going in for an emergent c-section for Mrs. Gudro, no time to an epidural you must do GA. Mrs. Gudro had premature rupture of membrane at 28 weeks and has been on a Magnesium drip to stop contractions. How will this affect you anesthetic technique?
    • A. 

      Must keep FiO2 low to prevent pulmonary alveolitis

    • B. 

      Pt is prone to electrolyte imbalances and cardiac arrhythmias

    • C. 

      Pt is at increased risk of bleeding since Mag will cause a low plt count

    • D. 

      Duration of action of muscle relaxants will be prolonged

  • 57. 
    The presence of the placenta in the cervical opening is known as what?
    • A. 

      Placenta Previa

    • B. 

      HELLP Syndrome

    • C. 

      Abruptio Placentea

    • D. 

      Uterine Atony

  • 58. 
    What is the cure for Pregnancy induced Hypertension?
    • A. 

      Inducing labor and vaginal delivery

    • B. 

      C-section delivery of baby

    • C. 

      Bedrest and Administration of Mag Sulfate drip

    • D. 

      Any of the above

  • 59. 
    The fetus is most sensitive to drugs during which trimester?
    • A. 

      3rd

    • B. 

      2nd

    • C. 

      1st

    • D. 

      Equally sensitive during all trimesters

  • 60. 
    What is age of viability for a Fetus?
    • A. 

      28 weeks

    • B. 

      30 weeks

    • C. 

      26 weeks

    • D. 

      24 weeks

  • 61. 
    What would be the muscle relaxant of choice for induction of a pregnant pt?
    • A. 

      Succinylcholine

    • B. 

      Rocuronium

    • C. 

      Cisatracurium

    • D. 

      Pancuronium

  • 62. 
    A pregnant pt with pre-eclampsia would most likely be placed on which of the following drips?
    • A. 

      Labetolol

    • B. 

      Magnesium Sulfate

    • C. 

      Hydralyzine

    • D. 

      Sodium Nitroprusside

  • 63. 
    What would be your preferred anesthetic method for a pt undergoing c-section who has a past history of mitral valve regurge?
    • A. 

      General

    • B. 

      MAC

    • C. 

      Regional

    • D. 

      Don't know, Don't care

  • 64. 
    What would be the preferred anesthetic technique for a pt undergoing c-section who has a past history of aortic stenosis?
    • A. 

      General

    • B. 

      MAC

    • C. 

      Regional

    • D. 

      Don't know, Don't care

  • 65. 
    Which of the following could not be safely given to prevent aspiration in a pregnant pt?
    • A. 

      Ranitidine

    • B. 

      Compazine

    • C. 

      Metaclopromide

    • D. 

      Bicitra

  • 66. 
    Morbid Obesity is defined as any BMI greater than what?
    • A. 

      28

    • B. 

      30

    • C. 

      35

    • D. 

      40

  • 67. 
    Which of the following interventions would be appropriate to manage an obstetric pt who has just aspirated?
    • A. 

      Administration of steroids

    • B. 

      Administration of antibiotics

    • C. 

      Suction

    • D. 

      All the above

  • 68. 
    Which of the following will not cross the placenta?
    • A. 

      Glycopyrolate

    • B. 

      Fentanyl

    • C. 

      Ephedrine

    • D. 

      Metaclopromide

  • 69. 
    Which of the following coagulation factors will not increase during pregnancy?
    • A. 

      Factor X

    • B. 

      Factor XI

    • C. 

      Factor VII

    • D. 

      Fibrinogen

  • 70. 
    HELLP Syndrome may be characterized by all of the following except..
    • A. 

      Hemolysis

    • B. 

      Elevated liver Enzymes

    • C. 

      Hypotension

    • D. 

      Greater susceptibility to bleeding

  • 71. 
    COMIC RELIEF: Shamelessly stolen from those watching it in class last week. :-)
    • A. 

      AAaggghh!! Scary!!!!

    • B. 

      Butterface!

    • C. 

      You know, for a dude he is pretty hot...

    • D. 

      All the above