Intro to Anesthesia Final

Question 1

AANA Code of Ethics

Answer 1

Principles of conduct & professional integrity (decision making and behavior of nurse anesthetists)

Question 2

Practice standards

Answer 2

Authoritative statements describing minimum rules and responsibilities for which anesthetists are held accountable

Question 3

Practice guidelines

Answer 3

Systematically developed statements to assist providers in clinical decision making (commonly accepted in crna community)

Question 4

Position statements

Answer 4

Express AANA’s official positions or beliefs on practice-related topics

Question 5

Position statements define:

Answer 5

Knowledge
Skills
Abilities specific to CRNAs

Question 6

Use of unnecessary invasive preoperative testing is most likely to put the provider in violation of the principle of:

Answer 6

Nonmaleficence (Obligation to do no harm; primum non nocere)

Question 7

Automy

Answer 7

Pt’s ability to choose w/o controlling interference by others, and without limitations that prevent meaningful choices

Question 8

Nonmaleficence

Answer 8

Asserts a provider has an obligation not to inflict hurt or harm

Question 9

No distinction between ___ or ___ harm

Answer 9

Unintentional or intentional

Question 10

Beneficence

Answer 10

Principle that providers should act for benefit of others (prevent harm and actively help patients)

Question 11

Justice

Answer 11

Principle that people under similar circumstances and conditions should be treated alike (distributive justice)

Question 12

Informed consent for anesthesia should include a discussion of which topics

Answer 12

Risks & benefits of each type of appropriate anesthetic
Patient preferences, questions, and fears

Question 13

6 elements of informed consent

Answer 13

Competence
Decision making capacity
Disclosure of information
Understanding of disclosed information
Voluntary consent
Documentation

Question 14

Assent is a term used when….

Answer 14

Minor children are included in the informed consent discussion
Agreement should be sought

Question 15

Implied consent is used in __

Answer 15

Emergencies, when immediate treatment is required and the patient is unconscious or unable to consent

Permits healthcare providers to provide lifesaving care

Question 16

What must an anesthesia provider do to obtain informed consent for epidural placement in a paturient who recently received 50mg of Meperidine

Answer 16

Determine that the patient has sufficient capacity

Question 17

Capacity is one of the elements of ____

Answer 17

Consent (should be ascertained as part of the informed consent process)

Question 18

Pre-anesthetic evaluation also includes:

Answer 18

Current H&P, labor progress, and effectiveness of current analgesia

Question 18

True or false: OB patients need to receive general and regional anesthetic consent

Answer 18

True

Question 18

What should occur if there is a maternal-fetal conflict?

Answer 18

Anesthesia providers should communicate with the mother open and non-coercive while procuring ethics consultation, referencing hospital policy, and reviewing state law

Question 19

Terminal cancer patient with DNR presents for port-a-cath placement. Which standard of nurse anesthesia practice has the most immediate relevance to the anesthetist’s preoperative activities?

Answer 19

Standard 4 on informed consent and related anesthesia services

Question 20

You should do what to a pre-existing advanced directive before a procedure?

Answer 20

RECONSIDER– some events that may occur are responses to the anesthetic and not part of the terminal disease process

Question 21

Who does the AANA recommend be present when discussing changes in advances directives during the informed consesnt process?

Answer 21

Patient, family and healthcare team

Question 22

Are DNR orders automatically suspended during procedures in the OR

Answer 22

No, policy language that dictates automatic suspension of advanced directives during anesthesia should be rewritten in favor of patient-centered approach

Question 23

Withdrawal

Answer 23

Physical and emotional response to very low drug levels

Question 24

Impairment

Answer 24

Inability to engage in activities of daily living

Question 25

Tolerance

Answer 25

Markedly diminished effects of the same drug amount

Question 26

Addiction

Answer 26

Need (physiological or compulsive) for a substance ** often associated with a loss of self control

Question 27

Substance use disorder

Answer 27

Recurrent use of a substance that leads to clinical and functional impairment

Question 28

First nurse to specialize anesthesia, setting foundation in 1877

Answer 28

Sister Mary Bernard

Question 29

Mother of Anesthesia, open drop ether and first to publish her work

Answer 29

Alice Magaw (1893)

Question 30

Private CRNA and pioneered nitrous oxide anesthesia, later establishing Lakeside Hospital in 1915

Answer 30

Agatha Hodgins

Question 31

Who started AANA in 1931

Answer 31

Agatha Hodgins

Question 32

Nurses first provided anesthesia to soldiers wounded during the ___

Answer 32

Civil War

Question 33

Post WW2, discredited ___

Answer 33

Anti-nurse anesthetist sentiments aimed to discredit the profession

Question 34

Nitrous oxide 1772 used for ___ by ___

Answer 34

Dental anesthesia by Sir Humphrey Davy

Question 35

Ether was popularized by ___

Answer 35

William Morton Ether Dome at Mass General Hospital 1844

Question 36

James Simpson developed

Answer 36

Chloroform in 1847

Question 37

AANA established in 1931 by

Answer 37

Agatha Hodgins

Question 38

First annual meeting in 1933

Answer 38

Beginning of organized support for CRNAs

Question 39

Certification Initiatives 1945 instituted mandatory certification for CRNAs to ___

Answer 39

Enhance professional standards (first certification exam administered)

Question 40

Accreditation Recognition (1955)

Answer 40

US Dept of Health recognized AANA as accrediting agency for nurse anesthesia schools

Question 41

State Practice Act 1972-1976

Answer 41

AANA and ASA issued Joint Statement on Anesthesia Practice

Question 42

Direct Reimbursement 1986

Answer 42

Congress passed legislation allowing CRNAs to receive direct reimbursement under Medicare Pt B, a significant recognition of role

Question 43

Professional Recognition 2000

Answer 43

First observation of National Nurse Anesthesia week

Question 44

Standard 14 Culture of Safety

Answer 44

Collaborative and cooperative patient care environment through interdisciplinary engagement, open engagement, a culture of safety and supportive leadership

Question 45

Standard 13 Wellness

Answer 45

Physically and mentally able to perform duties of the role

Question 46

Standard 12 Quality Improvement Process

Answer 46

Constant Assessment of anesthesia care for best patient outcomes

Question 47

Standard 11 Transfer of Care

Answer 47

Evaluation of patient's status and determine when it's appropriate to transfer the responsibility of care to another qualified healthcare provider

Question 48

Standard 10 Infection Control and Prevention

Answer 48

--

Question 49

Standard 9 Monitoring, Alarms

Answer 49

Document BP, HR, resps every 5 min for all anesthetics, continuous monitoring of oxygenation, ventilation, hemodynamics Thermoregulation (MH monitoring), neuromuscular monitoring when NMBs are used

Question 50

Standard 8 Patient Positioning

Answer 50

Proper body alignment to maintain perfusion, protecting pressure points, and nerve plexus

Question 51

Standard 7 Anesthesia Plan Implementation and Management

Answer 51

Continuous assessment of the patient's response to the anesthetic and surgical or procedural intervention

Question 52

Standard 6 Equipment

Answer 52

Prechecks, operating equipment safely

Question 53

Standard 5 Documentation

Answer 53

Communicate anesthesia care data and activities through legible, timely, accurate, and complete documentation in the patient's healthcare record

Question 54

Standard 4 Informed Consent for Anesthesia Care

Answer 54

Obtain and document or verify documentation that the patients or legal representative has given informed consent for planned anesthesia care or related services in accordance with law, accreditation standards, and institutional policy

Question 55

Standard 3 Plan for Anesthesia Care

Answer 55

Patient specific plan of care

Question 56

Standard 2 Pre-anesthesia patient evaluation and assessment

Answer 56

Anesthesia focused physical assessment, general health, home meds, relevant diagnostics, preexisting conditions

Question 57

Standard 1 Patient Rights

Answer 57

Autonomy, dignity, safety

Question 58

Medical direction involves an ____

Answer 58

Anesthesiologist overseeing the delivery of anesthesia care, allowing up to 4 CRNAs to work concurrently

Question 59

Medical supervision occurs when a physician oversees ___

Answer 59

More than 4 CRNAs, without the need for hands-on involvement, ensuring availability for assistance

Question 60

To legally achieve medical direction ___

Answer 60

Anesthesiologists must meet 7 specific billing requirements outlined in TEFRA of 1982

Question 61

How many states do not require physician supervision for CRNAs

Answer 61

43

Question 62

How many states have no supervision or direct requirements?

Answer 62

37