Exam 1
The nurse is completing a preoperative database on a client scheduled for back surgery the next day. Which question is most important to ask to possibly prevent an adverse patient outcome? "Have you or any family members ever suffered a reaction to anesthesia?" "Did you remember that you can take your blood pressure pill the morning of surgery?" "How long have you been suffering from back pain?" "When did you last eat?"
"Have you or any family members ever suffered a reaction to anesthesia?" Malignant hyperthermia is a rare but potentially fatal reaction that can be triggered by all inhalation anesthetics except nitrous oxide. Predisposition to the reaction is genetic. Malignant hyperthermia can prove fatal and therefore is the highest priority, among the options listed, in a preoperative assessment.
The nurse performs the change-of-shift checks that include verifying pump setting for the ordered propofol infusion. The nurse notes that the order is for 2 mg/kg/hr. The most recent weight measurement for the patient was 64 kg. The nurse notes that the pump should be infusing how many mg per hour? 2 mg 32 mg 128 mg 281 mg
128mg The patient weighs 64 kg. Multiplying 64 kg with 2 mg/kg/hr equals 128 mg/hr.
The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? 2 mL 5 mL 10 mL 20 mL
5mL Each dose will be 5 mL. The total of 20 mg is divided into two doses of 10 mg. The concentration is 2 mg/mL. Divide 10 mg by 2 mg to equal 5 mL.
The student nurse prepares to administer ketamine to a patient. The supervising nurse questions this administration for which patient? A 6-year-old boy with an allergy to lidocaine A 55-year-old female with a history of hypertension A 40-year-old male with a history of bipolar disorder A 12-month-old with a history of burns
A 40-year-old male with a history of bipolar disorder In the past, ketamine was used primarily in children. However, an updated guideline, issued in 2011, now recommends expanding ketamine use to include adults, and babies between 3 and 12 months old. Because of its potential for adverse psychologic effects, ketamine should generally be avoided in patients with a history of psychiatric illness.
Which receptors are considered adrenergic receptors? (Select all that apply.) A Alpha1 B Beta2 C Dopamine D Muscarinic E Beta1 F Alpha2
A B C E F Alpha, beta, and dopamine receptors are part of the sympathetic system and therefore are adrenergic receptors. Muscarinic receptors are part of the parasympathetic system and are cholinergic.
Which statements about the anticholinergic drug scopolamine are true? (Select all that apply.) A A side effect is sedation. B It is used for motion sickness. C A side effect is nausea and vomiting. D It is used for preanesthetic sedation. E It causes CNS excitation.
A B D Scopolamine is an anticholinergic drug with actions much like those of atropine, but with two exceptions. First, whereas therapeutic doses of atropine produce mild CNS excitation, therapeutic doses of scopolamine produce sedation. And second, scopolamine suppresses emesis and motion sickness, whereas atropine does not. Principal uses for scopolamine include motion sickness and production of preanesthetic sedation.
Which organs are controlled primarily by the parasympathetic system? (Select all that apply.) A Gastrointestinal tract B Respiratory tract C Cardiovascular system D Skin E Salivary glands
A B D E The sympathetic nervous system provides the predominant tone for the cardiovascular system.
Prior to discharge, the nurse provides teaching related to adverse effects of terazosin [Hytrin] to the patient and caregivers. Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) A Headache B Hypoglycemia C Nasal congestion D Erectile dysfunction E Orthostatic hypotensio
A C D E Terazosin's adverse effects include nasal congestion, inhibition of ejaculation, and orthostatic hypotension. In addition, terazosin is associated with a high incidence (16%) of headache.
The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? (Select all that apply.) Increased heart rate Excessive drowsiness Increased force of heart contraction Decreased cardiac output Bronchial dilation Decreased glucose levels
A C E Activation of beta1 and beta2 receptors results in (1) increased cardiac output (by increasing the heart rate and force of contraction); (2) dilation of the bronchi; and (3) elevation of the blood glucose level.
Which of the following statements about Pralidoxime are true? (Select all that apply.) A It is an antidote to organophosphate poisoning. B It is an antidote to reversible cholinesterase inhibitors. C It cannot cross the blood-brain barrier. D It reverses cholinesterase inhibition in the CNS. E Doses should be infused slowly.
A C E Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension.
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A Cardiac rhythm B Blood urea nitrogen C Central nervous system (CNS) tremor D Lung sounds
A Cardiac rhythm Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias.
The nurse is preparing to give a drug to stimulate activation of adrenergic receptors. Which effects indicate sympathetic stimulation? A Increase in heart rate B Constriction of pupils C Atrioventricular block D Sinus bradycardia
A Increase in heart rate Activation of the adrenergic receptors stimulates the sympathetic nervous system and causes an increase in heart rate.
The nurse knows that which drug acts by decreasing axonal conduction? A Lidocaine [Xylocaine], a local anesthetic B Citalopram [Celexa], an antidepressant C Morphine [Duramorph], a pain reliever D Halothane [Fluothane], a general anestheti
A Lidocaine Local anesthetics are neuropharmacologic agents that act by decreasing axonal conduction. Most neuropharmacologic agents act by altering synaptic transmission. Only a few alter axonal conduction. Drugs that alter synaptic transmission can produce effects that are much more selective than those produced by drugs that alter axonal conduction.
A nurse is preparing to give bethanechol [Urecholine]. What is an expected outcome of this drug? A Nondistended bladder B Increased heart rate and blood pressure C Improved pulse oximetry reading D Relief of cardiac rhythm problems
A Nondistended bladder Bethanechol is a muscarinic agonist and therefore activates muscarinic receptors. This can lead to relaxation of the urinary sphincter muscles and increased voiding pressure. It also can cause bradycardia and hypotension, bronchoconstriction, and dysrhythmias in hyperthyroid patients.
A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? A Parasympathetic activity would increase. B Parasympathetic signals would be depressed. C Sympathetic activity would increase. D Respiratory centers would be depressed.
A Parasympathetic activity would increase. Acetylcholinesterase is an enzyme that metabolizes acetylcholine. When acetylcholine is not broken down, it continues to send its message. Acetylcholine is associated mostly with the parasympathetic nervous system; therefore, this system would be stimulated by acetylcholine-inhibiting drugs
The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? A Prepare to administer phentolamine [Regitine]. B Ensure that naloxone [Narcan] is available. C Institute the protocol for congestive heart failure (CHF). D Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels
A Prepare to administer phentolamine [Regitine]. Phentolamine, an adrenergic antagonist, is used to prevent tissue necrosis after extravasation of a vasoconstrictor, such as epinephrine. The edema surrounding the peripheral IV suggests infiltration of the IV, not CHF. Naloxone is an opioid antagonist
The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? A Use as a preanesthesia medication B Treatment of tachycardias C Prevention of urinary retention D Reduction of intraocular pressure in glaucoma
A Use as a preanesthesia medication Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It often is administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.
The nurse is evaluating the teaching done with a patient who has a new prescription for transdermal clonidine [Catapres-TTS]. Which statement by the patient indicates understanding of the nurse's teaching? A- "I will apply the patch to a hairless, intact skin area on my upper arm." B- "I need to apply the patch before my evening meal." C- "The patch will not cause any skin reaction." D- "I will need to apply a new patch once every 3 to 4 days."
A- "I will apply the patch to a hairless, intact skin area on my upper arm." For a transdermal clonidine patch the patient is instructed to apply the patch to hairless, intact skin on the upper arm or torso, and to apply a new patch every 7 days. Localized skin reactions are common with transdermal clonidine patches.
Which statement is most appropriate for the nurse to include in the discharge teaching plan for a 30-year-old woman beginning a new prescription of clonidine [Catapres]? A- "If you stop taking this drug abruptly, your blood pressure might go up very high." B- "You will need to have your blood drawn regularly to check for anemia." C- "Take this medication first thing in the morning to reduce nighttime wakefulness." D- "This medication often is used to manage hypertension during pregnancy."
A- "If you stop taking this drug abruptly, your blood pressure might go up very high." Rebound hypertension is a potential adverse effect of clonidine. Patients should be warned against abrupt withdrawal. Clonidine is not associated with anemia. It can cause drowsiness and usually is taken at night. Clonidine is not recommended for pregnant patients.
The nurse is preparing to administer a dose of clonidine [Catapres]. Which is the best description of the action of this drug? A- It selectively activates alpha2 receptors in the central nervous system (CNS). B- It causes peripheral activation of alpha1 and alpha2 receptors. C- It depletes sympathetic neurons of norepinephrine. D- It directly blocks alpha and beta receptors in the periphery.
A- It selectively activates alpha2 receptors in the central nervous system (CNS). Clonidine is an alpha2-adrenergic agonist that causes selective activation of alpha2 receptors in the CNS. This in turn reduces sympathetic outflow to the blood vessels and the heart. Although the body's responses are similar to those from a peripheral adrenergic blocker, clonidine's action occurs in the CNS.
The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? Norepinephrine Serotonin Acetylcholine Dopamine
Acetylcholine Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.
The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient? A Obtain blood glucose. B Observe for lower leg edema. C Assess the heart rate. D Apply a pulse oximeter.
Assess the heart rate The cardiac effects of diltiazem and atenolol are the same. Both reduce heart rate, suppress AV conduction, and suppress myocardial contractility. When these drugs are administered together, excessive cardiosuppression may result.
The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine [Prostigmin], 75 mg PO twice daily. What is the most important initial nursing action? Obtain a measurement of the plasma level of neostigmine. Teach the patient to wear a Medic Alert bracelet. Assess the patient's ability to swallow. Check the patient's deep tendon reflexes (DTRs)
Assess the patient's ability to swallow Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.
The nurse prepares to administer the antidote to a patient in cholinergic crisis. Which medication does the nurse anticipate the healthcare provider to order? Neostigmine [Prostigmin] Atropine Pralidoxime [DuoDote] Dobutamine [Dobutrex]
Atropine Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors.
A patient is to be discharged home with a new prescription for prazosin [Minipress]. Which statement is most important for the nurse to include in the teaching plan? A "You should increase your intake of fresh fruits and vegetables." B "You should move slowly from a sitting to a standing position." C "Be sure to wear a Medic Alert bracelet while taking this medication." D "Take your first dose of this medication first thing in the morning."
B "You should move slowly from a sitting to a standing position." Orthostatic hypotension is the most serious adverse effect of prazosin and other alpha1 blockers. Patients should be taught to move slowly when changing from a supine or sitting position to an upright position to avoid dizziness and prevent falls. Fresh fruits and vegetables are good to include in the dietary teaching, but this is not as important as preventing hypotension. A Medic Alert bracelet should not be needed for this drug. This drug causes significant first-dose hypotension. The initial dose should be taken at bedtime. Patients should avoid driving and other hazardous activities for 12 to 24 hours after the first dose.
The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A A 60-year-old woman with an overactive bladder (OAB) B A 72-year-old man with glaucoma C A 45-year-old woman with peptic ulcer disease (PUD) D A 26-year-old man being prepared for surgery today
B A 72-year-old man with glaucoma Anticholinergic drugs tend to cause adverse effects of dry mouth, blurred vision, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, and asthma. They are contraindicated in patients with glaucoma because of the potential danger of increased intraocular pressure. Anticholinergics are used to treat OAB and are used as preanesthetic agents. They are not contraindicated in PUD.
Which phrase should the nurse use to best describe activation of a receptor? A An effect that causes the physiologic process to speed up B An effect that mimics the natural neurotransmitter for that receptor C An effect that improves the function of the receptor D An effect that causes the receptor to be more sensitive
B An effect that mimics the natural neurotransmitter for that receptor Receptor activation is an effect on receptor function equivalent to that produced by the natural neurotransmitter at a particular synapse. Activation of a receptor may slow down or speed up the process, depending on the function of that particular receptor. Activation does not have to do with improving receptor function or sensitivity.
The nurse is monitoring a patient prescribed with reserpine for the treatment of hypertension. Which assessment parameter indicates that this medication is effective? A- Decrease in diarrhea B- Blood pressure of 118/72 mm Hg C- Absence of bladder distention D- Improved symptoms of depression
B Blood pressure of 118/72 mm Hg The primary indication of reserpine is to control hypertension. It has been used to treat psychosis, but more effective drugs now are available for that purpose. Adverse effects of reserpine include severe depression with suicide risk, gastric ulcer formation, and diarrhea. Reserpine is not used to treat urinary retention.
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) A Terbutaline must be given by a parenteral route. B The selectivity of terbutaline is dose dependent. C The patient may experience tremor with terbutaline. D Terbutaline is a sympathomimetic drug. E Bronchoconstriction is a potential adverse effect of terbutaline.
B C D Terbutaline is a noncatecholamine adrenergic agonist (sympathomimetic) drug. It can be given orally, because it is not a catecholamine. Tremor and tachycardia are potential adverse effects. Terbutaline can be used to treat asthma and does not typically cause bronchoconstriction. When given at low therapeutic doses, it is selective for beta2 receptors.
Overdose of cholinesterase inhibitors causes which of the following? (Select all that apply.) A Xerostomia B Excessive muscarinic stimulation C Constipation D Respiratory depression E Cholinergic crisis
B D E Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect.
The nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? A Wheezing decreases due to bronchodilation. B Heart rate decreases to 60 beats/min C Diarrhea stool count decreases. D Oxygenation improves because of bronchodilation.
B Heart rate decreases to 60 beats/min Stimulation of the parasympathetic nervous system (PNS) causes slowing of the heart rate. The PNS does not regulate temperature. The PNS would facilitate peristalsis and thus would not decrease diarrhea. The PNS is associated with contraction of bronchial smooth muscle
Which statement made by the patient indicates understanding of teaching related to a new prescription for atenolol [Tenormin]? A "I will increase my fluids to prevent constipation." B "I will not stop taking this medication abruptly." C "I will take the first dose of this medicine at night." D "I will wear sunscreen and a hat when I work in the sun."
B I will not stop taking this medication abruptly Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. Patients should carry an adequate supply when traveling. It does not commonly cause constipation, first-dose hypotension, or photosensitivity.
Which label most aptly describes the drug atropine [Sal-Tropine]? A Cholinergic B Parasympatholytic C Muscarinic agonist D Parasympathomimetic
B Parasympatholytic Atropine is a muscarinic antagonist agent. Other terms for this agent are parasympatholytic, antimuscarinic, muscarinic blocker, and anticholinergic.
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? A A heart rate of 100 beats/min B Wheezing C A glucose level of 180 mg/dL D Urinary urgency
B Wheezing Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular (AV) heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system (CNS) effects.
The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease? (Select all that apply.) Dilation and inflammation of cranial blood vessels Beta-amyloid and neuritic plaques Neurofibrillary tangles and tau Autoimmune changes in the myelin sheath Firing of hyperexcitable neurons throughout the brain Neuronal degeneration and decreased acetylcholine
Beta-amyloid and neuritic plaques Neurofibrillary tangles and tau Neuronal degeneration and decreased acetylcholine AD is characterized by neuronal degeneration, reduced cholinergic transmission, beta-amyloid and neuritic plaques, and neurofibrillary tangles and tau. Dilation and inflammation of cranial blood vessels are associated with migraine. Multiple sclerosis is characterized by autoimmune changes in the myelin sheath, and epilepsy is associated with hyperexcitability of neurons and firing of those neurons throughout the brain.
The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin [Ditropan] for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan? A "You may experience a slower heart rate. Call your doctor if it is below 60." B "Ditropan is very effective. Most patients experience significant relief." C "Sip on water and suck on hard candy to help with the problem of dry mouth." D "Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan."
C "Sip on water and suck on hard candy to help with the problem of dry mouth." Oxybutynin is an anticholinergic drug that commonly causes dry mouth. Other side effects include constipation, tachycardia, urinary hesitancy, urinary retention, and visual disturbances. Oxybutynin is only moderately effective (30% better than placebo). It should not be taken with other drugs with anticholinergic properties, such as antihistamines, because of the additive anticholinergic effects
The nurse is administering diphenhydramine [Benadryl], a neuropharmacologic agent that works by doing what? A Preventing mast cells from releasing histamine B Preventing axonal conduction C Binding to histamine receptors, preventing receptor activation D Acting as an agonist to H1 histamine receptor
C Binding to histamine receptors, preventing receptor activation Drugs that bind to receptors and prevent their activation include naloxone (used to treat overdose with morphine-like drugs), antihistamines (used to treat allergic disorders), and propranolol (used to treat hypertension, angina pectoris, and cardiac dysrhythmias).
The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) A Check the blood urea nitrogen (BUN) and creatinine levels. B Obtain insulin from the medication cart. C Assess the patency of the IV line. D Review the allergy history. E Assess the vital signs.
C D E All of the actions mentioned might be appropriate for this patient. However, because epinephrine can cause necrosis with extravasation, the first priority is to assess the patency of the IV line before beginning administration. Reviewing the patient's allergy history is essential, as is assessing the vital signs, particularly the heart rate and blood pressure. Epinephrine is a vasoconstrictor and can cause a dramatic increase in the heart rate and blood pressure.
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? A Cardiac dysrhythmias B Hypertension C Diabetes D Angina
C Diabetes Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in patients with diabetes. It is safe to use propranolol in dysrhythmias, hypertension, and angina.
The nurse knows that the advantage of patients having multiple types of receptors to regulate bodily functions is what? A Improved maximal efficacy B Reduction of side effects and toxicity C Higher degree of selectivity D Lower therapeutic index
C Higher degree of selectivity Selectivity is one of the most desirable qualities a drug can have. Many neuropharmacologic drugs are highly selective, because the nervous system works through multiple receptors to regulate processes under its control.
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A Topical phenylephrine B Subcutaneous terbutaline C Intravenous epinephrine D Inhaled albuterol
C Intravenous epinephrine When beta1 receptors are activated, cardiac contraction is stimulated. When a beta1 agonist is indicated, epinephrine (given IV) is the preferred drug. Beta1 agonist drugs (eg, epinephrine), which are kept on the emergency cart, may be injected directly into the heart during an arrest. Alpha1 activation causes hemostasis, nasal decongestion, vasoconstriction, and mydriasis. Alpha2 activation reduces sympathetic outflow to the heart and blood vessels and relieves severe pain. Beta2 activation causes bronchodilation and relaxation of uterine smooth muscle. Topical phenylephrine is helpful for nasal congestion. Terbutaline is indicated for preterm labor and/or asthma. Albuterol is indicated for asthma.
The nurse is assessing a patient in a clinic who has been taking clonidine [Catapres] for hypertension. Which clinical findings are most indicative of an adverse effect of this drug? A- Cough and wheezing B- Epigastric pain and diarrhea C- Drowsiness and dry mouth D- Positive Coombs' test result and anemia
C- Drowsiness and dry mouth Drowsiness and dry mouth are common adverse effects (35% to 40%) associated with clonidine. The other effects are not commonly associated with clonidine.
A surgical intensive care unit patient has been on a propofol drip for an extended period of time related to multiple injuries and surgeries. The nurse knows to monitor for which signs of propofol infusion syndrome? (Select all that apply.) Metabolic alkalosis Cardiac failure Respiratory failure Renal failure Rhabdomyolysis
Cardiac failure, Renal failure, Rhabdomyolysis Rarely, prolonged, high-dose infusion leads to propofol infusion syndrome, characterized by metabolic acidosis, cardiac failure, renal failure, and rhabdomyolysis. Patients should be on a ventilator if they are on a propofol infusion because of respiratory depression.
The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? A "I will keep my medication in the refrigerator when I'm not using it." B "I should take this medication within 30 minutes of the onset of symptoms." C "I must remove my pants before injecting the medication into the leg." D "I will jab this medication firmly into my outer thigh if needed."
D "I will jab this medication firmly into my outer thigh if needed." The EpiPen should be stored in a cool, dark place, but refrigeration can damage the injection mechanism. The medication should be taken at the first sign of symptoms. Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the patient should form a fist around the unit with the black tip pointing down, remove the activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the unit, and massage the area for 10 seconds. The medication can be given directly through clothing if necessary.
The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system? A Norepinephrine B Epinephrine C Dopamine D Acetylcholine
D Acetylcholine Norepinephrine, epinephrine, dopamine, and acetylcholine are neurotransmitters for the peripheral nervous system, but acetylcholine is the most abundant. It is released by all preganglionic neurons in the sympathetic and parasympathetic systems. It is also released by all postganglionic neurons of the parasympathetic nervous system.
A nurse prepares to administer a new prescription for bethanechol [Urecholine]. Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? A Constipation B Hypertension C Psoriasis D Asthma
D Asthma Muscarinic agonists induce bronchospasm, which would cause problems for a patient with a history of asthma.
Which symptom is the most indicative of muscarinic poisoning? A Constipation B Heart rate of 140 beats/min C Blood pressure of 180/110 mm Hg D Blurred vision
D Blurred vision Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension
A nurse is preparing to give a medication that stimulates the beta2 receptors. Which response will the nurse expect from this drug? A Increased peristalsis B Constriction of the pupil C Hypoglycemia D Bronchodilation
D Bronchodilation Activation of beta2 receptors leads to bronchodilation; decreased uterine contractions; hyperglycemia; and vasodilation of the heart, lungs, and skeletal muscle. It does not produce increased peristalsis, constriction of the pupil, or hypoglycemia.
Which receptors mediate responses to the neurotransmitter acetylcholine? (Select all that apply.) A Alpha1 B Beta2 C Dopamine D Nicotinic E Muscarinic
D E Receptors that mediate the responses to the neurotransmitter acetylcholine are nicotinic and muscarinic.
Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A Epilepsy B Diabetic coma C Meningitis D Psychosis
D Psychosis Antimuscarinic poisoning often resembles psychosis and psychotic episodes. It is important to differentiate, because antipsychotic drugs have antimuscarinic properties and could intensify the symptoms of poisoning.
A patient who abuses cocaine, opioids, and other drugs frequently abuses which drug? A- Guanfacine B- Reserpine C- Methyldopa D- Clonidine
D- Clonidine Patients who abuse cocaine, opioids, and other drugs frequently abuse clonidine as well.
The nurse should monitor for which central nervous system (CNS) adverse effect that can result when sufficient amounts of local anesthetics are absorbed systemically? Hallucinations and nightmares Tremors of the lower extremities Excitation followed by depression Vertigo and nausea/vomiting
Excitation followed by depression Local anesthetics can cause CNS excitation followed by depression when large enough amounts are absorbed in the system. This can lead to drowsiness, loss of consciousness, and death.
Which condition is an indication for the use of succinylcholine [Anectine]? Pain relief after major surgery Loss of consciousness during surgery Facilitation of endotracheal intubation Relief of status epilepticus
Facilitation of endotracheal intubation Succinylcholine is an ultrashort-acting NM blocker used to facilitate insertion of an endotracheal tube for mechanical ventilation. Because an intact gag reflex can fight tube insertion past the glottis and into the trachea, reflexes can be suppressed temporarily by this short-acting agent. It does not provide pain relief or loss of consciousness. It is not indicated for the treatment of status epilepticus.
What is the primary effect of neuromuscular blockers? Flaccid paralysis Hypotension Loss of consciousness Reduction in pain
Flaccid paralysis The primary effect of neuromuscular blockers is relaxation of skeletal muscle, causing a state known as flaccid paralysis. Some neuromuscular blockers can lower blood pressure. Neuromuscular blockers do not diminish consciousness or perception of pain—even when administered in doses that produce complete paralysis.
The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse's instruction? A "I will need to wait for 6 months and then stop this medication." B "One missed dose will not affect my blood pressure." C "I may experience occasional chest pain and discomfort." D "I will not stop taking this drug without the approval of my healthcare provider."
I will not stop taking this drug without the approval of my healthcare provider Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. To decrease the risk of rebound excitation the dose should be tapered over 1 or 2 weeks. Patients should carry an adequate supply when traveling.
What is the pathophysiology for a myasthenic crisis? Insufficient ACh at the NMJ Excessive ACh at the NMJ Overdose with a cholinesterase inhibitor None of the above
Insufficient ACh at the NMJ Patients who are inadequately medicated may experience myasthenic crisis, a state characterized by extreme muscle weakness caused by insufficient ACh at the NMJ. A cholinesterase inhibitor (eg, neostigmine) is used to relieve the crisis.
Which best describes the rationale for using neostigmine [Prostigmin] in the treatment of myasthenia gravis? A It promotes neuromuscular blockade in the periphery. B It promotes emptying of the bladder and sphincter relaxation. C It reduces intraocular pressure and protects the optic nerve. D It increases the force of skeletal muscle contraction.
It increases the force of skeletal muscle contraction Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness.
The nurse is preparing to give neostigmine [Prostigmin]. Which best describes the action of this drug? A It inhibits acetylcholine at all cholinergic synapses. B It prevents inactivation of acetylcholine. C It prevents activation of muscarinic receptors. D It stimulates activation of adrenergic receptors.
It prevents inactivation of acetylcholine Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions.
The nurse anticipates giving propofol [Diprivan] to a patient who is undergoing mechanical ventilation. Which is an expected outcome for this medication? Improved respiratory excursion and oxygenation Loss of consciousness and hypotension Decreased respiratory and gastric secretions Analgesia and muscle relaxation
Loss of consciousness and hypotension Diprivan is an intravenous (IV) sedative-hypnotic used for sedation during mechanical ventilation. It can cause profound respiratory depression and hypotension. It does not improve excursion or oxygenation, nor does it decrease secretions. It does not have analgesic or muscle-relaxant properties.
Succinylcholine [Anectine] is contraindicated in a patient with which condition? Diabetes mellitus Hyperthyroidism Chronic obstructive pulmonary disease (COPD) Major burns during the emergent phase
Major burns during the emergent phase Succinylcholine promotes the release of potassium from tissues. Significant hyperkalemia is most likely to develop in patients with major burns during the emergent phase, multiple trauma, denervation of skeletal muscle, or upper neuron injury.
Which statement about memantine [Namenda] is false? Memantine is indicated for moderate or severe AD. Memantine modulates the effects of glutamate. Memantine does not slow the decline in function. The most common side effects are dizziness, headache, confusion, and constipation.
Memantine does not slow the decline in function. For many patients, the drug can slow the decline in function, and, in some cases, it may actually cause symptoms to improve. The other statements are true.
The nurse is caring for a patient who is receiving lidocaine [Xylocaine] by epidural injection. Which nursing intervention is most important when caring for this patient? Keeping the patient in a supine position for about 12 hours Monitoring the patient's blood pressure throughout the epidural infusion Preparing a double tourniquet for use during the infusion Reducing the intravenous (IV) infusion rate to prevent hypertension
Monitoring the patient's blood pressure throughout the epidural infusion Hypotension is the most common complication with epidural anesthetics. Monitoring of the blood pressure is an essential nursing intervention. Supine positioning is not required for epidural injections (spinal only). A double tourniquet is used for regional anesthesia. Hypertension is not an anticipated outcome.
When a surgical patient receives nitrous oxide at therapeutic concentrations as part of general anesthesia, which adverse effect is most likely to occur? Nausea and vomiting Slow emergence from anesthesia Hypotension and bradycardia Respiratory depression
Nausea and vomiting At therapeutic doses, nitrous oxide does not have serious adverse effects, such as longer central nervous system (CNS) depression or cardiac/respiratory depression. The major problem with this drug is postoperative nausea and vomiting.
A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a priority because of which associated adverse effect? A Reflex tachycardia B Heart palpitations C Cardiac dysrhythmias D Orthostatic hypotension
Orthostatic hypotension Doxazosin is an alpha1 blocker and can cause orthostatic hypotension. Common symptoms include dizziness or lightheadedness on standing, which may impair the patient's balance and increase the risk of a fall.
The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine [Anectine]. The patient develops muscle rigidity and a temperature of 105°F. Which nursing action is essential? Prepare to administer dantrolene [Dantrium]. Administer normal saline at 50 mL/hr. Administer morphine sulfate to relieve pain. Prepare for intubation and mechanical ventilation.
Prepare to administer dantrolene [Dantrium]. The patient is showing symptoms of malignant hyperthermia, a rare and potentially fatal complication of succinylcholine and inhalation anesthesia. Treatment includes discontinuation of succinylcholine and anesthesia; application of cooling blankets and ice packs; and IV administration of dantrolene, a muscle relaxant.
Which of these local anesthetic agents is most likely to cause an allergic response? Procaine [Novocain] Lidocaine [Xylocaine] Bupivacaine [Marcaine] Ropivacaine [Naropin]
Procaine [Novocain] Procaine is an ester-type anesthetic. Ester anesthetics pose a greater risk of allergic reactions than the amide-type anesthetics. All the other choices are amide anesthetics.
A nurse notices that one of the anesthesiologists returns from the staff lounge every day in a brief state of euphoria after her break. The nurse speaks to the unit manager, because she is concerned about abuse of which of these medications? Clonidine Propofol Midazolam Lorazepam
Propofol Although not regulated as a controlled substance, propofol is subject to abuse, primarily by anesthesiologists, nurse anesthetists, and other medical professionals, all of whom have easy access to the drug. Clinicians use it to produce instantaneous (but brief) sleep, after which they wake up feeling refreshed. When patients awake after receiving propofol, they often are talkative and report feeling elated and even euphoric.
Why does the nurse anticipate administering metoprolol [Lopressor] rather than propranolol [Inderal] for diabetic patients who need a beta-blocking agent? A Metoprolol is less likely to cause diabetic nephropathy. B Propranolol causes both beta1 and beta2 blockade. C Metoprolol helps prevent retinopathy in individuals with diabetes. D Propranolol is associated with a higher incidence of foot ulcers.
Propranolol causes both beta1 and beta2 blockade. Metoprolol is a second-generation beta blocker and as such is more selective. At therapeutic doses, it causes less bronchoconstriction and suppression of glycogenolysis, which can cause problems in diabetic patients. Propranolol blocks both beta1 and beta2 receptors.
The healthcare provider orders lidocaine injection SC before a skin biopsy. Which action should the nurse take? Question the order for further instructions. Administer the lidocaine. Refuse to administer the lidocaine. Suggest the use of procaine.
Question the order for further instructions The nurse should question the order for further instructions, including the dose to be administered, the location, and the use of epinephrine. The nurse should not administer, refuse to administer, or suggest the use of another medication without further information.
The nurse understands that which adverse effect is most significant for the botulinum toxin? Sedation Internal bleeding Respiratory failure Increased risk for infection
Respiratory failure Botulinum toxin blocks the release of acetylcholine by the neuron that controls skeletal muscles which paralyze the respiratory muscles causing respiratory failure.
Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? Donepezil [Aricept] Rivastigmine [Exelon] Galantamine [Reminyl] Memantine [NMDA]
Rivastigmine [Exelon] All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.
The nurse knows that local anesthetics stop axonal conduction by blocking what? Potassium channels in the axonal membrane Sodium channels in the axonal membrane Calcium channels in the axonal membrane Protein channels in the axonal membrane
Sodium channels in the axonal membrane Local anesthetics stop axonal conduction by blocking sodium channels in the axonal membrane. Propagation of an action potential requires movement of sodium ions from outside the axon to the inside. This influx takes place through specialized sodium channels. By blocking axonal sodium channels, local anesthetics prevent sodium entry, thereby bringing conduction to a halt
A patient goes to the emergency department after using organophosphate insecticides improperly. Which assessment finding would the nurse expect? Urinary retention Stool incontinence Mydriasis Flushed, dry skin
Stool incontinence A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis.
The nurse administering succinylcholine knows that the paralysis effect only lasts a few minutes because of which pathophysiologic action? Succinylcholine is rapidly degraded by pseudocholinesterase. Succinylcholine is rapidly metabolized by the liver. Succinylcholine is rapidly excreted by the kidneys. Succinylcholine is rapidly degraded by cholinesterase.
Succinylcholine is rapidly degraded by pseudocholinesterase. Paralysis is brief because succinylcholine is rapidly degraded by pseudocholinesterase, an enzyme present in plasma. This enzyme is called pseudocholinesterase to distinguish it from "true" cholinesterase, the enzyme found at synapses where ACh is the transmitter. Because of its presence in plasma, pseudocholinesterase is also known as plasma cholinesterase.
A patient is experiencing symptoms of the "fight-or-flight" response. Which autonomic process stimulates this response? Sympathetic system Parasympathetic system
Sympathetic system Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure.
What is essential for the nurse to confirm before starting vecuronium [Norcuron] as a continuous intravenous infusion? The patient has been intubated and is on mechanical ventilation. A Foley catheter has been inserted. Hourly blood glucose levels have been ordered. A nasogastric tube is in place for suction.
The patient has been intubated and is on mechanical ventilation. Vecuronium [Norcuron], an NM blocking agent, can cause respiratory arrest. Therefore the nurse must ensure that the patient has an established airway and assisted oxygenation and ventilation before starting the continuous IV infusion. A Foley catheter would help prevent incontinence but is not necessary. Hourly blood glucose levels are unnecessary, because hyperglycemia and hypoglycemia are not adverse effects. A nasogastric tube is not essential before initiation of the continuous infusion, but insertion may be considered afterward for gastric suctioning or feeding.
The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? They carry a positive charge. They compete with acetylcholine (ACh) for binding sites. They cause muscle relaxation. They interact with potassium.
They carry a positive charge All NM blockers have a quaternary nitrogen atom and therefore always carry a positive charge, making it difficult for them to cross membranes. The inability to cross membranes makes parenteral administration necessary. NM blockers do compete with ACh, cause muscle relaxation, and interact with potassium, but these factors do not necessitate oral administration.
The nurse is caring for a patient who is to receive a local anesthetic with lidocaine and epinephrine. What is the primary purpose of the epinephrine? To reduce the risk of an allergic reaction To improve transport of anesthetic into the axon To delay systemic absorption of the anesthetic To suppress excitability of the myocardium
To delay systemic absorption of the anesthetic As a vasoconstrictor, epinephrine reduces local blood flow and delays systemic absorption of the anesthetic. This prolongs the effects of the anesthetic at the site of action and reduces the risk of systemic toxicity.
The healthcare provider orders donepezil [Aricept] 10 mg PO every day. The tablets available are donepezil 5 mg. How many tablets will the patient receive? 0.5 2 5 10
Two 5-mg tablets will equal the 10-mg dose ordered.
The nurse is explaining differential sensitivity to the nursing student with regard to the use of local anesthetics. The nurse explains that which perception is lost first? Pain Cold Warmth Touch
pain Although local anesthetics can block traffic in all neurons, blockade develops more rapidly in some neurons than in others. Specifically, small, nonmyelinated neurons are blocked more rapidly than large, myelinated neurons. Because of this differential sensitivity, some sensations are blocked sooner than others. Specifically, perception of pain is lost first, followed in order by perception of cold, warmth, touch, and deep pressure.
The following statements about neuromuscular blockers are true except: they cannot be absorbed by the GI tract. they easily cross the placenta. they cannot cross the blood-brain barrier. they have no effect on the CNS.
they easily cross the placenta. Neuromuscular blockers cannot be absorbed from the gastrointestinal tract, cannot cross the blood-brain barrier, and hence have no effect on the central nervous system (CNS). Neuromuscular blockers cannot readily cross the placenta.
