Chapter 16: Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents and Ganglionic Blocking Agents

Chapter 16: Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents and Ganglionic Blocking Agents

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse is taking report during shift change and is told that a patient is paralyzed with neuromuscular blockers. While performing the physical assessment, which finding should the nurse anticipate?

a.	The patient will be essentially unconscious.
b.	The patient will be heavily sedated, but conscious.
c.	The patient will be stuporous but can be aroused.
d.	The patient will remain conscious.

 

 

ANS:   D

Neuromuscular blocking agents cause relaxation of the skeletal muscle, producing a state known as flaccid paralysis. However, they do not cross the blood-brain barrier and thus would not lead to unconsciousness.

Neuromuscular blockers do not cause unconsciousness, because they do not cross the blood-brain barrier.

Neuromuscular blockers would not cause the patient to be heavily sedated, because they cannot cross the blood-brain barrier.

Neuromuscular blockers would not cause the patient to be stuporous, but arousable, because they do not cross the blood-brain barrier.

 

DIF:    Cognitive Level: Application             REF:    pp. 142-143

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A nurse is preparing a patient for a procedure. Prior to the procedure, in which a neuromuscular blocking agent is to be used, the nurse evaluates the patient’s electrolytes. Which abnormality would provoke the most concern for the nurse?

a.	Hyponatremia
b.	Hypercalcemia
c.	Hypomagnesemia
d.	Hypokalemia

 

 

ANS:   D

Low potassium levels can enhance paralysis, whereas high potassium levels can reduce paralysis. Because electrolyte status can influence the depth of neuromuscular blockade, it is important to maintain normal electrolyte balance.

There are no indications that sodium, calcium, and/or magnesium have similar effects of potassium in relation to neuromuscular blocking agents.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 143-144

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

3. A patient in the ICU is on a mechanical ventilator with an endotracheal tube. The patient begins trying to pull at the endotracheal tube and other tubing. The nurse administers a prn order for tubocurarine. The nurse can anticipate which of the following areas of the body will experience the effects of the medication first?

a.	The levator muscle of the eyelid and muscles of mastication
b.	The muscles in the lower extremities
c.	The muscles controlling the glottis
d.	The muscles of respiration and the diaphragm

 

 

ANS:   A

Although tubocurarine can paralyze all skeletal muscles, not all muscles are affected at once. The first to become paralyzed are the levator muscle of the eyelid and the muscles of mastication.

Paralysis occurs next in muscles of the limbs, abdomen, and glottis as a result of the administration of tubocurarine.

The last muscles affected by the administration of tubocurarine are the muscles of respiration, including the intercostals and diaphragm.

 

DIF:    Cognitive Level: Application             REF:    pp. 143-144

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

4. A nurse receives a patient postoperatively who received a neuromuscular blocker, tubocurarine, during surgery. The nurse is performing a physical assessment, including frequent vital signs assessment. Which finding indicates that the frequency of assessments may be decreased?

a.	The patient can state his name, the appropriate date, and the year.
b.	The patient can void when needed.
c.	The patient can move all extremities fully.
d.	The patient has vital signs within normal limits.

 

 

ANS:   C

Tubocurarine can be used for muscle relaxation during surgery. The frequency of vital signs could be decreased once the medication as been fully metabolized by the body, as indicated by the ability of the patient to move all extremities fully.

The patient’s ability to state his name, the date, and the year would indicate that he is oriented, not that the effects of the neuromuscular blocking agent have worn off.

The ability to void when needed will indicate that the effects of the anesthesia and the neuromuscular blocking agent may have worn off, but this is not the most appropriate indicator for decreasing assessments by the nurse.

The vital signs are not indicative of the neuromuscular blocking agent being completely metabolized by the body.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 142-143

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies