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

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

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nurse is caring for an intubated patient who is receiving pancuronium for neuromuscular blockade. The patient’s eyes are closed, and the patient is not moving any extremities. The heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what?

a.	Request an order for an antihistamine to prevent a further drop in blood pressure.
b.	Request an order for serum electrolytes to evaluate for hyperkalemia.
c.	Review the patient’s chart for a history of myasthenia gravis (MG).
d.	Talk to the patient while giving care and explain all procedures.

 

 

ANS:  D

Pancuronium is a competitive neuromuscular blocker and is used to paralyze skeletal muscles by neuromuscular blockade. The first muscles affected are those of the eyelids, so patients given this medication cannot open their eyes. Inability to move the extremities is an expected effect. Because these medications do not have central nervous system (CNS) effects, the patient is conscious and awake; therefore, caregivers should continue to talk to the patient while providing care. Atracurium, not pancuronium, can cause hypotension secondary to histamine release. High potassium levels would reduce paralysis. Patients with a history of MG would have increased paralysis. Nothing indicates that this patient is experiencing extreme effects from this medication.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 136 | p. 138

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. While preparing a patient for a procedure in which a neuromuscular blocking agent will be used, the nurse reviews the patient’s preprocedure laboratory values. Which abnormality would cause the most concern?

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 effects similar to those of potassium in relation to neuromuscular blocking agents.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 136 | p. 138

TOP:   Nursing Process: Assessment

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

 

3. Which areas of the body show the effects of neuromuscular blockers last?

a.	Levator muscle of the eyelids and the muscles of mastication
b.	Muscles in the lower extremities
c.	Muscles controlling the glottis
d.	Muscles of respiration and the diaphragm

 

 

ANS:  D

Although neuromuscular blockers can paralyze all skeletal muscles, not all muscles are affected at once. The last muscles affected by neuromuscular blockers are the muscles of respiration, including the intercostals and the diaphragm. The first to become paralyzed are the levator muscle of the eyelids and the muscles of mastication. Paralysis occurs next in the muscles of the limbs, abdomen, and glottis.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 136

TOP:   Nursing Process: Assessment

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

 

4. A patient will receive atracurium [Tracrium] during surgery for neuromuscular blockade. The nurse caring for this patient will correctly perform which of the following actions?

a.	Assess the patient for signs of CNS depression.
b.	Ensure that dantrolene is available in case of a serious adverse reaction.
c.	Monitor the patient’s blood pressure closely.
d.	Review the preprocedure laboratory values related to renal and hepatic function.

 

 

ANS:  C

Atracurium is used for muscle relaxation during surgery. Unlike other drugs in this class, it can cause hypotension secondary to antihistamine release. Cholinesterase inhibitors can reverse this reaction. Drugs in this class do not cause CNS depression. Dantrolene is the agent used to treat malignant hyperthermia, which is triggered by succinylcholine. Atracurium is eliminated primarily by plasma cholinesterase and not by the renal or hepatic routes.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 138

TOP:   Nursing Process: Planning

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