Deck 18: Skeletal Muscle Relaxants Neuromuscular Blocking Agents

Question 1

Adverse effects of nondepolarizing neuromuscular blocking agents include which of the following?
1)Bronchospasm
2)Tachycardia
3)Apnea
4)Increased airway resistance
5)Increased blood pressure

A)1 and 3 only
B)2,4,and 5 only
C)1,2,4,and 5 only
D)1,2,3,4,and 5

Answer 1

1,2,3,4,and 5

Question 2

Which of the following are examples of nondepolarizing neuromuscular blocking agents?
1)Succinylcholine (Anectine)
2)Pancuronium (Pavulon)
3)Rocuronium (Zemuron)
4)Vecuronium (Norcuron)

A)1 and 2 only
B)2 and 3 only
C)2,3,and 4 only
D)1,2,3,and 4

Answer 2

2,3,and 4 only

Question 3

Characteristics of depolarizing neuromuscular blocking agents include which of the following?
1)Cannot be reversed
2)Effects last 60 to 90 seconds
3)Shorter acting than nondepolarizing agents
4)Cause fasciculation
5)Cause total paralysis in 60 to 90 seconds

A)1,3,and 5 only
B)2,3,and 4 only
C)1,3,4,and 5 only
D)1,2,3,4,and 5

Answer 3

1,3,4,and 5 only

Question 4

Skeletal muscle contraction occurs during

A)repolarization.
B)depolarization.
C)nonpolarization.
D)electrolyte depletion.

Question 5

Examples of skeletal muscle include which of the following?
1)Quadriceps
2)Bronchial wall
3)Biceps
4)Diaphragm
5)Cardiac fibers

A)5 only
B)1,3,and 4 only
C)2 and 4 only
D)1,2,3,and 5 only

Question 6

Of the following,the only depolarizing agent is

A)cisatracurium.
B)pancuronium.
C)succinylcholine.
D)vecuronium.

Question 7

Nondepolarizing agents are administered

A)by inhalation.
B)orally.
C)topically.
D)parenterally.

Question 8

Atracurium and cisatracurium are eliminated by

A)the kidneys in urine.
B)hepatic metabolism.
C)excretion in bile.
D)Hofmann degradation.

Question 9

Primary clinical uses of neuromuscular blocking agents include which of the following?
1)Facilitate endotracheal intubation
2)Relieve anxiety
3)enhance patient-ventilator synchrony
4)Relax muscle during surgery
5)Reduce intracranial pressure in intubated patients

A)1 and 2 only
B)1,2,and 3 only
C)1,3,4,and 5 only
D)1,2,3,4,and 5

Question 10

The termination of the nerve axon on the skeletal muscle fiber is called the

A)neuromuscular junction.
B)adrenergic receptor.
C)skeletal-muscular junction.
D)cholinergic receptor.

Question 11

Your patient has been give succinylcholine in an effort to facilitate endotracheal intubation.However,you are unable to place an endotracheal tube.You should

A)administer neostigmine to reverse the paralysis and allow the patient to breathe spontaneously.
B)manually ventilate the patient until succinylcholine wears off.
C)administer a cholinesterase inhibitor other than neostigmine.
D)immediately place the patient on continuous positive airway pressure (CPAP).

Question 12

Immediately after acetylcholine is released at the neuromuscular junction,it is inactivated by

A)pseudocholinesterase.
B)acetaminophen.
C)adenyl cyclase.
D)acetylcholinesterase.

Question 13

Maximal paralyzing effect of succinylcholine is reached in

A)60 to 90 seconds.
B)2 to 5 minutes.
C)5 to 10 minutes.
D)10 to 20 minutes.

Question 14

Succinylcholine would be given to

A)assist with mechanical ventilation.
B)intubate patients.
C)reduce blood pressure.
D)reduce intracranial pressure.

Question 15

The neurotransmitter released by all somatic motor nerves is

A)epinephrine.
B)acetylcholine.
C)norepinephrine.
D)acetylcholinesterase.

Question 16

Agents that paralyze skeletal muscle by simple competitive inhibition of acetylcholine at muscle receptor sites are called

A)nondepolarizing.
B)depolarizing.
C)antagonizing.
D)repolarizing.

Question 17

Which of the following is an exhibited characteristic of nondepolarizing neuromuscular blocking agents?

A)They are tertiary ammonium drugs
B)They quickly diffuse across the blood-brain barrier
C)They reach peak effect slowly when given intravenously
D)They are poorly absorbed from the gastrointestinal tract

Question 18

Neuromuscular blocking agents do which of the following?
1)Decrease consciousness
2)Paralyze skeletal muscle
3)Relieve bronchospasm
4)Increase force of myocardial contraction
5)Alter pain perception

A)2 only
B)3 and 4 only
C)1,2,and 5 only
D)2,3,and 4 only

Question 19

Benefits of neuromuscular paralysis in ventilator management include which of the following?
1)Improved ventilation
2)Better synchrony with the ventilator
3)Reduced ventilator pressures
4)Improved oxygenation
5)Decreased intrathoracic pressure

A)1 and 4 only
B)3 and 5 only
C)1,2,3,and 5 only
D)1,2,3,4,and 5

Question 20

Nondepolarizing neuromuscular blocking agents can be reversed by administering

A)cholinesterase inhibitors.
B)parasympatholytics.
C)sympathomimetics.
D)acetylcholine inhibitors.

Question 21

Clinical factors that potentiate neuromuscular blockade include
1)acidosis.
2)hyponatremia.
3)hypocalcemia.
4)hypokalemia.
5)hypothermia.

A)2 and 3 only
B)2,3,and 4 only
C)1,2,3,and 4 only
D)1,2,3,4,and 5

Question 22

A nondepolarizing agent has a(n)_____________duration of action to a depolarizing agent.

A)longer
B)shorter
C)equal

Question 23

Factors that should be considered when choosing a neuromuscular blocking agent include
1)duration of procedure.
2)onset of action.
3)hemodynamic stability.
4)histamine release.
5)cost.

A)1 and 2 only
B)1,3,and 4 only
C)1,2,3,and 4 only
D)1,2,3,4,and 5

Question 24

Succinylcholine is metabolized by

A)cholinesterase inhibitors.
B)succinylmonocholine.
C)laudanosine.
D)pseudocholinesterase.

Question 25

Succinylcholine is metabolized to

A)cholinesterase inhibitors.
B)succinylmonocholine.
C)laudanosine.
D)pseudocholinesterase.

Question 26

Your patient has been given neostigmine for reversal of the nondepolarizing blockade agent he received during surgery.On examination,you observe severe bradycardia and increased salivation.What is a possible explanation?

A)These are both responses following most kinds of surgery
B)Bradycardia and salivation are not concerns of the respiratory therapist
C)These are side effects of cholinesterase inhibitors
D)The patient should immediately be placed on continuous positive airway pressure (CPAP).The cardiologist can address these clinical manifestations

Question 27

Clinical factors that inhibit neuromuscular blockade include
1)alkalosis.
2)hypernatremia.
3)hypercalcemia.
4)thrombocytopenia.
5)hypothermia.

A)1 and 3 only
B)2,3,and 4 only
C)1,2,3,and 4 only
D)1,2,3,4,and 5

Question 28

A technique used for monitoring blockade that evaluates the conduction of an impulse across the neuromuscular junction using supramaximal stimulus at a frequency of 2 Hz over 2 seconds is referred to as

A)TOF.
B)2 by 2 measuring.
C)negative inspiratory force.
D)hand-grip strength.

Question 29

Nondepolarizing agents

A)cause muscles to fasciculate and remain in a refractory state.
B)bind to acetylcholine receptors and cause a sustained postsynaptic membrane depolarization.
C)produce paralysis and muscle weakness by competing with acetylcholine for binding at the acetylcholine receptors.
D)all of the above are correct.

Question 30

You are taking care of an intubated trauma patient who must remain immobile.The patient has a medical history of end-stage renal failure and atrial fibrillation.What is the most appropriate neuromuscular blocking agent?

A)Succinylcholine (Anectine)
B)Pancuronium (Pavulon)
C)Rocuronium (Zemuron)
D)Cisatracurium (Nimbex)