Question 1

The nurse is caring for a client with multisystem organ failure. Which client assessment findings are under the control of the sympathetic nervous system?&#10;A) Blood glucose level 14 mmol/L&#10;B) Blood pressure 180/90 mmHg&#10;C) Total cholesterol level 4.8 mmol/L&#10;D) Respiratory rate 14 and regular&#10;E) Hyperactive bowel sounds&#10;

Accepted Answer

Rationale 1: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function.
Rationale 2: The constriction and relaxation of arterioles is controlled entirely by the sympathetic nervous system.
Rationale 3: Metabolic effects such as the mobilization of lipids for energy are a sympathetic nervous system function.
Rationale 4: The respiratory rate would be faster and deeper when under sympathetic nervous system control.
Rationale 5: When under the sympathetic nervous system control, peristalsis is temporarily suspended.

Question 2

A client who is suspected to have myasthenia gravis is given a small dose of postoperative medication. The client subsequently develops increased muscle weakness. Which medication should the nurse anticipate administering immediately?

A) A dopamine agonist
B) A calcium channel blocker
C) A cholinesterase inhibitor
D) A sympathetic stimulant

A cholinesterase inhibitor

Accepted Answer

Rationale 1: This would relax the peripheral muscles.
Rationale 2: This would relax cardiac contractility.
Rationale 3: This would increase muscle strength.
Rationale 4: A parasympathetic stimulant would be needed.

Question 3

A client with Alzheimer disease is admitted for an overdose of galantamine (Reminyl) What signs and symptoms will the nurse likely assess in this client?&#10;A) Bradycardia&#10;B) Vomiting&#10;C) Muscle twitching&#10;D) Abdominal cramping&#10;E) Urinary retention&#10;

Accepted Answer

Rationale 1: Tachycardia, not bradycardia is a sign of progressing cholinergic crisis.
Rationale 2: Vomiting is a sign of intense parasympathetic stimulation associated with a cholinergic crisis.
Rationale 3: Muscle twitching is a sign of intense parasympathetic stimulation associated with a cholinergic crisis.
Rationale 4: Abdominal cramping is a sign of intense parasympathetic stimulation associated with a cholinergic crisis.
Rationale 5: Urinary retention is not associated with a cholinergic crisis.

Question 4

Why are adrenergic agonists such as epinephrine given parenterally or by inhalation instead of orally?&#10;A) They are not easily digested in the gastrointestinal tract.&#10;B) They produce toxic by-products in the blood.&#10;C) They are rapidly absorbed by the blood.&#10;D) Catecholamines are metabolized in the liver by the enzymes MAO.&#10;

Accepted Answer

Rationale 1: Adrenergic agonists are not digested in the gastrointestinal tract.
Rationale 2: No toxic by-products are produced.
Rationale 3: Adrenergic agonists are not rapidly absorbed by the blood.
Rationale 4: Epinephrine is metabolized by the enzymes MAO and COMT in the liver and in most tissues; hence, it is not taken orally.

Question 5

The nurse is preparing a care plan for an elderly client diagnosed with hypertension, who is prescribed prazosin (Minipress) 1 mg 2 times a day. Which instructions should the nurse include in the care plan for this client?

A) This drug decreases urinary output and causes urinary retention.
B) The first dose should be given at bedtime.
C) Monitor for drug-related side effects such as dizziness, fatigue, and weakness.
D) Client must be recumbent for 3 to 4 hours if the first dose is given during the daytime.
E) This drug can cause severe constipation, so a high-fiber diet is advisable.

Accepted Answer

Rationale 1: Prazosin (Minipress) does not decrease urinary output but causes an increase in urinary frequency due to more active smooth muscle contractions in the urinary tract.
Rationale 2: Administer initial dose of prazosin (Minipress) at bedtime to minimize adverse effects, such as postural hypotension and syncope.
Rationale 3: The most common side effects of prazosin include dizziness, drowsiness, fatigue, weakness, palpitations, orthostatic hypotension, and headache, since this drug is an alpha1-adrenergic blocker that causes a rapid decrease in peripheral resistance that reduces blood pressure.
Rationale 4: If the initial dose of prazosin (Minipress) must be taken during the day, advise the client to remain recumbent for at least 3 to 4 hours and not to perform hazardous activities during that time.
Rationale 5: Prazosin (Minipress) does not cause constipation.

Question 6

A client is prescribed an alpha1 antagonist for blood pressure control. When instructing the client, the nurse will include that this medication performs which action?&#10;A) Blocks alpha1 receptors on arterial smooth muscle&#10;B) Dilates veins&#10;C) Blocks alpha2 receptors on arterial smooth muscle&#10;D) Reduces the heart rate&#10;E) Decrease the force of myocardial contraction&#10;

Accepted Answer

Rationale 1: Alpha1 antagonists block alpha1 receptors on arterial smooth muscle, which directly lowers blood pressure.
Rationale 2: Alpha1 antagonists dilate veins, which indirectly lowers the blood pressure by decreasing venous return to the heart.
Rationale 3: Although a few agents selectively block alpha2-adrenergic receptors, they are used for research purposes and have no clinical application.
Rationale 4: Beta blockers reduce the heart rate.
Rationale 5: Beta blockers reduce the force of myocardial contraction.

Question 7

A client reports feeling lightheaded and dizzy with palpitations after being instructed to increase the dose of a prescribed beta-adrenergic antagonist. How should the nurse respond to this client's symptoms?

A) "This is first-dose phenomenon."
B) "If the dose is increased again, take the medication at bedtime."
C) "This will go away in time."
D) "Maybe you have another health problem that needs to be examined."
E) "You may have taken too much medication."

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Accepted Answer

Rationale 1: First-dose phenomenon is the onset of orthostatic hypotension when beginning or changing the dose of a beta-adrenergic antagonist.
Rationale 2: Taking the medication at bedtime will reduce the onset of first-dose phenomenon.
Rationale 3: Although this reaction may dissipate in time, this statement does not explain the cause of the client's symptoms.
Rationale 4: The client is experiencing first-dose phenomenon because of the increase in the dosage.
Rationale 5: The client was taking the prescribed increased dose of the medication.

Question 8

A client asks the nurse, &#34;What would happen if I stop taking the beta-blocker my physician ordered?&#34; Which response by the nurse is the most appropriate?&#10;A) &#34;You may start sweating and have palpitations.&#34;&#10;B) &#34;You may get a headache.&#34;&#10;C) &#34;You could develop nausea and vomiting.&#34;&#10;D) &#34;Nothing will occur.&#34;&#10;E) &#34;The medication will not work if prescribed again.&#34;&#10;

Accepted Answer

Rationale 1: If beta blockers are withdrawn abruptly, the client could develop sweating and palpitations because of sensitivity of the heart to catecholamines.
Rationale 2: If beta blockers are withdrawn abruptly, the client could develop a headache because of sensitivity of the heart to catecholamines.
Rationale 3: Nausea and vomiting are not symptoms of rebound cardiac excitation from abruptly withdrawing a beta blocker.
Rationale 4: There are symptoms of cardiac rebound excitation that occur when abruptly withdrawing a beta blocker.
Rationale 5: There is no information to support the concept that a beta blocker will not be effective again if previously abruptly withdrawn.

Deck 7: Brief Review of the Autonomic Nervous System and Neurotransmitters