Chapter 33-ANS

Question 1

The nurse understands that dilation of the pupil to permit more light to enter the eye is stimulated by the:

Answer 1

sympathetic nervous system.

Question 2

A substance released into a synapse in order to carry an impulse from one nerve to another is known as a:

Answer 2

neurotransmitter.

Question 3

Which of the following is a chemical agent used within the autonomic nervous system?

Answer 3

norepinephrine- Norepinephrine and acetylcholine are the ANS neurotransmitters.

Question 4

The condition of a client is rapidly deteriorating. The nurse’s physical responses to this situation is predominantly controlled by the

Answer 4

sympathetic nervous system. This situation would stimulate the fight-or-flight response of the sympathetic nervous system.

Question 5

The nurse is administering a drug to stimulate alpha-1 adrenergic receptors. The nurse should:

Answer 5

monitor the client’s blood pressure.-This drug will cause contraction of the peripheral blood vessels, with a responding increase in blood pressure.

Question 6

The nurse understands that these receptors are believed to control neurotransmitter release at the presynaptic neuron in the autonomic nervous system:

Answer 6

alpha-2. Alpha-2 receptors are believed to be the “controllers” of neurotransmitter release at the presynaptic neuron.

Question 7

The nurse is administering an intravenous infusion of a medication that stimulates beta-1 receptors. The nurse should:

Answer 7

place the client on a cardiac monitor.- This will stimulate the client’s heart rate and force of heart muscle contraction, and with intravenous administration the client should be monitored closely for both effectiveness and adverse effects such as tachyarrhythmias.

Question 8

A client with bronchial asthma (reactive airway disease) can be expected to be relieved by the administration of a drug that stimulates which of the following receptors?

Answer 8

beta-2-Beta-2 receptors are located primarily in bronchial smooth muscle and will cause bronchial dilation when stimulated.

Question 9

The nurse is preparing to administer a sympathomimetic medication. This type of medication also is referred to as a(n):

Answer 9

adrenergic agent-Sympathomimetic agents mimic the sympathetic nervous system activities, so they also are referred to as adrenergic agents.

Question 10

The nurse is caring for a client prescribed albuterol and understands that this agent is a(n):

Answer 10

beta-2 adrenergic receptor agonist.- This defines both the classification and action of albuterol.

Question 11

When administering a sympathomimetic drug to a client, the nurse would expect the client to exhibit

Answer 11

mydriasis.

Question 12

A neurotransmitter present in both the sympathetic and parasympathetic nervous systems is:

Answer 12

acetylcholine- is present in both systems.

Question 13

The nurse understands that antispasmodics, particularly those with anticholinergic activity, should be given with care to older persons because older adults:

Answer 13

are especially sensitive to developing CNS side effects of these drugs.
Because of the normal changes that occur with antispasmodics, these clients are more likely to develop CNS side effects from these agents.

Question 14

When teaching an older client prescribed darifenacin, the nurse recognizes that which of the following client comments indicate an understanding of the teaching?

Answer 14

“I will take care not to get overheated when taking this drug.”- For older clients, synthetic anticholinergics decrease their ability to perspire.

Question 15

The nurse would be prepared to administer which of the following drugs preoperatively to decrease the risk of emesis and aspiration during general anesthesia?

Answer 15

glycopyrrolate-This drug, also known as Robinul, is an anticholinergic used for this purpose.

Question 16

An older client is prescribed pilocarpine. The best method to determine the effectiveness of the teaching is to:

Answer 16

have client demonstrate how to administer these eyedrops.

Question 17

The nurse understands that most agents that have antispasmodic activity act by:

Answer 17

antagonizing the action of acetylcholine.-

This is the anticholinergic action of most antispasmodic agents.

Question 18

An older client is prescribed metoprolol for hypertension. The nurse identifies that the highest priority nursing diagnosis for this client after receiving this medication is:

Answer 18

risk for injury, falls.- In therapy with adrenergic blocking agents, the client is at risk for falls related to hypotension and dizziness (adverse effects of these agents).

Question 19

A 60-year-old client is being treated with tacrine. When caring for this client, it is important for the nurse to monitor this client’s:

Answer 19

electrolyte levels.- Effects of this cholinergic agent include diarrhea and increased urinary output, which can lead to dehydration and electrolyte imbalances.

Question 20

The nurse recognizes that the one drug of the following antispasmodic drugs that is used only for the treatment of urinary tract spasm is:

Answer 20

oxybutynin chloride.- This drug has approval only for the treatment of urinary tract spasms.

Question 21

The nurse should provide which of the following instructions (provided it is not contraindicated by the client’s condition) to a client receiving sympathomimetic medications?

Answer 21

Increase fluid intake-: Sympathomimetic agents decrease GI motility and tone, placing the client at risk for constipation.

Question 22

The nurse understands that the transdermal form of scopolamine HBr is used primarily for:

Answer 22

prevention of nausea and vomiting associated with motion sickness in adults.-This is the primary use for scopalamine transdermal form.

Question 23

Through a medication error, a client is experiencing an overdose of atropine sulfate. The nurse should:

Answer 23

prepare to administer intravenous physostigmine

This is an antidote for anticholinergic overdose.

Question 24

The nurse would question a prescription for the preoperative use of glycopyrrolate in a client:

Answer 24

undergoing open-heart surgery.- Because of the tachycardia associated with anticholinergics and that this would delay the stopping of the heart for this surgery, glycopyrrolate is contraindicated.

Question 25

Adrenergic drugs mimic the action of the sympathetic nervous system. Which of the following is a response of the sympathetic nervous system?

Answer 25

open the airway- This is a sympathetic (adrenergic) response.

Question 26

After teaching a client prescribed an alpha-adrenergic blocker about adverse effects of his medication, the nurse assesses that the client understands the teaching when the client responds:

Answer 26

“I should rise slowly from a reclined or sitting position.”

These agents are used to treat hypertension and can cause orthostatic hypotension.

Question 27

An unconscious hospitalized client is receiving an anticholinergic agent. The nurse should:

Answer 27

provide frequent mouth care.- Dry mouth is an adverse effect of anticholinergic agents and also the client is npo due to his unconscious state, so frequent mouth care is imperative.

Question 28

A client is prescribed 20 mg of a medication in two divided doses. The pharmacy supplies the medication as 20 mg/5 mL syringes. The client should receive an individual dose of:

Answer 28

2.5 mL.-10 mg divided by 20 mg = 0.5; multiplied by 5 mL = 2.5 mL.

Question 29

One of the major cautions in using anticholinergic drugs is their narrow therapeutic index. The nurse knows this means:

Answer 29

the difference between a therapeutic and toxic dose is small.
A narrow therapeutic index means the difference between the therapeutic dose and the toxic dose is small.

Question 30

The nurse would prepare to administer Toviaz:

Answer 30

orally

Question 31

The client receiving anticholinergics would be monitored for which of the following? Select all that apply.

Answer 31

b. decreased urinary output
c. skin rash
e. eye pain

Question 32

Which of the following statements could be included in client teaching concerning agents that affect the autonomic nervous system? Select all that apply.

Answer 32

b. Sucking on hard candy may help relieve dry mouth.
c. Clients have the potential for urinary retention.
d. If the client is an older adult, he or she should be monitored for excessive CNS stimulation.
e. Blurred vision may be an adverse effect.
f. Clients should avoid high environmental temperatures due to the diminished ability to perspire.

Question 33

The client is receiving glycopyrrolate. Which of the following statements by the nurse indicate an understanding of this medication? Select all that apply.

Answer 33

a. “Its safety in clients younger than 16 years of age has not been established.”
b. “My client may complain of photophobia.”
c. “I will need to monitor the heart rate due to the adverse effect of tachycardia.”
d. “It antagonizes the effect of antiglaucoma agents.”
e. “It should not be combined in the same syringe with diazepam.”