Unit 5: Chapter 29 (Karch 7th Ed) - Introduction to the Autonomic Nervous System 1.

Question 1

1. The central nervous system (CNS) cells, where the impulses for the sympathetic nervous system (SNS)
   originate, are located where?
   A) Cranium and sacral area of the spinal cord
   B) Hypothalamus and the medulla
   C) Nerve membranes
   D) Thoracic and lumbar sections of the spinal cord

Answer 1

Ans: D
Feedback:
The SNS is also called the thoracolumbar system because the CNS cells, where the impulses for the
SNS originate, are located in the thoracic and lumbar sections of the spinal cord. The parasympathetic
nervous system (PNS) is called the craniosacral system because the CNS neurons, where the impulses
for the PNS originate, are found in the cranium and the sacral area of the spinal cord. Alpha2-receptors
are located on nerve membranes and the hypothalamus and medulla are located where the main nerve
centers for the autonomic nervous system (ANS) are located.

Question 2

2. The nurse assesses that the patient is having a sympathetic response when noting what manifestations?
   A) Decrease in sweating, decrease in respirations, and pupil constriction
   B) Decrease in heart rate and perfusion, and an increase in inflammatory reactions
   C) Increase in blood pressure, bronchodilation, and decreased bowel sounds
   D) Increased motility and secretions in the GI tract, and constriction of bronchi and pupils

Answer 2

Ans: C
Feedback:
When stimulated, the sympathetic nervous system prepares the body to flee or to turn and fight (Figure
29.3). Cardiovascular activity increases, as do blood pressure, heart rate, and blood flow to the skeletal
muscles. Respiratory efficiency also increases; bronchi dilate to allow more air to enter with each
breath, and the respiratory rate increases. Pupils dilate to permit more light to enter the eye, to improve
vision in darkened areas (which helps a person to see to fight or flee). Sweating increases to dissipate
heat generated by the increased metabolic activity.

Question 3

3. An anatomy and physiology instructor scratches chalk across the blackboard causing a screeching
   sound. Several students get a feeling like their hair is standing on end. This response is part of the
   sympathetic stress reaction and is called what?
   A) Diaphoresis
   B) Diuresis
   C) Piloerection
   D) Vasoconstriction

Answer 3

Ans: C
Feedback:
The goose flesh or hair standing on end reaction that occurs as part of the stress response is called
piloerection. Diaphoresis refers to sweating. Diuresis is the loss of water through the kidneys.
Vasoconstriction is a muscle contraction in the blood vessel leading to blood vessel narrowing.

Question 4

4. The nurse administers a drug to the patient whose heart rate is bradycardic aimed at increasing heart
   rate and myocardial activity. What adrenergic receptor is this drug stimulating?
   A) Alpha1
   B) Alpha2
   C) Beta1
   D) Beta2

Answer 4

Ans: C
Feedback:
Beta1-receptors are found in cardiac tissue where they can stimulate increased myocardial activity and
increased heart rate. Alpha1-receptors are found in blood vessels, in the iris, and in the urinary bladder.
Alpha2-receptors are located on nerve membranes and act as modulators of norepinephrine release.
Beta2-receptors are found in smooth muscle in blood vessels, in the bronchi, in the periphery, and in
uterine muscle

Question 5

5. The nurse administers a drug that stimulates the parasympathetic nervous system. What physiological
   response would indicate the drug is working?
   A) Vasoconstriction
   B) Increased gastrointestinal (GI) motility
   C) Increased heart rate
   D) Pupil dilation

Answer 5

Ans: B
Feedback:
When the parasympathetic nervous system is stimulated, the result is increased GI motility, decreased
GI secretions, decreased heart rate, and pupillary constriction, which all result from stimulation of the
sympathetic nervous system.

Question 6

6. When the nurse administers a drug that stimulates the nicotinic receptors, what manifestation would
   indicate the drug is working?
   A) Increased gastrointestinal (GI) motility
   B) Decrease in heart rate
   C) Muscle contraction
   D) Pupil constriction

Answer 6

Ans: C
Feedback:
Nicotinic receptors are located in the central nervous system (CNS), the adrenal medulla, the autonomic
ganglia, and the neuromuscular junction. Stimulation of nicotinic receptors causes muscle contractions,
autonomic responses, and release of norepinephrine from the adrenal medulla. Increased GI motility,
decreased heart rate, and pupil constriction are the result of stimulation of the muscarinic receptors.

Question 7

7. A young woman who lives alone comes home at night to find a man in her apartment. What body
   responses would be expected for the young woman?
   A) Increased blood pressure (BP), increased heart rate, and pupil dilation
   B) Decrease sweating, decreased BP, and increased heart rate
   C) Pupil constriction, increased respiratory rate, and decreased heart rate
   D) Increased sweating, decreased respiratory rate, and increased BP

Answer 7

Ans: A
Feedback:
When stimulated by a stressful or fearful situation, the sympathetic nervous system (SNS) prepares the
body to flee or to turn and fight. Cardiovascular activity increases as do blood pressure, heart rate, and
blood flow to skeletal muscles. Respiratory rate increases, pupils dilate, and sweating increases.
Decrease in sweating, BP, heart rate, respiratory rate, and pupil constriction indicate stimulation of the
parasympathetic nervous system, which would not be stimulated by fear.

Question 8

8. When there is stimulation of the sympathetic nervous system (SNS), blood is diverted away from the
   gastrointestinal (GI) tract. What might the nurse assess that would indicate this diversion of blood flow
   to the GI tract?
   A) Increased blood glucose levels
   B) Decreased bowel sounds
   C) Increased blood pressure
   D) Decreased immune reactions

Answer 8

Ans: B
Feedback:
When blood is diverted away from the GI tract, bowel sounds decrease and digestion slows
dramatically, sphincters are constricted, and bowel evacuation cannot occur. Increased blood glucose
levels, elevated blood pressure, and decreased immune reaction are due to SNS stimulation but are not
concerned with the GI tract.

Question 9

9. A patient is being admitted to the floor following a motor vehicle accident. Because of the stressful
   nature of the event, the nurse anticipates the patient will continue to have a sympathetic stress reaction
   during the postoperative period. When monitoring the patient’s serum electrolytes, what will the nurse
   closely monitor?
   A) Increased calcium
   B) Decreased potassium
   C) Increased chloride
   D) Decreased sodium

Answer 9

Ans: B
Feedback:
Aldosterone, also released with adrenal stimulation, retains sodium and water and causes the excretion
of potassium in the urine. As water is retained, sodium is also retained, therefore increasing serum
levels. Chloride levels are unlikely to change significantly. Calcium is not involved

Question 10

10. What does the body require in order to produce acetylcholine?
A) Tyramine
B) Tyrosine from the diet
C) Choline from the diet
D) Bilirubin from the liver

Answer 10

Ans: C
Feedback:
Acetylcholine (ACh) is an ester of acetic acid and an organic alcohol called choline. Cholinergic nerves
use choline, obtained in the diet, to produce ACh. Tyramine and tyrosine are associated with
norepinephrine production. Bilirubin is not a neurotransmitter.

Question 11

11. Which of these is a neurotransmitter?
A) Calcium
B) Cholinesterase
C) Acetylcholine (ACh)
D) Monoamine oxidase

Answer 11

Ans: C
Feedback:
The last step in the production of the neurotransmitter involves choline acetyltransferase, an enzyme
that is also produced within cholinergic nerves. Just like norepinephrine, the ACh is produced in the
nerve and travels to the end of the axons, where it is packaged into vesicles. Calcium is an electrolyte
and not a neurotransmitter. Cholinesterase breaks down acetylcholine and is an enzyme, not a
neurotransmitter. Monoamine oxidase is an enzyme that breaks down norepinephrine.

Question 12

12. Neurons that use acetylcholine as its neurotransmitter are what type of neurons?
A) Cholinergic
B) Dopaminergic
C) GABA-ergic
D) Serotonergic

Answer 12

Ans: A
Feedback:
Neurons that use ACh as their neurotransmitter are called cholinergic neurons. Other options are
incorrect

Question 13

13. The nursing student learns that the hypothalamus serves what purpose?
    A) Causes the secretion of adrenocorticotropic hormone (ACTH)
    B) Controls voluntary movement
    C) Secretes norepinephrine
    D) Helps maintain red blood cell production

Answer 13

Ans: A
Feedback:
The hypothalamus causes the secretion of ACTH, leading to a release of the adrenal hormones
including cortisol, which suppresses the immune and inflammatory reactions to preserve energy that
otherwise, might be used by these activities. The hypothalamus does not have a role in controlling
voluntary movement. The adrenal glands secrete norepinephrine. Red blood cells are produced in the
bone marrow and are stimulated to produce the cells by epoetin secreted by the kidney

Question 14

14. Central nervous system drugs bind to receptors embedded in the cell membranes of neurons.
    Cholinergic receptors have been classified as what?
    A) Muscarinic
    B) Hormones
    C) Enzymes
    D) Proteins

Answer 14

Ans: A
Feedback:
Cholinergic receptors or acetylcholine receptors are found on organs and muscles. They have been
classified as muscarinic receptors and nicotinic receptors. Cholinergic receptors are not classified as
hormones, enzymes, or proteins.

Question 15

15. What helps to prevent overstimulation of effector sites on nerve membranes?
A) Alpha1-receptors
B) Alpha2-receptors
C) Beta1-receptors
D) Beta2-receptors

Answer 15

Ans: B
Feedback:
Alpha2-receptors are located on nerve membranes and act as modulators of norepinephrine release.
When norepinephrine is released from a nerve ending, it crosses the synaptic cleft to react with its
specific receptor site. Some of it also flows back to react with the alpha-receptor on the nerve
membrane. This causes a reflex decrease in norepinephrine release. In this way, the Alpha2-receptor
helps to prevent overstimulation of effector sites

Question 16

16. The sympathetic nervous system (SNS) is associated with a fight-or-flight reaction. What reaction is the
    parasympathetic nervous system is associated?
    A) Recover and repair
    B) Respond and return
    C) Rest and digest
    D) Calm and peace

Answer 16

Ans: C
Feedback:
Although the SNS is associated with the stress reaction and expenditure of energy, the parasympathetic
nervous system is associated with activities that help the body to store or conserve energy, a rest-anddigest
response.

Question 17

17. The control systems of the body act in many ways to maintain homeostasis. These homeostatic control
    systems regulate the functions of the cell, integrate the functions of different organ systems, and do
    what else?
    A) Control vital functions
    B) Feed cells under stress
    C) Act on invading organisms
    D) Shut down the body at death

Answer 17

Ans: A
Feedback:
In many areas, the parasympathetic nervous system works in opposition to the sympathetic nervous
system. This allows the autonomic system to maintain a fine control over vital functions. This is a
homeostatic control system. Homeostatic control systems do not feed cells when they are under stress,
they do not act on invading organisms, and do they shut down the body at death.

Question 18

18. The nurse administers a medication that stimulates the parasympathetic nervous system (PNS). What
    manifestations would indicate the medication is working? (Select all that apply.)
    A) Hyperactive bowel sounds
    B) Increased saliva production
    C) Elevated heart rate
    D) Urinary incontinence
    E) Constricted pupils

Answer 18

Ans: A, B, E
Feedback: PNS stimulation results in increased motility and secretions in the gastrointestinal (GI) tract to promote
digestion and absorption of nutrients: decreased heart rate and contractility to conserve energy and
provide rest for the heart; constriction of the bronchi, with increased secretions; relaxation of the GI
and urinary bladder sphincters, allowing evacuation of waste products; pupillary constriction, which
decreases the light entering the eye and decreases stimulation of the retina. While urinary sphincters
relax, they do not lose control so incontinence would not be an expected manifestation.

Question 19

19. The nurse administers a parasympathetic stimulator that only stimulates nicotinic receptors. What
    effects would the nurse expect to assess? (Select all that apply.)
    A) Muscle contraction
    B) Slowing heart rate
    C) Increased bladder contraction
    D) Signs and symptoms of a stress reaction
    E) Release of epinephrine from adrenal medulla

Answer 19

Ans: A, D, E
Feedback:
Stimulation of nicotinic receptors causes muscle contractions, autonomic responses such as signs and
symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla.
Stimulation of muscarinic receptors causes pupil constriction, increased gastrointestinal (GI) motility
and secretions (including saliva), increased urinary bladder contraction, and a slowing of the heart rate

Question 20

20. Neurotransmitters are small molecules that exert their actions through specific proteins, called
    receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?
    A) In the dendrite terminal
    B) In the presynaptic junction
    C) In the postsynaptic junction
    D) In the axon terminal

Answer 20

Ans: D
Feedback:
Norepinephrine is made by the nerve cells using tyrosine, obtained in the diet. Dihydroxyphenylalanine
(dopa) is produced by a nerve, using tyrosine from the diet and other chemicals. With the help of the enzyme dopa decarboxylase, the dopa is converted to dopamine, which in turn is converted to
norepinephrine in the axon terminals of adrenergic cells. The norepinephrine then is stored in granules
or storage vesicles within the cell.

Question 21

21. The patient is undergoing chronic stress and has a prolonged sympathetic response. What type of drug
    could this patient receive to reduce the sympathetic response? (Select all that apply.)
    A) A drug that reduces sympathetic response
    B) A drug that increases sympathetic response
    C) A drug that reduces parasympathetic response
    D) A drug that increases parasympathetic response
    E) A drug that reduces central nervous system (CNS) response

Answer 21

Ans: A, D, E
Feedback:
Decreasing sympathetic response would reduce the stress response, whereas increasing
parasympathetic response would have the same effect. Although not optional, a medication that slowed
down the entire nervous system would also work. In many areas, the parasympathetic nervous system
works in opposition to the sympathetic nervous system (SNS). This allows the autonomic system to
maintain a fine control over internal homeostasis. For example, the SNS increases heart rate, whereas
the parasympathetic nervous system decreases it. Thus, the autonomic nervous system can influence
heart rate by increasing or decreasing sympathetic activity or by increasing or decreasing
parasympathetic activity.

Question 22

22. Where are Alpha1-receptors found? (Select all that apply.)
A) Blood vessels
B) The iris
C) Nerve membranes
D) Urinary bladder
E) Stomach sphincters

Answer 22

Ans: A, B, D
Feedback: Alpha1-receptors are found in blood vessels, in the iris, and in the urinary bladder. Alpha2-receptors are
located on nerve membranes. Option E is a distracter

Question 23

23. The nurse administers a drug to treat hypertension that causes vasodilation of blood vessels. What is the
drug stimulating?
A) Alpha1-receptors
B) Alpha2-receptors
C) Beta1-receptors
D) Beta2-receptors

Answer 23

Ans: D
Feedback:
In blood vessels, beta2 stimulation leads to vasodilation. Stimulation of Alpha1-receptors causes
vasoconstriction. Beta1 and Alpha2-receptors are not involved with blood vessels

Question 24

24. The nurse administers a drug that stimulates beta2 receptors. What type of health condition would this
drug treat?
A) Heart disease
B) High lipid levels
C) Diabetes
D) Respiratory disease

Answer 24

Ans: D
Feedback:
Beta2-receptors are found in the smooth muscle in blood vessels, in the bronchi, in the periphery, and in
uterine muscle. Beta2-receptors also cause dilation in the bronchi. Beta1-receptor stimulation would
improve some heart disease and are responsible for increased lipolysis. Because beta2-receptors
increase release of glucagon and the breakdown of glycogen, increasing serum glucose levels,
stimulation of these receptors would exacerbate diabetes.

Question 25

25. What is another name for the parasympathetic nervous system?
A) Craniosacral system
B) Cephalocaudal system
C) Preganglionic system
D) Thoracolumbar system

Answer 25

Ans: A
Feedback:
The parasympathetic system is sometimes called the craniosacral system because the central nervous
system neurons that originate parasympathetic impulses are found in the cranium (one of the most
important being the vagus or tenth cranial nerve) and in the sacral area of the spinal cord. The
thoracolumbar system is the sympathetic nervous system. The other options are distractors

Question 26

26. The nurse administers a medication that stimulates the muscarinic receptors. What types of
    manifestations will the nurse assess in this patient that indicate the drug is working?
    A) Pupil dilation
    B) Increased activity of bowel sounds
    C) Increased heart rate
    D) Muscle contractions

Answer 26

Ans: B
Feedback:
Stimulation of muscarinic receptors increases gastrointestinal (GI) motility which would cause
increased activity of bowel sounds. Other effects include pupil constriction, increased urinary bladder
contraction, and a slowing of the heart rate. Stimulation of nicotinic receptors cause muscle
contractions.

Question 27

27. When muscarinic receptors are stimulated, what happens physiologically in the body? (Select all that
    apply.)
    A) Pupil constriction
    B) Pupil dilation
    C) Increased secretions
    D) Increased bladder contraction
    E) Increased heart rate

Answer 27

Ans: A, C, D
Feedback:
Stimulation of muscarinic receptors causes pupil constriction, increased gastrointestinal (GI) motility
and secretions (including saliva), increased urinary bladder contraction, and a slowing of the heart rate.
Pupils are constricted, not dilated and heart rate slows, it does not increase.

Question 28

28. The nurse administers a drug that stimulates the nicotinic receptors. What assessment findings would
    indicate effectiveness of the drug? (Select all that apply.)
    A) Muscle contractions
    B) Release of norepinephrine from the adrenal medulla
    C) Signs and symptoms of a stress reaction
    D) Urinary incontinence
    E) Hyperactive bowel sounds

Answer 28

Ans: A, B, C
Feedback:
Stimulation of nicotinic receptors causes muscle contractions, autonomic responses such as signs and
symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla.
Urinary incontinence would not be associated with stimulation of the nicotinic receptors and increased
bowel activity would result from muscarinic receptors.

Question 29

29. The body makes norepinephrine by using what from the diet?
A) Tyrosine
B) Thiamine
C) Tryptophan
D) Trichonosis

Answer 29

Ans: A
Feedback:
Norepinephrine is made by adrenergic nerves using tyrosine from the diet. Therefore the other options
are incorrect

Question 30

30. The nurse administers a drug that causes vasoconstriction, contracted piloerection muscles, pupil
    dilation, closure of salivary sphincter, and male sexual emission. What receptor is this drug
    stimulating?
    A) Alpha1-receptors
    B) Alpha2-receptors
    C) Beta1-receptors
    D) Beta2-receptors

Answer 30

Ans: A
Feedback:
Stimulation of Alpha1-receptors results in vasoconstriction of blood vessels, increased peripheral
resistance with increased blood pressure, contracted piloerection muscles, pupil dilation, thickened
salivary secretions, closure of the urinary bladder sphincter, and male sexual emission. None of the
other receptors, when stimulated, would have this effect.

Question 31

31. The nurse accompanies the physician into the patient’s room and remains after the patient is told he has
    cancer and it is likely to be terminal. The patient’s respirations become rapid and deep, pupils dilate,
    and measurement of vital signs indicates the patient’s heart rate and blood pressure are elevated. What
    type of response is the nurse assessing?
    A) Sympathetic nervous system (SNS) response
    B) Parasympathetic nervous system (PNS) response
    C) Muscarinic receptor stimulation response
    D) Nicotinic receptor stimulation response

Answer 31

Ans: A
Feedback: When stimulated, the SNS prepares the body to flee or to turn and fight. Cardiovascular activity
increases, as do blood pressure, heart rate, and blood flow to the skeletal muscles. Respiratory
efficiency also increases; bronchi dilate to allow more air to enter with each breath, and the respiratory
rate increases. Pupils dilate to permit more light to enter the eye to improve vision in darkened areas.
PNS would lower heart rate and blood pressure and would constrict pupils. Stimulation of muscarinic
receptors cause pupil constriction, increased gastrointestinal (GI) motility and secretions (including
saliva), increased urinary bladder contraction, and a slowing of the heart rate. Stimulation of nicotinic
receptors causes muscle contractions, autonomic responses such as signs and symptoms of a stress
reaction, and release of norepinephrine and epinephrine from the adrenal medulla.

Question 32

32. Muscarinic and nicotinic receptors are part of what system?
A) The limbic system
B) The reticular activating system
C) The sympathetic nervous system
D) The parasympathetic nervous system

Answer 32

Ans: D
Feedback:
Cholinergic receptors or acetylcholine receptors of the parasympathetic nervous system are found on
organs and muscles. They have been classified as muscarinic receptors and nicotinic receptors. Because
these receptors are part of the parasympathetic nervous system, all other options are incorrect.

Question 33

33. After the effector cell has been stimulated by acetylcholine (ACh), what enzyme stops this stimulation
    and allows the effector membrane to repolarize?
    A) Decarboxylase
    B) Norepinephrine
    C) Acetylcholinesterase
    D) Catecholamine

Answer 33

Ans: C
Feedback:
After the effector cell has been stimulated by ACh, stimulation of the receptor site must be terminated
and destruction of any ACh must occur. The destruction of ACh is carried out by the enzyme
acetylcholinesterase. This enzyme reacts with the ACh to form a chemically inactive compound. The
breakdown of the released ACh is accomplished in 1/1,000 second, and the receptor is vacated, allowing the effector membrane to repolarize and be ready for the next stimulation. Dopa
decarboxylase is an enzyme that converts dopa to dopamine. Norepinephrine is a catecholamine as are
dopamine, serotonin, and epinephrine

Question 34

34. The nurse is teaching a class about the autonomic nervous system for critical care nurses. What
    statements, if made by the nurse during the class, are accurate? (Select all that apply.)
    A) Adrenergic receptors respond to norepinephrine.
    B) Adrenergic receptors are part of the sympathetic nervous system.
    C) Cholinergic receptors are part of the parasympathetic nervous system.
    D) Cholinergic receptors include alpha- and beta- receptors.
    E) Cholinergic and adrenergic receptors are part of the autonomic nervous system.

Answer 34

Ans: A, B, C, E
Feedback:
The sympathetic nervous system contains the adrenergic receptors that respond to norepinephrine and
include alpha- and beta-receptors. The parasympathetic nervous system contains the cholinergic
receptors including the muscarinic and nicotinic receptors that respond to acetylcholine. Together the
sympathetic and parasympathetic systems, including cholinergic and adrenergic receptors, make up the
autonomic nervous system. Option D is incorrect.

Question 35

35. What statement correctly explains the nerve impulse transmission?
    A) The impulse travels from the central nervous system (CNS) to the preganglionic neuron to the
    ganglia to the postganglionic neuron to the neuroeffector cells.
    B) The impulse travels from the preganglionic neuron to the CNS to the ganglia to the postganglionic
    neuron to the neuroeffector cells.
    C) The impulse travels from the preganglionic neuron to the ganglia to the postganglionic neuron to
    the CNS to the neuroeffector cell.
    D) The impulse travels from the CNS, to the neuroeffector cells, to the preganglionic neuron to the
    ganglia to the postganglionic neuron.

Answer 35

Ans: A
Feedback:
The autonomic nervous system does not send impulses directly to the periphery. Instead, axons from CNS neurons end in ganglia, or groups of nerve bodies that are packed together, located outside of the
CNS. These ganglia receive information from the preganglionic neuron that started in the CNS and
relay that information along postganglionic neurons. The postganglionic neurons transmit impulses to
the neuroeffector cells muscles, glands, and organs.