TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 16-20
Chapter 16: Drugs That Block Nicotinic Cholinergic
Transmission: Neuromuscular Blocking Agents and
Ganglionic Blocking Agents
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.
DIF: Cognitive Level: Application REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects | Adverse Effects | Precautions and
Contraindications 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.
DIF: Cognitive Level: Analysis REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects | Precautions and Contraindications
TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. Which of the following areas of the body shows the effects of tubocurarine 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 tubocurarine can paralyze all skeletal muscles, not all muscles are affected
at once. The last muscles affected by tubocurarine 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.
DIF: Cognitive Level: Application REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects 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.
DIF: Cognitive Level: Analysis REF: Competitive Neuromuscular
Blockers | Properties of Individual Agents TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
5. While preparing a patient for a second esophageal dilation procedure, the nurse explains
that succinylcholine (Anectine) will be used for muscle relaxation. The patient is anxious
and reports not being able to swallow for several hours after the previous procedure.
What will the nurse do?
a. Be prepared to provide mechanical ventilation after the procedure.
b. Have dantrolene available, because this patient is at increased risk for side effects.
c. Reassure the patient that this is expected after neuromuscular blockade.
d. Request an order for a pseudocholinesterase level.
ANS: D
Succinylcholine is used for muscle relaxation during short procedures, such as
esophageal dilation, because of its short duration. The effects wear off minutes after
the drug is withdrawn, because plasma pseudocholinesterase quickly degrades it.
Patients who have prolonged effects may have low plasma pseudocholinesterase
levels and should be evaluated if this is suspected. Mechanical ventilation may be
necessary if the drug is given, but the prudent nurse would rather avoid this by taking
preventive measures instead of treating the adverse reaction after the fact. Dantrolene
should always be available when succinylcholine is used because of the risk of
malignant hyperthermia; however, nothing indicates that this particular patient is at
greater risk than others. Prolonged neuromuscular blockade is not a normal reaction.
DIF: Cognitive Level: Analysis REF: Depolarizing Neuromuscular
Blockers: Succinylcholine | Adverse Effects TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
6. A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia
with a group of nursing students. Which statement by a student indicates a need for
further teaching?
a. “Analgesics should be given to help with muscle pain.”
b. “Dantrolene helps to slow the metabolic activity in skeletal muscles.”
c. “If malignant hyperthermia occurs, the succinylcholine must be stopped
immediately.”
d. “The patient may need an intravenous infusion of cold saline.”
ANS: A
Malignant hyperthermia is a rare but potentially fatal adverse reaction that can be
CHAPTERS 16-20
Chapter 16: Drugs That Block Nicotinic Cholinergic
Transmission: Neuromuscular Blocking Agents and
Ganglionic Blocking Agents
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.
DIF: Cognitive Level: Application REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects | Adverse Effects | Precautions and
Contraindications 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.
DIF: Cognitive Level: Analysis REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects | Precautions and Contraindications
TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. Which of the following areas of the body shows the effects of tubocurarine 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 tubocurarine can paralyze all skeletal muscles, not all muscles are affected
at once. The last muscles affected by tubocurarine 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.
DIF: Cognitive Level: Application REF: Competitive Neuromuscular
Blockers | Pharmacologic Effects 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.
DIF: Cognitive Level: Analysis REF: Competitive Neuromuscular
Blockers | Properties of Individual Agents TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
5. While preparing a patient for a second esophageal dilation procedure, the nurse explains
that succinylcholine (Anectine) will be used for muscle relaxation. The patient is anxious
and reports not being able to swallow for several hours after the previous procedure.
What will the nurse do?
a. Be prepared to provide mechanical ventilation after the procedure.
b. Have dantrolene available, because this patient is at increased risk for side effects.
c. Reassure the patient that this is expected after neuromuscular blockade.
d. Request an order for a pseudocholinesterase level.
ANS: D
Succinylcholine is used for muscle relaxation during short procedures, such as
esophageal dilation, because of its short duration. The effects wear off minutes after
the drug is withdrawn, because plasma pseudocholinesterase quickly degrades it.
Patients who have prolonged effects may have low plasma pseudocholinesterase
levels and should be evaluated if this is suspected. Mechanical ventilation may be
necessary if the drug is given, but the prudent nurse would rather avoid this by taking
preventive measures instead of treating the adverse reaction after the fact. Dantrolene
should always be available when succinylcholine is used because of the risk of
malignant hyperthermia; however, nothing indicates that this particular patient is at
greater risk than others. Prolonged neuromuscular blockade is not a normal reaction.
DIF: Cognitive Level: Analysis REF: Depolarizing Neuromuscular
Blockers: Succinylcholine | Adverse Effects TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
6. A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia
with a group of nursing students. Which statement by a student indicates a need for
further teaching?
a. “Analgesics should be given to help with muscle pain.”
b. “Dantrolene helps to slow the metabolic activity in skeletal muscles.”
c. “If malignant hyperthermia occurs, the succinylcholine must be stopped
immediately.”
d. “The patient may need an intravenous infusion of cold saline.”
ANS: A
Malignant hyperthermia is a rare but potentially fatal adverse reaction that can be
