Chapter 13 Physiology of the Peripheral Nervous System

Chapter 13: Physiology of the Peripheral Nervous System Test Bank MULTIPLE CHOICE 1. What is the target organ when a beta1 agonist is administered? a. heart b. kidney c. respiratory d. liver ANS: A A beta1 agonist increases the patient’s heart rate and blood pressure and is used in heart failure. Beta1 agonists would not be used for kidney, respiratory, or liver failure. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 110 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? a. “The digestive functions of the body” b. “The cardiovascular system” c. “The fight-or-flight response” d. “Body temperature” ANS: A The sympathetic nervous system does not regulate digestive functions of the body—the parasympathetic nervous system does; further education is needed. The sympathetic nervous system regulates the cardiovascular system, the fight-or-flight response, and the body temperature; no further education is needed. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 103 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect? a. Hypotension b. Tachycardia c. Tachypnea d. Urinary retention ANS: B Beta agonists are used for asthma because of their beta2 effects on bronchial smooth muscle, causing dilation. Beta1 effects cause tachycardia and hypertension. Beta receptors do not exert effects on the bladder. PTS: 1 DIF: Cognitive Level: Application REF: pp. 110-111 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching? a. “It activates three cholinergic receptor subtypes.” b. “It has effects in the parasympathetic, sympathetic, and somatic nervous systems.” c. “It is used at most junctions of the peripheral nervous system.” d. “Its transmission is terminated by reuptake into the cholinergic nerve terminal.” ANS: D Acetylcholine (ACh) is destroyed by acetylcholinesterase, an enzyme that degrades ACh into two inactive products: acetate and choline. Choline is taken up into the nerve terminal. ACh activates three receptor sites: nicotinicN, nicotinicM, and muscarinic. ACh has effects throughout the peripheral nervous system (PNS) and is used at most junctions in the PNS. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 112 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see? a. Decreased sweating b. Bronchodilation c. Increased cardiac output d. Pinpoint pupils ANS: C Norepinephrine (NE) is the most common neurotransmitter released by all postganglionic neurons of the sympathetic nervous system except those going to sweat glands where ACh is the neurotransmitter. NE acts on alpha1, alpha2, and beta1 receptors to increase the force and rate of cardiac contraction, thus increasing cardiac output. ACh would increase sweating. Bronchodilation occurs when epinephrine activates beta2 receptors on bronchial smooth muscle. NE affects alpha1 receptors to dilate the pupils. PTS: 1 DIF: Cognitive Level: Application REF: p. 105 | pp. 110-111 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. Many medications list side effects that include dry mouth, constipation, and urinary retention. What kinds of effects are these? a. Alpha adrenergic b. Anticholinergic c. Beta adrenergic d. Sympathetic ANS: B Cholinergic stimulation by ACh causes increased salivation, increased gastrointestinal (GI) motility, and relaxation of the bladder trigone and sphincter. Anticholinergic medications inhibit these responses, causing dry mouth, constipation, and urinary retention. Alpha-adrenergic agents effect processes in the sympathetic nervous system, causing peripheral vasoconstriction and pupil dilation, among other effects. The effects of beta-adrenergic medications are seen mostly in the heart and blood vessels. The sympathetic nervous system has both cholinergic and adrenergic transmitters. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 110-111 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A nurse is explaining activation of beta2 receptors to nursing students during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching? a. “Beta2 activation results in bronchodilation.” b. “Beta2 activation results in contraction of uterine muscle.” c. “Beta2 activation results in glycogenolysis.” d. “Beta2 activation results in vasodilation of skeletal muscles.” ANS: B Beta2 activation would result in relaxation of uterine smooth muscle, not contraction; this statement indicates a need for further teaching. Bronchodilation is an effect of beta2 activation; no further teaching is needed. Beta2 activation does result in glycogenolysis; no further teaching is needed. Beta2 activation does result in vasodilation of skeletal muscle; no further teaching is needed. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 111 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A pregnant patient is in premature labor. Which class of drug will she be given? a. Alpha1 agonist b. Anticholinergic c. Beta2 agonist d. Beta2 antagonist ANS: C Beta2 agonists cause relaxation of uterine muscle, slowing or stopping the contractions that precipitate labor. An alpha1 agonist would have effects on the heart and arterioles. Anticholinergic drugs generally are given for their effects on the urinary and GI tracts and do not affect uterine muscle. A beta2 antagonist would cause increased constriction of uterine muscle. PTS: 1 DIF: Cognitive Level: Application REF: pp. 110-111 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse? a. Pulse oximetry reading of 88% b. Blood pressure of 100/60 mm Hg c. Respiratory rate of 28 breaths per minute d. Heart rate of 110 beats per minute ANS: D A beta agonist dilates respiratory smooth muscle, but as a side effect, it can stimulate the heart. A heart rate of 110 beats per minute is a concern, because this medication may further increase the already elevated heart rate. A pulse oximetry reading of 88% is a concern, but the medication causes bronchodilation and increased oxygenation; this should increase the pulse oximetry reading. A blood pressure of 100/60 mm Hg is on the low side, but this medication may actually cause an increase in blood pressure as a side effect; this should not concern the nurse before administration of the medication. A respiratory rate of 28 breaths per minute is elevated; however, this medication should increase oxygenation by bronchodilation, and the patient’s respiratory rate should decrease once oxygenation has improved. Therefore, this should not concern the nurse. PTS: 1 DIF: Cognitive Level: Application REF: pp. 110-111 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies