Autonomic Nervous System

When describing the functions of the ANS, which of the following would the instructor include?

A) Maintenance of balance and posture

B) Maintenance of the special senses

C) Regulation of integrated internal body functions

D) Coordination of peripheral and central nerve pathways

C) Regulation of integrated internal body functions

The ANS differs from other systems in the CNS in that it:

A) Uses only peripheral pathways

B) Affects organs and muscles via a two-neuron system

C) Uses a unique one-neuron system

D) Bypasses the CNS in all of its actions

B) Affects organs and muscles via a two-neuron system

If you suspect that a person is a very stressed and is experiencing a sympathetic stress rxn, you would expect to find:

A) Increased bowel sounds and urinary output

B) Constricted pupils and warm, flushed skin

C) Slow heart rate and decreased systolic blood pressure

D) Dilated pupils and elevated systolic blood pressure

D) Dilated pupils and elevated systolic blood pressure

The nurse determines that the beta2 receptors in the SNS have been stimulated by which finding?

A) Increased heart rate

B) Increased myocardial contraction

C) Bronchial dilation

D) Uterine contraction

C) Bronchial dilation

The parasympathetic nervous system, in most situations, opposes the actions of the SNS, allowing the ANS to:

A) Generally have no effect

B) Maintain a fine control over internal homeostasis

C) Promote digestion

D) Respond to stress more effectively

B) Maintain a fine control over internal homeostasis

Cholinergic neurons, those using ACh as their neurotransmitter, would be least likely found in:

A) Motor nerves on skeletal muscles

B) Preganglionic nerves in the sympathetic and parasympathetic systems

C) Postganglionic nerves in the parasympathetic system

D) The adrenal medulla

D) The adrenal medulla

Stimulation of the PNS would cause:

A) Slower heart rate and increased GI secretions

B) Faster heart rate and urinary retention

C) Vasoconstriction and bronchial dilation

D) Pupil dilation and muscle paralysis

A) Slower heart rate and increased GI secretions

Select all that apply: The SNS:

A) Is called the thoracolumbar system

B) Is called the fight-or-flight system

C) Is called the craniosacral system

D) Uses ACh as its sole neurotransmitter

E) Uses epinephrine as its sole neurotransmitter

F) Is active during stress reaction

A) Is called the thoracolumbar system

B) Is called the fight-or-flight system

F) Is active during stress reaction

Select all that apply: The sympathetic system uses catecholamines at the postganglionic receptors. Which of the following are considered to be catecholamines?

A) Dopamine

B) Norepinephrine

C) ACh

D) Epinephrine

E) MAO

F) Serotonin

A) Dopamine

B) Norepinephrine

D) Epinephrine

F) Serotonin

Once a postganglionic receptor site has been stimulated the neurotransmitter must be broken down immediately. The sympathetic system breaks down postganglionic neurotransmitters by using:
A) Liver enzymes and acetylcholinesterase
B) Acetylcholinesterase and MAO
C) COMT and liver enzymes
D) MAO and COMT

D) MAO and COMT

The instructor determines that teaching about adrenergic drugs has been successful when the class identifies the drugs as also being called:

A. Sympatholytic Agents

B. Cholinergic Agents

C. Sympathomimetic Agents

D. Anticholinergic Agents

C. Sympathomimetic Agents

The adrenergic agent of choice for treating the signs and symptoms of allergic rhinitis is:

A. Norepinephrine

B. Phenylephrine

C. Dobutamine

D. Dopamine

B, Phenylephrine

An adrenergic agent being used to treat shock infiltrates into the tissue with intravenous administration. What action by the nurse would be most appropriate?

A. Watch the area for nay signs of necrosis and report it to the physician

B. Notify the physician and decrease the rate of infusion

C. Remove the IV and prepare phentolamine for administration to the area

D. Apply ice and elevate the arm

C. Remove the IV and prepare phentolamine for administration to the area

Phenylephrine, an alpha-specific agonist, is found in many cold and allergy preparations. The nurse instructs the patient to be alert for which adverse effects?

A. Urinary retention and pupil constriction

B. Hypotension and slow heart rate

C. Personality changes and increased appetite

D. Cardiac arrhythmias and difficulty urinating

D. Cardiac arrhythmias and difficulty urinating

Adverse effects associated with adrenergic agonists are related to the generalized stimulation of the sympathetic nervous system and could include:

A. Slowed heart rate

B. Constriction of the pupils

C. Hypertension

D. Increased gastrointestinal secretions

C. Hypertension

A patient as elected to take an over-the-counter cold preparation that contains phenylephrine. The nurse would advise the patient not to take that drug is the patient has:

A. Thyroid or cardiovascular disease

B. A cough and runny nose

C. Chronic obstructive pulmonary disease

D. Hypotension

A. Thyroid or cardiovascular disease

Isoproterenol is a nonspecific beta-agonist. The nurse might expect to administer this drug for which of the following conditions: (Select all that apply)

A. Preterm labor

B. Bronchospasm

C. Cardiac standstill

D. Shock

E. Heart block in transplanted hearts

F. Heart failure

B. Bronchospasm

C. Cardiac standstill

D. Shock

E. Heart block in transplanted hearts

A nurse would question the order for an adrenergic-agonist for a patient who is also receiving which of the following: (Select all that apply)

A. Anticholinergic drugs

B. Halogenated hydrocarbon anesthetics

C. Beta-blockers

D. Benzodiazepines

E. Monoamine oxidase inhibitors

F. Tricyclic antidepressants

B. Halogenated hydrocarbon anesthetics

C. Beta-blockers

E. Monoamine oxidase inhibitors

F. Tricyclic antidepressants

Adrenergic blocking drugs, because of their clinical effects, are also known as
a. anticholinergics.
b. sympathomimetics.
c. parasympatholytics.
d. sympatholytics.

d. sympatholytics.

The nurse would anticipate administering drugs that generally block all adrenergic receptor sites to treat
a. allergic rhinitis.
b. COPD.
c. cardiac-related conditions.
d. premature labor

c. cardiac-related conditions.

Phentolamine (Regitine), an alpha-adrenergic blocker, is most frequently used
a. to prevent cell death after extravasation of intravenous dopamine or norepinephrine.
b. to treat COPD in patients with hypertension or arrhythmias.
c. to treat hypertension and BPH in male patients.
d. to block bronchoconstriction during acute asthma attacks.

a. to prevent cell death after extravasation of intravenous dopamine or norepinephrine.

A patient with which conditions would most likely be prescribed an alpha1-selective adrenergic blocking agent?
a. COPD and hypotension
b. Hypertension and BPH
c. Erectile dysfunction and hypotension
d. Shock states and bronchospasm

b. Hypertension and BPH

The beta-blocker of choice for a patient who is hypertensive and has angina is
a. nadolol.
b. propranolol.
c. timolol.
d. carteolol.

a. nadolol.

A nurse would question an order for beta1-selective adrenergic blocker for a patient with
a. cardiac arrhythmias.
b. hypertension.
c. cardiogenic shock.
d. open-angle glaucoma.

c. cardiogenic shock.

A smoker who is being treated for hypertension with a beta-blocker is most likely receiving
a. a nonspecific beta-blocker.
b. an alpha1-specific beta-blocker.
c. beta- and alpha-blockers.
d. a beta1-specific blocker.

d. a beta1-specific blocker.

You would caution a patient who is taking an adrenergic blocker
a. to avoid exposure to infection.
b. to stop the drug if he or she experiences flu-like symptoms.
c. that it can be dangerous to stop the drug abruptly.
d. to avoid exposure to the sun.

c. that it can be dangerous to stop the drug abruptly.

A nurse would question an order for a beta-adrenergic blocker if the patient was also receiving what other drugs?
a. Clonidine
b. Ergot alkaloids
c. Aspirin
d. NSAIDs
e. Triptans
f. Epinephrine

a. Clonidine
b. Ergot alkaloids
d. NSAIDs
f. Epinephrine

The beta-adrenergic blocker propranolol is approved for a wide variety of uses. Which of the following are approved indications?
a. Migraine headaches
b. Stage fright
c. Bronchospasm
d. Reinfarction after an MI
e. Erectile dysfunction
f. Hypertension

a. Migraine headaches
b. Stage fright
d. Reinfarction after an MI
f. Hypertension

Indirect-acting cholinergic agents:
a. react with acetylcholine receptor sites on the membranes of effector cells.
b. react chemically with acetylcholinesterase to increase acetylcholine concentrations.
c. are used to increase bladder tone and urinary excretion.
d. should be given with food to slow absorption.

b. react chemically with acetylcholinesterase to increase acetylcholine concentrations

A patient is to receive pilocarpine. The nurse understands that this drug would be most likely used to treat which of the following?
a. Myasthenia gravis
b. Neurogenic bladder
c. Sjögren disease dry mouth
d. Alzheimer disease

c. Sjögren disease dry mouth

Myasthenia gravis is treated with indirect-acting cholinergic agents that:
a. lead to accumulation of acetylcholine in the synaptic cleft.
b. block the GI effects of the disease, allowing for absorption.
c. directly stimulate the remaining acetylcholine receptors.
d. can be given only by injection because of problems associated with swallowing.

a. lead to accumulation of acetylcholine in the synaptic cleft.

A patient with myasthenia gravis is no longer able to swallow. Which of the following would the nurse expect the physician to order?
a. Rivastigmine
b. Memantine
c. Pyridostigmine
d. Edrophonium

c. Pyridostigmine

Alzheimer disease is marked by a progressive loss of memory and is associated with:
a. degeneration of dopamine-producing cells in the basal ganglia.
b. loss of acetylcholine-producing neurons and their target neurons in the CNS.
c. loss of acetylcholine receptor sites in the parasympathetic nervous system.
d. increased levels of acetylcholinesterase in the CNS.

b. loss of acetylcholine-producing neurons and their target neurons in the CNS.

The nurse would expect to administer donepezil to a patient with Alzheimer disease who:
a. cannot remember family members' names.
b. is mildly inhibited and can still follow medical dosing regimens.
c. is able to carry on normal activities of daily living.
d. has memory problems and would benefit from once-a-day dosing.

d. has memory problems and would benefit from once-a-day dosing.

Adverse effects associated with the use of cholinergic drugs include:
a. constipation and insomnia.
b. diarrhea and urinary urgency.
c. tachycardia and hypertension.
d. dry mouth and tachycardia.

b. diarrhea and urinary urgency.

Nerve gas is an irreversible acetylcholinesterase inhibitor that can cause muscle paralysis and death. An antidote to such an agent is:
a. atropine.
b. propranolol.
c. pralidoxime.
d. neostigmine.

c. pralidoxime.

A nurse is explaining myasthenia gravis to a family. Which of the following points would be included in the explanation? (SATA)
a. It is thought to be an autoimmune disease.
b. It is associated with destruction of acetylcholine receptor sites.
c. It is best treated with potent antibiotics.
d. It is a chronic and progressive muscular disease.
e. It is caused by demyelination of the nerve fiber.
f. Once diagnosed, it has a 5-year survival rate.

a. It is thought to be an autoimmune disease.
b. It is associated with destruction of acetylcholine receptor sites.

d. It is a chronic and progressive muscular disease.

A nurse would question an order for a cholinergic drug if the patient was also taking which drugs? (SATA)
a. Theophylline
b. NSAIDs
c. Cephalosporin
d. Atropine
e. Propranolol
f. Memantine

a. Theophylline
b. NSAIDs

d. Atropine

Anticholinergic drugs are used
a. to allow the sympathetic system to become more dominant.
b. to block the parasympathetic system, which is commonly hyperactive.
c. as the drugs of choice for treating ulcers.
d. to stimulate GI activity.

a. to allow the sympathetic system to become more dominant.

Atropine and scopolamine work by blocking
a. nicotinic receptors only.
b. muscarinic and nicotinic receptors.
c. muscarinic receptors only.
d. adrenergic receptors to allow cholinergic receptors to dominate.

c. muscarinic receptors only.

Which of the following suggestions would the nurse make to help a patient who is receiving an anticholinergic agent reduce the risks associated with decreased sweating?
a. Covering the head and using sunscreen
b. Ensuring hydration and temperature control
c. Changing position slowly and protecting from the sun
d. Monitoring for difficulty swallowing and breathing

b. Ensuring hydration and temperature control

Which of the following would the nurse be least likely to include when developing a teaching plan for a patient who is receiving an anticholinergic agent?
a. Encouraging the patient to void before dosing
b. Setting up a bowel program to deal with constipation
c. Encouraging the patient to use sugarless lozenges to combat dry mouth
d. Performing exercises to increase the heart rate

d. Performing exercises to increase the heart rate

SATA
A nurse would expect atropine to be used for which of the following?
a. To depress salivation
b. To dry up bronchial secretions
c. To increase the heart rate
d. To promote uterine contractions
e. To treat myasthenia gravis
f. To treat Alzheimer disease

a. To depress salivation
b. To dry up bronchial secretions
c. To increase the heart rate

Remembering that anticholinergics block the effects of the parasympathetic nervous system, the nurse would question an order for an anticholinergic drug for patients with which conditions?
a. Ulcerative colitis
b. Asthma
c. Bradycardia
d. Inner ear imbalance
e. Glaucoma
f. Prostatic hyperplasia

a. Ulcerative colitis
e. Glaucoma
f. Prostatic hyperplasia