Elsevier Adaptive Quizzing - Quiz performance.pdf

8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Performance Exit Topic 4 Autonomic Nervous System Due Jun 2, 2024 by 11:59 pm...

8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Performance Exit Topic 4 Autonomic Nervous System Due Jun 2, 2024 by 11:59 pm Final Score 70% 35 out of 50 questions answered correctly Completed on Jun 2, 2024 8:17 pm Incorrect (15) https://eaqng.elsevier.com/#/quizPerformance/58806524 1/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which description of anticholinergic medications is accurate? “Anticholinergics increase saliva production.” “Anticholinergics cause problems with urinary retention.” “In small doses, anticholinergics increase the heart rate.” “In large doses, anticholinergics decrease muscle rigidity.” Rationale Anticholinergic drugs relax the bladder detrusor muscle and increase constriction of the internal sphincter; these two effects may result in urinary retention. Thus the nursing student’s statement about anticholinergics causing problems with urinary retention indicates that the nurse’s teaching was effective. Anticholinergic drugs inhibit the parasympathetic nervous system and thereby decrease salivation. These drugs in high doses inhibit the vagus nerve and thereby increase the heart rate. When given in small doses, anticholinergics decrease muscle rigidity and tremors, so they are prescribed for patients with Parkinson disease. p. 191 https://eaqng.elsevier.com/#/quizPerformance/58806524 2/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which physiologic effect would be unexpected with the administration of cholinergic agonists? Increased peristalsis Increased blood pressure Increased bronchial secretions Increased pupillary constriction Rationale Cholinergic agonists stimulate the parasympathetic nervous system, resulting in decreased, not increased, blood pressure due to vasodilation. Thus increased blood pressure would be unexpected. Other effects of cholinergic agonists include increased tone and motility of the gastrointestinal system, resulting in increased peristalsis; stimulation of bronchial smooth muscle contraction and increased bronchial secretions; and increased pupillary constriction. p. 189 https://eaqng.elsevier.com/#/quizPerformance/58806524 3/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which clinical presentation is suggestive of complications of anticholinergic drugs? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Diarrhea Dry mouth Tachycardia Blurred vision Bronchospasm Rationale Clinical manifestations of complications associated with the use of anticholinergic drugs include dry mouth, tachycardia, and blurred vision. These complications occur due to blockage of cholinergic receptors. Diarrhea and bronchospasm are not complications of anticholinergic drugs. https://eaqng.elsevier.com/#/quizPerformance/58806524 4/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error https://eaqng.elsevier.com/#/quizPerformance/58806524 5/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Which assessment finding would prompt the nurse to hold the medication and contact the health care provider if the nurse is preparing to administer an indirect-acting cholinergic agonist? Temperature of 98.6ºF Pulse of 50 beats per minute Blood pressure of 150/88 mm Hg Respiratory rate of 18 breaths per minute Rationale Indirect-acting cholinergic agonists act by inhibiting or inactivating cholinesterase, permitting acetylcholine to accumulate at the receptor sites. When acetylcholine is increased, the parasympathetic system is stimulated, which can result in a decreased heart rate. Therefore an assessment finding of a pulse rate less than 60 beats per minute would prompt the nurse to hold the medication and contact the health care provider. Body temperature is regulated by the hypothalamus gland. The blood pressure is elevated at 150/88 mm Hg, but an indirect-acting cholinergic agonist would lower it slightly. Respiration is controlled by the medulla oblongata. p. 190 https://eaqng.elsevier.com/#/quizPerformance/58806524 6/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which statement best describes the rationale behind the nurse instructing a patient who has received atropine eye drops for an eye examination to remain in a darkened room or wear sunglasses for several hours until the medication wears off? “Atropine causes miosis.” “Atropine causes paralysis of the iris sphincter.” “Atropine causes relaxation of ciliary muscles.” “Atropine causes elevation of intraocular pressure.” Rationale Atropine causes paralysis of the iris sphincter by blocking muscarinic receptors in the eye. This leads to dilation of the pupils. Consequently, the eye cannot adapt to bright light. Muscarinic agonists cause miosis; atropine causes mydriasis. Atropine relaxes the ciliary muscles and thus causes blurred vision. This also causes an elevation in intraocular pressure, which increases the risk for glaucoma. Nevertheless, it is not an indication for remaining in a darkened room or wearing sunglasses. p. 195 https://eaqng.elsevier.com/#/quizPerformance/58806524 7/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which body part is controlled and regulated by the autonomic nervous system? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Eyes Heart Urinary bladder Skeletal system Respiratory system Gastrointestinal (GI) tract Rationale The autonomic nervous system acts on smooth muscles and glands. Its functions include control and regulation of the eyes, heart, urinary bladder, respiratory system, and GI tract. It is an involuntary system over which humans have little or no control; humans breathe, their hearts https://eaqng.elsevier.com/#/quizPerformance/58806524 8/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance beat, and peristalsis continues without them realizing it. Humans have voluntary control over the skeletal system; it is not controlled by the autonomic nervous system. Report content error Which adverse reaction would the nurse monitor for in a patient taking bethanechol for the treatment of urinary retention? Mydriasis Constipation Hypertension Bronchospasms Rationale Adverse effects of taking bethanechol include bronchospasms, hypotension, tachycardia, headaches, seizures, and gastrointestinal upset. Thus the nurse would monitor for bronchospasms in a patient taking bethanechol for the treatment of urinary retention. Miosis, not mydriasis, may result from the use of bethanechol. Mydriasis, constipation, and hypertension are not expected adverse reactions from the use of bethanechol. p. 188 https://eaqng.elsevier.com/#/quizPerformance/58806524 9/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which assessment finding is a clinical indicator of parasympathetic nervous system stimulation? Retention of urine Dilation of the pupils Dilation of the bronchi Slowing of the heart rate Rationale The parasympathetic nervous system performs seven regulatory functions: slowing the heart rate, increasing gastric secretions, emptying the bladder, emptying the bowel, focusing the eye for near vision, constricting the pupil, and contracting bronchial smooth muscle. Thus slowing of the heart rate is one clinical indicator of parasympathetic nervous system stimulation. Parasympathetic nervous system stimulation relaxes the bladder, allowing the release, not the retention, of urine. Alpha stimulation leads to dilation of the pupils. Cholinergic drugs help the bronchi to contract rather than dilate. p. 189 https://eaqng.elsevier.com/#/quizPerformance/58806524 10/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which condition in a patient’s history would put the patient at an increased risk for adverse effects after the administration of a beta blocker? Wrist injury Diabetes mellitus on insulin Hyperactivity disorder Myocardial infarction Rationale A history of diabetes and insulin usewould put the patient at an increased risk for adverse effects after the administration of a beta blocker.In diabetic patients on insulin, beta blockers lead to an increased risk of hypoglycemia. Diabetic patients may be unable to tell when their blood glucose levels fall too low. Therefore beta blockers are contraindicated in patients with diabetes mellitus. A patient with a wrist injury would not be at risk, because it is a minor injury. A patient with hyperactivity disorder may sometimes be prescribed a beta blocker as a treatment therapy. A patient with a history of myocardial infarction would benefit from a beta blocker, as beta blockers https://eaqng.elsevier.com/#/quizPerformance/58806524 11/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance block the harmful effects of the catecholamines that increase the heart rate after myocardial infarction. p. 183 Report content error Which statement(s) describes (describe) how the therapeutic effect of atenolol differs from the therapeutic action of prazosin in decreasing blood pressure? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected The beta1 antagonist causes vasodilation. The alpha1 antagonist causes vasodilation. The beta1 antagonist decreases heart rate and cardiac output. The alpha1 antagonist decreases heart rate and cardiac output. The beta1 antagonist decreases cardiac contractility and conduction velocity. The alpha1 antagonist decreases cardiac contractility and conduction velocity. https://eaqng.elsevier.com/#/quizPerformance/58806524 12/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Rationale The beta1 antagonist atenolol decreases blood pressure by decreasing heart rate, cardiac output, cardiac contractility, and conduction velocity. The alpha1 antagonist prazosin decreases blood pressure by causing vasodilation. The beta1 antagonist atenolol does not cause vasodilation, and the alpha1 antagonist prazosin does not decrease heart rate, cardiac output, cardiac contractility, or conduction velocity. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger the answer in your mind or provide an important clue to an earlier question. pp. 184-185 Report content error Which response is a result of sympathetic nervous system stimulation? Pupillary dilation Bronchial constriction Increased peristalsis Decreased heart rate https://eaqng.elsevier.com/#/quizPerformance/58806524 13/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Rationale Stimulation of the sympathetic nervous system results in pupillary dilation. Stimulation of the parasympathetic nervous system results in bronchial constriction, increased peristalsis, and decreased heart rate. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple- choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 176 Report content error Which side effect will the nurse include in an education session about bethanechol for the treatment of urinary retention? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Nausea Constipation Abdominal cramps https://eaqng.elsevier.com/#/quizPerformance/58806524 14/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Dysuria Urinary urgency Rationale Bethanechol chloride has side effects of nausea, abdominal cramps, and urinary urgency. Constipation is not a side effect, but diarrhea is. Dysuria is not a side effect because the medication instead causes urinary frequency and urgency. p. 188 Report content error Which statement by the patient indicates that the nurse’s teaching is effective if the nurse is teaching the patient about the administration of an adrenergic agonist medication? “I should limit my fluid intake while taking this medication.” “I should avoid drinking my morning coffee while taking this drug.” “There’s no need to stop eating chocolate while I’m on this medication.” “One glass of red wine with meals will not interfere with the medication.” https://eaqng.elsevier.com/#/quizPerformance/58806524 15/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Rationale Caffeine, such as that found in coffee and chocolate, should be avoided while on the medication because it can further irritate the cardiac and central nervous systems. Thus the patient’s statement about avoiding coffee while taking the drug indicates that the nurse’s teaching is effective. The patient should increase fluid intake, not limit fluid intake, to prevent constipation. Alcohol ingestion should be avoided because it causes vasodilation, increasing the risk for hypotension. Study Tip: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test, and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question. p. 182 Report content error Which assessment finding would the nurse expect in a patient taking a selective beta1-receptor blocker? Pulse of 62 beats per minute Wheezing bilaterally https://eaqng.elsevier.com/#/quizPerformance/58806524 16/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Irregular apical pulse Bounding radial pulse Rationale Blocking of selective beta1 receptors results in a decrease in heart rate, conduction, and contractility, with no bronchoconstriction. This results in a lowered pulse, so the nurse would expect to find a pulse rate of 62 beats per minute. Wheezing would not be expected, as this would indicate bronchoconstriction. The nurse would expect the apical pulse to be regular, and a bounding radial pulse would not be expected if contractility is decreased. p. 183 Report content error Which assessment finding would indicate that propranolol is having a therapeutic effect? Lung fields clear Normal sinus rhythm Strong peripheral pulses https://eaqng.elsevier.com/#/quizPerformance/58806524 17/18 8/7/24, 1:31 PM Elsevier Adaptive Quizzing - Quiz performance Blood pressure of 130/75 mm Hg Rationale Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The patient’s blood pressure is within normal limits, which indicates a therapeutic effect. Clear lung sounds indicate that the patient is not having respiratory side effects. Nonselective beta blockers are not typically given for cardiac dysrhythmias. Strong peripheral pulses are an indication that circulation and cardiac output may be strong; however, these are not related to the drug action. p. 183 Correct (35) https://eaqng.elsevier.com/#/quizPerformance/58806524 18/18