Musculoskeletal and Autonomic Nervous System Review

True/False
Indicate whether the statement is true or false.

____ 1. Competitive neuromuscular blocking agents mimic the action of acetylcholine.

____ 2. Methocarbamol (Robaxin) may turn urine brown, black, or green.
____ 3. Antidotal drugs such as neostigmine can only reverse the actions of competitive neuromuscular blocking
agents.
____ 4. Centrally acting skeletal muscle relaxants are useful in treating chronic disorders characterized by involuntary
motor activity.
____ 5. Neuromuscular blockade, the intentional paralysis of a client using medications that paralyze skeletal muscle
groups, also causes paralysis of cardiac muscle.
____ 6. Anticholinergic drugs cause relaxation of the smooth muscle in the bronchi.
____ 7. Because of a decline in the thermal regulatory system, older adults may experience hypothermia when taking
anticholinergic drugs.
____ 8. The older adult is at risk of urinary retention when taking anticholinergic drugs. This can lead to fluid
overload.
____ 9. Antispasmodics should not be administered to clients with acute narrow-angle glaucoma.

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 10. Neuromuscular blocking agents are used for all the following except:
a. facilitate surgery by reducing muscle movement.
b. for the treatment of muscle spasm caused by cerebral palsy.
c. facilitate electroconvulsive therapy by reducing muscle movement.
d. to prevent muscle spasm of the larynx in clients who require endotracheal intubation.
____ 11. All the following statements regarding neuromuscular blocking agents are true except:
a. The use of quinidine and similar antiarrhythmic agents is avoided in clients who have
recently received neuromuscular blocking agents.
b. All neuromuscular blocking agents are capable of causing respiratory paralysis.
c. Neuromuscular blocking agents are not useful for treating muscle rigidity of neurological
disease or trauma.
d. Neuromuscular blocking agents can be used for long-term treatment of chronic disorders
such as arthritis.
____ 12. Adverse hepatic effects associated with the use of dantrolene (Dantrium) are most likely to occur:
a. within days of initiating therapy.
b. several weeks after initiating therapy.
c. 3-12 months after initiating therapy.
d. after therapy has been discontinued.
____ 13. The most common reason for use of neuromuscular blockade is to:
a. sedate clients with a head injury.
b. prepare the client for surgery.
 c. facilitate intubation and mechanical ventilation.
d. decrease spasticity and muscular rigidity.
____ 14. Nursing care of the client receiving a neuromuscular blocking agent while on a mechanical ventilator includes
all of the following except:
a. make sure all alarms on mechanical ventilators are set to detect changes in ventilatory
pressure.
b. leave the client alone as much as possible so the client will not be stimulated.
c. provide frequent reassurance to the client.
d. communicate to the client what the nurse is going to do before touching the client.
____ 15. Which of the following agents should be used with great caution in a client who has recently received a
neuromuscular blocking agent?
a. gentamicin (Garamycin) c. diazepam (Valium)
b. levodopa d. aspirin
____ 16. Which of the following drugs directly relaxes skeletal muscles?
a. methocarbamol (Robaxin) c. aspirin
b. dantrolene (Dantrium) d. diazepam (Valium)
____ 17. Neuromuscular blocking agents are usually administered:
a. intravenously. c. intramuscularly.
b. orally. d. subcutaneously.
____ 18. Centrally acting skeletal muscle relaxants most often produce:
a. rashes and itching. c. insomnia.
b. edema. d. drowsiness and sedation.
____ 19. Dantrolene may be administered preoperatively to:
a. facilitate mechanical ventilation.
b. prevent development of malignant hyperthermia.
c. facilitate induction of anesthesia.
d. clients with history of myasthenia gravis.
____ 20. Antidotal drugs for neuromuscular blocking agents include:
a. Romazicon. c. succinylcholine.
b. neostigmine. d. Narcan.
____ 21. Which of the following drugs is most likely to cause photosensitivity reactions?
a. dantrolene (Dantrium) c. tubocurarine chloride
b. pancuronium bromide (Pavulon) d. methocarbamol (Robaxin)
____ 22. Which of the following should be avoided for use in clients using centrally acting skeletal muscle relaxants?
a. acetaminophen (Tylenol) c. alcohol
b. ibuprofen (Advil) d. dextromethorphan
____ 23. Which of the following drugs is frequently used in treating skeletal muscle spasm associated with multiple
sclerosis or cerebral palsy?
a. methocarbamol (Robaxin) c. cyclobenzaprine (Flexeril)
b. dantrolene (Dantrium) d. carisoprodol (Rela)
____ 24. A client diagnosed as having myasthenia gravis would benefit most by using:
a. neostigmine (Prostigmin). c. baclofen (Lioresal).
b. orphenadrine (Norflex). d. methocarbamol (Robaxin).
____ 25. The nurse is aware that the drug administered primarily for diagnosis of myasthenia gravis is:
a. edrophonium (Tensilon). c. cyclobenzaprine (Flexeril).
b. methocarbamol (Robaxin). d. carisoprodol (Soma).
____ 26. Common adverse effects experienced by clients receiving drugs like pyridostigmine include:
a. excessive salivation, diarrhea, bradycardia.
 b. excessive salivation, constipation, tachycardia.
c. dry mouth, diarrhea, bradycardia.
d. dry mouth, constipation, tachycardia.
____ 27. Which of the following is not a term used to describe a branch of the autonomic nervous system?
a. somatic nervous system c. adrenergic nervous system
b. parasympathetic nervous system d. cholinergic nervous system
____ 28. A substance released into a synapse in order to carry an impulse from one nerve to another is known as a:
a. ganglionic transmitter. c. catecholamine agonist.
b. neuromuscular agonist. d. neurotransmitter.
____ 29. Which of the following is a chemical agent utilized within the autonomic nervous system?
a. histamine c. levonorgestrel
b. norepinephrine d. methylxanthine
____ 30. Another name for the sympathetic portion of the autonomic nervous system is the:
a. breed and feed portion. c. fight or flight portion.
b. quick response portion. d. synthetic impulse portion.
____ 31. Alpha-1 adrenergic receptors are found primarily in the:
a. heart. c. lungs.
b. bladder. d. peripheral blood vessels.
____ 32. Which receptors are believed to control neurotransmitter release in the autonomic nervous system?
a. beta-2 c. alpha-2
b. beta-1 d. alpha-1
____ 33. Cardiac function can best be altered by stimulating which of the following receptors?
a. beta-2 c. alpha-2
b. beta-1 d. alpha-1
____ 34. An asthmatic condition can be expected to be relieved by the administration of a drug that stimulates which of
the following receptors?
a. beta-2 c. alpha-2
b. beta-1 d. alpha-1
____ 35. Sympathomimetic drugs are sometimes also referred to as:
a. adrenergic drugs. c. muscarinic drugs.
b. cholinergic drugs. d. nicotinic drugs.
____ 36. Miosis is a term that refers to:
a. dilation of bronchioles. c. impaired glucose metabolism.
b. slowed heart rate. d. contraction of the pupil.
____ 37. Administration of a sympathomimetic drug to a client is likely to result in:
a. constricted bronchioles.
b. decreased force of cardiac contraction.
c. mydriasis.
d. decreased heart rate.
____ 38. A neurotransmitter present in both the sympathetic and parasympathetic nervous system is:
a. acetylcholine. c. glycogen.
b. norepinephrine. d. acetylcholinesterase.
____ 39. Antispasmodics, particularly those with anticholinergic activity, should be given with care to older persons
because the elderly:
a. are especially sensitive to developing CNS side effects of these drugs.
b. are more likely to have glaucoma than younger people.
c. are more likely to have prostatic hypertrophy (males) than younger people.
d. all of the above
____ 40. When used to treat gastric ulcers, antispasmodics are usually administered:
a. with meals and on first rising.
b. 1/2 hour after meals.
c. at bedtime only.
d. 1/2 hour before meals and at bedtime.
____ 41. Administration of a cholinergic agent such as neostigmine (Prostigmin) is likely to result in:
a. mydriasis. c. constipation.
b. lacrimation. d. increased heart rate.
____ 42. Which of the following drugs is commonly administered preoperatively to decrease the risk of emesis and
aspiration during general anesthesia?
a. tacrine c. scopolamine
b. glycopyrrolate d. physostigmine
____ 43. Which of the following statements best describes the procedure for administering tincture of belladonna?
a. Shake well and dilute it in milk.
b. Refrigerate before administration and take it undiluted.
c. Mix it in a small amount of applesauce or juice.
d. Dilute it in a caffeinated beverage and drink it through a straw.
____ 44. Most agents that have antispasmodic activity act by:
a. stimulating the release of acetylcholine.
b. blocking the conduction of nerve impulses in the brain.
c. blocking the action of norepinephrine in the body.
d. antagonizing the action of acetylcholine.
____ 45. Which of the following is not a side effect seen in the use of antispasmodic agents?
a. difficult urination c. lowered body temperature
b. dry mouth d. increased pressure within the eye
____ 46. Which of the following antispasmodic agents is a belladonna derivative?
a. scopolamine HBr
b. clidinium bromide (Quarzan)
c. propantheline bromide (Pro-Banthîne)
d. isopropamide iodide (Darbid)
____ 47. Which of the following antispasmodic drugs is used only for the treatment of urinary tract spasm?
a. dicyclomine HCl (Bentyl)
b. mepenzolate bromide (Cantil)
c. oxybutynin chloride (Ditropan)
d. propantheline bromide (Pro-Banthîne)
____ 48. Which of the following is not an action associated with atropine?
a. pupillary constriction c. reduction of saliva
b. decreased gastrointestinal motility d. reduction of bronchial secretions
____ 49. A transdermal form of which of these drugs is used primarily for the prevention of nausea and vomiting
associated with motion sickness in adults?
a. l-hyoscyamine sulfate (Anaspaz) c. scopolamine HBr
b. flavoxate (Urispas) d. methantheline bromide (Banthîne)
____ 50. Persons scheduled for thyroid function tests are advised to discontinue which of these drugs 1 week before the
test?
a. anisotropine (Valpin 50)
b. isopropamide iodide (Darbid)
c. propantheline bromide (Pro-Banthîne)
d. atropine sulfate
____ 51. Antispasmodics that are belladonna derivatives are contraindicated in clients with:
 a. renal disease. c. prostatic hypertrophy.
b. narrow angle glaucoma. d. all of the above
____ 52. Adrenergic drugs mimic the action of the sympathetic nervous system. Which of the following is a response
of the sympathetic nervous system?
a. decreased heart rate
b. contraction of the pupils
c. open the airway
d. increased motility and tone of the GI tract
____ 53. A common adverse effect of alpha adrenergic blockers is:
a. hypertension. c. increased respiratory rate.
b. hypotension. d. decreased respiratory rate.
____ 54. Older adults are at increased risk of falls when taking sympatholytic drugs because they are more sensitive to
the actions of these agents. A priority nursing diagnosis for these clients is:
a. Risk for altered urinary elimination related to disease process.
b. Risk for ineffective airway clearance related to breathing disorder.
c. Risk for injury related to medication regimen.
d. Risk for altered nutrition related to lifestyle.
____ 55. Anticholinergic agents are contraindicated for use as a preoperative medication for clients undergoing heart
surgery. Which of the following adverse effects of anticholinergic agents makes them undesirable for this
purpose?
a. tachycardia c. hypertension
b. bradycardia d. hypotension
____ 56. One of the major cautions in using anticholinergic drugs is their narrow therapeutic index. The nurse knows
this means:
a. it only takes a small amount of medication to treat the problem.
b. the difference between a therapeutic and toxic dose is small.
c. clients may stop taking the medication due to side effects.
d. the therapeutic level of a drug is reached quickly.
Musculoskeletal and Autonomic Nervous System Review
Answer Section

TRUE/FALSE

1. ANS: F PTS: 1
2. ANS: T PTS: 1
3. ANS: T PTS: 1
4. ANS: T PTS: 1
5. ANS: F PTS: 1
6. ANS: T PTS: 1
7. ANS: F PTS: 1
8. ANS: F PTS: 1
9. ANS: T PTS: 1

MULTIPLE CHOICE

10. ANS: B PTS: 1

11. ANS: D PTS: 1
12. ANS: C PTS: 1
13. ANS: C PTS: 1
14. ANS: B PTS: 1
15. ANS: A PTS: 1
16. ANS: B PTS: 1
17. ANS: A PTS: 1
18. ANS: D PTS: 1
19. ANS: B PTS: 1
20. ANS: B PTS: 1
21. ANS: A PTS: 1
22. ANS: C PTS: 1
23. ANS: B PTS: 1
24. ANS: A PTS: 1
25. ANS: A PTS: 1
26. ANS: A PTS: 1
27. ANS: A PTS: 1
28. ANS: D PTS: 1
29. ANS: B PTS: 1
30. ANS: C PTS: 1
31. ANS: D PTS: 1
32. ANS: C PTS: 1
33. ANS: B PTS: 1
34. ANS: A PTS: 1
35. ANS: A PTS: 1
36. ANS: D PTS: 1
37. ANS: C PTS: 1
38. ANS: A PTS: 1
39. ANS: D PTS: 1
40. ANS: D PTS: 1
41. ANS: B PTS: 1
42. ANS: B PTS: 1
43. ANS: C PTS: 1
44. ANS: D PTS: 1
45. ANS: C PTS: 1
46. ANS: A PTS: 1
47. ANS: C PTS: 1
48. ANS: A PTS: 1
49. ANS: C PTS: 1
50. ANS: B PTS: 1
51. ANS: D PTS: 1
52. ANS: C PTS: 1
53. ANS: B PTS: 1
54. ANS: C PTS: 1
55. ANS: A PTS: 1
56. ANS: B PTS: 1