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Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents and Ganglionic Blocking Agents

1. Succinylcholine (Anectine) is contraindicated in a patient with which condition? A) Diabetes mellitus B) Hyperthyroidism C) Chronic obstructive pulmonary disease (COPD) D) Major burns Succinylcholine promotes the release of potassium from tissues. Significant hyperkalemia is most likely to develop in patients with major burns, multiple trauma, denervation of skeletal muscle, or upper neuron injury. Correct Answer(s): D 2. The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? A) They carry a positive charge. B) They compete with acetylcholine (Ach) for binding sites. C) They cause muscle relaxation. D) They interact with potassium. All NM blockers contain a quaternary nitrogen atom and always carry a positive charge, making it difficult for them to cross membranes. The inability to cross membranes makes parenteral administration necessary. NM blockers do compete with ACh, cause muscle relaxation, and interact with potassium, but these do not necessitate oral administration. Correct Answer(s): A 3. It is important to monitor the patient for which serious adverse effect of neuromuscular blocking agents? A) Apnea B) Anuria C) Hyperglycemia D) Hypoglycemia All NM blocking agents can cause respiratory arrest. They do not cause decreased urinary output, hyperglycemia, or hypoglycemia. Correct Answer(s): A 4. Which of the following conditions is an indication for the use of succinylcholine (Anectine)? A) Pain relief after major surgery B) Loss of consciousness during surgery

C) Facilitation of mechanical ventilation D) Relief of status epilepticus Succinylcholine is an ultrashort-acting NM blocker used to facilitate mechanical ventilation in patients whose spontaneous respirations fight the rhythm of the respirator. It does not provide pain relief or loss of consciousness. It is not indicated for the treatment of status epilepticus. Correct Answer(s): C 5. The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine (Anectine). The patient develops muscle rigidity and a temperature of 105F. Which nursing action is essential? A) Prepare to administer dantrolene (Dantrium). B) Administer normal saline at 50 mL/hr. C) Administer morphine sulfate to relieve pain. D) Prepare for intubation and mechanical ventilation. The patient is experiencing symptoms of malignant hyperthermia, which is a rare and potentially fatal complication of succinylcholine and inhalation anesthesia. Treatment includes discontinuation of succinylcholine and anesthesia; cooling blankets and ice packs; and intravenous (IV) dantrolene, a muscle relaxant. Correct Answer(s): A