CVICU EXAM Questions and Verified Answers/Accurate Solutions| New Update Already
Graded A+
Example of a depolarizing neuromuscular blocking agent succinylcholine
Example of a non-depolarizing neuromuscular blocking agent rocuronium
Classification of NMBA that competes with acetylcholine to occupy the receptor sites on the
motor end plate non-depolarizing neuromuscular blocking agent.
By blocking access to the receptors, they prevent acetylcholine-induced depolarization (no ion
channels are opened, no action potential is generated).
Type of NMBA that is reversed by anticholinesterase drugs? What is an example of an
anticholinesterase drug? non-depolarizing neuromuscular blocking agent.
Reversed by neostigmine.
What NMBA causes contraction of skeletal muscle cells? depolarizing neuromuscular
blocking agents.
Initially causes fasciculations, then flaccid paralysis caused by desensitization at the receptor to
acetylcholine.
What NMBA mimics the actions of acetylcholine? Succinylcholine (depolarizing
neuromuscular blocking agents).
Stimulate nicotinic receptors and open up the ion channels, leading to depolarization.
,What NMBA causes the diaphragm muscle to be 'paralyzed' last and recovered first?
non-depolarizing.
Small muscles in the eyelids are paralyzed first, followed by extremities, jaw, intercostal
muscles, abdominal muscles and then the diaphragm.
4 indications for the administration of a neuromuscular blocking agent. 1. To facilitate
intubation.
2. To facilitate mechanical ventilation.
3. To reduce metabolic demands by stopping muscle movement.
4. Cessation of movement for critical diagnostic studies on intubated/ventilated patients.
5. To control status epilepticus or severe agitation.
Primary indication for administration of anticholinesterase agents. To reverse the effects
of non-depolarizing neuromuscular blockade agents. They allow increased transmission of
nerve impulses by inhibiting the activity of cholinesterase, which normally destroys
acetylcholine. For example, neostigmine.
Give two examples of anticholinergic agents used with anticholinesterase agents. 1.
Atropine
2. Glycopyrrolate
What interventions must be provided prior to administering a non-depolarizing agent? 1.
Patient must be intubated and ventilated on a control mode of ventilation.
2. Bagging unit must be at bedside.
3. Sedation must be administered prior to NMBA!
4. Explain procedures to patient and family if possible.
5 nursing care responsibilities for the patient receiving neuromuscular blockade agents.
1. Patient must be under extremely close observation (totally ventilator dependent).
, 2. Cardiac and ventilator alarms MUST be set and in operation at all times.
3. Provide mouth care q2h (and prn) to prevent ventilator acquired pneumonia.
4. Provide skin care and turning q2h (and prn) to prevent skin breakdown.
5. Monitor electrolytes (imbalances can potentiate or diminish the effects of NMBA).
What medications should be given to all patients receiving neuromuscular blocking agents?
Analgesia and sedation.
Sedation MUST be administered prior to neuromuscular blocking agents! Analgesics should be
considered and administered if necessary.
Succinylcholine should be administered with extreme caution in the setting of what electrolyte
imbalance? Hyperkalemia. Caused by prolonged opening of the ion channels of the
nicotinic receptors during the depolarization phase, which lets a lot of potassium ions into the
extracellular fluid.
Why should range of motion exercises only be done by physiotherapy when patients are
receiving NMBA? Paralysis decreases joint and limb protection and increases risk for
joint dislocation.
Identify 3 potential adverse effects of a neuromuscular blocking agent 1. Prolonged
action of the drug after discontinuation
2. Hypotension
3. Tachycardia
4. Bronchoconstriction
Clinical assessment is performed to determine subsequent dosing of NMBA. Identify four
clinical responses to assess for. 1. A cleft in the plateau portion of the ETCO2 waveform.
2. Ventilator asynchrony.
3. Patient movement or diaphragmatic movement (triggering the ventilator).
Graded A+
Example of a depolarizing neuromuscular blocking agent succinylcholine
Example of a non-depolarizing neuromuscular blocking agent rocuronium
Classification of NMBA that competes with acetylcholine to occupy the receptor sites on the
motor end plate non-depolarizing neuromuscular blocking agent.
By blocking access to the receptors, they prevent acetylcholine-induced depolarization (no ion
channels are opened, no action potential is generated).
Type of NMBA that is reversed by anticholinesterase drugs? What is an example of an
anticholinesterase drug? non-depolarizing neuromuscular blocking agent.
Reversed by neostigmine.
What NMBA causes contraction of skeletal muscle cells? depolarizing neuromuscular
blocking agents.
Initially causes fasciculations, then flaccid paralysis caused by desensitization at the receptor to
acetylcholine.
What NMBA mimics the actions of acetylcholine? Succinylcholine (depolarizing
neuromuscular blocking agents).
Stimulate nicotinic receptors and open up the ion channels, leading to depolarization.
,What NMBA causes the diaphragm muscle to be 'paralyzed' last and recovered first?
non-depolarizing.
Small muscles in the eyelids are paralyzed first, followed by extremities, jaw, intercostal
muscles, abdominal muscles and then the diaphragm.
4 indications for the administration of a neuromuscular blocking agent. 1. To facilitate
intubation.
2. To facilitate mechanical ventilation.
3. To reduce metabolic demands by stopping muscle movement.
4. Cessation of movement for critical diagnostic studies on intubated/ventilated patients.
5. To control status epilepticus or severe agitation.
Primary indication for administration of anticholinesterase agents. To reverse the effects
of non-depolarizing neuromuscular blockade agents. They allow increased transmission of
nerve impulses by inhibiting the activity of cholinesterase, which normally destroys
acetylcholine. For example, neostigmine.
Give two examples of anticholinergic agents used with anticholinesterase agents. 1.
Atropine
2. Glycopyrrolate
What interventions must be provided prior to administering a non-depolarizing agent? 1.
Patient must be intubated and ventilated on a control mode of ventilation.
2. Bagging unit must be at bedside.
3. Sedation must be administered prior to NMBA!
4. Explain procedures to patient and family if possible.
5 nursing care responsibilities for the patient receiving neuromuscular blockade agents.
1. Patient must be under extremely close observation (totally ventilator dependent).
, 2. Cardiac and ventilator alarms MUST be set and in operation at all times.
3. Provide mouth care q2h (and prn) to prevent ventilator acquired pneumonia.
4. Provide skin care and turning q2h (and prn) to prevent skin breakdown.
5. Monitor electrolytes (imbalances can potentiate or diminish the effects of NMBA).
What medications should be given to all patients receiving neuromuscular blocking agents?
Analgesia and sedation.
Sedation MUST be administered prior to neuromuscular blocking agents! Analgesics should be
considered and administered if necessary.
Succinylcholine should be administered with extreme caution in the setting of what electrolyte
imbalance? Hyperkalemia. Caused by prolonged opening of the ion channels of the
nicotinic receptors during the depolarization phase, which lets a lot of potassium ions into the
extracellular fluid.
Why should range of motion exercises only be done by physiotherapy when patients are
receiving NMBA? Paralysis decreases joint and limb protection and increases risk for
joint dislocation.
Identify 3 potential adverse effects of a neuromuscular blocking agent 1. Prolonged
action of the drug after discontinuation
2. Hypotension
3. Tachycardia
4. Bronchoconstriction
Clinical assessment is performed to determine subsequent dosing of NMBA. Identify four
clinical responses to assess for. 1. A cleft in the plateau portion of the ETCO2 waveform.
2. Ventilator asynchrony.
3. Patient movement or diaphragmatic movement (triggering the ventilator).
