Author Question: While preparing a patient for a second esophageal dilation procedure, the nurse explains that ... (Read 33 times)

meagbuch · **on:** Jul 23, 2018

While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine (Anectine) will be used for muscle relaxation.

The patient is anxious and reports not being able to swallow for several hours after the previous procedure. What will the nurse do?
a. Be prepared to provide mechanical ventilation after the procedure.
b. Have dantrolene available, because this patient is at increased risk for side effects.
c. Reassure the patient that this is expected after neuromuscular blockade.
d. Request an order for a pseudocholinesteras e level.

Question 2

A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer?

a. Donepezil (Aricept)
b. Edrophonium (Reversol)
c. Neostigmine (Prostigmin)
d. Physostigmine

memslove · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: D
Succinylcholine is used for muscle relaxation during short procedures, such as esophageal dilation, because of its short duration. The effects wear off minutes after the drug is withdrawn, because plasma pseudocholinesteras e quickly degrades it. Patients who have prolonged effects may have low plasma pseudocholinesteras e levels and should be evaluated if this is suspected. Mechanical ventilation may be necessary if the drug is given, but the prudent nurse would rather avoid this by taking preventive measures instead of treating the adverse reaction after the fact. Dantrolene should always be available when succinylcholine is used because of the risk of malignant hyperthermia; however, nothing indicates that this particular patient is at greater risk than others. Prolonged neuromuscular blockade is not a normal reaction.

Answer to Question 2

ANS: D
Physostigmine is the drug of choice for treating poisoning from atropine and other drugs that cause muscarinic blockade. Donepezil is used to treat Alzheimer's disease. Edrophonium is used to distinguish between a myasthenic crisis and a cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier and would not effectively treat this patient's CNS symptoms.