When the nurse administers a drug that stimulates the nicotinic receptors, what manifestation would indicate that the drug is working?

Pupil constriction

Muscle contraction

Increase GI motility

Decrease in heart rate

Answer and Explanation

The Correct Answer is B

A) Pupil constriction: Pupil constriction (miosis) is primarily mediated by the parasympathetic nervous system through muscarinic receptors, not nicotinic receptors. Nicotinic receptors, when stimulated, affect skeletal muscle contraction, not the size of the pupils.

B) Muscle contraction: Nicotinic receptors are located on skeletal muscle cells and are responsible for mediating muscle contraction when activated. When a drug stimulates nicotinic receptors, the expected outcome is muscle contraction, as these receptors play a critical role in neuromuscular transmission.

C) Increase GI motility: While nicotinic receptors are involved in muscle contraction, they are not the primary mediators of gastrointestinal motility. Muscarinic receptors, which are part of the parasympathetic nervous system, primarily control GI motility. Stimulating muscarinic receptors would lead to increased motility, but not nicotinic receptors.

D) Decrease in heart rate: A decrease in heart rate is typically associated with the stimulation of muscarinic receptors, particularly those that influence the parasympathetic nervous system (vagal tone). Nicotinic receptor activation does not directly influence heart rate; in fact, their stimulation is more related to skeletal muscle contraction.

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Correct Answer is D

Explanation

A) A patient with hypotension:
Patients with hypotension may have reduced blood flow to organs, which could potentially decrease the absorption and effectiveness of many medications, including opioids. As a result, the need for a higher dose is not typical. Instead, careful dosing and monitoring are required to avoid further lowering blood pressure, which could lead to more complications.

B) A patient with a concussion:
Concussions affect the brain and can lead to symptoms like dizziness, confusion, or nausea, which may alter how medications are metabolized or tolerated. However, a concussion does not typically require higher opioid doses. In fact, opioids should be used cautiously in such patients due to the risk of exacerbating neurological symptoms or respiratory depression.

C) A patient 3 days after surgery:
Patients recovering from surgery may require pain management, but the opioid dose typically adjusts based on their pain levels and recovery stage. While some patients may still need opioids for pain control, they may not require higher-than-expected doses. Over time, doses are often tapered as healing progresses, and pain lessens.

D) A patient with cancer:
Cancer patients, particularly those with advanced stages or chronic pain, may develop increased opioid tolerance. This means that over time, they may require higher doses to achieve the same level of pain relief. This phenomenon is known as "opioid tolerance," where the body becomes less responsive to the drug, necessitating dose adjustments.

A. Decreased blood pressure B. Decreased heart rate C. Increased body temperature D. Increased blood pressure

Correct Answer is D

Explanation

A) Decreased blood pressure:
Isoproterenol (Isuprel) is a non-selective beta-adrenergic agonist that primarily stimulates beta-1 and beta-2 receptors. It causes vasodilation through beta-2 stimulation, but its predominant effect is increasing heart rate and cardiac output via beta-1 stimulation. This tends to result in an increase in blood pressure

B) Decreased heart rate:
Isoproterenol generally leads to an increase in heart rate because of its beta-1 adrenergic activity, which stimulates the heart's pacemaker cells. It is commonly used to treat bradycardia (slow heart rate).

C) Increased body temperature:
Although isoproterenol can lead to increased heart rate and blood flow, it does not directly cause a significant increase in body temperature. Temperature changes are more commonly seen with drugs affecting metabolism or those that induce fever.

D) Increased blood pressure:
Isoproterenol stimulates beta-1 receptors in the heart, leading to increased heart rate and cardiac output, which typically results in an increase in blood pressure. However, due to its beta-2 effects, there can be some vasodilation, which may counteract this effect slightly. Despite this, the overall effect of isoproterenol is typically an increase in blood pressure, especially in a shock setting, where improving circulation is critical.

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When the nurse administers a drug that stimulates the nicotinic receptors, what manifestation would indicate that the drug is working?

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