Pharm 02 Review: Adrenergic Agents

Phentolamine is the agent used to treat extravasation of dobutamine. False True

True Explanation: Maintain phentolamine on standby in case extravasation occurs.

Adrenergic drugs mimic the effects of stimulating what part of the nervous system? autonomic central parasympathetic sympathetic

sympathetic Explanation: An adrenergic drug is an agent that produces effects like those produced by stimulation of the sympathetic nervous system and therefore has widespread effects on body tissues.

A nurse is caring for a client who has been receiving an adrenergic medication. Which statement by the client alerts the nurse about an adverse effect of the medication and a reason to call the prescriber? "I feel a "fluttering" feeling in my heart." "I wonder what triggered this allergic reaction?" "I am concerned about this hospitalization." "I have a nervous feeling."

"I feel a "fluttering" feeling in my heart." Explanation: Management of the client receiving an adrenergic agent varies and depends on the medication being used, the reason for administration, and the client's response to the drug. Nursing judgment is necessary when reporting adverse reaction. Report adverse effects such as the development of cardiac arrhythmias immediately regardless of the time of day or night. A report of a nervous feeling, or concern about the hospitalization need not be dealt with on an emergent basis. The client is not experiencing an allergic reaction.

Which client is most likely to benefit from the administration of an adrenergic agonist? A man who has a diagnosis of primary hypertension A man who is in cardiogenic shock following a myocardial infarction A woman who has been admitted with a suspected ischemic stroke A woman who is in labor and may require a caesarean section

A man who is in cardiogenic shock following a myocardial infarction Explanation: One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes? Beta-adrenergic drugs Beta-adrenergic blocking drugs Beta-blocking agonist Beta-helping drugs

Beta-adrenergic blocking drugs Explanation: Beta-adrenergic blocking drugs prevent epinephrine and norepinephrine from occupying receptor sites on cell membranes. Beta-adrenergic drugs stimulate epinephrine and norepinephrine release so that they can occupy more of the receptor sites. Beta Blocking agonist cause epinephrine to bind to sites causing airways to open. There is no such thing as beta-helping drugs.

A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize? Respiratory assessment Cardiac monitoring Monitoring of intracranial pressure Arterial blood gases

Cardiac monitoring Explanation: The high potential for adverse effects that is associated with the use of dopamine necessitates vigilant cardiac monitoring. Respiratory assessment, ABGs, and monitoring of ICP are likely indicated by the patient's injuries, but these are not directly related to the use of dopamine.

Which would the nurse identify as a naturally occurring catecholamine? Dopamine Dobutamine Ephedrine Metaraminol

Dopamine Explanation: Dopamine is a naturally occurring catecholamine. Dobutamine, ephedrine, and metaraminol are synthetic catecholamines.

What would the nurse expect to assess in a client receiving an alpha- and beta-adrenergic agonist? Hypotension Personality changes Diarrhea Dyspnea

Dyspnea Explanation: Adverse effects of alpha- and beta-adrenergic agonists include dyspnea, hypertension, and constipation. Personality changes are associated with alpha-specific adrenergic agonists.

Which herbs has been removed from most weight-loss medications due to potential legal liability? Ginseng Rose hips Gingko Ephedra

Ephedra Explanation: Ephedra has serious adverse reactions, such as hypertension and irregular heart beat. These side effects have been associated with stroke and heart attacks. The Food and Drug Administration has warnings against taking weight-loss pills that have ephedra in them. Gingko, ginseng, and rose hips have not had these serious side effects.

Adrenergic drugs produce which effect? Decreased kidney perfusion Increased heart rate Decreased respiratory rate Urinary retention

Increased heart rate Explanation: Adrenergic drugs are used in cardiac arrest for their cardiac stimulant and peripheral vasoconstrictive effects.

The nurse would contact the health care provider before administering an adrenergic drug to a client who is also taking which drug? Diuretic Antibiotic MAO inhibitor Analgesic

MAO inhibitor Explanation: Adrenergic drugs are contraindicated in clients taking MAO inhibitors. It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Concurrent use of MAO inhibitors and adrenergic drugs may lead to a danger of cardiac dysrhythmias, respiratory depression, and acute hypertensive crisis, with possible intracranial hemorrhage, convulsions, coma, and death.

A home care nurse is visiting a patient to assess blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) in the kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine? To increase appetite Treatment of bronchial asthma Methamphetamine production Treatment of sinusitis

Methamphetamine production Explanation: Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.

A client who is in shock has been prescribed a dopamine intravenous infusion. What component of the client's existing medication regimen most increases the client's risk for adverse effects? Vitamin B6 Phenelzine Levothyroxine Albuterol

Phenelzine Explanation: Phenelzine is a monoamine oxidase (MAO) inhibitor; MAO is partially responsible for the deactivation of norepinephrine in synapses of the sympathetic nervous system and alterations in its levels can affect norepinephrine levels. Albuterol, levothyroxine and vitamin B6 are not reported to create a risk for drug-drug interactions.

Which agent would the nurse expect to find when reviewing over-the-counter allergy products? Dopamine Clonidine Phenylephrine Midodrine

Phenylephrine Explanation: Phenylephrine is found in many cold and allergy products because it is so effective in constricting topical vessels and decreasing the swelling and signs and symptoms of rhinitis.

A 27-year-old client has been in the intensive care unit for two weeks following a car accident. The primary nurse is concerned that the client is not getting the rest needed for recovery. Which nursing diagnosis would be appropriate for this problem? Risk for Narcolepsy related to nighttime wakefulness Risk for Disturbed Sleep Pattern related to hospitalization Risk for Body Image Disturbance related to injuries Risk for Psychosis related to head injury

Risk for Disturbed Sleep Pattern related to hospitalization Explanation: Sleep patterns are disturbed constantly when a client is in the ICU. The client will have lots of noise around him, will be awoken for vital signs, turning, medications, etc. The room will not be completely dark. Adrenergic medications can make it difficult to sleep. All of these can lead to disturbed sleep patterns. Narcolepsy is a medical diagnosis that describes a client who falls asleep multiple times a day. The client's body image is not likely the issue with sleeping. There is no evidence in the above scenario that suggests psychosis or head injury.

The adrenergic branch of the autonomic nervous system is also known by which name? Sympathetic nervous system Parasympathetic nervous system Somatic nervous system Central nervous system

Sympathetic nervous system Explanation: The sympathetic nervous system is also known as the adrenergic branch.

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider? A diastolic blood pressure of 75 mm Hg Systolic blood pressure below 100 mm Hg Pulse rate of 60 beats per minute Temperatures reading of 97.6°F

Systolic blood pressure below 100 mm Hg Explanation: The nurse must immediately report to the health care provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats per minute, and a temperature reading of 97.6°F are normal and need not be reported immediately.

Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly. False True

True

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately? Urinary output Physical assessment Vital signs Pain evaluation

Vital signs Explanation: When a client is to receive an adrenergic agent for shock, obtain the blood pressure, pulse rate and quality, and respiratory rate and rhythm. Urinary output, pain, and the physical assessment are not a priority in shock.

A client experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The client's right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve which of the clients symptoms? acute bronchospasm. acute anxiety. discoloration in her hand. pain and swelling around the sting site.

acute bronchospasm. Explanation: The client is most likely experiencing anaphylaxis, and the epinephrine is being given to produce bronchodilation by stimulation of beta-2 adrenergic receptors and is the drug of choice to treat anaphylactic shock. The epinephrine does not directly affect the pain, redness, or swelling. It can actually add to anxiety because it stimulates all adrenergic receptors and can cause CNS excitation.

Epinephrine causes relaxation of: superficial blood vessels. sphincter muscles. smooth muscles in the intestinal wall. bronchioles.

bronchioles. Explanation: Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.

The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result? decreased oxygen demand by the myocardium increased heart rate vasoconstriction of the coronary arteries decreased heart muscle contractions

increased heart rate Explanation: The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. Beta1 activation results in increased force of myocardial contraction, or a positive inotropic effect and increased speed of electrical conduction in the heart.

A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce? increased bronchoconstriction decreased coronary circulation increased vasoconstrictive effects decreased cerebral circulation

increased vasoconstrictive effects Explanation: Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction.

Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? A 17-year-old female with symptoms of an upper respiratory infection A 47-year-old female with hypertension A 62-year-old male with gout A 52-year-old male with adult-onset diabetes

A 47-year-old female with hypertension Explanation: Phenylephrine is an alpha-1 adrenergic agonist and a drug commonly used topically for relief of nasal and nasopharyngeal mucosal congestion and to produce mydriasis for ophthalmologic procedures. Phenylephrine acts as a vasopressor causing vasoconstriction of the arterioles. The vasoconstriction from phenylephrine use can increase peripheral resistance and blood pressure. People with hypertension should not take over-the-counter cold and allergy preparations containing phenylephrine because it can further increase their already elevated blood pressure. Patients with diabetes and gout have not been identified as being at risk for adverse reactions from the use of phenylephrine. A patient with an upper respiratory infection may actually benefit from use of the drug.

An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist? Terbutaline Albuterol Phenylephrine Epinephrine

Epinephrine Explanation: Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist.

Which would the nurse expect to be given to a client experiencing acute bronchospasm? Norepinephrine Metaraminol Epinephrine Dopamine

Epinephrine Explanation: Epinephrine would be used to treat bronchospasm. Dopamine is indicated for the treatment of congestive heart failure. Metaraminol is used to treat shock if norepinephrine or dopamine cannot be used. Norepinephrine is used to treat shock and during cardiac arrest to promote sympathetic activity.

An adrenergic drug would be prescribed to produce what physiological effect? increased heart rate urine concentration decreased respiratory rate decreased blood pH

increased heart rate Explanation: Adrenergic drugs cause an increase in heart rate and respiratory rate. They do not directly induce urinary incontinenceurine concentration, and they do not reduce blood pH.