Chapter 23: Adrenergic Drugs prepu
Which condition is treated with an adrenergic agonist?
Anaphylaxis Explanation: Epinephrine, a prototype adrenergic agonist, is used to relieve the acute bronchospasm and laryngeal edema of anaphylactic shock. Since adrenergic agonists act as cardiac stimulants, some versions may be used to treat severe bradycardia or hypotension.
Which is an effect of epinephrine?
Increased heart rate Explanation: Epinephrine increases heart rate and acts as a bronchodilator. It has peripheral vasoconstrictive effects and increases blood pressure.
A client has been prescribed dopamine. Which action would be appropriate for the nurse to implement?
Inspect the needle site and surrounding tissues for leakage. Explanation: The nurse should inspect the needle site and surrounding tissues for leakage of the solution into the surrounding subcutaneous tissues. Dopamine should not be mixed with sodium bicarbonate. Dopamine should be administered intravenously, not intramuscularly. The nurse should monitor blood pressure every 2 minutes, not every 10 minutes, from the beginning of therapy until the desired blood pressure is achieved.
Which client is most likely to benefit from the administration of an adrenergic agonist?
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.
A nurse is reviewing the therapeutic use of adrenergic agonists. When reviewing their use in clients of differing ages, what principle should guide the nurse's actions?
Adrenergic agonists can be used for varied indications across the lifespan. Explanation: The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support clients experiencing shock. They are used in clients of all ages. Older adults must be monitored more closely in most cases, but their use is not contraindicated. They are generally incompatible with pregnancy and breastfeeding.
The nurse calculates the infusion rate for administering dopamine to a premature infant in the neonatal intensive care unit who is in cardiogenic shock secondary to a cardiac anomaly. What is the nurse's next priority action?
Ask another nurse to perform independent calculation. Explanation: It is good practice to have a second person check the dosage calculation before administering the drug to avoid potential toxic effects. When having calculations double checked, it is best to let the other person work out separate calculations rather than just looking at the nurse's calculation first because this will be more likely to catch an error. The nurse would have another nurse perform calculations rather than the HCP. Only after calculations are correct would the drug be administered, usually through a central line or the nurse may establish a peripheral line. Permission from parents is not required above general permission needed to care for the neonate.
Mrs. Kelly Johnson, aged 46, was admitted to the hospital due to prior myocardial infarction, or heart attack. The diagnostic test revealed that her heart was unable to pump enough blood to adequately perfuse the vital organs. What type of shock does she seem to have suffered from?
Cardiogenic shock Explanation: Cardiogenic shock is the result of the heart's inability to pump enough blood to adequately perfuse the vital organs. This type of shock may be caused by myocardial infarction, ventricular arrhythmias, severe cardiomyopathy, or congestive heart failure. Hypovolemic shock results from a decrease in circulating blood volume from bleeding or hemorrhage. Obstructive shock is caused by a massive blockage in blood flow that results in inadequate tissue perfusion, and septic shock occurs when a severe infection brings about circulatory insufficiency.
A client suffering an acute myocardial infarction may develop which type of shock?
Cardiogenic-obstructive shock Explanation: Acute myocardial infarction may lead to cardiogenic-obstructive shock. Hypovolemic shock occurs as the result of significantly diminished blood volume. Hypervolemic shock or hypervolemia is known as fluid overload results in heart failure. Distributive shock occurs when there are changes to the blood vessels causing dilation, but no additional blood volume. The blood is redistributed within the body
A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement?
Continually assess the client for physiological changes and notify the primary care provider with changes. Explanation: When caring for a client receiving an adrenergic medication for shock, the nurse will continually assess the client for changes in his vital signs, perfusion, and any adverse reactions. Telling a family that their loved one might die is not an appropriate nursing action at that time. Seizures, hypothermia, and dementia are not common side effects of adrenergic medications, and an adrenergic medication should not be abruptly stopped. The nurse needs to stay close to a client to do frequent assessments; sleep deprivation may occur, but it is not the primary concern when a client is in shock.
Which herbs has been removed from most weight-loss medications due to potential legal liability?
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.
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?
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.
A group of nursing students are reviewing information about the types of shock. The students demonstrate understanding of the information when they identify which occurs as a result of gastrointestinal bleed?
Hypovolemic shock Explanation: Hypovolemic shock occurs as the result of significantly diminished blood volume, which occurs from a GI bleed. Hypervolemic shock or hypervolemia is known as fluid overload results in heart failure. Cardiogenic-obstructive shock is associated with physical obstruction in the great vessels of the heart, resulting in inadequate tissue perfusion. Distributive shock occurs when there are changes to the blood vessels causing dilation, but no additional blood volume. The blood is redistributed within the body.
The nurse notes that a client is prescribed midodrine. Which action should the nurse take before giving the client this medication?
Measure orthostatic blood pressure. Explanation: Midodrine is an alpha-1 adrenergic agent used to treat orthostatic hypotension in clients who do not respond to traditional therapy. It causes peripheral vasoconstriction and increases vascular tone and blood pressure. Because of this, the client can develop supine hypertension. The client needs to have blood pressure monitored in the standing, sitting, and supine positions to determine if this will be a problem for the client. A cardiac monitor is not indicated for this medication. Oxygen is not indicated for this medication. The client does not need to empty the bladder before receiving a dose of this medication.
Epinephrine is contraindicated in clients with which diseases or disorders?
Narrow-angle (or closed-angle) glaucoma Explanation: Epinephrine and other adrenergic drugs are contraindicated in clients with narrow-angle glaucoma (closed-angle glaucoma) because the drugs increase intraocular pressure and mydriasis. Asthma, bronchoconstriction, and hypotension are among the disorders and diseases treated with adrenergic drugs.
After reviewing the routes of administration for beta-specific adrenergic agonists, a group of students demonstrate the need for additional study when they identify isoproterenol as being administered by which route?
Oral Explanation: Isoproterenol is administered IV, IM, or subcutaneously. It is not administered orally
A client was brought by ambulance into the emergency department. The client appears disoriented, pale, tachycardic, and hypotensive. There is excessive bleeding from the head and bruises across the cheek and abdomen. What is the priority step in managing this client?
Provide basic life support while attempting to treat hypovolemic shock Explanation: The priority steps in shock management are basic life support, such as clearing his airway, providing adequate oxygenation and ventilation, and supporting his circulation. After these are done, further tests such as an abdominal CAT and x-rays can be obtained. The client is confused, so obtaining organ donor consent is not legal if the client is not of "sound mind and body" at the time of consent. Also, the transplant team can obtain this consent from family members later if necessary.
The nurse is caring for a client receiving an adrenergic agent. Which approach would the nurse expect when the client's status improves and the medication is to be discontinued?
Titrate reduced doses over 2-4 days. Explanation: An adrenergic agent should not be stopped abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, hypertensive encephalopathy, and possible death. The medication is to be tapered over 2-4 days. Adrenergic agents are not tapered by giving a dose in the morning for 4 days or by providing intermittent doses every 4-6 hours
A client is in shock and is receiving dopamine. The nurse knows that the proper way dopamine should be given is by what method?
Via an electric infusion pump, by itself, and titrated to desired systolic blood pressure Explanation: Dopamine should be administered via an electric infusion pump, by itself and titrated to the desired systolic blood pressure. It is not an IM medication. It should not be given with other medications, and it is not given as an IV bolus, no matter where the IV is located.
What client would be most likely to benefit from the administration of a beta2-specific adrenergic agonist?
a client who is having an exacerbation of chronic bronchitis Explanation: Most of the beta2-specific adrenergic agonists are used to manage and treat asthma, bronchospasm, and other obstructive pulmonary diseases. This is a more likely indication than hypotension, arrhythmias, or a need for pupil dilation.
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?
assess heart rate. Explanation: The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would be no need to check blood glucose or measure urinary output, and though respiratory rate is monitored it is not the priority measure.
Epinephrine causes relaxation of:
bronchioles. Explanation: Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.
The nurse is caring for a client who is receiving an intravenous infusion of dobutamine. What nursing diagnosis has most likely prompted this intervention?
decreased cardiac output Explanation: Dobutamine is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle. As such, it directly addresses a client's decreased cardiac output. This would have an indirect effect on peripheral tissue perfusion while gas exchange and neurovascular function would remain largely unchanged.
The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result?
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.
Which medication is a synthetic catecholamine prescribed for the treatment of bradycardia?
isoproterenol Explanation: Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors to stimulate heart rate. Neither pseudoephedrine, ephedrine, nor epinephrine is synthetic catecholamine.
A need for additional education on the administration of epinephrine is needed when a new nursing graduate indicates that epinephrine can be effectively administered by what route?
oral Explanation: Administration of epinephrine is by inhalation, injection, or topical application. Oral administration of the drug is not effective, because enzymes in the GI tract and liver destroy it.
The nurse is transcribing new orders for sympathomimetic medications prescribed for a geriatric client. What should the nurse expect the dosage to be?
the lowest possible effective dosage Explanation: Older clients should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. The other options are incorrect..
Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels?
α1 receptors Explanation: Vasoconstriction of peripheral blood vessels occurs as the result of stimulation of α1 receptors. Stimulation of these receptors regulates the release of neurotransmitters and decreases the tone, motility, and secretions of the GI tract. Stimulation of these receptors increases the heart rate and force of myocardial contraction. Stimulation of these receptors leads to vasodilation of the peripheral vessels and also causes bronchodilation.
Which of following adrenergic receptors is responsible for decreased tone, motility, and secretions of the GI tract? (Choose one)
α2 receptors Explanation: Decreased tone, motility, and secretions of the GI tract are the result of stimulation of α2 receptors.
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?
β1 receptors Explanation: β1 receptors are responsible for increased heart rate and increased force of myocardial contraction. Vasoconstriction of peripheral blood vessels occurs as the result of stimulation of α1 receptors. Stimulation of α2 receptors inhibits release of norepinephrine into synapses of sympathetic nervous system. Stimulation of β2 receptors leads to vasodilation of the peripheral vessels and also causes bronchodilation
A client with a history of allergies is prescribed an auto-injector for self-administration in case of an allergic reaction. The nurse understands that this device contains which drug?
Epinephrine Explanation: An auto-injector device contains the drug epinephrine. Dobutamine is a potent vasopressor used to treat low blood pressure. Isoproterenol is a selective drug that acts chiefly on β receptors used to treat shock, bronchospasm during anesthesia, and cardiac standstill. Norepinephrine is used to treat shock, hypotension, and cardiac arrest
A client is experiencing anaphylaxis. What drug will the nurse most likely administer?
Epinephrine Explanation: Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine used to treat severe hypotension and shock that persists after adequate fluid volume replacement. Acetylcysteine is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia
Adrenergic drugs increase the potential risk for what adverse effect?
cardiac arrhythmias Explanation: Adrenergic drugs can cause possible irritable cardiac arrhythmias due to beta1 activity. They have no appreciable effect on intestinal wall muscles and do not cause decreased level of consciousness. Adrenergic drugs can cause an increase, not decrease, in blood sugar levels.
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?
β2 receptors Explanation: Vasodilation of peripheral vessels and bronchodilation are the result of stimulation of β2 receptors.
Which is expected after the administration of an adrenergic medication such as epinephrine? (Select all that apply.)
Increased heart rate Vasoconstriction Explanation: Adrenergic medications activate the "fight-or-flight" mechanism in the body, causing increased heart rate, vasoconstriction, increased ease and rate of breathing, etc. They are used to treat hypotension, not cause hypotension.
An older adult client who is experiencing hypovolemic shock is prescribed intravenous (IV) dopamine. Which action would the nurse take while monitoring the client while receiving this medication?
Monitor the client's cardiac rhythm. Explanation: Older adult clients commonly experience the adverse effects of adrenergic drugs. Older adult clients may need to be on lower doses of the drug because they are more prone to having a toxic level of the drug due to changes in renal or hepatic metabolism and excretion. The client should have cardiac rhythm monitored because serious arrhythmias could occur while receiving this medication. The client is acutely ill and should not be out of bed in a chair. The supine position is not needed, and the lower extremities do not need to be elevated when receiving this drug.
When administering an adrenergic drug, a nurse understands that which is the primary neurotransmitter of the sympathetic nervous system?
Norepinephrine Explanation: Norepinephrine is the primary neurotransmitter of the sympathetic nervous system. Dopamine is a catecholamine neurotransmitter that is released during the body's stress response and includes norepinephrine and epinephrine. In the brain, serotonin acts as a neurotransmitter that is involved in the control of pain perception, the sleep-wake cycle, and mood. Acetylcholine acts as a neurotransmitter between muscle and the nerve endings of the parasympathetic nervous system.
The nurse is reviewing the medical record of a client who is receiving adrenergic drug therapy to treat hypovolemic shock. Which nursing diagnosis would the nurse be least likely to note?
Risk for Allergy Response Explanation: Risk for Allergy Response would be appropriate for a client experiencing an allergic reaction or anaphylactic shock, not hypovolemic shock. Hypovolemic shock can have decreased cardiac output due to low volume, ineffective tissue perfusion due to the body shunting what volume it has to major organs, and a disturbed sleep pattern due to confusion and altered mental state
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 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.
In providing care to a client with wheezing, the nurse knows that a medication targets which receptors?
beta 2 Explanation: Beta 2 receptors are found on the bronchial smooth muscles, and medications that stimulate beta 2 receptors cause bronchodilation. Alpha 1 receptors cause vasoconstriction of peripheral blood vessels. Alpha 2 receptors decrease tone, motility, and secretions of the GI tract. Beta 1 receptors increase heart rate and force of myocardial contraction.
A client is admitted to the emergency department with signs and symptoms of cardiogenic shock. Isoproterenol is administered intravenously. What assessment should the nurse prioritize when monitoring for therapeutic effects?
blood pressure Explanation: Isoproterenol stimulates beta-adrenergic receptors. Blood pressure is increased, and heart rate is increased. These are the main desired outcomes, and for this reason blood pressure assessment would be prioritized over the assessment of LOC, reflexes, and coagulation.
A client has been treating seasonal rhinitis with an adrenergic agonist that they have been purchasing at a local pharmacy. The nurse recognizes the client might be using which medication?
ephedrine Explanation: Ephedrine has been used to treat seasonal rhinitis by stimulating the release of norepinephrine from nerve endings and directly acting on adrenergic receptor sites. Although ephedrine was formerly used for situations ranging from the treatment of shock to chronic management of asthma and allergic rhinitis, its use in many areas is declining because of the availability of less toxic drugs with more predictable onset and action. Clonidine is never used to treat allergies. Dopamine and norepinephrine are used to treat shock
Treatment with norepinephrine in a client diagnosed with hypotension has been unsuccessful. What second-line vasopressors would the nurse suspect the health care provider might prescribe? Select all that apply.
phenylephrine vasopressin epinephrine Explanation: If hypotension persists despite maximal doses of norepinephrine (or dopamine), second-line vasopressors are epinephrine, phenylephrine, and vasopressin. Phentolamine is used to treat extravasation resulting from the intravenous (IV) administration of norepinephrine.
The nurse is preparing to administer a sympathomimetic drug to a client. How does this drug achieve a therapeutic effect?
stimulating alpha- and beta-receptors Explanation: Drugs that are generally sympathomimetic are called alpha-agonists (stimulate alpha-receptors) and beta-agonists (stimulate beta-receptors). These agonists stimulate all of the adrenergic receptors; that is, they affect both alpha- and beta-receptors.
A client goes to his primary care provider for a cut finger. The provider is going to put sutures into the tip of the client's finger. Lidocaine with 2% epinephrine is ordered verbally by the provider. What should the nurse do?
Ask if he really wants epinephrine in the lidocaine since he is working on the tip of the finger. The nurse remembers from her reading that epinephrine is contraindicated in fingertips. Explanation: The use of epinephrine in lidocaine is common when placing sutures. However, epinephrine vasoconstricts the blood vessels and is not to be used on the tips of fingers, noses, or ears because necrosis of the tissue is possible. If a nurse knows something is wrong, he or she should speak up to prevent errors from occurring. By lying and saying that lidocaine without epinephrine is the only thing available, it may keep this client's finger safe, but perhaps not the next finger that the same provider sutures.
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective?
Bronchodilation Explanation: A beta-specific agonist would lead to bronchodilation. A beta-specific agonist would cause an increased heart rate. Tremor is an adverse effect of a beta-specific agonist. A beta-specific agonist would increase cardiac conductivity.
A client suffering an acute myocardial infarction may develop which type of shock
Cardiogenic-obstructive shock Explanation: Acute myocardial infarction may lead to cardiogenic-obstructive shock. Hypovolemic shock occurs as the result of significantly diminished blood volume. Hypervolemic shock or hypervolemia is known as fluid overload results in heart failure. Distributive shock occurs when there are changes to the blood vessels causing dilation, but no additional blood volume. The blood is redistributed within the body.
A 16-year-old client arrives at the emergency department (ED) stung by a bee and used an EpiPen prior to arriving in the ED. The client is breathing well now. What would the nurse do next for this client?
Obtain from the client as much information about the bee sting and physical reaction to the sting as possible. Explanation: Once a client gives themselves an injection with an EpiPen, they should seek medical care. The nurse should obtain as much information about the bee sting symptoms as possible from the client.(For example, was there wheezing, breaking out in hives, have swelling of the tongue, etc.?) In an emergency situation, the client, a minor, could be treated without parental consent. A nurse would need an order prior to starting an IV and giving a medication.
When describing the adrenergic branch of the autonomic nervous system to a group of nursing students, the instructor would also refer to it as which type of nervous system?
Sympathetic nervous system Explanation: The sympathetic nervous system is also known as the adrenergic branch. The parasympathetic nervous system is known as the cholinergic branch. The central nervous system is responsible for wakefulness, quick reaction to stimuli, and quickened reflexes. The somatic branch of the peripheral nervous system (PNS) is concerned with sensation and voluntary movement.
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following?
Sympathomimetics Explanation: Sympathomimetics are drugs that produce activity similar to the neurotransmitter norepinephrine. Drugs that block or inhibit the sympathetic nervous system are called antiadrenergic drugs, adrenergic blocking drugs, or sympatholytics
An 80-year-old client has been brought to the emergency department in shock. The client is receiving dopamine. The nurse should prioritize the assessment for what potentially serious adverse effect?
cardiac arrhythmia Explanation: Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older clients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes. Blood dyscrasias, hepatic toxicity, and renal insufficiency are not commonly associated with dopamine use. In fact, at lower doses, dopamine increases renal perfusion.
A client being treated with intravenous (IV) fluids for hypovolemic shock is prescribed an adrenergic medication. For which reason should the nurse closely monitor the effects of this medication on the client?
diagnosed with peripheral vascular disease Explanation: Adrenergic drugs should be used with caution in clients with peripheral vascular disease because the condition could be exacerbated by the systemic vasoconstriction that this medication causes. Dilated pupils is an expected reaction to the medication. Adrenergic drugs increase blood flow to the kidneys, increasing urine output. A urine output of 50 ml the last hour would be an expected response. Adrenergic medications can cause constipation. An episode of diarrhea is not a reason to be concerned that the client is receiving this medication.
The nurse is admitting a client with injuries following a bicycle crash. When reviewing the client's pre-admission medication regimen, the nurse reads that the client takes formoterol twice daily. When planning this client's care, the nurse should include:
frequent respiratory assessments. Explanation: Formoterol is given for the treatment of asthma, so the nurse should prioritize respiratory assessments. The inclusion of this particular medication does not create a need for increased cardiac, blood pressure or mental status assessments.
A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:
increase blood pressure Explanation: For a client in shock, dopamine helps to increase blood pressure. The alpha stimulation produces increased peripheral resistance, raising the blood pressure as the dose of dopamine increases. The drug's dosage is titrated upward until adequate perfusion of vital organs is achieved. Beta-1 stimulation produces increased cardiac output by increasing the force of contraction and heart rate. The drug does not have a direct effect on body temperature.
The nurse provides a client with a dose of the beta-selective adrenergic agonist isoproterenol. Which assessment finding indicates the medication is effective?
increased heart rate Explanation: Therapeutic effects of isoproterenol are related to its stimulation of all beta-adrenergic receptors. Desired effects of the drug include increased heart rate, conductivity, and contractility in addition to effects on the respiratory and vascular system. Anticipated effects of the medication include dilated and not constricted pupils. Sweating and not warm, dry skin is an expected effect. An increase and not a decrease in urine output would occur as an effect on the blood vessels to the kidneys
Adrenergic drugs mimic the effects of stimulating what part of the nervous system?
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. These drugs do not mimic the effect of the parasympathetic nervous system. The autonomic nervous system comprises the sympathetic and parasympathetic systems.