Chapter 30 Adrenergic Agonists PrepU
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?
β2 receptors
The nurse is aware that epinephrine may be administered in what ways? (Select all that apply.)
-Inhalation -IV -Topical
A patient has been administered dobutamine HCL. Which of the following adverse reactions should the nurse monitor for in the patient?
Cardiac arrhythmias
Adrenergic drugs produce which of the following effects?
Increased heart rate
Which of the following is an effect of epinephrine?
Increased heart rate
The nurse is assessing a patient who is receiving clonidine. Which of the following might the nurse assess?
Photophobia
Another name for adrenergic drugs is:
Sympathomimetic drugs.
Which of the following would a nurse expect as a possible adverse effect when administering a beta-specific adrenergic agonist? Select all that apply.
• Restlessness • Headache
You are caring for a patient who is in hypovolemic shock. The patient's condition is increasing in severity. What features will present clinically?
• Tachycardia • Decreased urinary output • Cool extremities
A nurse may be asked to administer adrenergic drugs to clients with which of the following conditions? Select all that apply:
• Hypovolemic shock • Respiratory distress • Allergic reactions • Cardiac arrest
Which of the following is expected after the administration of an adrenergic medication such as epinephrine?
• Increased heart rate • Vasoconstriction
The nurse knows that beta receptors are found in which areas of the body? Select all that apply.
• Myocardium • Peripheral blood vessels • Bronchial smooth muscles
Which of the following adverse effects might a client receiving clonidine exhibit?
• Photophobia • Personality changes • Difficulty urinating
Which of the following would a nurse expect as a possible adverse effect when administering a beta-specific adrenergic agonist?
• Restlessness • Headache
What would the nurse expect to assess in a client receiving an alpha- and beta-adrenergic agonist?
Dyspnea
A patient with diabetes who receives an alpha-specific adrenergic agonist is at risk for hypoglycemia
False
A parent hears the doctor talking and uses the word extravasation. The parent comes to the nurse to ask what extravasation means. What would be a correct answer by the nurse?
"Extravasation is when fluid escapes from a blood vessel into the surrounding tissue."
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."
A nurse is providing teaching to a client just prescribed midodrine for his orthostatic hypotension. Which nursing instruction is very important that the client understands?
"Only take midodrine when standing. Taking it while lying down can cause very high blood pressure."
isoprotereno only available in
IV form
dobutamine
treatment of heart failure
The nurse is teaching a patient about safe use of adrenergic drugs. Which of the following statements should be included in the teaching?
"Talk to your doctor before taking any other medications."
A nurse suspects that a client is experiencing shock based on which assessments? Select all that apply.
* Cyanosis * Disorientation * Tachypnea
A patient receives phenylephrine intravenously. The nurse would expect the drug to last for how long?
15 to 20 minutes
alpha-specific adrenergic agonists reach peak levels in
20-45 minutes
The nurse receives a prescription to infuse Dopamine 5 mcg/kg/min IV. The drug is supplied as 1 mg/mL solution, and the pt weighs 70 kg. How many milliliters per hour will the nurse set the pump to deliver?
21 mL/hr
A pt receives a dose of phenylephrine intravenously. The nurse would expect the drug to last for how long? A) 15-20 min B) 25-30 min C) 35-40 min D) 5-10 min
A
Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?
A man who is in cardiogenic shock following a myocardial infarction
A patient has been prescribed dopamine. Which intervention should the nurse perform during the drug regimen?
Administer dopamine only via IV route.
Which receptor does phenylephrine stimulate?
Alpha1
A pt has been receiving a Dobutamine infusion and is being monitored closely. What assessment finding would suggest an inadequate therapeutic response? A) The pt's respiratory rate is 26 breaths per minute B) The pt has peripheral edema in the lower extremities and sacrum C) The pt's urine output over the past 6 hours is 125 mL of concentrated urine D) The pt's oral temperature has risen over the past several hours to 100.6 F
B
Adverse effects associated with adrenergic agonists are related to the generalized stimulation of the SNS and could include: A) Slowed heart rate B) Constriction of the pupils C) Hypertension D) Increased GI secretions
C
All alpha and beta adrenergic agonists can be administered via what route? A) Subcutaneous B) IM C) IV D) PO
C
Which agent would the nurse identify as being available in a transdermal form?
Clonidine
Phenylephrine Indications
Cold and allergies; shock and shock-like states; supraventricular tachycardias; glaucoma; allergic rhinitis; otitis media
The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is taking dobutamine for congestive heart failure. What would be most important to monitor in this patient?
Compliance with drug regimen
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 relevant changes
Phenylephrine, an alpha-specific agonist, is found in many cold and allergy preparations. The nurse instructs the patient to be alert for which adverse effects? A) Urinary retention and pupil constriction B) Hypotension and slow heart rate C) Personality changes and increased appetite D) Cardiac arrhythmias and difficulty urinating
D
Which of the following would be the nurse need to keep in mind about the use of dobutamine for treating heart failure?
Does not raise myocardial oxygen demand
A client is experiencing shock and is extremely hypotensive. Which would the nurse expect to be the drug most likely to be given?
Dopamine
Which of the following would the nurse expect to assess in a client receiving an alpha- and beta-adrenergic agonist?
Dyspnea
Which of the following herbs have been removed from most weight-loss medications due to potential legal liability?
Ephedra
A patient suffers from bronchial asthma. Which of the following medications will be administered?
Epinephrine
An increased dosage of digoxin would be needed if the patient is also taking midodrine.
False
True or False: A pt with diabetes who receives an alpha specific adrenergic agonist is at risk for hypoglycemia.
False; Can cause HYPERglycemia
The nurse is reviewing the history of a patient who is to receive midodrine. Which of the following would alert the nurse to a contraindication for the drug?
Glaucoma
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?
Improved cardiac contractility
A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Intropin). For a patient in shock, dopamine helps to
Increase blood pressure
The client is given epinephrine for an exacerbation of asthma. What response to the medication would the nurse expect?
Increased ease of breathing and increased heart rate
A nurse is attending to a client who has been administered Levophed. Which of the following adverse reactions associated with Levophed should the nurse monitor for in the client? Select all that apply.
Lightheadedness • Nausea
The nurse would contact the physician before administering an adrenergic drug to a client who is also taking which drug?
MAO inhibitor
Epinephrine can be administered by multiple routes. Which is not an appropriate route?
Oral
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?
Methamphetamine production
A male client is diagnosed with type 2 diabetes, asthmatic bronchitis, benign prostatic hyperplasia, and hyperlipidemia. He takes an adrenergic medication as part of his daily drug regimen. As part of his education plan, the nurse would teach the client to observe for which signs and symptoms?
Painful urination
The nurse is reviewing the medical record of a client who is taking an alpha- and beta adrenergic agonist. Which of the following would be of least concern to the nurse?
St. John's wort
The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity?
Stimulates electrical and mechanical activity
Another name for adrenergic drugs is
Sympathomimetic drugs.
Clonidine Indications
Treatment of essential hypertension; chronic pain; to ease opiate withdrawal; used only for adults
adrenergic agonist
a drug that stimulates the adrenergic receptors of the sympathetic nervous system, either directly (by reacting with receptor sites) or indirectly (by increasing norepinephrine levels)
A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient'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 the patient's
acute bronchospasm.
A client has an IV of dopamine administered in the right arm. The IV becomes dislodged from the vein and dopamine has been being given in the surrounding tissue instead of the vein. The nurse should stop the IV and:
administer phentolamine (an alpha adrenergic blocking drug) to the site to minimize necrosis.
A child is brought to the pediatrician's office for trouble breathing. On exam, the child has severe wheezing. The nurse knows that the provider might prescribe which medication for this child?
albuterol
In providing care to a client with wheezing, the nurse knows that a medication targets which of the following receptors?
beta 2
glycogenolysis
breakdown of stored glucose to increase the blood glucose levels
Adrenergic drugs increase the potential risk for what adverse effect?
cardiac arrhythmias
Clonidine specifically stimulates
central nervous system (CNS) alpha2-receptors
A client is experiencing anaphylaxis. What drug will the nurse most likely administer?
epinephrine
Patients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk
for overstimulation, including increased blood pressure, stroke, and death. Counsel patients to avoid these combinations.
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
An adrenergic drug would be prescribed to produce what physiological effect?
increased heart rate
The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result?
increased heart rate
beta-specific adrenergic agonists prototype
isoprotereno
The nurse knows that which of the following medications can interact with adrenergic medications and cause hypertension?
oxytocin
Transdermal Clonidine
slow release over 7 day period only having to be changed weekly
alpha-agonist
specifically stimulating to the alpha-receptors within the sympathetic nervous system, causing body responses seen when the alpha-receptors are stimulated
beta-agonist
specifically stimulating to the beta-receptors within the sympathetic nervous system, causing body responses seen when the beta-receptors are stimulated
Adrenergic drugs mimic the effects of stimulating what part of the nervous system?
sympathetic
Another name for adrenergic drugs is:
sympathomimetic drugs
alpha-specific adrenergic agonists should not be stopped suddenly
taper the drug over 2 to 4 days when it is being discontinued
Which adrenergic receptor is responsible for the vasoconstriction of peripheral blood vessels?
α1 receptors
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?
β1 receptors
What represents the two types of receptors that are found in the adrenergic nervous system? Select all that apply.
• Alpha receptors • Beta receptors
While educating a client on the use of midodrine (ProAmatine) the nurse should tell the client to report which of the following changes? Select all that apply:
• Vision changes • Bradycardia • Difficulty urinating
Which of the following conditions is treated with an adrenergic agonist?
Anaphylaxis
A patient is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
Increased vasoconstrictive effects
Epinephrine is contraindicated in patients with which of the following diseases or disorders?
Narrow-angle (or closed-angle) glaucoma
Select all that apply: A nurse would question the order for an adrenergic agonist for a pt who is also receiving which of the following: A) Anticholinergic drugs B) Halogenated hydrocarbon anesthetics C) Beta-blockers D) Benzodiazepines E) MAOIs F) TCAs
B C E F
While educating a client on the use of midodrine (ProAmatine) the nurse should tell the client to report which changes? (Select all that apply.)
* Vision changes * Bradycardia * Difficulty urinating
Adrenergic medications such as epinephrine and dopamine are commonly used for in the treatment of clients in which treatment settings? Select all that apply.
-Dentist's office -Intensive care unit -Emergency department
The clinic nurse is teaching a client about terbutaline. What would the nurse be sure to include in the teaching? Mark all that apply.
-Dosage -Adverse effects -What problems to report immediately
Which would a nurse expect as a possible adverse effect when administering a beta-specific adrenergic agonist? (Select all that apply.)
-Headache -Restlessness
A nurse monitoring a client receiving dopamine should be aware of which of the following adverse reactions that may result? Select all that apply:
-Nausea -Cardiac arrhythmias -Headache
A client is being treated in the intensive care unit for cardiogenic shock. The client has been prescribed an intravenous infusion of dopamine 5 mcg/kg/minute. The client weighs 220 lbs and the medication is available in a 500-ml bag containing 400 mg of dopamine. At what rate in mL/hour should the nurse administer the medication? Give your answer to one decimal place.
37.5 mL
A pt has elected to take an OTC cold preparation that contains phenylephrine. The nurse would advise the pt not to take that drug if the pt has: A) Thyroid or CV disease B) A cough and runny nose C) COPD D) Hypotension
A
A pt in shock has been prescribed isoproterenol. When preparing to administer this the nurse should: A) Establish reliable IV access B) Ensure the pt is capable of using an inhaler C) Educate the pt about expected adverse effects D) Check the pt blood glucose level
A
A pt receives a beta-specific agonist. What assessment findings would indicate to the nurse that the drug is effective? A) Relief from shortness of breath B) Resolution of glaucoma C) Relief of pain D) Increased level of consciousness
A
The nurse has entered a pt's room and found the pt unresponsive, in respiratory and cardiac arrest. The nurse has initiated a code blue and the resuscitation team has come to the bedside. The nurse should anticipate an order for what intervention? A) Administration of norepinephrine IV B) STAT administration of Midodrine C) Administration of Phenylephrine IM D) Administration of Dobutamine IV
A
The nurse is assessing a pt who is experiencing significant CNS effects after receiving an alpha-specific adrenergic agonist. What finding is most likely? A) Anxiety B) Tinnitus C) Respiratory depression D) Disorientation
A
The nurse is reviewing the history of a pt who is to receive Midodrine. What would alert the nurse to contraindication for the drug? A) Glaucoma B) Vasomotor spasm C) Thyrotoxicosis D) Diabetes
A
The nurse is reviewing the medication regimen of an older adult who has just admitted to a long-term care facility. The nurse reads that the pt takes Droxidopa. What should the nurse include in the pt's care plan? A) Supervise the pt during transfers B) Spread out activities every throughout the day C) Ensure the pt's diet does not include grapefruit juice D) Monitor the pt's respiratory status closely
A
Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A 47-year-old female with hypertension
Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A 47-year-old female with hypertension
Select all that apply: The nurse is teaching the pt about phenylephrine who is in preparation for discharge. What are the priority teaching points the nurse will include? A) Importance of notifying the provider if sudden weight gain occurs B) Potential for feelings of fear, anxiety, and restlessness C) Procedure for injecting the med subcutaneously D) Symptoms of hypotension to report to provider E) Importance of avoiding OTC cough and cold meds
A B E
SATA. Why would the nurse expect to see Dobutamine ordered for the pt in end-stage heart failure? A) It increased myocardial contractility, thus increasing cardiac output without much change in heart rate B) It is a naturally occurring catecholamine that the body normally produces in small amounts C) It does not increase the oxygen demand of the cardiac muscle the way other drugs in this class do D) It has a slight preference for alpha-receptor sites E) The drug is absorbed rapidly after injection and achieves a rapid onset of action
A C E
In what age group are adrenergic agonists contraindicated? A) Older adults B) Adolescents C) Children D) No age group
ANS: D Feedback: The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support patients experiencing shock. They are used in patients of all ages. Therefore, the other options are incorrect responses.
A patient has been prescribed midodrine. Which of the following interventions should the nurse perform to ensure that the patient doesn't develop supine hypertension?
Administer midodrine during the day
A client is receiving dopamine intravenously in the right arm. The IV becomes dislodged from the vein, and dopamine has been being given in the surrounding tissue instead of the vein. What should the nurse do immediately after stopping the IV?
Administer phentolamine to the site.
What is the nurse's rationale for administering clonidine to treat hypertension? A) Clonidine stimulates alpha2-receptors. B) Clonidine stimulates alpha1-receptors. C) Clonidine stimulates beta2-receptors. D) Clonidine stimulates beta1-receptors.
Ans: A Feedback: Clonidine specifically stimulates alpha2-receptors and is used to treat hypertension because its action blocks release of norepinephrine from nerve axons. Therefore, the other options are incorrect answers.
How does ephedrine act on the body? A) Stimulates the release of norepinephrine B) Acts indirectly on beta-adrenergic receptor sites C) Stimulates the release of dopamine D) Acts indirectly on alpha-adrenergic receptor sites
Ans: A Feedback: Ephedrine stimulates the release of norepinephrine from nerve endings and acts directly on adrenergic receptor sites. Therefore, the other options are incorrect.
The student nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically? A) Rests the tip of the dropper against the lower eyelid B) Grasps the lower eyelid and pulls it away to form a pocket C) Applies gentle pressure to the inside corner of the eye for 3 to 5 minutes D) Instructs the patient to close his or her eyes and look downward
Ans: A Feedback: First, wash hands thoroughly. Do not touch the dropper to the eye or to any other surfaces. Have the patient tilt his or her head back or lie down and stare upward. Gently grasp the lower eyelid and pull the eyelid away from the eyeball. Instill the prescribed number of drops into the lower conjunctival sac and then release the lid slowly (Fig. 30.1). Have the patient close the eye and look downward. Apply gentle pressure to the inside corner of the eye for 3 to 5 minutes. Do not rub the eyeball and do not rinse the dropper. If more than one type of eyedrop is being used, wait 5 minutes before administering the next one.
The nurse needs to be aware, before administering, that what drug has a duration of action of only 1 to 2 minutes? A) Isoproterenol B) Dopamine C) Phenylephrine D) Ephedrine
Ans: A Feedback: Isoproterenol has a duration of action lasting 1 to 2 minutes with immediate onset of action. Dopamine acts as long as the drug is infusing with peak action 10 minutes after initiating the infusion. Phenylephrine's duration of action is 15 to 20 minutes. Ephedrine's duration of action will depend on how the drug is administered as it could be given intramuscularly, subcutaneously, IV, or orally, but no matter by what route it is administered, the duration of action is longer than 1 to 2 minutes.
A patient is admitted to the emergency department in shock. Isoproterenol (Isuprel) is administered. What would the nurse expect the effect of the isoproterenol to be? A) Increased blood pressure B)Decreased blood pressure C)Increased body temperature D) Decreased heart rate
Ans: A Feedback: Isoproterenol stimulates beta-adrenergic receptors. Blood pressure is increased and heart rate is increased. Body temperature should not be affected.
The nurse is admitting a mental health patient and collects the medication history. The patient says he takes Haldol, midodrine, hydrochlorothiazide, acetaminophen, and Cymbalta. The nurse will call the provider to discuss what dangerous drug combination? A) Haldol and midodrine B) Hydrochlorothiazide and midodrine C) Cymbalta and midodrine D) Acetaminophen and midodrine
Ans: A Feedback: Midodrine can precipitate increased drug effects of digoxin, beta-blockers, and many antipsychotics. Such combinations should be avoided. The other drug combinations do not pose any immediate concerns.
The nursing instructor is quizzing a student who is preparing to administer an alpha-specific adrenergic agonist to a patient. The instructor asks the student what the student will assess in this patient after administering the drug. What is the student's best response? A) Blood pressure B) Respirations C) Mental status D) Vision
Ans: A Feedback: Monitor blood pressure, pulse, rhythm, and cardiac output regularly, even with ophthalmic preparations, to adjust dosage or discontinue the drug if cardiovascular effects are severe. Respirations, mental status, or vision may also need to be monitored but they are not impacted significantly by the drug being given.
The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided? A)A 47-year-old woman with hypertension B)A 52-year-old man with adult onset diabetes C)A 17-year-old girl with symptoms of an upper respiratory infection D)A 62-year-old man with gout
Ans: A Feedback: Phenylephrine, a potent vasoconstrictor and alpha1-agonist with little or no effect on the heart or bronchi, is used in many combination cold and allergy products. Patients with hypertension should avoid these drugs because serious increases in blood pressure could occur. Use of this drug in patients with diabetes and gout are not contraindicated. An upper respiratory infection may be an indication for the drug.
The pharmacology instructor is discussing adrenergic agonists with the nursing class. Which drugs would the instructor tell the nursing students are generally indicated for the treatment of shock, bronchospasm, and some types of asthma? A) Sympathomimetic drugs B) Beta-blocking drugs C) Parasympathetic stimulating drugs D) Anticatecholamine drugs
Ans: A Feedback: These drugs generally are indicated for the treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Beta-blocking drugs, parasympathetic stimulating drugs, and anticatecholamine drugs are not the drugs of choice in these situations.
A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The patient weighs 12.5 kg. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV? A) 0.0625 mg B) 0.075 mg C) 0.08 mg D) 0.085 mg
Ans: A Feedback: To calculate the minimum dosage, multiply the child's weight in kg by the lower dosage range; 12.5 × 0.005 = 0.0625 mg.
When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.) A) Dobutamine (Dobutrex) B) Epinephrine (Adrenalin, Sus-Phrine) C) Dopamine (Intropin) D) Clonidine (Catapres) E) Albuterol (Proventil)
Ans: A, B, C Feedback: Agents that affect both alpha- and beta-receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine. Clonidine is an alpha-specific adrenergic agonist; albuterol is a beta-specific adrenergic agonist.
When assessing a patient who has been prescribed midodrine, what would the nurse assess for? A) Pancreatic disease B) Renal failure C) Open-angle glaucoma D) Hypothyroidism
Ans: B Feedback: Assess for contraindications or cautions: any known allergies to the drug to avoid hypersensitivity reactions; presence of any cardiovascular diseases, which could be exacerbated by the vascular effects of these drugs; thyrotoxicosis, or diabetes, which would lead to an increase in thyroid stimulation or glucose elevation; chronic renal failure, which could be exacerbated by drug use; renal or hepatic impairment, which could interfere with drug excretion or metabolism; and current status of pregnancy and lactation. Options A, C, and D are incorrect.
The nurse is planning discharge teaching for a patient who is taking clonidine (Catapres). What would be most important for the nurse to include when teaching about adverse effects? A)Pupil constriction B)Strange dreams C)Increased urine output D)Increased appetite
Ans: B Feedback: Central nervous system effects from clonidine therapy include feelings of anxiety, restlessness, depression, fatigue, strange dreams, and personality changes. However, bad dreams would be the most upsetting and stressful effect for the patient. Pupil dilation, decreased urine output, and anorexia are all adverse effects of clonidine.
An 80-year-old patient has been brought to the emergency department in shock. The patient is receiving dopamine (Intropin). What potentially serious adverse effect will the nurse monitor for? A)Blood dyscrasia B)Cardiac arrhythmia C)Hepatic toxicity D)Renal insufficiency
Ans: B Feedback: Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older patients 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 patient comes to the clinic complaining of seasonal rhinitis. What adrenergic agonist would be prescribed for treatment of seasonal rhinitis? A)Dobutamine (Dobutrex) B)Ephedrine (generic) C)Dopamine (Intropin) D)Norepinephrine (Levophed)
Ans: B Feedback: 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. Dobutamine is used to treat congestive heart failure. Dopamine and norepinephrine are used to treat shock.
The patient is taking midodrine (ProAmatine). What is the most important nursing action to include in the plan of care for this patient? A)Monitor urine output. B)Monitor blood pressure. C)Monitor heart rate. D)Monitor respirations.
Ans: B Feedback: Midodrine is an oral drug used to treat orthostatic hypotension in patients who do not respond to traditional therapy. It activates alpha-adrenergic receptors, leading to peripheral vasoconstriction and an increase in vascular tone and blood pressure. This effect can cause serious supine hypertension. Patients should be monitored in the standing, sitting, and supine positions to determine whether this will be a problem. It is also important to monitor heart rate, respirations, and urine output in this patient. However, assessing for supine hypertension would pose the greatest threat to the patient and would take priority.
A client is being treated for asthma. Which of the following would the nurse expect to administer?
Beta-2-specific adrenergic agonist
The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include? A)Monitoring the patient for diarrhea B)Monitoring blood pressure and heart rate every 2 to 4 hours C)Assessing skin turgor for dehydration D)Assessing for fatigue and lethargy
Ans: B Feedback: Sympathetic stimulation will cause hypertension and increased heart rate so it is important these be monitored. Sympathetic stimulation will also result in increased sweating, decreased gastrointestinal activity, and a sense of anxiety and heightened awareness. Diarrhea, dehydration, fatigue, and lethargy would not be expected.
A 4-year-old girl is prescribed an albuterol (Proventil) inhaler for her asthma. What is the recommended safe dosage for this patient? A) 1.25 to 2.5 mg q.i.d B) 1.25 to 2.5 mg b.i.d C) 2 mg q.i.d D) 0.5 to 1 mg b.i.d
Ans: B Feedback: The recommended dosage for albuterol when given via inhaler is 1.25 to 2.5 mg b.i.d. When taken orally, the dosage is 2 mg t.i.d. or q.i.d. The other options are incorrect because they are outside the acceptable dosage range.
The nurse receives an order to begin a dopamine (Intropin) infusion at 5 mcg/kg/min. The patient weighs 50 kg. Each milliliter of solution contains 3 mg of dopamine. How many mL/h will the nurse set the pump to deliver? A) 3 mL/h B) 5 mL/h C) 3,000 mL/h D) 83.3 mL/h
Ans: B Feedback: To calculate this dosage, multiply the ordered mcg by the weight (5 ×50 kg) to yield mcg/min (250 mcg/min) and then multiply this times 60 to get mcg/h (250 ×60 = 15,000 mcg/h). Convert mcg/h to mg/h (15,000/1,000 = 15 mg/h). Set up ratio (3 mg/1 mL = 15 mg/X mL) and cross multiply (3X = 15 mg). Divide both sides by 3 to yield 5 mL/h to deliver 5 mg/kg/min.
The clinic nurse is teaching a patient about transdermal clonidine (Catapres). What information would be included in the nurse's teaching plan? (Select all that apply.) A) Change the patch in the morning. B) Rotate the site where the patch is placed. C) Monitor blood pressure daily. D) Stop the drug immediately if adverse effects occur. E) Keep the physician informed of any new diagnoses or medications.
Ans: B, C, E Feedback: Transdermal patches should not be placed in the same site repeatedly so it is important to instruct the patient to rotate sites to improve absorption of drug. Blood pressure should be monitored daily and the patient should be provided with acceptable ranges versus when to notify the physician because severe hypertension can occur. Due to drug-drug interactions, contraindications, and cautions related to specific diagnosis (cardiovascular disease, vasomotor spasm, thyrotoxicosis, diabetes, renal or hepatic impaiment), it is important for the patient to inform the physician if another physician prescribes a medication or a new diagnosis for decisions to be made about whether to continue the drug or change the dosage. The patch is changed weekly and not every morning. The patient should be taught not to stop the drug abruptly because it could lead to tachycardia, hypertension, arrhythmias, flushing, and even death.
When giving beta-specific adrenergic agonists, at what age is an adult dose given? A) 10 years B) 11 years C) 12 years D) 13 years
Ans: C Feedback: Adult doses are given to children who are 12 years and older (see dosages in Table 30.3, page 497.) Therefore, the other options are incorrect.
Isoproterenol is reserved for use in emergency situations. What is the rationale for this? A) Its onset of action B) Its duration of action C) Its adverse effects D) Its peak plasma concentration
Ans: C Feedback: Because of its many adverse effects, isoproterenol is reserved for use in emergency situations that do not respond to other, safer therapies. It is not reserved for emergency use because of its onset of action, its duration of action, or its peak plasma concentration.
What drug would the nurse expect to administer if beta-specific adrenergic agonist effects are desired to prevent bronchospasm during anesthesia? A)Dobutamine (Dobutrex) B)Ephedrine (generic) C)Isoproterenol (Isuprel) D)Phenylephrine (Neo-Synephrine)
Ans: C Feedback: Isoproterenol is a beta-specific adrenergic agonist used to prevent bronchospasm during anesthesia. Phenylephrine is an alpha-specific adrenergic agonist. Both dobutamine and ephedrine are alpha- and beta-adrenergic agonists.
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? A) Insert an intravenous catheter B) Obtain permission from parents C) Ask another nurse to perform independent calculation D) Show the nurse's calculations to the physician
Ans: C Feedback: 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 doctor. 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.
When transcribing new orders for sympathomimetic medications prescribed for a geriatric patient, the nurse expects the dosage will be what? A) The average adult dosage B) Slightly higher than adult dosages C) The lowest possible effective dosage D) Approximately half the normal adult dosage
Ans: C Feedback: Older patients should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. Other options are incorrect.
The nurse is serving a breakfast tray to the patient receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the patient's diet when finding what on the tray? A) Eggs B) Bacon C) Coffee D) Milk
Ans: C Feedback: Patients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death. The nurse should counsel patients to avoid these ingredients. There would be no reason to prevent the patient from ingesting eggs, bacon, or milk.
Which of the following would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?
Beta-adrenergic blockers
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?
Beta-adrenergic blocking drugs
The nurse is caring for a male patient who is taking a monoamine oxidase inhibitor (MAOI). The patient complains of seasonal rhinitis and the intern for his service orders phenylephrine nasal spray. What is the nurse's priority action? A) Verify patency of the nares. B) Review the patient's medication history. C) Question the order with the prescriber. D) Position the patient to give the drug as ordered.
Ans: C Feedback: Phenylephrine, combined with MAOIs, can cause severe hypertension, headache, and hyperpyrexia. This combination should be avoided. As a result, the priority action is to remind the intern the patient is taking an MAOI and obtain an order for a different drug. Until the new order is received, no other actions would be taken.
What action do sympathomimetic drugs have in the body? A) Decreased heart rate B) Decreased blood pressure C) Increased respirations D) Increased intraocular pressure
Ans: C Feedback: Sympathomimetic drugs increase respirations. Heart rate and blood pressure are also increased and intraocular pressure is decreased.
A nurse receives an order for clonidine (Catapres) for a 25-year-old pregnant woman. What is the nurse's priority action? A)Weigh the patient to obtain correct dose/kg/day. B)Have a second nurse check the dose before administering the drug. C)Consult with the physician about the order. D)Make sure the patient is wearing a fetal monitor.
Ans: C Feedback: The nurse would consult with the physician to ensure awareness of the pregnancy and desire to administer this drug. There are no adequate studies about use during pregnancy and lactation, so use should be reserved for situations in which the benefit to the mother outweighs any potential risk to the fetus or neonate. The nurse should question the prescriber regarding this order. It would not be necessary to implement the other options.
The nursing students are studying sympathomimetic drugs. How do these drugs act on the body? A)Stimulate beta receptors and block alpha-receptors B)Stimulate alpha-receptors and block beta-receptors C)Block adrenergic receptors D)Stimulate both alpha and beta-receptors
Ans: D Feedback: 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.
The nurse is preparing to give isoproterenol parenterally. Before starting to administer the drug, what does the nurse ensure is on hand in case a severe reaction occurs? A) An alpha-adrenergic blocker B) An alpha-adrenergic stimulant C) A beta-adrenergic stimulant D) A beta-adrenergic blocker
Ans: D Feedback: Ensure that a beta-adrenergic blocker is readily available when giving parenteral isoproterenol in case severe reaction occurs. This makes other options incorrect.
A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence? A) Phenylephrine B) Propranolol C) Phenylalanine D) Phentolamine
Ans: D Feedback: Maintain phentolamine on standby in case extravasation occurs; infiltration of the site with 10 mL of saline containing 5 to 10 mg of phentolamine is usually effective in saving the area. Phenylephrine, propranolol, and phenylalanine are not indicated for use when extravasation occurs.
alpha-specific adrenergic agonists adverse effects
Anxiety Restlessness Depression Fatigue Strange dreams Personality changes
A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic antagonist would be to
Assess heart rate
A pt has been prescribed Midodrine 10 mg PO t.i.d. How should the nurse best assess for therapeutic effects? A) Auscultate the pt's apical heart rate for 1 minute B) Assess the pt's lying, sitting, and standing BP C) Assess the patency of the pt's nasal passages D) Assess the pt for SOB on exertion
B
A pt has been taking Indacaterol once per day, as prescribed. What assessment would the nurse perform when monitoring for therapeutic effects? A) Assessing BP B) Assessing for activity tolerance C) Assessing orientation to person, place, and time D) Assessing heart rate
B
SATA. A female college student who has been trying to lose weight with little success has expressed an interest in trying Ephedra. What should the nurse teach the pt? A) The drug would be contraindicated during pregnancy B) There are serious risks associated with the use of Ephedra C) Ephedra is no longer legally available in the US D) Despite being classified as a herb, Ephedra is only available with a prescription E) Ephedra has been banned due to abuse potential
B
The adrenergic agent of choice for treating the signs and symptoms of allergic rhinitis is: A) Norepinephrine B) Phenylephrine C) Dobutamine D) Dopamine
B
The home nurse arrives at the pt's home when the pt is eating lunch. What should prompt the nurse to address dietary needs of the pt receiving home infusion of Dobutamine? A) The pt's meal includes a tuna fish sandwich, carrot and celery strips, a glass of milk, and a slice of apple pie B) The pt's meal includes homemade vegetable soup, salt-free crackers, a diet cola, chocolate cake, and coffee C) The pt's meal includes an egg salad sandwich, fresh vegetables with ranch dressing, and lemonade D) The pt's meal includes a chef's salad, rye crisps, and a glass of milk
B
Select all that apply: Isoproterenol is a nonspecific beta agonist. The nurse might expect to administer this drug for which of the following conditions? A) Preterm labor B) Bronchospasm C) Cardiac standstill D) Shock E) Heart block in transplanted hearts F) Heart failure
B C D E
Epinephrine causes relaxation of
Bronchioles
A patient receives a beta-specific agonist. Which of the following would lead the nurse to determine that the drug is effective?
Bronchodilation
An adrenergic agent being used to treat shock infiltrates into the tissue with intravenous administration. Which action by the nurse would be most appropriate? A) Watch the area for any signs of necrosis and report it to the physician B) Notify the physician and decrease the rate of infusion C) Remove the IV and prepare phentolamine for administration to the area D) Apply ice and elevate the arm
C
The instructor determines that teaching about adrenergic drugs has been successful when the class identifies the drugs as also being called: A) Sympatholytic agents B) Cholinergic agents C) Sympathomimetic agents D) Anticholinergic agents
C
The nurse is assessing a hospital pt who has just been prescribed Clonidine. What action should the nurse prioritize? A) Assessing the IV site for extravasation B) Auscultating breath sounds q1h for the first dose C) Implementing falls' precautions D) Monitoring oxygen saturation
C
Select all that apply: When assessing a pt receiving a beta specific adrenergic agonist, the nurse would identify what findings as adverse effects of the drug? A) Bradycardia B) Steatorrhea (fatty stools) C) Restlessness D) Headache E) Pupil constriction
C D
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?
Cardiac monitoring
The nurse knows that what physiologic changes will effect a client's stroke volume?
Changes in heart contraction
A nurse is caring for an elderly patient who is to be administered isoproterenol. Which change monitored in the patient should the nurse report immediately to the primary health care provider?
Changes in pulse rate
The nurse is monitoring a pt who is receiving a Dobutamine infusion for treatment of heart failure. The nurse observes that the pt's heart rate has risen from 62 beats per minute to 64 beats per minute since the infusion began. What is the nurse's best action? A) Ensure that Dantrolene is readily available for STAT administration B) Anticipate the administration of Norepinephrine to potentiate the Dobutamine C) Ensure that the primary care provider is aware that the pt's heart rate has not increased significantly D) Continue to monitor the pt's cardiac status closely
D
After reviewing the topic of catecholamines, a group of students demonstrates the need for additional study when they identify which of the following as a synthetic catecholamine?
Dopamine
Alpha- And Beta-Adrenergic Agonists Prototype
Dopamine
Which of the following would the nurse identify as a naturally occurring catecholamine?
Dopamine
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
Anaphylaxis kits for clients allergic to bee stings would contain which medications?
Epinephrine
Anaphylaxis kits for clients allergic to bee stings would contain which of the following medications?
Epinephrine
Which of the following would the nurse expect to be given to a patient experiencing acute bronchospasm?
Epinephrine
A patient has been diagnosed with narrow-angle glaucoma. What ocular effect will be produced if the patient is prescribed an adrenergic agent?
Mydriasis
Epinephrine is contraindicated in patients with which diseases or disorders?
Narrow-angle (or closed-angle) glaucoma
A nurse would instruct a patient to apply a clonidine patch at which frequency?
Every 7 Days
The patient has been taking clonidine and is now being changed to another antihypertensive drug. How will the nurse instruct the patient regarding discontinuing the clonidine? A) "Check your blood pressure and pulse every 2 to 4 hours." B) "Inform your family the drug is being changed." C) "Reduce clonidine gradually over 2 to 4 days." D) "Keep an over-the-counter analgesic available to treat headaches."
Feedback: Do not discontinue clonidine abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper drug over 2 to 4 days. It is not necessary to teach the patient to check blood pressure and pulse every 2 to 4 hours, discuss plans for changing medications with the family, or prepare the patient for severe headaches.
The autonomic nervous system controls which body functions? (Select all that apply.)
Heart rate Blood pressure Glandular secretions GI activity
A patient has been administered dobutamine. The patient is also being administered β-adrenergic blocking drugs. Which of the following adverse reactions should the nurse monitor for in the patient as a result of combining the two drugs?
Hypertension
A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan?
Hypertension may be a side effect of the medication.
A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?
Inhalation
A patient has been prescribed dopamine. Which of the following interventions should the nurse perform while caring for the patient?
Inspect the needle site and surrounding tissues for leakage
Phenylephrine can be given via
Intramuscularly (IM) subcutaneously IV Orally Nasally Ophthalmic solution
A patient suffers from bradycardia. Which of the following medications is a synthetic catecholamine for the treatment of bradycardia?
Isoproterenol (Isuprel)
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
Clonidine is available in
Oral Transdermal Patch IV- via epidural infusion to help to control pain in cancer patients.
The intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with which of the following?
Phentolamine
Alpha-Specific Adrenergic Agonists Prototype
Phenylephrine
When applied topically to the eye, which drug produces dilation of the pupil without changing accommodation?
Phenylephrine
Which agent would the nurse expect to find when reviewing over-the-counter allergy products?
Phenylephrine
A client has been diagnosed with asthma and prescribed albuterol 2 inhalations q6h. When providing client education, what should the nurse teach the client?
Restlessness and anxiety are possible after administration
A client has been in the intensive care unit for two weeks following his car accident. His primary nurse is concerned that he is not getting the sleep he needs to recover. She decided to write a nursing diagnosis in the client's chart to work on this problem. Which nursing diagnosis would be appropriate to write for this problem?
Risk for Disturbed Sleep Pattern related to living in the intensive care unit for two weeks (noise, light, etc.), as well as side effects from medications
The adrenergic branch of the autonomic nervous system is also known by which name?
Sympathetic nervous system
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following?
Sympathomimetics
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 healthcare provider?
Systolic BP below a 100mm HG
The nurse understands that local anesthetics containing adrenergics should not be used on which part of the body?
The fingers
The nurse is administering epinephrine IV push. The nurse checks for patency of the IV prior to administration of the drug. The nurse realizes that if the IV is infiltrated, the medication will result in tissue extravasation. What is the reason for such an occurrence?
The medication causes vasoconstriction, limiting the blood flow to the area.
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True
Phentolamine is the agent used to treat extravasation of dobutamine.
True
True or False: Beta specific adrenergic agonists are primarily used to treat obstructive pulmonary conditions.
True
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
A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately?
Vital signs
The adrenergic branch of the nervous system controls many functions in the body. The nurse knows that which of the following body functions are controlled by the adrenergic branch? Select all that apply.
• Heart rate • Respiratory rate • Muscle blood flow
Ephedrine and ephedra-containing herbal preparations are often abused as an alternative to amphetamines. What substances are identified as herbal preparations?
• Herbal ecstasy • Ma huang
A nurse may be asked to administer adrenergic drugs to clients with which conditions? (Select all that apply.)
• Hypovolemic shock • Respiratory distress • Allergic reactions • Cardiac arrest
Ephedrine stimulates the release of
norepinephrine from nerve endings and acts directly on adrenergic receptor sites used for treatment of hypotension
Which of the following represent the two types of receptors that are found in the adrenergic nervous system? Select all that apply:
• Alpha receptors • Beta receptors
Contraindications to adrenergic drugs include what conditions? (Select all that apply.)
• Cardiac dysrhythmias • Hyperthyroidism • Hypersensitivity to sulfites
Contraindications to adrenergic drugs include what conditions? (Select all that apply.
• Cardiac dysrhythmias • Hyperthyroidism • Hypersensitivity to sulfites
In order to improve client outcomes, early recognition of the signs and symptoms of shock by the nurse is important. A nurse is caring for a client that has recently suffered an acute myocardial infarction. Which of the following are signs and symptoms of shock for which the nurse should monitor the client? Select all that apply:
• Decreased urinary output • Hypoxia • Tachypnea
In order to improve client outcomes, early recognition of the signs and symptoms of shock by the nurse is important. A nurse is caring for a client that has recently suffered an acute myocardial infarction, which of the following are signs and symptoms of shock for which the nurse should monitor the client? Select all that apply
• Decreases urinary output • Hypoxia • Tachypnea
In order to improve client outcomes, early recognition of the signs and symptoms of shock by the nurse is important. A nurse is caring for a client that has recently suffered an acute myocardial infarction, which of the following are signs and symptoms of shock for which the nurse should monitor the client? Select all that apply:
• Decreases urinary output • Hypoxia • Tachypnea
Adrenergic medications are commonly used for treatment in which of the following places? Select all that apply.
• Dentist office • Intensive care unit • Emergency department
The autonomic nervous system controls which of the following body functions? Select all that apply:
• Heart rate • Blood pressure • Glandular secretions • GI activity
