JES PHARM EXAM 2

A patient who has been taking a beta blocker for 6 moths tells the nurse during a followup visit that she wants to stop taking this medication. She is wondering if there is any problem with stopping the medication all at once. What is the nurses' best response? a. "no, there are no ill effects if this medication is stopped." b. "There should be only minimal effects if you stop this medication." c. "You may experience orthostatic hypotension if you stop this medication abruptly." d. "If you stop this medication suddenly there is a possibility you may experience chest pain or rebound hypertension."

d. "If you stop this medication suddenly there is a possibility you may experience chest pain or rebound hypertension."

which adverse effects will you see with an infusion of beta-adrenergic agonist

mild tremors, tachycardia, palpitations, nervousness

When a pt is taking an adrenergic drug, the nurse should expect to observe which effect?

A. increased heart rate

The neurotransmitter responsible for transmission of nerve impulses to effect cells in PSNS is called:

C. Acetylcholine

when a PT has experienced infiltration of a peripheral infusion of dopamine, the nurse knows that injecting the alpha blocker phentolamine will result in local

vasodilation

Drug herbal interactions for gingko biloba

warfarin

when administering beta blockers, the nurse knows that which guideline for administration and monitoring is correct?

weaning off the meds is necessary to prevent rebound hypertension

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which instructions are appropriate? Select all that apply. Select one or more: a. "Rinse your mouth with water after using the inhaler, and spit out the water." b. "Clean the plastic inhaler casing weekly by removing the canister, then washing the casing in warm soapy water. Let it dry before reassembling." c. "Use a peak flow meter to measure your response to therapy." d. "Gargle after using the inhaler and then swallow." e. "Continue to use this inhaler, even if you are feeling better." f. "Use this inhaler as directed for asthma attacks."

"Rinse your mouth with water after using the inhaler, and spit out the water." "Clean the plastic inhaler casing weekly by removing the canister, then washing the casing in warm soapy water. Let it dry before reassembling." "Continue to use this inhaler, even if you are feeling better." "Use a peak flow meter to measure your response to therapy."

A cholinergic drug is prescribed for a pt. The nurse checks the pt's medical history, knowing that this drug is contraindicated in which disorders? Select all that apply

- B. 2, 3, 5, 6, - Gastroinintestinal obstruction - Bradycardia -hypotention - COPD

Atropine would be appropriate for which of the following pt? select all that apply.

-D. 1, 4, 6 - A pt who has suddenly developed symptomatic bradycardia and a heart rate of 32 beats per minute -a pt, preoperatively, to reduce salivary and gastroinintestinal secretions -a pt w/ severe diarrhea

A nurse is teaching a client about bethanechol hydrochloride (Urecholine). The nurse informs the client that this drug warrants which of the following precautions: 1. Rise slowly from lying positions. 2. Count pulse rate frequently to assess for bradycardia. 3. Avoid diarrhea by eating binding foods. 4. Maintain aspiration precautions because of excess saliva.

1. Rise slowly from lying positions. This medication may lead to orthostatic hypotension and warrants careful position changes. Although bradycardia is a risk, it is not important to count pulse rate frequently.

Clients with nausea and vomiting are frequently prescribed antihistamines and anticholinergics. Side effects associated with antihistamines and anticholinergics include: 1. drowsiness and dry mouth 2. bradycardia and fatigue 3. tachycardia and dyspnea 4. abdominal cramps and nausea

1. drowsiness and dry mouth These are common side effects.

Anticholinergics for parkinsonism are used during which stage of the disorder? 1. early 2. intermediate 3. late 4. They are not effective in treating this disorder.

1. early These medications are indicated early in treatment.

A client has urinary retention. He was prescribed bethanechol chloride 25 mg, tid, po. The primary action of direct-acting cholinergic bethanechol chloride (Urecholine) is to: 1. increase urination 2. increase salivation 3. decrease heart rate 4. increase GI motility

1. increase urination This medication increases bladder contraction, leading to more effective bladder emptying.

Indirect-acting cholinergics act by: 1. inhibiting the action of the enzyme cholinesterase 2. promoting the action of the enzyme cholinesterase 3. inhibiting the action directly on the cholinergic receptors 4. promoting the action directly on the cholinergic receptors

1. inhibiting the action of the enzyme cholinesterase This is the function of indirect-acting cholinergics.

Your client has myasthenia gravis. Client teaching should include: 1. instructing the client to take the drug on time to avoid respiratory muscle weakness 2. informing the client that if a dose of the drug is missed to double the drug dose when the next dose is scheduled 3. instructing the client that if muscle weakness occurs, to rest, and if it persists to call the health care provider the next day 4. informing the client that if respiratory distress occurs, rest, double the drug dose, and call the health care provider

1. instructing the client to take the drug on time to avoid respiratory muscle weakness Even small gaps in time may cause respiratory muscle weakness; therefore the time schedule is strict.

Bethanechol chloride (Urecholine) is contraindicated if a client has a history of: 1. severe bradycardia and hypotension 2. tachycardia and hypertension 3. urinary retention and abdominal distention 4. hypertension and urinary retention

1. severe bradycardia and hypotension Side effects of this medication are decreasing the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension.

Cholinergic agents have specific effects on the body. Select the actions of cholinergic medications from the following: 1. dilate pupils 2. decrease heart rate 3. stimulate gastric muscle 4. dilate blood vessels 5. dilate bronchioles 6. increase salivation 7. constrict pupils

2. decrease heart rate 3. stimulate gastric muscle 4. dilate blood vessels 6. increase salivation 7. constrict pupils These are the actions of the parasympathetic nervous system, or the "feed and breed response."

Atropine and atropine-like drugs are anticholinergics. Atropine is usually prescribed as one of the preoperative drugs. The primary use for atropine as a preoperative drug is to: 1. increase heart rate 2. decrease salivation 3. decrease GI motility 4. decrease urination

2. decrease salivation This is the function of preoperative atropine in order to decrease the risk of aspiration during intubation.

Some cholinesterase inhibitors are used to improve memory in mild to moderate Alzheimer's dementia. These agents act by: 1. decreasing cholinergic function 2. enhancing cholinergic function 3. increasing anticholinergic function 4. blocking cholinergic action

2. enhancing cholinergic function These medications inhibit the enzyme designed to break down cholinergics and are thought to improve memory in mild to moderate Alzheimer's dementia

A client is ordered bethanechol chloride (Urecholine) for urinary retention. A nurse is adding up the client's intake and output for the 8-hour shift. The client's I = 850 ml, O = 350 ml. The nurse should: 1. administer an extra dose of bethanechol 2. palpate the client's bladder 3. increase the client's fluid intake 4. continue the plan of care

2. palpate the client's bladder The client's output is adequate but does not match the intake. The nurse should assess for bladder distention and retention.

Teaching clients taking anticholinergic includes: 1. encouraging the use of alcohol and caffeine before bedtime for sleep disorders 2. suggesting hard candy, chewing gum, and oral hygiene for dry mouth 3. instructing the client to report dizziness and a slow pulse rate immediately 4. instructing the client to avoid lifting heavy objects

2. suggesting hard candy, chewing gum, and oral hygiene for dry mouth Dry mouth is a common side effect of the anticholinergics.

The usefulness of cholinesterase inhibitors for controlling myasthenia gravis is: 1. for diagnostic purposes 2. to increase muscle strength 3. to decrease muscle strength 4. to promote urination

2. to increase muscle strength By inhibiting the enzymes, acetylcholine is made more available to aid in muscle stimulation and the force of muscle contraction.

Parasympathomimetics mimic the parasympathetic neurotransmitter acetylcholine. Another drug group name for parasympathomimetics is: 1. adrenergics 2. adrenergic blockers 3. cholinergics 4. anticholinergics

3. cholinergics This is another word for parasympathomimetics.

The major responses to anticholinergic drugs include: 1. decreased heart rate and increased salivation 2. pupil constriction and increased bronchial secretions 3. increased heart rate and decreased salivation 4. increased urine output and pupil constriction

3. increased heart rate and decreased salivation These are the responses to anticholinergic medications.

A client is receiving bethanechol chloride (Urecholine) orally. What other route of administration can be used to give bethanechol? 1. intramuscular 2. intravenous 3. subcutaneous 4. intradermal

3. subcutaneous Bethanechol may be given orally or subcutaneously.

A client experiences bradycardia as a result of vagal stimulation. The nurse would expect to administer: 1. bethanechol chloride (Urecholine) 2. benztropine (Cogentin) 3. metoclopramide (Reglan) 4. atropine sulfate (atropine)

4. atropine sulfate (atropine) Atropine is given to increase heart rate in patients with vagally stimulated bradycardia.

Certain anticholinergics are used for parkinsonism. One of the purposes for their use is to: 1. increase salivation and drooling 2. increase muscle tone 3. increase urination 4. decrease tremors and rigidity

4. decrease tremors and rigidity This is the use for parkinsonism, a disease that includes tremors, bradykinesia, rigidity, and drooling.

Atropine-like drugs are contraindicated in clients with: 1. parkinsonism 2. a peptic ulcer 3. cirrhosis 4. glaucoma

4. glaucoma Atropine may cause pupillary dilation, which increases intraocular pressure.

Parasympathomimetics affect the cardiovascular, gastrointestinal (GI), and urinary systems, as well as the eye, causing: 1. increased pulse rate 2. decreased GI motility 3. decreased bladder contraction 4. myosis (pupil constriction)

4. myosis (pupil constriction) These agents decrease pulse rate, increase GI motility, and increase bladder contraction.

An example of a cholinesterase inhibitor used for clients with early-stage Alzheimer's dementia is: 1. ambenonium chloride (Mytelase) 2. bethanechol chloride (Urecholine) 3. atropine sulfate 4. tacrine hydrochloride (Cognex)

4. tacrine hydrochloride (Cognex) This is the medication commonly given for Alzheimer's dementia and is thought to improve memory.

Side effects to expect from anticholinergic (parasympatholytic) drugs, such as atropine, include which effects? (Select all that apply.) A) Dilated pupils (mydriasis) B) Urinary retention C) Dry mouth D) Diarrhea E) Increased sweating

A, B, C: Anticholinergic effects block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. These include mydriasis, decreased bladder contraction, and decreased oral secretions. The effect on the gastrointestinal system would be to decrease gastrointestinal motility, not cause diarrhea. Sweating would decrease as a result of anticholinergic drugs.

Your patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.) A) Heart rate B) Blood pressure C) Urine output D) Liver enzymes

A, B, C: The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output.

Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A) Limit your alcohol consumption. B) Report symptoms of anorexia and fatigue. C) Take your medication only as needed. D) Notify your physician if blood glucose levels rise above the level set for you.

A, B, D: Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. All other options are correct.

Beta-blockers are used to treat which disorders? (Select all that apply.) A) Hypertension B) COPD C) Angina pectoris D) Cardiac dysrhythmias

A, C, D: Beta-blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta-blockers can exacerbate COPD as they block beta2 receptors and subsequent bronchodilation.

Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A) Stimulate insulin secretion from beta cells B) Increase hepatic glucose production C) Enhance action of insulin in various tissues D) Inhibit breakdown of insulin by liver

A, C, D: The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.

Atropine would be appropriate for which of the following patients? Select all that apply. A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats per minute B. A patient who has suddenly developed symptomatic tachycardia and a heart rate of 180 beats per minute C. A patient with severe narrow-angle glaucoma D. A patient, preoperatively, to reduce salivary and gastrointestinal secretions E. A patient newly diagnosed with myasthenia gravis F. A patient with severe diarrhea

A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats per minute D. A patient, preoperatively, to reduce salivary and gastrointestinal secretions F. A patient with severe diarrhea Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and used to decrease intestinal motility. The other options are contraindications to the use of atropine.

When monitoring a patient who is taking a cholinergic drug, the nurse should watch for which cardiovascular effect? A. Bradycardia B. Tachycardia C. Vasoconstriction D. Palpitations

A. Bradycardia The cardiovascular effects of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs.

The nurse is reviewing the mechanism of action of cholinergic drugs. The desired effects of cholinergic drugs come from the stimulation of which receptors?

A. Muscarinic

The nurse is reviewing the mechanism of action of cholinergic drugs. The desired effects of cholinergic drugs come from the stimulation of which receptors? A. Muscarinic B. Nicotinic C. Cholinergic D. Ganglionic

A. Muscarinic The desired effects come from muscarinic receptor stimulation; many of the undesirable adverse effects are due to nicotinic receptor stimulation.

The nurse is about to administer a stat dose of atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse should monitor the patient closely for which adverse effect? A. Tachycardia B. Bradycardia C. Ectopic beats D. Cardiac standstill

A. Tachycardia Cardiovascular effects of cholinergic-blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are not correct.

The nurse caring for a patient who is receiving beta, agonist drug therapy needs to be aware that these drugs cause A. increased cardiac contractility b. decreased heart rate c. bronchoconstriction d. increased GI tract motility

A. increased cardiac contractility

When an adremergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as a positive ____effect.

A. inotropic

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce A) a positive inotropic, positive chronotropic, and positive dromotropic effect. B) a positive inotropic, negative chronotropic, and negative dromotropic effect. C) a negative inotropic, positive chronotropic, and positive dromotropic effect. D) a negative inotropic, negative chronotropic, and negative dromotropic effect.

A: Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).

Patient teaching for a patient being discharged on a beta-blocker includes which statement? A) "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." B) "If you become dizzy, do not take your medication for 2 days and then restart on the third day." C) "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." D) "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

A: Beta-blockers have a negative chronotropic effect and could cause symptomatic bradycardia and/or heart block. The physician should be consulted before administering to a patient with bradycardia (heart rate <60 beats/min).

The nurse is admitting a patient with a history of angina and hypertension who is currently experiencing moderate heart failure. The patient's current medication regimen includes digoxin, furosemide, and accupril. Which medication would be most beneficial to add to this patient's treatment plan? A) carvedilol (Coreg) B) propranolol (Inderal) C) esmolol (Brevibloc) D) sotalol (Betapace)

A: Carvedilol (Coreg), a combined alpha1- and beta-blocker, has been shown to slow the progression of heart failure and decrease the frequency of hospitalization in patients with mild to moderate (Class II or III) heart failure. Carvedilol is most commonly added to digoxin, furosemide, and angiotensin-converting enzyme (ACE) inhibitors when used to treat heart failure.

The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect? A) Decrease in gastrointestinal motility B) Decrease in urinary frequency C) Increase in heart rate D) Increase in blood pressure

A: Dicyclomine is an antispasmodic cholinergic blocker used to decrease gastrointestinal motility in patients with functional gastrointestinal disorders such as irritable bowel syndrome.

The doctor has ordered dopamine to treat your patient's hypovolemic shock due to severe blood loss. For the medication to be effective, the physician must also order A) fluid replacement. B) beta-stimulating drugs. C) antibodies. D) fluid restriction.

A: Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system.

When administering 30 units regular insulin and 70 units NPH insulin, the nurse will perform which action? A) Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B) Inform the patient that mixing insulins will help increase insulin production. C) Rotate sites at least once weekly and label the sites used on a diagram. D) Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption.

A: Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? A) insulin glargine (Lantus) B) insulin glulisine (Apidra) C) regular insulin (Humulin R) D) NPH insulin (Humulin N)

A: Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. When teaching the patient about this medication, the nurse recognizes that A) pramlintide slows gastric emptying.B) pramlintide increases glucagon excretion. C) pramlintide works to prevent side effects of insulin. D) pramlintide is an oral drug administered 15 minutes before meals.

A: Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion, and centrally modulating appetite and satiety. It is only administered subcutaneously.

For the most complete absorption, the recommended site for insulin injection should be into which area of the body? A) Abdomen B) Arm C) Thigh D) Buttocks

A: Thigh areas and outer areas of the upper arm may be used for insulin injection, but some practitioners recommend only using the abdomen because of more complete absorption.

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication. B) Disturbed sensory perception related to adverse central nervous system effects of the drug. C) Deficient knowledge related to therapeutic regimen. D) Risk for injury related to possible side effects of the adrenergic blockers.

A: Using the ABCs of prioritization, Ineffective tissue perfusion (cerebral and cardiovascular) puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Which of the following is a rapid-acting insulin with an onset of action of less than 15 minutes? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)

B: Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short acting.

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? Select all that apply. Select one or more: a. Montelukast (Singulair) b. Epinephrine c. Fluticasone (Flovent) Rotadisk inhaler d. Zafirlukast (Accolate) tablet

Albuterol (Proventil) nebulizer solution Epinephrine Aminophylline IV infusion

A patient has just been switched from scopolamine to a synthetic derivative. He questions the switch and asks, "What's the big advantage for me?" Which answer by the nurse is correct? A. "The synthetic derivatives are usually less expensive." B. "Synthetic derivatives may be associated with fewer adverse effects." C. "Your insurance company covers only certain types of medications." D. "Synthetic derivatives are less potent and have less chance for toxicity."

B. "Synthetic derivatives may be associated with fewer adverse effects." Synthetic derivatives are associated with fewer adverse effects than naturally occurring anticholinergic drugs.

A cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? Select all that apply. A. Bladder atony B. Gastrointestinal obstruction C. Bradycardia D. Alzheimer's disease E. Hypotension F. Chronic obstructive pulmonary disease

B. Gastrointestinal obstruction C. Bradycardia E. Hypotension F. Chronic obstructive pulmonary disease Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs.

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline (Evoxac) for the treatment of xerostomia. The nurse will monitor for what therapeutic effect? A. Reduction of salivation B. Stimulation of salivation C. Reduction of gastrointestinal peristalsis D. Improvement of fine motor control

B. Stimulation of salivation Cevimeline is a direct-acting cholinergic drug that is used to stimulate salivation in patients who have xerostomia (dry mouth), one of the manifestations of Sjögren's syndrome.

A patient with myasthenia gravis has received a prescription for pyridostigmine. The nurse should include which teaching point for this patient? a. the drug is taken once in the am for maximum effect. B. The drug should be taken 30 minutes before eating meals. c. The drug should be taken 30 minutes after eating meals. d. This drug can be given without regard to meals

B. The drug should be taken 30 minutes before eating meals.

A pt is experiencing a severe anaphylactic reation to an antibiotic. Which drug will the nurse expect to use to treat this condition?

B. epinephrine

An adrenergic agonist is ordered for a pt in shock. The nurse will note that this drug has had its primary intended effect if which assessment finding is observed?

B. increased blood pressure

The nurse is developing a care plan for a pt who is taking an anticholonergic drug. Which nursing dx would likely be appropriate for this pt?

B. urinary retention

When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? A) insulin glargine (Lantus) B) glipizide (Glucotrol) C) insulin glulisine (Apidra) D) NPH insulin (Humulin N)

B: All currently available oral antidiabetic drugs are contraindicated for pregnant patients.

A priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs would be A) Risk for injury related to excessive central nervous system stimulation. B) Impaired gas exchange related to thickened respiratory secretions. C) Urinary retention related to loss of bladder tone. D) Deficient knowledge related to pharmacologic regimen.

B: Although all of these nursing diagnoses are appropriate, the priority is determined remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat A) postoperative hypotension. B) urinary atony. C) respiratory atelectasis. D) postoperative ischemic colitis.

B: Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.

Cholinergic (parasympathomimetic) drugs are indicated for which situation? A) Treating a postoperative patient who has bradycardia B) Lowering intraocular pressure in patients with glaucoma C) Inhibiting muscular activity in the bladder D) Preventing salivation and sweating

B: Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.

Cholinergic (parasympathomimetic) drugs have which therapeutic effect? A) Urinary retention B) Increased gastrointestinal motility C) Mydriasis D) Vasoconstriction

B: Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing gastrointestinal motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.

The nurse knows a common expected adverse effect of iron supplementation is which effect?A) Fatigue B) Constipation C) Heartburn D) Flatus

B: Constipation and change in the color of stool to darker or green are the most common complaints with iron supplementation and are expected.

The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to A) relieve anxiety and restless behavior of the patient. B) increase levels of acetylcholine in the brain by blocking its breakdown. C) block the effects of acetylcholine at the presynaptic neurons. D) help control associated urinary incontinence.

B: Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. Donepezil is an indirect-acting anticholinesterase drug.

The nurse is educating a patient on diet. Which food will the nurse encourage the patient to include in a diet as a source of folate? A) Cheese B) Dried beans C) Steak D) Apples

B: Dried beans, green vegetables, and oranges are some of the common folate-containing foods.

When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate? A) Increase fluid and fiber in the diet to prevent constipation. B) Take the medication 30 minutes before meals. C) If a dose is missed, double the next dose to prevent withdrawal. D) Common side effects include tachycardia and hypertension.

B: Drugs used for myasthenia gravis should be given about 30 minutes before meals to allow for onset of action and therapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, and hypertension are not effects of cholinergic medications. A missed dose should never be doubled.

To achieve the most beneficial effect, the nurse plans to administer glipizide (Glucotrol) A) with food. B) 30 minutes before a meal. C) 15 minutes postprandial. D) at bedtime.

B: Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.

Diabetic teaching includes treatment of hypoglycemia with which drug? A) propranolol (Inderal) B) glucagon C) acarbose (Precose) D) bumetanide (Bumex)

B: Glucagon stimulates glycogenolysis, raising serum glucose levels.

The nurse will plan to inject iron dextran by which of the following techniques? A) Subcutaneous injection with a ½-inch, 25-gauge needle B) Intramuscular injection using the Z-track method C) Intradermal injection with a sunburst technique of administration D) Intramuscular injection with a ½-inch, 18-gauge needle

B: Iron dextran should be administered deep in a large muscle mass using the Z-track method and a 23-gauge, 1½-inch needle to prevent skin irritation and potential necrosis.

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication? A) nadolol (Corgard) B) phentolamine (Regitine) C) dobutamine (Dobutrex) D) verapamil (Calan)

B: Phentolamine is a potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma.

The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which of the following medications to treat this infiltration? A) lidocaine (Xylocaine) B) phentolamine (Regitine) C) nitroprusside (Nipride) D) naloxone (Narcan)

B: Phentolamine is an alpha-blocker that causes vasodilation, thus counteracting the vasoconstrictive effects of the infiltrated dopamine. The vasodilation will increase blood flow to the site and decrease the risk of tissue necrosis.

Propranolol (Inderal) is an effective A) selective alpha-adrenergic antagonist. B) nonselective beta-adrenergic antagonist. C) beta1-adrenergic antagonist. D) beta2-adrenergic antagonist.

B: Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure? A) acarbose (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)

B: The concurrent use of metformin iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.

Your patient is to receive dopamine 5 mcg/kg/min. He weighs 176 lb. You have dopamine 400 mg in 500 mL D5W. You will infuse this at A) 20 mL/hr. B) 30 mL/hr. C) 35 mL/hr. D) 50 mL/hr.

B: The patient's weight of 176 lb is converted to kilograms by dividing 176 by 2.2 = 80 kg. 5 mcg/kg/min multiplied by 80 kg = 400 mcg, or 0.4 mg/min. Dividing 0.4 mg/min by 400 mg/500 mL = 0.5 mL/min, which when multiplied by 60 minutes = 30 mL/hour.

A patient presents with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously? A) 0.3 mg B) 0.5 mg C) 1.25 mg D) 2 mg

B: The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

The nurse monitors a patient taking tolterodine (Detrol) for which therapeutic effect? A) Decrease in gastrointestinal motility B) Decrease in urinary frequency C) Increase in heart rate D) Increase in blood pressure

B: Tolterodine (Detrol) blocks the muscarinic receptors in the bladder to decrease urinary frequency and urgency.

A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the physician's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate? A. "Increase the dosage to twice daily." B. "It takes time for the cure to take effect." C. "It may take up to 6 weeks to see an improvement." D. "Take the medication on an empty stomach for improved absorption."

C. "It may take up to 6 weeks to see an improvement." Donepezil therapy is not a cure for Alzheimer's disease, but it may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals, and the medication should not be abruptly stopped or the dosage increased without the physician's approval because of the possibility of serious complications.

A 62 yr old woman has started taking donepezil for early stage alzheimer's disease. Her daughter expresses relief that "there is finally a pill to cure AD" What is the nurse's best response? A. "She should expect reversal of symptoms within a few days." B. "The dosage should be increased if no imporvement is noted" C. "This drug may help to improve symptoms, but is is not intended as a cure" D. "Yes, it has been a great help for many patients."

C. "This drug may help to improve symptoms, but is is not intended as a cure"

A 62 yr old woman has started taking donepezil for early-stage alzheimers disease. Her daughter expresses relief that "there is finally a pill to cure Alzheimers disease." What is the nurse's best response?

C. "This drug may help to improve symptoms, but it is not intended as a cure."

When giving an anticholinergic drug, the nurse should monitor for which adverse effect from this drug? A. Excessive urination B. Diaphoresis C. Dry mouth D. Pupillary constriction

C. Dry mouth Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention.

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse should teach this patient to look for which therapeutic effects? A. Decreased pulse rate B. Abdominal cramping C. Increased bowel sounds and passage of flatus D. Decreased frequency and urgency of voiding patterns

C. Increased bowel sounds and passage of flatus In patients suffering a decrease in gastrointestinal peristalsis postoperatively, taking a cholinergic drug should result in an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements that indicate increased gastrointestinal peristalsis.

The nurse notes in the patient's medication history that the patient is taking a cholinergic-blocking drug. Based on this finding, the nurse interprets that the patient has which disorder? A. Glaucoma B. Myasthenia gravis C. Irritable bowel disease D. Genitourinary obstruction

C. Irritable bowel disease Cholinergic-blockers may be used to treat irritable bowel disease. Glaucoma, myasthenia gravis, and genitourinary obstruction are contraindications to the use of these drugs.

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease? A. Parkinson's disease B. Multiple sclerosis C. Myasthenia gravis D. Bell's palsy

C. Myasthenia gravis Edrophonium, another indirect-acting cholinergic drug, is commonly used to diagnose myasthenia gravis. Edrophonium is not used in diagnosing Parkinson's disease, multiple sclerosis, or Bell's palsy.

A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important include in the teaching? A. The medication should be taken with meals to avoid gastrointestinal distress. B. Daytime doses should be given close together for maximal therapeutic effect. C. The medication should be taken 30 minutes before eating to improve swallowing and chewing. D. The medication is taken only if difficulty swallowing occurs during a meal.

C. The medication should be taken 30 minutes before eating to improve swallowing and chewing. Taking the medication 30 minutes before meals allows for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication.

The nurse is reviewing sympatheric nervous system agonists. Adrenergic drugs that cause relaxation of the brochi and broncholodation stimulate _____ receptors.

C. beta 2 -adrenergic

the burse is reviewing sympathetic nervous system agonists. Adrenergic drugs that cause relaxation of the bronchi and bronchodialtion stimulate_____ receptors.

C. beta 2- adrenergic

when giving an anticholinergic drug, the nurse should monitor for which adverse effect from this drug?

C. dry mouth

The nurse notes in the pt's medical history that the pt is taking a cholinergic-blocking drug. Based on this finding, the nurse interprets that the pt has which disorder?

C. irritable bowel disease

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug? A. pilocarpine B. bethanechol C. physostigmine D. cholinesterase

C. physostigmine Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase (AChE), thus reversing the neuromuscular blockade produced by anticholinergic poisoning. The other drugs listed are not appropriate antidotes.

Adrenergic drug produce effects similar to those of the _____ nervous system.

C. sympathetic

A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that A) Afrin nasal spray is not an effective nasal decongestant. B) the medication needs to be used every 30 minutes for maximum effectiveness. C) the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray. D) adrenergic decongestants should only be used prophylactically, not to treat acute congestion.

C: Afrin nasal spray is a sympathomimetic drug with both alpha- and alpha-beta-adrenergic effects. The alpha-adrenergic activity is responsible for causing vasoconstriction in the nasal mucosa. However, excessive use of nasal decongestants can lead to greater congestion because of a rebound phenomenon that occurs when use of the product is stopped.

Alpha-glucosidase inhibitors differ from the sulfonylureas in that they A) greatly stimulate pancreatic insulin release. B) greatly increase the sensitivity of insulin receptor sites. C) delay the absorption of glucose, leading to lower glucose levels. D) cannot be used in combination with other antidiabetic drugs.

C: Alpha-glucosidase is an enzyme necessary for the absorption of glucose from the gastrointestinal tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

An example of a cardioselective beta-blocker includes A) propranolol (Inderal). B) labetalol (Normodyne). C) atenolol (Tenormin). D) sotalol (Betapace).

C: At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at A) 10:00 AM. B) 2:00 PM. C) 5:00 PM. D) 8:00 PM.

C: Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Epinephrine, as an adrenergic (sympathomimetic) drug, produces which of the following therapeutic effects? A) Urinary retention B) Bronchial constriction C) Increased heart rate and contractility D) Decreased intestinal motility

C: Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. The other effects listed are parasympathomimetic in nature.

Which would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness? A) At bedtime B) Every 4 hours as needed C) 4 to 5 hours before travel D) At the first sign of motion sickness

C: For the prevention of motion sickness, scopolamine is available in a convenient transdermal delivery system (a patch) that can be applied just behind the ear 4 to 5 hours before travel. Each patch has a 72-hour duration of action, thus necessitating a change only every 3 days.

A patient presents to the emergency room with insecticide poisoning. The nurse prepares to administer which dose of atropine intravenously? A) 0.3 mg B) 0.5 mg C) 2 mg D) 4 mg

C: Higher doses of atropine (1 to 3 mg) are needed to treat cholinergic overdoses such as insecticide poisoning.

Which insulin can be administered by continuous intravenous infusion? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)

C: Regular insulin is the only insulin used for intravenous therapy.

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? A) acarbose (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)

C: Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.

A patient tells the nurse that she wants to begin taking a Ginkgo biloba preparation for memory enhancement. What possible drug interactions should the nurse warn this patient about? A. Digoxin, diuretics, and steroids B. All caffeine-containing products C. Alcoholic beverages D. Aspirin, any nonsteroidal antiinflammatory drugs, and warfarin

D. Aspirin, any nonsteroidal antiinflammatory drugs, and warfarin Drug interactions may occur between the taking of aspirin, nonsteroidal antiinflammatory drugs, and the anticoagulants warfarin and heparin and the taking of ginkgo biloba. The other options are not correct.

a 72 yr old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities such as golfing, and doing his own yard work. What should the nurse emphasize to him during the teaching session about his drug therapy?

D. He should take measures to reduce the occurrence of heat stroke during his activities.

A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as hiking, golfing, and doing his own yard work. What should the nurse emphasize to him during the teaching session about his drug therapy? A. Drowsiness may interfere with his outdoor activities. B. Increased salivation may occur during exercise and outside activities. C. Fluid volume deficits may occur as a result of an increased incidence of diarrhea. D. He should take measures to reduce the occurrence of heat stroke during his activities.

D. He should take measures to reduce the occurrence of heat stroke during his activities. Elderly patients who take an anticholinergic drug should be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms.

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's action? A. Prevents memory loss in later stages B. Reverses the course of Alzheimer's disease C. Provides sedation to prevent agitation and restlessness D. May help to improve the symptoms of Alzheimer's disease

D. May help to improve the symptoms of Alzheimer's disease Donepezil is used to treat mild to moderate dementia occurring in Alzheimer's disease and may improve the symptoms of the disease.

A pt is brought to the emergency department with severe case of atropine overdose. Which drug will the nurse expect to administer?

D. Physostigmine

What i another name for an adrenergic drug? A. anticholinergic drug B. parasymphathetic Drug C. central nervou systsem drug D. Sympathomimetic drug

D. Sympathomimetic drug

A patient has had an overdose of an intravenous cholinergic drug. The nurse should expect to administer which drug as an antidote? A. atenolol B. bethanechol C. dobutamine D. atropine sulfate

D. atropine sulfate Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity.

A patient is brought to the emergency department with a severe case of atropine overdose. Which drug will the nurse expect to administer? A. atenolol B. bethanechol C. scopolamine D. physostigmine

D. physostigmine Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial, however. The other options are not correct choices.

The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. The purpose of this drug in this setting is to A. control the heart rate. B. relax the patient. C. reduce urinary frequency. D. reduce secretions.

D. reduce secretions. Anticholinergic drugs are given preoperatively to control secretions during surgery. The other options are not correct.

When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that A) these medications may be taken with antacids to minimize gastrointestinal distress. B) hot baths and showers will help enhance the therapeutic effects and are encouraged. C) alcohol intake is encouraged for its vasodilating effects. D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

D: Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with A) beta-blockers. B) diuretics. C) alpha1-blockers. D) MAO inhibitors.

D: Adrenergic drugs combined with MAO inhibitors can lead to extreme hypertension. All the other drugs listed are used to treat hypertension.

When assessing for cardiovascular effects of a beta-blocker, the nurse understands that these drugs produce A) a + inotropic, + chronotropic, and + dromotropic effect. B) a + inotropic, - chronotropic, and - dromotropic effect. C) a - inotropic, + chronotropic, and + dromotropic effect. D) a - inotropic, - chronotropic, and - dromotropic effect.

D: Beta-blockers exert a sympatholytic effect, blocking the effects of sympathetic nervous system stimulation, causing a decrease in heart rate (negative chronotropic), conductivity (negative dromotropic), and contractility (negative inotropic).

The nurse would question an order for cevimeline (Evoxac) in a patient with a history of A) leg cramps. B) hemorrhoids. C) tachycardia. D) narrow-angle glaucoma.

D: Cevimeline (Evoxac) is a direct-acting cholinergic drug used to stimulate salivation in patients having a disorder known as Sjögren's syndrome, which causes xerostomia (dry mouth). It is contraindicated in any condition in which pupillary miosis might be undesirable, such as narrow-angle glaucoma or iritis, and also in uncontrolled asthma.

The nurse would include which statement when teaching a patient about insulin glargine? A) "You should inject this insulin just before meals because it is very fast acting." B) "The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day." C) "You can mix this insulin with NPH insulin to enhance its effects." D) "You cannot mix this insulin with regular insulin and thus will have to take two injections."

D: Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins.

Nonselective beta-blockers may be used to treat

D: Nonselective beta-blockers are used to treat supraventricular arrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure, COPD, and heart block secondary to their negative inotropic effect (heart failure), blocking of bronchodilation (COPD), and negative chronotropic effects (heart block).

Adverse reactions to bethanechol include A) constipation. B) hypertension. C) tachycardia. D) headache.

D: Side effects of bethanechol include abdominal cramps, diarrhea, hypotension, bradycardia, and headache.

When administering ferrous sulfate (iron) to a patient, the nurse plans to give this medication with which fluid to increase absorption of the iron? A) 8 ounces of water B) 4 ounces of milk C) Hot tea D) Orange juice

D: The absorption of iron can be enhanced when it is given with ascorbic acid (vitamin C), which is present in orange juice.

-endogenous vasoactive catecholamine, acts directly on both alpha and beta adrenergic receptors of SNS. Administered in Emergency situations, primary vasoactive drugs used in many advanced cardiac life support protocols. Low dosages stimulate beta receptors-increase force of contraction and heart rate, can also be used to treat acute asthma and anaphylactic shock because has bronchodilatory effects in beta receptors in lungs. At high dosages, it stimulates alpha receptors causing vasconstriction-raising BP.

Epinephrine

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. Which instruction by the nurse is correct? Select one: a. "Limit use of this spray to 3 to 5 days." b. "Expect the beneficial effects to be delayed at least 1 week." c. "Continue the spray until nasal stuffiness has resolved." d. "Avoid use of this spray if a fever develops."

a. "Limit use of this spray to 3 to 5 days."

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. He has just become unconscious. What is the nurse's first action? Select one: a. Give him intravenous glucose b. Call the lab to order a fasting blood glucose level. c. Have the patient eat glucose tablets. d. Have the patient consume fruit juice, a nondiet soft drink, or crackers.

a. Give him intravenous glucose

The nurse is preparing to administer insulin intravenously. Which statement about intravenous insulin is true? Select one: a. Only Regular insulin can be administered intravenously. b. Any form of insulin can be administered intravenously at the same dose as that ordered for subcutaneous administration. c. Insulin aspart or lispro can be administered intravenously, although there must be a 50% dose reduction. d. Insulin should never be given intravenously

a. Only Regular insulin can be administered intravenously.

Patient who are taking beta blockers for angina need to be taught which information a. These drugs are for long term prevention of angina episodes b. These drugs must be taken as soon as angina pain occurs. c. These drugs should be discontinued if dizziness is experienced. d. These drugs should be carried with the patient at all times in case angina occurs.

a. These drugs are for long term prevention of angina episodes

The nurse is aware that adrenergic drugs may be used to treat which conditions? a. asthma b. glaucoma c. hypertension d. nasal congestion e. seizures f. nausea and vomiting

a. asthma b. glaucoma d. nasal congestion

A patient took an accidental overdose of a cholinergic drug while at home. He comes to the ER with severe abdominal cramping and bloddy disarrhea. The nurse expects that which drug will be used to treat this patient? a. atropine b. physostimine c. lidocaine d. protamine sulfate

a. atropine

The nurse will prepare to give which drug to a patient who is experiencing a cholinergic crisis? a. atropine b. tacrine (cognex) c. donepezil (aricept) d. physostigmine

a. atropine

The nurse is providing education about anticholinergic drug therapy to an alderly patient. An important point to emphasize would be to a. avoid exposure to high temperatures b. limit liquid intake to avoid fluid overload c. begin an exercise program to avoid adverse effects d. stop the medication if excessive mouth dryness occurs

a. avoid exposure to high temperatures

When monitoring a patient who is taking a cholinergic drug, the nurse should watch for which cardiovascular effect? a. bradycardia b. tachycardia c. vasoconstriction d. palpitations

a. bradycardia

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught a patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 per minute, he should be instructed to a. contact his physician for instructions. b. reduce the dose of his bate blocker by half c. continue the medication because this is an expected effect d. skip the medication dose that day and check his pulse again the next day.

a. contact his physician for instructions.

The nurse administering a cholinergic blocking drug to a patient who is experiencing drug induced extrapyramidal effects would assess for which therapeutic effect? a. decreased muscle rigidity and tremors b. increased heart rate c. decreased bronchial secreations d. decreased GI motility and peristalsis

a. decreased muscle rigidity and tremors

The nurse will monitor for which adverse effects of anticholinergic drugs? (select all that apply) a. dilated pupils b. constricted pupils c. dry mouth d. urinary retention e. urinary frequency f. diarrhea

a. dilated pupils c. dry mouth d. urinary retention

A woman who is allergic to bees has just been stung while out in her garden. She reaches for her beesting kit, which would most likely contain which drug? a. epinephrine (epipen) b. methylphenidate HCl (Ritalin) c. dopamine d. norepinephrine (levophed)

a. epinephrine (epipen)

Before giving an anticholinergic drug, the nurse should check the patient's history for which conditions? (select all that apply) a. glaucoma b. osteoporosis c. acute asthma d. thyroid disease e. diabetes mellitus f. benign prostatic hyperplasia

a. glaucoma c. acute asthma f. benign prostatic hyperplasia

A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker is to a. increase urine output b. prevent stimulation of the herat by catecholamines c. increase the contractility of the heart muscle. d. cause peripheral vasodilation

a. increase urine output

When a patient is taking an adrenergic drug, the nurse should expect to observe what effect? a. increased HR b. bronchial constriction c. peripheral vasoconstriction d. increased intestinal peristalsis

a. increased heart rate

When an adrenergic drug stimulates beta1 adrenergic receptors, the result is an increased force of contraction, which is known as a positive ______ effect. a. inotropic b. adrenergic c. dromotropic d. chronotropic

a. inotropic

The nurse is monitoring a patient who is receiving an infusion of a beta-adrenergic agonist. Which adverse effects may occur with this infusion? (select all that apply) a. mild tremors b. brachycardia c. tachycardia d. palpitations e. drowsiness f. nervousness

a. mild tremors c. tachycardia d. palpitations f. nervousness

A patient is taking an alpha blocker as treatment for benign prostatic hypertrophy. The nurse monitors for which potential drug effects? (select all that apply) a. orthostatic hypotension b. increased blood pressure c. increased urine flow d. headaches e. bradycardia

a. orthostatic hypotension c. increased urine flow d. headaches

The nurse discovers that the IV infusion of a patient who has been receiving an IV vasopressor has infiltrated. The nurse will expect which drug to be used to reverse the effects of the basopressor in the infiltrated area? a. phentolamine b. prazosin (minipress) c. ergotamine d. metoprolol (lopressor)

a. phentolamine

The nurse is about to administer a stat dose of atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse should monitor the patient closely for which adverse reaction? a. tachycardia b. bradychardia c. ectopic beats d. cardiac standstill

a. tachycardia

Adrenergic blockade at the alpha-adrenergic receptors leads to which of the following effects? (select all that apply) a. vasodilation b. decreased blood pressure c. increased blood pressure d. constriction of the pupil e. tachycardia

a. vasodilation b. decreased blood pressure d. constriction of the pupil

when giving anticholinergic drugs , the nurse keeps in mind that contraindications include

benign prostatic hyperplasia

for a PT receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate?

asses the IV site hourly to rule out infiltration

a PT is receiving dobutamine for shock and is complaining of feeling more skipping beats than yesterday. the nurses next action should be to...

asses the PT's vital signs and cardiac rhythm

before initiating therapy with a nonselective beta-blocker, the nurse should asses the PT for the presence of

asthma

the nurse is aware that the presence of which condition may be a problem with beta blocker drugs?

asthma

a PT took an accidental overdose of cholinergic drug while at home. he comes to the ER with abdominal cramping and bloody diarrhea. the nurse expects what drug will be used

atropine

A 28 yr old woman is preparing to take a cruise and has asked for a prescription drug to prevent motion sickness, the physicain orders scopolamine transdermal patches. The nurse should include which statemtn when teaching the patient about this drug? a. "The patch can be applied anywhere on the upper body." b. " Apply the patch 4 to 5 hours before travel." c. " Apply the patch just before boarding the ship" d. "be sure to change the patch daily."

b. " Apply the patch 4 to 5 hours before travel."

When monitoring a patient who is taking a thyroid replacement hormone, which of the following are signs of an excessively high dose of this drug? Select one: a. Bradycardia, somnolence, and ataxia b. Nervousness, irritability, and palpitations c. Dry skin, weakness, and weight gain d. Drowsiness, coughing, and neck pain

b. Nervousness, irritability, and palpitations

A patient has been given an alpha-blocker as treatment for benign prostatic hyperplasia. Which instruction is important to include when the nurse is teaching him about the effects of this medication? a. avoid foods and drinks that contain caffeine b. change positions slowly to aboid orthostatic blood pressure changes. c. watch for weight loss of 2 lbs within a week d. take extra supplements of calcium.

b. change positions slowly to aboid orthostatic blood pressure changes.

When a drug is characterized as having a negative chronotropic effect, the nurse knows what to expect a. improved sinoatrial nodal firing b. decreased heart rate c. decreased ectopic beats d. increased force of cardiac contractions

b. decreased heart rate

When assessing for adverse effects of anticholinergic drug therapy, the nurse whould expect to find that the patient complains of which drug effect? a. diaphoresis b. dry mouth c. diarrhea d. urinary frequency

b. dry mouth

When giving IV cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (select all that apply) a. peripheral tingling b. hypotension c. dry mouth d. syncope e. dyspnea f. tinnitus

b. hypotension d. syncope e. dyspnea

The undesirable effects of cholinergic drugs may from stimulation of which receptors? a. cholinergic b. nicotine c. muscarinic d. ganglionic

b. nicotine

The nurse is giving a dose of bethanechol to a post operative patient. The nurse is aware that contraindications to bethanechol include: a. bladder atony b. peptic ulcer c. urinary retention d. gastric retention

b. peptic ulcer

During a teaching seassion for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for a. rescue treatment of acute prochospasms b. prevention of bronchospasm c. reduction of airway inflammation d. long term treatment of sinus congestion

b. prevention of bronchospasm

In reviewing the medication orders for a newly admitted patient, the nurse recognizes that which is an indication for atropine sulfate? a. myasthenia gravis b. reduction of secretions preoperatively c. tachycardia due to sinoatrial node defeccts d. narrow angle glaucoma

b. reduction of secretions preoperatively

A patient has received an inadvertent overdose of a cholinergic drug. The nurse will monitor for which early signs of a cholinergic crisis? (select all that apply) a. dry mouth b. salivation c. flushing of the skin d. abdominal cramps e. constipation f. dyspnea

b. salivation c. flushing of the skin d. abdominal cramp f. dyspnea

When a patient has experienced infiltration of a peripheral infusion of dopamine, the nurse knows that injecting the alpha blocker phentolamine (regitine) will result in local a. vasoconstriction b. vasodilation c. analgesia d. hypotension

b. vasodilation

the nurse providing teaching for a PT who has a new prescription for beta1 blockers will keep in mind that these drugs may result in which effect?

bradycardia

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers should the nurse give to the patient? Select one: a. "The two drugs should be taken at least 2 hours apart." b. "The order of administration does not matter with these two drugs." c. "The bronchodilator should be taken first. d. "The corticosteroid should be taken first."

c. "The bronchodilator should be taken first.

A 13 year old girl was diagnosed with asthma 2 years ago. Today her physician wants to start her on salmeterol (serevent) administered via inhaler. The nurse needs to remember to include which statement when teaching the girl and her family about this drug? a. "It should be taken at the first sign of an asthma attack" b. "the dosage is two puffs ever 4 hours or any time needed for asthma attacks." c. "This inhaler is for prevention of asthma attacks, not for an acute attack." d. "Be sure to take your steroid inhaler first."

c. "This inhaler is for prevention of asthma attacks, not for an acute attack."

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? Select one: a. Anxiety and peripheral vasoconstriction b. Fatigue and depression c. Oral candidiasis and dry mouth d. Headache and rapid heart rate

c. Oral candidiasis and dry mouth

A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. He has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, his pneumonia has resolved, but when monitoring his blood glucose levels, the nurse notices that his blood glucose level is still elevated, and he has required small amounts of sliding-scale insulin coverage. What is the best explanation for this elevation? Select one: a. His type 2 diabetes has converted to type 1. b. His type 2 diabetes has converted to type 1. c. The corticosteroids may cause an increase in glucose levels d. The antibiotics may cause an increase in glucose levels.

c. The corticosteroids may cause an increase in glucose levels

The family of a patient who has recently been diagnosed with alzheimer's is asking about the new drug prescribed to treat this disease. The patients wife says "I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment." Which should the nurse reply with? A. "The sooner he starts the medicine, the sooner it can have this effect" b. These effects won't be seen for a few months." c. These drugs do not cure AD, Lets talk about what the physician said to expect with this drug therapy" d. "His response to this drug therapy will depend on how far along he is the disease process."

c. These drugs do not cure AD, Lets talk about what the physician said to expect with this drug therapy"

he nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? Select one: a. When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first. b. During times of illness, patients should increase their insulin dosage by 25%. c. When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first d. Patients should use the injection site that is the most accessible.

c. When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first

For a patient receiving a vasoactive drug such as IV dopamine, which action by the nurse is most appropriate? a. monitor the gravity drip infusion closely and adjust as needed b. assess the patient' cardiac function by checking the radial pulse c. assess the IV site hourly to rule out infiltration d. administer the drug by IV boluses according to the patients blood pressure

c. assess the IV site hourly to rule out infiltration

The nurse providing teaching for a patient who has a new prescription for beta blockers will keep in mind that these drugs may result in which effect? a. tachycardia b. tachypnea c. bradycardia d. bradypnea

c. bradycardia

The nurse administering the phosphodiesterase inhibitor inaminrone recognizes that this drug should have a positive inotropic effect. This effect will result in increased a. heart rate b. blood vessel dilation c. force of cardiac contraction d. conduction of electrical impulses across the heart

c. force of cardiac contraction

A 19-year-old college student has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she calls the clinic to report that she feels no better. The nurse's response is based on the fact that Select one: a. she probably did not take her medication as instructed. b. her diet may be causing absorption problems. c. full therapeutic effects may not occur for 3 to 4 weeks. d. she will probably require surgery for a cure.

c. full therapeutic effects may not occur for 3 to 4 weeks.

During patient teaching for a 70 year old man who will be taking an anticholinergic drug, the nurse will reinforce that this medication places the patient at high risk for which problem? a. angina b. fluid overload c. heatstroke d. hypothermia

c. heatstroke

As part of treatment for early heart failure, a patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse will monitor the patient's lab work for which potential effect? a. agranulocytosis b. proteinuria c. hyperkalemia d. hypoglycemia

c. hyperkalemia

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse should teach this patient to look for which therapeutic effects? a. decreased pulse rate b. abdominal cramping c. increased bowel sounds and passage of flatus d. decrease frequency and urgency of voiding patterns

c. increased bowel sounds and passage of flatus

The desired effects of a cholinergic drugs come from stimulation of which receptors? a. cholinergic b. nicotine c. muscarinic d. ganglionic

c. muscarinic

A patient has a new prescription for a beta blocker as part of treatment for hypertension. The nurse is reviewing the patient's current medications and notes that there may be a concern regarding interactions with which medication? a. thyroid hormone supplement b. antibiotic for a sinus infection c. oral hypoglycemic for type II diabetes mellitus d. oral contraceptive

c. oral hypoglycemic for type II diabetes mellitus

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for adverse effects associated with the use of xanthine derivatives, including Select one: a. drowsiness. b. diarrhea. c. palpitations. d. bradycardia.

c. palpitations.

Adrenergic drugs produce effects similar to those of the ________ nervous system. a. central b. somatic c. sympathetic d. parasympathetic

c. sympathetic

During the assessment of a patient about to receive a cholinergic blocking drug, the nurse should determine whether the patient is taking any drugs that may potentially interact with the anticholinergic including: a. opiods, such as morphine sulfate b. antibiotics such as penicillin c. tricyclic antidepressants, such as amitriptyline d. anticonvulsants, such as phenobarbital

c. tricyclic antidepressants, such as amitriptyline

When a patient mentions bethanechol when asked about his medication history, the nurse recognizes that this drug is used for the treatment of which condition? a. diarrhea c. urinary incontinence d. bladder spasms

c. urinary incontinence

When administering beta blockers, the nurse knows that which guideline for administration and monitoring is correct? a. the drug may be discontinued at any time b. postural hypotension is not a problem with this drug. c. wearing off the medication is necessary to prevent rebound hypertension d. the patient should stop taking the medication at once if he or she gains 3-4 lbs in a week.

c. wearing off the medication is necessary to prevent rebound hypertension

A patient is taking the direct acting cholinergic drug bethanechol before meals. After 3 days, he calls his health care provider's office and complains of occasional nausea and vomiting. The nurse should give which instruction? a. "Continue to take it on an empty stomach to minimized GI upset" b. "if this continues, you can skip a dose and try it again tomorrow" c. "If these symptoms continue, take the doses in the evening" d. "Take this medication with meals to reduce GI upset"

d. "Take this medication with meals to reduce GI upset"

After receiving a nebulizer treatment with a beta-agonist, a patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? Select one: a. "We will hold the treatment for 24 hours." b. "I will notify the physician about this adverse effect." c. "The next scheduled nebulizer treatment should be skipped." d. "This is an expected adverse effect. Let me take your pulse

d. "This is an expected adverse effect. Let me take your pulse

A patient is receiving dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. The nurse's next action should be to a. monitor for other signs of a therapeutic response to the drug. b. titrate the drug to a higher dose to reduce the palpiations c. discontinue the dobutamine immediately d. assess the patient's vital signs and cardiac rhythm

d. assess the patient's vital signs and cardiac rhythm

Before initiating therapy with a nonselective beta blocker, the nurse should assess the patient for the presence of a hypertension b liver disease c. pancreatitis d. asthma

d. asthma

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condistion may be a problem is these drugs are used? a. hypertension b. essential tremors c. exertional angina d. asthma

d. asthma

When giving anticholinergic drugs, the nurse keeps in mind that contraindications include: a. chronic bronchitis b. peptic ulcer disease c. irritable bowel syndrome d. benign prostatic hyperplasia

d. benign prostatic hyperplasia

While assessing the patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient? a. increased heart rate b. decreased heart rate c. decreased conduction d. increased ectopic beats

d. decreased heart rate

The nurse is administering an adrenergic drug and will monitor for which possible effect? a. urinary retention b. hypotension c. decreased respiratory rate d. increased heart rate

d. increased heart rate

When caring for a patient with a diagnosis of myasthenia gravis, the nurse can expect to see which drug ordered for the symptomatic treatment a. bethanechol (urecholine) b. tacrine (cognex) c. donepezil (aricept) d. physostigmine

d. physostigmine

A patient who has recently had an MI has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to a. cause vasodilation of the coronary arteries b. prevent hypertension c. increase conduction through the SA node d. protect the heart from circulation catecholamines

d. protect the heart from circulation catecholamines

A 58 year old man has had a myocardial infarction, has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor), and he becomes upset. "I don't have high blood pressure--why did my doctor give me this medicine?" The nurse explains to him that a. this medication prevents emboli taht may lead to another MI b. beta-blockers will improve blood flow to the kidneys c. it is begin prescribed to prevent the hypertension that often occurs post MI d. studies have shown that this medication has greatly increased survival rates in patients after an MI

d. studies have shown that this medication has greatly increased survival rates in patients after an MI.

when a drug is characterized as having a negative chronotropic effect the nurse knows to expect

decreased heart rate

the nurse administering a cholinergic blocking drug to a PT who is experiencing drug induced extrapyramidal effects would asses for which therapeutic effect?

decreased muscle rigidity and tremors

Inotropic

drug that influence the force or energy of muscular contractions, particularly contraction of the heart muscle

Dromotropic

drugs that influence the conduction of electrical impulses within tissues

Chronotropic

drugs that influence the rate of the heartbeat

when asses for adverse effects of anticholinergic drugs, the nurse is most likely to see...

dry mouth

Adverse effects of anticholinergic drugs

dry mouth, photophobia, tachy, blurred vision, Increased heart rate, dysrhthmias, CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium, dilated pupils, decreased visual accommodation, increased intraocular pressure, decreased salivation, gastric secretions, and motility, urinary retention, decreased sweating, decreased bronchial secretions

A drug that is an MAO inhibitor

increase the effects of catecholamines by inhibiting their breakdown

the nurse is caring for a PT who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause...

increased cardiac contractility

the nurse is giving a dose of bethanechol to a post operative PT. the nurse is aware that contraindication to bethanechol include

peptic ulcer

a PT is taking a beta blocker for heart failure, the nurse knows that the purpose of the beta blocker is to

prevent stimulation of the heart by catecholamines

during a teaching session for a PT who is receiving inhaled salmeterol, the nurse emphasized that the drug is indicated for

prevention of bronchospasm

a PT who has recently had an MI has started therapy with a beta-blocker. The nurse explains that the main purpose of the beta-blocker for this PT is to

protect the heart from circulating catecholamines

a PT is taking the direct acting cholinergic drug bethanechol before meals. after 3 days, he calls his health care provider and complains of occasional nausea and vomiting the nurse should give which instruction?

take this med with meals to reduce GI upset

Alpha blocker used primarily to treat BPH and exclusively for male patients, Block alpha adrenergic receptors on smooth muscle within the prostate and bladder. Results in relaxation of smooth muscle fibers, and improved urinary flow. Contraindications are known drug allergies, and concurrent use of erectile dysfunction drugs. Adverse effects include headache, abnormal ejaculation, rhinitis, Available for oral use. Interacts with other alpha blockers, calcium channel blockers, and ED meds

tamsulosin

a PT with myathenia gravis has received a prescription for pyridostigmine. the nurse should include which teaching point?

the drug should be taken 30 before eating meals

which drug may potentially interact with anticholinergic drugs?

tricyclic antidepressants (amitriptyline)