PH - Ch. 29-33 PrepU Questions
A nurse is giving medication instruction to a client who is taking metoprolol (Lopressor). Which statement by the client would indicate that teaching has been effective?
""I should never stop taking this drug abruptly."
Muscarinic receptors would be found most likely at which location?
Sweat glands
The adrenergic branch of the autonomic nervous system is also known by which name?
Sympathetic nervous system
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
The anatomy and physiology instructor is discussing adrenergic receptors with the nursing class. What adrenergic receptor would the instructor tell the students is found in the blood vessels, iris, and urinary bladder?
Alpha1
The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition?
Alzheimer's disease
The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which?
Alzheimer's.
Which is consistent with the parasympathetic nervous system? (Select all that apply.)
It allows the autonomic system to maintain a fine control over internal homeostasis; It is sometimes called the craniosacral system.
A client with myasthenia gravis is administered neostigmine (Prostigmin). How does this cholinergic drug produce its effect?
It stimulates the parasympathetic nervous system.
A female client is scheduled for an exploratory laparoscopy. She has been prescribed an anticholinergic agent. Why is it important to administer the anticholinergic agent in the preoperative phase?
It will decrease respiratory secretions.
Jack Thomas is a 45-year-old automobile mechanic with a history of throat cancer. Jack has just undergone radical neck resection. As a result of the surgery, Jack suffers from xerostomia, a dry mouth condition. He is prescribed pilocarpine therapy. What advice should you give Jack regarding the drug therapy?
Jack should be cautioned about blurred vision and its hazards.
A client presents to the emergency department reporting rapid heart rate, severe headache, and pounding in the chest. While obtaining the clients history, the nurse learns the client stopped taking medications because the prescriptions ran out and had no funds to refill them. The nurse knows that which medications being abruptly stopped could be causing these symptoms?
Labetalol
A client is experiencing sympathetic stimulation in response to a stressful event. Which substance will most affect the client's sodium and water retention?
Aldosterone
The client has been ordered a nonselective beta-blocking agent called propranolol, PO. Propranolol is used in the treatment of which disorders
All the above
What represents the two types of receptors that are found in the adrenergic nervous system? Select all that apply.
Alpha receptors; Beta receptors
A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors
Increase in the level of acetylcholine in CNS
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
How do direct-acting cholinergic drugs affect the bladder? (Select all that apply.)
Increased tone and contractility, Relaxation of the sphincter, Ability to better empty the bladderWhile preparing a client for an eye examination, the nurse explains that the eye drops, an ophthalmic anticholinergic preparation, will cause the pupil to: dilate.
The client is receiving bethanical for bladder atony. What assessment findings indicate the effect of this medication?
Increased urinary output
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
Increased vasoconstrictive effects
The adrenergic receptors are categorized as alpha or beta. Which action results from stimulation of alpha2 receptors?
Inhibited release of norepinephrine
A 70-year-old client is taking a cholinergic blocking drug. The family has noticed the client is a confused, excited, and not voiding normally. What would be the appropriate action by the nurse in this situation?
Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider.
Which medication is an alpha-adrenergic blocker?
Phentolamine (Regitine)
A client has received a dose of dopamine intravenously. The client's IV was infiltrated, and the dopamine was injected into the subcutaneous tissues. Which medication will prevent the vasoconstriction and tissue necrosis based on this action?
Phentolamine mesylate (Regitine)
Which agent would the nurse expect to find when reviewing over-the-counter allergy products?
Phenylephrine
A nurse administering a cholinergic-blocking medication to a client should monitor the client for which visual adverse reactions? (Select all that apply.)
Photophobia, Mydriasis, Cycloplegia
A graduate of a nursing program is scheduled to take the NCLEX today. The test-taker's heart is racing and pupils are dilated. What can the test-taker attribute to this reaction?
Sympathetic nervous system
Phentolamine is the agent used to treat extravasation of dobutamine.
True
Norepinephrine is made by nerve cells using which substance?
Tyrosine
Epinephrine causes relaxation of:
bronchioles.
The client with a history of asthma is ordered propranolol to treat his hypertension. The nurse questions the order because propranolol may cause:
bronchospasm.
A client is experiencing a stress response. Which would the nurse expect to assess?
Diminished bowel sounds
Anticholinergics do not block the effects of acetylcholine in the central nervous system.
False
Atropine is derived from the belladonna plant.
True
Nerve fibers secreting norepinephrine are called:
adrenergic fibers.
A client has been placed on the drug bethanical. The client asks a nurse to explain how the drug bethanechol works. What would be a correct response?
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."
The nurse is educating a client who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the client?
"Do not drive or operate machinery."
Which patient statement indicates the need for additional teaching about propranolol?
"I can stop the drug once my blood pressure is controlled."
Which patient statement indicates the need for additional teaching about propranolol?`
"I can stop the drug once my blood pressure is controlled."
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching?
"I need to exercise frequently outside in the warm weather."
A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication?
"I should expect the medication to decrease pressure in my eye."
A client has been administered atropine for sinus bradycardia. Which symptom is noted with large doses of atropine?
Flushing
A nurse is giving medication instruction to a client who is taking metoprolol (Lopressor). Which statement by the client would indicate that teaching has been effective?
"I should never stop taking this drug abruptly."
The physician has ordered scopolamine transdermally for motion sickness. Which statement by the client indicates an understanding of the medication's administration guideline?
"I will change the patch every 3 days."
The physician has ordered scopolamine transdermally for motion sickness. Which statement by the patient indicates an understanding of the medication's administration guideline?
"I will change the patch every 3 days."
A client is using a transdermal application of scopolamine. Which instruction would the nurse include when teaching the client how to use this drug?
"Make sure the area you are using is clean, dry, and free from cuts."
A patient is to receive metoprolol. What would the nurse include in the teaching plan for this patient?
"Take this drug with food to help promote its absorption."
The nurse is teaching a patient about safe use of adrenergic drugs. Which statement should be included in the teaching?
"Talk to your doctor before taking any other medications."
A nurse has administered a drug that will have a therapeutic effect on the client's parasympathetic nervous system. The nurse understands the drug will primarily affect what neurotransmitter?
Acetylcholine
What does the body create using choline?
Acetylcholine
What is the substance responsible for transmission of nerve impulses across the parasympathetic nervous system?
Acetylcholine
What neurotransmitter does the cholinergic system use?
Acetylcholine
Which neurotransmitter is involved in pre- and postganglionic activity in the parasympathetic nervous system?
Acetylcholine
Nicotinic receptors would be found in which location?
Adrenal medulla
Which condition is treated with an adrenergic agonist?
Anaphylaxis
A patient who is being treated for Alzheimer's disease is receiving donepezil (Aricept), a cholinergic agent, and his pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia?
Atropine
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
Atropine
Which would be most important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction?
Atropine
Nicotinic receptors are found in which area?
Autonomic basal ganglia
A patient is admitted to the emergency room after a car accident. Based on the experience of the emergency room nurse, what system will affect a response to the emergency?
Autonomic nervous system
A client is experiencing urinary retention. The client has been prescribed terazosin (Hytrin). What condition contributes to the urinary retention
Benign prostatic hypertrophy
A client in distress has been given dobutamine, a medication intended to increase myocardial activity and heart rate. This medication likely stimulates what adrenergic receptor?
Beta-1
A client with asthma is prescribed albuterol to dilate the bronchioles. The nurse understands that this drug is likely acting on which receptors
Beta-2
A client with asthma is prescribed albuterol to dilate the bronchioles. The nurse understands that this drug is likely acting on which receptors?
Beta-2
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 caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client?
Cholinergic blocking
Which would the nurse identify as a naturally occurring catecholamine?
Dopamine
Which would be included when describing the parasympathetic nervous system structure and function?
Ganglia are located close to or within the effector tissue. Muscarinic and nicotinic receptors are found in the parasympathetic nervous system.
The nurse is preparing a teaching plan for a client who is taking rivastigmine. What precaution should the nurse teach the client and family to minimize the risk of adverse GI effects?
Having small, frequent meals
Adrenergic nerves use tyrosine from the diet to make which neurotransmitters?
Norepinephrine
The nurse is assessing a client. What assessment finding is the clearest indicator of autonomic function?
The client's respiratory rate is 22 breaths per minute
A 78-year-old man is admitted to the emergency department (ED) with bradycardia resulting from overdose of donepezil. The nurse knows that the ED physician is likely to order which medication?
atropine.
Myasthenia gravis is a(n):
autoimmune disorder.
The nursing student correctly identifies the transmitter in the cholinergic neuropathways that appears insufficient in clients with Alzheimer's disease is which?
acetylcholine.
The functions of the autonomic nervous system (ANS) can be broadly described as:
activities designed to maintain a constant internal environment, to respond to stress or emergencies, and to repair body tissues.
A client has recently been prescribed a drug that treats hypertension by blocking the sympathetic receptors in the sympathetic nervous system. This action is characteristic of which?
an adrenergic antagonist.
Norepinephrine is mainly:
an excitatory neurotransmitter that stimulates the brain to generalized increased activity.
A nurse observing a client receiving treatment with edrophonium (Tensilon) for myasthenia gravis notices the client clenching the jaw, salivating excessively, experiencing and muscle weakness, rigidity, and spasm. These are all symptoms of:
cholinergic crisis.
A patient is receiving a beta-1 selective blocker after a myocardial infarction to prevent reinfarction. The nurse understands that the rationale for using the drug would be to:
decrease cardiac workload.
Anticholinergic drugs are used in ophthalmology to
dilate the pupils.
A nurse is caring for a client in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the client's chart for indications of:
history of acute myocardial infarction.
A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:
increase blood pressure.
A patient experiences diarrhea after receiving a nonselective adrenergic blocking agent. The nurse understands that this effect is most likely due to:`
increased parasympathetic dominance.
Which observation might indicate that timolol is achieving the desired effect in a client?
intraocular pressure decreases
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as:
sympathomimetics.
A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?
take the medication with food.
When should a patient receiving propantheline (Pro-Banthine) as an adjunctive therapy for peptic ulcers be advised to take the medication?
30 minutes before meals
The nurse is preparing medications for administration on the unit. In which client is metoprolol mostly likely contraindicated?
A 35-year-old post-MI female with a heart rate of 42 bpm
Which client is most likely to benefit from the administration of an adrenergic agonist?
A man who is in cardiogenic shock following a myocardial infarction
A nurse is monitoring a patient with Alzheimer's disease for initiation of therapy. In which patient is the administration of donepezil contraindicated?
A patient with asthma
Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which statement accurately describes a difference between the populations related to the use of anticholinergics?
Adverse effects tend to be more severe in children.
A 75-year-old male client is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which drug would the nurse expect the physician to order to relieve these symptoms?
Anticholinergics
A 4-year-old girl is brought to the emergency department by her mother. The mother reports the child has been vomiting, The nurse notes the child's face is flushed and is diaphoretic. The mother thinks the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which drug would be administered?
Atropine
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?
Beta-adrenergic blocking drugs
A client is experiencing urinary retention after surgery. The nurse would anticipate administering:
Bethanechol
A client has been admitted to the cardiac unit for heart failure and has been ordered carvedilol (Coreg). The client's blood pressure is 80/50. What should the nurse do?`
Call the provider and advise them of the client's blood pressure prior to administering the medication.
Administration of which classes of medications can decrease secretions of the upper respiratory tract?
Cholinergic blocking drug
A nurse is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client?
Cholinergic crisis
The nurse is caring for a client who is taking neostigmine and presents to the emergency department with symptoms of respiratory depression. The nurse is aware that this client has developed which severe complication related to the use of neostigmine?
Cholinergic crisis
A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, the patient develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms?
Cholinergic overdose
A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?
Decrease the heart rate
The nursing instructor is explaining the role of the parasympathetic nervous system in influencing body functions. Which change in a patient's body functions would be directly related to the stimulation of the parasympathetic nervous system?
Decreased heart rate
The nurse is assessing a patient with glaucoma. What therapeutic effect will the health care provider expect from the cholinergic agonist administered?
Decreased intraocular pressure
What would a nurse expect to assess in a patient who is receiving a nonselective adrenergic agent?
Decreased renin levels
The nursing instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?
Degeneration of cholinergic pathways
A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The physician orders bethanechol. The nurse is aware that bethanechol is included in which drug classification
Direct-acting cholinergic drug
A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the physician to take?
Discontinue the cholinergic medication secondary to the diagnosis of bradycardia.
A patient is diagnosed with Alzheimer's disease. Which medications are administered for the treatment of Alzheimer's disease?
Donepezil (Aricept)
Which herbs has been removed from most weight-loss medications due to potential legal liability?
Ephedra
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
A client is using a scopolamine patch for treatment of motion sickness. The nurse would instruct the client to change the patch at which frequency?
Every 3 days
A client who is prescribed a scopolamine patch, the nurse determines that the teaching was successful when the client states that she will change the patch in which time frame?
Every 3 days
A cholinergic crisis is characterized by:
Excessive stimulation of the parasympathetic nervous system.
A 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the physician's office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. What does the nurse expect the physician to do for this client?
Explain to the client that the medication is contraindicated because of her medical history
A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessment findings?`
Heart rate and blood pressure
After teaching a group of students about anticholinergic agents, the instructor determines the need for additional teaching when the students identify what condition as a contraindication for use?
Hypertension
A patient is receiving doxazosin. The nurse would assess the patient for development of which conditions? (Select all that apply.)
Hypotension; Edema; Weakness
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?
Improved cardiac contractility
A client with symptomatic bradycardia has been receiving atropine for the past 4 days and the client reports constipation. What is the most important suggestion the nurse could give the client?
Increase bulk in the diet.
The nurse would contact the physician before administering an adrenergic drug to a client who is also taking which drug?
MAO inhibitor
A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem?
Myasthenia gravis
A client with advanced-stage Alzheimer's disease is seen by a physician who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as:
Namenda.
The nurse identifies which drug as commonly ordered to stop Alzheimer's disease?
None of the above
The anatomy and physiology instructor is discussing the role of neurotransmitters in the autonomic nervous system. Which would the instructor identify as the main adrenergic neurotransmitter?
Norepinephrine
An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused and is taken to the sick-bay of the ship. The nurse knows that which is a likely reason for these symptoms?
Older clients have a greater chance of adverse reactions to cholinergic blocking drugs.
A client is prescribed propantheline. The nurse would administer this drug by which route?
Oral
A patient is prescribed dicyclomine. The nurse would expect to administer this drug by which route?
Oral
A client is prescribed glycopyrrolate. The nurse understands that this drug may be administered by which route? (Select all that apply.)
Oral, Intramuscular, Subcutaneous, Intravenous
A patient with dementia of Alzheimer's disease is prescribed rivastigmine by the primary health care provider. Which is the correct method of administering rivastigmine to the patient?
Orally
A patient has received the evening meal and is recovering from surgery. What nervous system is stimulated?
Parasympathetic nervous system
The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs
Parasympathetic nervous system
A male client is prescribed an anticholinergic drug by his physician. He likes to hike with his grandchildren. The home care nurse instructs the client that anticholinergic medications have which effect?
Prevents sweating and heat loss and increasing the risk of heat stroke
The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving:
Propranolol
A nurse administers a decongestant that stimulates alpha-1 receptors. What would most likely occur?
Pupil dilation
The cholinergic blocking drug glycopyrrolate (Robinul) is used in conjunction with anesthesia for which reason?
Reduction of oral secretions
Most of the free norepinephrine molecules are taken up by the nerve terminal that releases them in which process?
Reuptake
Which agent would a nurse expect to administer transdermally?
Scopolamine
Which would a nurse identify as a contraindication for the use of a beta-1 selective blocker?
Sinus bradycardia
The main nerve centers for the autonomic nervous system (ANS) are located in which locations? (Select all that apply.)
Spinal cord, Medulla, Hypothalamus
The nurse is reviewing the medical record of a client who is taking an alpha- and beta adrenergic agonist. What would be of least concern to the nurse?
St. John's wort
A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider?
Systolic blood pressure below 100 mm Hg
After teaching a group of students about adrenergic blockers that may be used to treat benign prostatic hypertrophy, the instructor determines that the teaching has been successful when the students identify:
Tamsulosin.
A famous magician is known for his outlandish feats, such as being underwater for 10 minutes while removing handcuffs. Some have postulated that he has control over his autonomic nervous system in ways that most people do not. What would be an example of an autonomic response he may have control over?
The rate of his heart beat
After teaching a group of students about the differences between the sympathetic nervous system and the parasympathetic nervous system, the instructor determines that the students have understood the information when they state:
The sympathetic nervous system preganglionic fibers are short, while those in the parasympathetic nervous system are long.
A patient with benign prostatic hypertrophy (BPH) has been prescribed tamsulosin. How do alpha1-adrenergic blocking agents, such as tamsulosin, assist in treating the symptoms of BPH?
They inhibit contraction of the urinary bladder.
The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?
This is cholinergic crisis, and the physician needs to be notified immediately.
A female client has been taking Aricept for several months. The family feels that she is better and wants to stop the medication. What would be an important teaching point?
This medication is a treatment, not a cure. If you stop it, she will lose any benefits that she has gained.
In the sympathetic nervous system, which is the origin of central nervous system nerves?
Thoracic spinal cord
A provider orders timolol (Timoptic) for glaucoma. The order reads Timoptic 1 gtt PO bid. The nurse knows that something is wrong with this order. What is it?
Timoptic is given in the eye, not PO.
A 35-year-old female has been diagnosed with hyperthyroidism. Her doctor has prescribed propranolol to achieve which effect?
To decrease heart rate
The nurse is preparing a client for pacemaker surgery. The physician orders atropine to be given 30 minutes before the client is taken to the operating room. The nurse knows this medication is ordered for what reason?
To dry up respiratory secretions to prevent aspiration during surgery
Atropine is the most widely used anticholinergic agent.
True
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True
Sympathetic stimulation of the heart causes:
an increased rate and force of myocardial contraction.
A 75-year-old male with no history of hypertension has been prescribed nadolol. The nurse knows that the client is likely taking the drug to treat
angina.
Prior to the administration of a sympatholytic drug, the nurse should check a client's blood pressure and:`
apical pulse.
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?
assess heart rate.
The nurse frequently sees mature male clients with BPH seeking treatment for symptoms. After ensuring they do not test positive for prostate cancer, pharmacological intervention is one of a few treatment modalities available. Pharmacokinetics indicate alpha1-blocking agents as a treatment choice due to their:
prevention of smooth muscle contraction in nonvascular tissues.
Cholinergic drugs are contraindicated in all situations except in clients with:
urinary retention or postoperative abdominal distention due to paralytic ileus.
A client is taking rivastigmine for Alzheimer's disease. The nurse will evaluate the client regularly for:
weight loss.
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?
β2 receptors
