Pharm Ch. 29
Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels?
α1 receptors
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?
β1 receptors
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?
β2 receptors
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
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective?
Bronchodilation
The nurse is teaching a client about safe use of adrenergic drugs. Which statement should be included in the teaching?
"Talk to your health care provider before taking any other medications."
A client is receiving phenylephrine via intramuscular injection. The nurse would expect the drug to begin acting in approximately which amount of time?
10 to 15 minutes
What is the nurse's rationale for administering clonidine to treat hypertension? A) Clonidine stimulates alpha2-receptors. B) Clonidine stimulates alpha1-receptors. C) Clonidine stimulates beta2-receptors. D) Clonidine stimulates beta1-receptors.
A
A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The patient weighs 12.5 kg. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV? A) 0.0625 mg B) 0.075 mg C) 0.08 mg D) 0.085 mg
A
A patient is admitted to the emergency department in shock. Isoproterenol (Isuprel) is administered. What would the nurse expect the effect of the isoproterenol to be? A) Increased blood pressure B) Decreased blood pressure C) Increased body temperature D) Decreased heart rate
A
How does ephedrine act on the body? A) Stimulates the release of norepinephrine B) Acts indirectly on beta-adrenergic receptor sites C) Stimulates the release of dopamine D) Acts indirectly on alpha-adrenergic receptor sites
A
The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is receiving an infusion of dobutamine (Dobutrex) to treat congestive heart failure. What is the priority nursing assessment? A) Capillary refill time and vital signs B) Effectiveness of comfort measures C) Dietary intake and hydration D) Compliance with treatment plan
A
The nurse is admitting a mental health patient and collects the medication history. The patient says he takes Haldol, midodrine, hydrochlorothiazide, acetaminophen, and Cymbalta. The nurse will call the provider to discuss what dangerous drug combination? A) Haldol and midodrine B) Hydrochlorothiazide and midodrine C) Cymbalta and midodrine D) Acetaminophen and midodrine
A
The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided? A) A 47-year-old woman with hypertension B) A 52-year-old man with adult onset diabetes C) A 17-year-old girl with symptoms of an upper respiratory infection D) A 62-year-old man with gout
A
The nurse needs to be aware, before administering, that what drug has a duration of action of only 1 to 2 minutes? A) Isoproterenol B) Dopamine C) Phenylephrine D) Ephedrine
A
The nursing instructor is quizzing a student who is preparing to administer an alpha-specific adrenergic agonist to a patient. The instructor asks the student what the student will assess in this patient after administering the drug. What is the student's best response? A) Blood pressure B) Respirations C) Mental status D) Vision
A
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
When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.) A) Dobutamine (Dobutrex) B) Epinephrine (Adrenalin, Sus-Phrine) C) Dopamine (Intropin) D) Clonidine (Catapres) E) Albuterol (Proventil)
A,B,C
Which receptor does phenylephrine stimulate?
Alpha1
A 4-year-old girl is prescribed an albuterol (Proventil) inhaler for her asthma. What is the recommended safe dosage for this patient? A) 1.25 to 2.5 mg q.i.d B) 1.25 to 2.5 mg b.i.d C) 2 mg q.i.d D) 0.5 to 1 mg b.i.d
B
A patient comes to the clinic complaining of seasonal rhinitis. What adrenergic agonist would be prescribed for treatment of seasonal rhinitis? A) Dobutamine (Dobutrex) B) Ephedrine (generic) C) Dopamine (Intropin) D) Norepinephrine (Levophed)
B
An 80-year-old patient has been brought to the emergency department in shock. The patient is receiving dopamine (Intropin). What potentially serious adverse effect will the nurse monitor for? A) Blood dyscrasia B) Cardiac arrhythmia C) Hepatic toxicity D) Renal insufficiency
B
The nurse is planning discharge teaching for a patient who is taking clonidine (Catapres). What would be most important for the nurse to include when teaching about adverse effects? A) Pupil constriction B) Strange dreams C) Increased urine output D) Increased appetite
B
The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include? A) Monitoring the patient for diarrhea B) Monitoring blood pressure and heart rate every 2 to 4 hours C) Assessing skin turgor for dehydration D) Assessing for fatigue and lethargy
B
The nurse receives an order to begin a dopamine (Intropin) infusion at 5 mcg/kg/min. The patient weighs 50 kg. Each milliliter of solution contains 3 mg of dopamine. How many mL/h will the nurse set the pump to deliver? A) 3 mL/h B) 5 mL/h C) 3,000 mL/h D) 83.3 mL/h
B
The patient is taking midodrine (ProAmatine). What is the most important nursing action to include in the plan of care for this patient? A) Monitor urine output. B) Monitor blood pressure. C) Monitor heart rate. D) Monitor respirations.
B
When assessing a patient who has been prescribed midodrine, what would the nurse assess for? A) Pancreatic disease B) Renal failure C) Open-angle glaucoma D) Hypothyroidism
B
The clinic nurse is teaching a patient about transdermal clonidine (Catapres). What information would be included in the nurse's teaching plan? (Select all that apply.) A) Change the patch in the morning. B) Rotate the site where the patch is placed. C) Monitor blood pressure daily. D) Stop the drug immediately if adverse effects occur. E) Keep the physician informed of any new diagnoses or medications.
B,C,E
A client is being treated for asthma. What would the nurse expect to administer?
Beta-2-specific adrenergic agonist
What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?
Beta-adrenergic blockers
The nurse is administering an adrenergic agonist to a client. The nurse realizes that this medication will cause stimulation of the sympathetic nervous system. Which effects will it produce? Select all that apply.
Bronchodilation Decreased bladder tone
A nurse receives an order for clonidine (Catapres) for a 25-year-old pregnant woman. What is the nurse's priority action? A) Weigh the patient to obtain correct dose/kg/day. B) Have a second nurse check the dose before administering the drug. C) Consult with the physician about the order. D) Make sure the patient is wearing a fetal monitor.
C
Isoproterenol is reserved for use in emergency situations. What is the rationale for this? A) Its onset of action B) Its duration of action C) Its adverse effects D) Its peak plasma concentration
C
The nurse calculates the infusion rate for administering dopamine to a premature infant in the neonatal intensive care unit who is in cardiogenic shock secondary to a cardiac anomaly. What is the nurse's next priority action? A) Insert an intravenous catheter B) Obtain permission from parents C) Ask another nurse to perform independent calculation D) Show the nurse's calculations to the physician
C
When giving beta-specific adrenergic agonists, at what age is an adult dose given? A) 10 years B) 11 years C) 12 years D) 13 years
C
A patient has been administered dobutamine HCL. Which adverse reactions should the nurse monitor for in the patient?
Cardiac arrhythmias
A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize?
Cardiac monitoring
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
Which agent would the nurse identify as being available in a transdermal form?
Clonidine
A nurse is caring for a 25-year-old client who is being given an adrenergic drug for shock. Which action should the nurse do?
Continually assess the client for physiological changes and notify the primary care provider with changes.
A nurse suspects that a client is experiencing shock based on which assessments? Select all that apply.
Cyanosis Disorientation Tachypnea
A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence? A) Phenylephrine B) Propranolol C) Phenylalanine D) Phentolamine
D
Which would the nurse identify as a naturally occurring catecholamine?
Dopamine
Which herbs has been removed from most weight-loss medications due to potential legal liability?
Ephedra
A patient suffers from bronchial asthma. Which medication is a mixed-acting adrenergic drug?
Ephedrine
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
Which would the nurse expect to be given to a client experiencing acute bronchospasm?
Epinephrine
A patient with diabetes who receives an alpha-specific adrenergic agonist is at risk for hypoglycemia. (T/F)
FALSE
Alpha- and beta-specific adrenergic agonists are primarily used to treat obstructive pulmonary conditions. (T/F)
FALSE
An increased dosage of digoxin would be needed if the patient is also taking midodrine. (T/F)
FALSE
The nurse is reviewing the history of a patient who is to receive midodrine. Which would alert the nurse to a contraindication for the drug?
Glaucoma
A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan?
Hypertension may be a side effect of the medication.
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?
Improved cardiac contractility
Which is an effect of epinephrine?
Increased heart rate
Which is expected after the administration of an adrenergic medication such as epinephrine? (Select all that apply.)
Increased heart rate Vasoconstriction
A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?
Inhalation
After reviewing the routes of administration for beta-specific adrenergic agonists, a group of students demonstrate the need for additional study when they identify isoproterenol as being administered by which route?
Oral
The nurse is assessing a patient who is receiving clonidine. Which might the nurse assess?
Photophobia
Which adverse effect might a client receiving clonidine exhibit? (Select all that apply.)
Photophobia Personality changes Difficulty urinating
The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity?
Stimulates electrical and mechanical activity
The adrenergic branch of the autonomic nervous system is also known by which name?
Sympathetic nervous system
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True
Phentolamine is the agent used to treat extravasation of dobutamine. T/F
True
Prior to beginning therapy with an adrenergic agent, the nurse would expect to obtain what assessments? (Select all that apply.)
Vital signs Urinalysis Blood glucose
A client has an IV of dopamine administered in the right arm. The IV becomes dislodged from the vein and dopamine has been being given in the surrounding tissue instead of the vein. The nurse should stop the IV and:
administer phentolamine (an alpha adrenergic blocking drug) to the site to minimize necrosis.
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?
assess heart rate.
Which medication will most likely be administered to a client experiencing anaphylaxis?
epinephrine
A nurse would instruct a patient to apply a clonidine patch at which frequency?
every 7 days
An adrenergic drug would be prescribed to produce what physiological effect?
increased heart rate
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
increased vasoconstrictive effects
A client is taking an OTC allergy product. The nurse would expect to find that this product most likely contains:
phenylephrine
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?
Beta-adrenergic blocking drugs
The pharmacology instructor is discussing adrenergic agonists with the nursing class. Which drugs would the instructor tell the nursing students are generally indicated for the treatment of shock, bronchospasm, and some types of asthma? A) Sympathomimetic drugs B) Beta-blocking drugs C) Parasympathetic stimulating drugs D) Anticatecholamine drugs
A
The student nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically? A) Rests the tip of the dropper against the lower eyelid B) Grasps the lower eyelid and pulls it away to form a pocket C) Applies gentle pressure to the inside corner of the eye for 3 to 5 minutes D) Instructs the patient to close his or her eyes and look downward
A
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 nurse is caring for a male patient who is taking a monoamine oxidase inhibitor (MAOI). The patient complains of seasonal rhinitis and the intern for his service orders phenylephrine nasal spray. What is the nurse's priority action? A) Verify patency of the nares. B) Review the patient's medication history. C) Question the order with the prescriber. D) Position the patient to give the drug as ordered.
C
The nurse is serving a breakfast tray to the patient receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the patient's diet when finding what on the tray? A) Eggs B) Bacon C) Coffee D) Milk
C
The patient has been taking clonidine and is now being changed to another antihypertensive drug. How will the nurse instruct the patient regarding discontinuing the clonidine? A) "Check your blood pressure and pulse every 2 to 4 hours." B) "Inform your family the drug is being changed." C) "Reduce clonidine gradually over 2 to 4 days." D) "Keep an over-the-counter analgesic available to treat headaches."
C
What action do sympathomimetic drugs have in the body? A) Decreased heart rate B) Decreased blood pressure C) Increased respirations D) Increased intraocular pressure
C
What drug would the nurse expect to administer if beta-specific adrenergic agonist effects are desired to prevent bronchospasm during anesthesia? A) Dobutamine (Dobutrex) B) Ephedrine (generic) C) Isoproterenol (Isuprel) D) Phenylephrine (Neo-Synephrine)
C
In what age group are adrenergic agonists contraindicated? A) Older adults B) Adolescents C) Children D) No age group
D
The nurse is preparing to give isoproterenol parenterally. Before starting to administer the drug, what does the nurse ensure is on hand in case a severe reaction occurs? A) An alpha-adrenergic blocker B) An alpha-adrenergic stimulant C) A beta-adrenergic stimulant D) A beta-adrenergic blocker
D
The nursing students are studying sympathomimetic drugs. How do these drugs act on the body? A) Stimulate beta receptors and block alpha-receptors B) Stimulate alpha-receptors and block beta-receptors C) Block adrenergic receptors D) Stimulate both alpha and beta-receptors
D
Adrenergic medications such as epinephrine and dopamine are commonly used for in the treatment of clients in which places? Select all that apply.)
Dentist's office Intensive care unit Emergency department
The nurse is administering epinephrine IV push. The nurse checks for patency of the IV prior to administration of the drug. The nurse realizes that if the IV is infiltrated, the medication will result in tissue extravasation. What is the reason for such an occurrence?
The medication causes vasoconstriction, limiting the blood flow to the area.
The nurse is admitting a client with injuries following a bicycle crash. When reviewing the client's pre-admission medication regimen, the nurse reads that the client takes formoterol twice daily. When planning this client's care, the nurse should include:
frequent respiratory assessments.
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.
What is the expected outcome when phenylephrine is administered? Select all that apply.
increased systolic blood pressure increased diastolic blood pressure decreased renal perfusion
The intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with:
phentolamine
When transcribing new orders for sympathomimetic medications prescribed for a geriatric patient, the nurse expects the dosage will be what? A) The average adult dosage B) Slightly higher than adult dosages C) The lowest possible effective dosage D) Approximately half the normal adult dosage
C
