Pharmacology Autonomic Nervous System
A client is administered atropine to increase the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal stimulation.
The nurse is teaching a client about atropine that will be administered preoperatively. How should the nurse explain the purpose of the medication?
It prevents complications such as bradycardia and hypotension.
A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?
It stimulates the parasympathetic nervous system.
A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather?
Keep well hydrated
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 prescribed dicyclomine. The nurse would expect to administer this drug by which route?
Oral
A patient is experiencing a heart rate of 42 beats per minute. Which system contributes to bradycardia?
Parasympathetic nervous system
The nursing instructor is discussing cholinergic drugs with his clinical group. What system would the instructor tell the students is stimulated by cholinergic drugs?
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 client with Alzheimer's disease is being treated with the medication Exelon. The nurse knows that this drug is also used to treat which disorder?
Parkinson's disease
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)
The nurse is assessing a patient who is receiving clonidine. Which might the nurse note?
Photophobia
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 client is prescribed glycopyrrolate preoperatively. The nurse integrates understanding of the drug's action, explaining that this drug will help achieve which effect?
Reduction of oral secretions
Most of the free norepinephrine molecules are taken up by the nerve terminal that releases them in which process?
Reuptake
A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client?
Risk for Injury related to dizziness and fatigue
A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment?
Rivastigmine
A client is taking an OTC allergy product. The nurse would expect to find that this product most likely contains:
phenylephrine.
First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect?
Administer the dose at bedtime
Nicotinic receptors would be found in which location?
Adrenal medulla
What would a nurse expect to assess in a patient who is receiving a nonselective adrenergic agent?
Decreased renin levels
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 health care provider to take?
Discontinue the cholinergic medication secondary to the diagnosis of bradycardia.
A nursing mother is being prepared for an eye condition which requires a prescription for atropine. What nursing intervention should the nurse implement to assure safe and effective atropine therapy?
Discuss an alternative feeding method until the atropine is no longer prescribed
The nurse is assessing a client who received epinephrine, an adrenergic drug, for the treatment of cardiac arrest. The nurse would expect to observe what effect of the drug?
Increased heart rate
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
Atropine
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.
CNS drugs can either stimulate or depress the central nervous system. What helps to prevent overstimulation of effector sites?
Norepinephrine
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
Increased vasoconstrictive effects
What does the body create using choline?
Acetylcholine
What is the resulting physiologic effect when the parasympathetic nervous system is stimulated?
Increased GI motility
Epinephrine causes relaxation of:
bronchioles.
A patient is receiving sotalol. Which instruction would be most important for the nurse to provide to the patient to ensure maximum effectiveness of the drug?
"Be sure to take the drug on an empty stomach."
A client who has been prescribed bethanechol asks a nurse to explain how the drug 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."
A client admitted to a cardiac unit asks why a rest period is required each afternoon. The nurse's response should be based on what information regarding the PNS?
"Clients are encouraged to rest and relax during this time, free of families and visitors."
Which patient statement indicates to the nurse that the patient is experiencing an adverse effect of hyoscyamine?
"I feel like my heart is going to jump out of my chest."
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."
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 nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration?
30 to 90 minutes
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
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
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
The client is taking digitalis and has not been monitoring pulse rate. The client presents to the emergency department via ambulance experiencing digitalis toxicity and symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia?
Atropine
The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?
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
An adult client with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this client's health problem is ultimately attributable to what pathophysiologic process?
Autoimmune destruction of acetylcholine receptors
Which would the nurse include in a teaching plan for a client who is prescribed an anticholinergic agent?
Avoiding activities that require alertness
A client is experiencing urinary retention. The client has been prescribed terazosin (Hytrin). What condition contributes to the urinary retention?
Benign prostatic hypertrophy
What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?
Beta-adrenergic blockers
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?
Beta-adrenergic blocking drugs
The 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 heart and can stimulate increased myocardial activity and increase heart rate?
Beta1
A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication?
Bradycardia
Which effect results from activation of beta2 receptors?
Bronchodilation
The client has been ordered a beta-adrenergic blocking medication. The nurse knows that these medications are used to treat which diagnoses? Select all that apply.
Cardiac arrhythmia Heart failure Glaucoma
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 client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition?
Cholinergic overdose
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy?
Cholinergic stimulation in her infant
A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement?
Continually assess the client for physiological changes and notify the primary care provider with changes.
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
When there is stimulation of the SNS, blood is diverted away from the GI tract. What indicates this diversion?
Decreased bowel sounds
Which agent would be most appropriate to administer to a client with Alzheimer's disease?
Donepezil
Which would the nurse identify as a naturally occurring catecholamine?
Dopamine
The clinic nurse is teaching a client about terbutaline. What would the nurse be sure to include in the teaching? Mark all that apply.
Dosage Adverse effects What problems to report immediately
A client is experiencing anaphylaxis. What drug will the nurse most likely administer?
Epinephrine
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
After teaching a female 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 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the health care provider'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 provider to do for this client?
Explain to the client that the medication is contraindicated because of her medical history
The client is a 67-year-old with AD. When treating a client with Alzheimer's disease, it is important to involve which group of people?
Family members and caregivers
Which symptom should the nurse monitor for when caring for a client whose sinus bradycardia has been treated with large doses of atropine?
Flushing
A client has had a stroke and computed tomography reveals infarcts in multiple brain regions. An infarct in which region is most likely to affect the function of the client's autonomic nervous system?
Hypothalamus
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
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
The nurse is conducting an assessment of a newly admitted client. What assessment finding should suggest to the nurse that the client's muscarinic cholinergic receptors are being stimulated?
The client has "pinpoint" pupils.
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 client has been prescribed the nonselective beta-adrenergic blocker, timolol for the treatment of open angle glaucoma. What instructions should the nurse provide to assure the effectiveness of the medication?
The proper method for instilling eye drops
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.
The nurse is preparing a client for pacemaker surgery. The health care provider 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
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True
Phentolamine is the agent used to treat extravasation of dobutamine.
True
Norepinephrine is made by nerve cells using which substance?
Tyrosine
The client is ordered bethanechol subcutaneously. After giving the client the injection of bethanechol, the nurse should make sure that what is available?
Urinal, bed pan, and call light
A 4 year old has been prescribed an anticholinergic medication. The nurse should instruction the parents to monitor and report changes in basic function
Urinary output
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.
A nurse is caring for a patient who is having a sympathetic response. A sympathetic response involves:
an increase in blood pressure, bronchi dilation, and decreased bowel sounds
Sympathetic stimulation of the heart causes:
an increased rate and force of myocardial contraction.
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 is reviewing the medication history of a client who is receiving drug therapy for Alzheimer's disease. What medication should the nurse question?
atropine
What is the primary goal for prescribing an anticholinergic agent for a preoperative client?
decrease respiratory secretions
The nurse is preparing to administer eye drops containing an anticholinergic preparation to a client prior to an eye examination. Before administration, the nurse explains that the eye drops will cause what pupil reaction?
dilatation
Anticholinergic drugs are used in ophthalmology to
dilate the pupils.
The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication?
dry mucous membranes
The client has been ordered a nonselective beta-blocking agent called propranolol, PO. Propranolol is used in the treatment of which disorders?
hypertension, angina, cardiac arrhythmias, hypertrophic subaortic stenosis, migraine prophylaxis, and myocardial infarction.
A patient with diabetes who uses insulin is also receiving labetalol. The nurse would monitor the patient closely for:
hypoglycemia.
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
The nurse is caring for a client with asthma who has been administered albuterol in order to promote bronchodilation and relieve shortness of breath. When giving this medication, the nurse has affected the client's autonomic nervous system by:
stimulating beta2-receptors.
A client has begun to experience post-operative pain and the client's heart rate has increased from 72 beats per minute to 96 beats per minute. The nurse should attribute this change to the effect of:
stimulation of beta1 receptors in the sympathetic nervous system.
Adrenergic drugs mimic the effects of stimulating what part of the nervous system?
sympathetic
The nurse is providing medication education to a client prescribed an adrenergic blocker. Which nervous system is the specific focus of this classification of medications?
sympathetic
The teaching priority for a diabetic male client being treated with a non-specific beta-blocker would be to:
understand signs and symptoms of hypo- or hyperglycemic reaction.
