Prep U ch 27
A 4-year-old is admitted to the Emergency Department in shock after a motor vehicle accident. The patient is found to be 12.5 kilograms. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005-0.01 mg/kg IV? a) 0.08 mg b) 0.0625 mg c) 0.075 mg d) 0.085 mg
0.0625 mg
A nurse is caring for an elderly patient who is to be administered isoproterenol. Which of the following changes monitored in the patient should the nurse report immediately to the primary healthcare provider? a) Changes in appetite b) Changes in temperature c) Changes in pulse rate d) Changes in glucose level
Changes in pulse rate
With certain health conditions, adrenergic drugs should NOT be used. Which of the following are examples? Choose all that apply. a) Myocardial ischemia b) Anaphylactic reaction c) Cerebrovascular accident d) Hypertensive crisis e) Atrial fibrilation
Atrial fibrilation • Myocardial ischemia • Hypertensive crisis • Cerebrovascular accident Explanation: Contraindications to using adrenergic drugs include cardiac dysrhythmias, angina pectoris, hypertension, hyperthyroidism, and cerebrovascular disease; stimulation of the sympathetic nervous system worsens these conditions. Use of epinephrine during an anaphylactic reaction is appropriate.
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes? a) Beta-helping drugs b) Beta-blocking fish c) Beta-adrenergic blocking drugs d) Beta-adrenergic drugs
Beta-adrenergic blocking drugs Correct Explanation: Beta-adrenergic blocking drugs prevent epinephrine and norepinephrine from occupying receptor sites on cell membranes. Beta-adrenergic drugs stimulate epinephrine and norepinephrine release so that they can occupy more of the receptor sites. There is no such thing as beta-blocking fish or beta-helping drugs. (less)
Epinephrine causes relaxation of: a) Superficial blood vessels. b) Bronchioles. c) Sphincter muscles. d) Smooth muscles in the intestinal wall.
Bronchioles. Correct Explanation: Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.
A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most appropriate for this patient? a) Disturbed Sensory Perception b) Disturbed Sleep Pattern, Insomnia Related to CNS Excitation c) Imbalanced Nutrition: Less Than Body Requirements d) Ineffective Tissue Perfusion
Disturbed Sleep Pattern, Insomnia Related to CNS Excitation Correct Explanation: In relation to comfort, the appropriate nursing diagnosis would be "Disturbed Sleep Pattern, Insomnia Related to CNS Excitation." "Imbalanced Nutrition: Less Than Body Requirements" would be related to drug-induced anorexia or nausea. "Disturbed Sensory Perception" would be related to impaired vision, and "Ineffective Tissue Perfusion" would be related to the cardiovascular effects of the drug.
Which of the following herbs have been removed from most weight-loss medications due to potential legal liability? a) Gingko b) Ephedra c) Rose hips d) Ginseng
Ephedra Correct Explanation: Ephedra has serious adverse reactions, such as hypertension and irregular heart beat. These side effects have been associated with stroke and heart attacks. The Food and Drug Administration has warnings against taking weight-loss pills that have ephedra in them. Gingko, ginseng, and rose hips have not had these serious side effects. (less)
Excessive use of ephedrine and pseudoephedrine can lead to toxicity. Although hemoperfusion is not effective in clearing these drugs from the body, urinary acidification may enhance their elimination. Which of the following statements explains why urinary acidification is not routinely used? a) It presents the risk of renal damage. b) Dialysis permits more effective elimination. c) The effects of toxicity are mild. d) It presents the risk of liver damage.
It presents the risk of renal damage. Correct Explanation: Although urinary acidification may enhance elimination of ephedrine and pseudoephedrine, the technique is not routinely used because of the risk of renal damage from myoglobin deposition in the kidney. Like hemoperfusion, dialysis is ineffective in removal of the drugs. Effects of toxicity can include severe hypertension, seizures, and intracranial hemorrhage.
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? a) Intramuscular b) Oral c) Intravenous d) Subcutaneous
Oral Correct Explanation: Isoproterenol is administered IV, IM, or subcutaneously. It is not administered orally.
A 75-year-old male client is diagnosed with chronic obstructive lung disease; he also has a history of cardiac dysrhythmias, hyperlipidemia, and hypertension. His physician orders a metered-dose inhaler. The nurse will teach the client to report which symptom to the physician? a) Skin lesions b) Persistent edema c) Palpitations d) Gastrointestinal upset
Palpitations Correct Explanation: A major function of the home care nurse is to teach clients to use the drugs correctly (especially metered-dose inhalers), to report excessive CNS or cardiac stimulation to a health care provider, and not to take OTC drugs or herbal preparations with the same or similar ingredients as prescription drugs. (less)
Which of the following is stimulated during the body's fight-or-flight response to a stressful condition? (Choose one) a) Central nervous system b) Somatic nervous system c) Parasympathetic nervous system d) Sympathetic nervous system
Sympathetic nervous system Correct Explanation: The sympathetic branch of the autonomic nervous system is stimulated during the body's fight-or-flight response to a stressful condition.
A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary healthcare provider? a) Pulse rate of 60 beats per minute b) Systolic blood pressure below 100 mm Hg c) A diastolic blood pressure of 75 mm Hg d) Temperatures reading of 97.6°F
Systolic blood pressure below 100 mm Hg Correct Explanation: The nurse must immediately report to the healthcare provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats per minute, and a temperature reading of 97.6°F are normal and need not be reported immediately.
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly. a) True b) False
true
The predominant effect in response to activation of alpha-1 receptors by an adrenergic drug is vasoconstriction. True or false? a) False b) True
true
You are preparing discharge teaching for four patients. Which patient should be advised by the nurse that OTC cold and allergy preparations contain phenylephrine and should be avoided? a) A 62-year-old male with gout b) A 17-year-old female with symptoms of an upper respiratory infection c) A 52-year-old male with adult onset diabetes d) A 47-year-old female with hypertension
A 47-year-old female with hypertension Explanation: Phenylephrine is a stimulant that will raise blood pressure and increase heart rate. Patients with hypertension should avoid these drugs because serious increases in blood pressure could occur. Hypotension and gout are not associated with this drug. An upper respiratory infection may be an indication for the drug. (less)
Which of the following patients is most likely to benefit from the administration of an adrenergic agonist? a) A woman who is in labor and may require a caesarean section b) A woman who has been admitted with a suspected ischemic stroke c) A man who has a diagnosis of primary hypertension d) A man who is in cardiogenic shock following a myocardial infarction
A man who is in cardiogenic shock following a myocardial infarction Correct Explanation: One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.
ch of the following receptors does phenylephrine stimulate? a) Alpha1 b) Alpha2 c) Beta1 d) Beta2
Alpha1 Correct Explanation: Phenylephrine stimulates alpha1 receptors.
A nurse is caring for an elderly patient who is to be administered isoproterenol. Which of the following changes monitored in the patient should the nurse report immediately to the primary healthcare provider? a) Changes in appetite b) Changes in pulse rate c) Changes in temperature d) Changes in glucose level
Changes in pulse rate Explanation: The nurse should report any changes observed in pulse rate or rhythm immediately. Changes in glucose level, appetite, or temperature need not be reported immediately to the primary care provider unless they are severe. (less)
An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which of the following would the nurse include as an alpha- and beta-adrenergic agonist? a) Albuterol b) Phenylephrine c) Terbutaline d) Epinephrine
Epinephrine Correct Explanation: Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist. (less)
Which of the following is the adrenergic drug of choice for treatment of anaphylactic shock? a) Epinephrine b) Isoproterenol c) Phenylephrine d) Dopamine
Epinephrine Correct Explanation: Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.
______________ is the prototype of the adrenergic drugs.
Epinephrine (Adrenalin) Explanation: Epinephrine (Adrenalin) is the prototype of the adrenergic drugs. The others are all examples of adrenergic drugs.
A client is seen in the emergency department for third-degree burns over 50% of his body. The nurse knows that this client is experiencing what type of shock due to fluid loss? a) Cardiogenic shock b) Septic shock c) Anaphylactic shock d) Hypovolemic shock
Hypovolemic shock Correct Explanation: Clients with severe burns lose large amounts of fluid through their burns. Often, this causes hypovolemic shock. Septic shock is circulatory insufficiency resulting from overwhelming infection. Cardiogenic shock occurs when cardiac output is insufficient and perfusion to vital organs cannot be maintained (e.g., during ventricular arrhythmias). Anaphylactic shock is caused by a hypersensitivity to a substance resulting in massive vasodilation. (less)
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective? a) Improved cardiac contractility b) Bronchoconstriction c) Uterine contraction d) Decreased heart rate
Improved cardiac contractility Correct Explanation: The desired effects of isoproterenol include improved contractility and conductivity, increased heart rate, bronchodilation, relaxation of the uterus, and increased blood flow to skeletal muscles and splanchnic beds. (less)
Adrenergic drugs produce which of the following effects? a) Decreased kidney perfusion b) Increased heart rate c) Decreased respiratory rate d) Urinary retention
Increased heart rate Correct Explanation: Adrenergic drugs are used in cardiac arrest for their cardiac stimulant and peripheral vasoconstrictive effects.
The intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with which of the following? a) Hyaluronidase b) Sodium bicarbonate c) Lactated Ringer's solution d) Phentolamine
Phentolamine Explanation: If extravasation occurs, the nurse should infiltrate the site with 10 mL of saline containing 5 to 10 mg of Phentolamine. Hyaluronidase and sodium bicarbonate may be used for extravasation of certain antineoplastic agents. Lactated Ringer's solution would be inappropriate.
The adrenergic branch of the autonomic nervous system is also known by which of the following names? (Choose one) a) Central nervous system b) Parasympathetic nervous system c) Sympathetic nervous system d) Somatic nervous system
Sympathetic nervous system Correct Explanation: The sympathetic nervous system is also known as the adrenergic branch.
The nurse is teaching a patient about safe use of adrenergic drugs. Which of the following statements should be included in the teaching? a) "You shouldn't take cold remedies or appetite suppressants while on this drug, but you can take any other medication safely." b) "Tell your health care provider if you are allergic to penicillin." c) "You can take cold medications while on this drug, but talk to your doctor about other medications." d) "Talk to your doctor before taking any other medications."
Talk to your doctor before taking any other medications." Explanation: Patients taking adrenergic drugs should be instructed to take no other medications without their physicians' knowledge and approval. Many over-the-counter cold remedies and appetite suppressants contain adrenergic drugs, and use of these along with prescribed adrenergic drugs can result in overdose and serious cardiovascular or central nervous system problems. In addition, adrenergic drugs can interact with numerous other drugs to increase or decrease effects. Patients who are allergic to sulfites should alert their physicians, since adrenergic drugs are contraindicated in that population. (less)
The nurse understands that local anesthetics containing adrenergics should not be used on which part of the body? a) The back b) The chest c) The fingers d) The abdomen
The fingers Explanation: Local anesthetics containing adrenergics should not be used in any area of the body with a single blood supply (fingers, toes, nose, and ears).
The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. True or False? a) False b) True
True Correct Explanation: The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. Another adrenergic effect resulting from beta1 activation is increased renin secretion from the kidneys.
Ephedra (ma huang) is an OTC dietary supplement. Which of the following describes ephedra and its actions? Choose all that apply. a) Linked to increased risk of hypertension, heart attack, stroke, and death b) Boosts sports performance c) Used for weight control d) Available over-the-counter
Used for weight control • Boosts sports performance • Linked to increased risk of hypertension, heart attack, stroke, and death Explanation: Ephedra (ma huang) is an OTC dietary supplement used for weight control, boosting sports performance, and increasing energy levels. It has been linked to increased risk of hypertension, heart attack, stroke, and death. The FDA prohibited the sale of any dietary supplements containing ephedrine alkaloids in 2004. (less)
Which of the following would the nurse expect to be given to a patient experiencing acute bronchospasm? a) Metaraminol b) Epinephrine c) Norepinephrine d) Dopamine
b
A client 16 years of age arrives at the emergency department (ED) saying she was stung by a bee and used her EpiPen prior to arriving in the ED. She is breathing well now. What would the nurse do next for this client? a) Explain that she is fine and does not need to be seen because she already gave herself the medication. b) Start an IV and give epinephrine STAT before she goes into cardiac arrest. c) Explain that she needs a parent or guardian to sign admission papers prior to being seen in the emergency department. d) Obtain from her, and those who were with her, as much information about the bee sting (and her physical reaction to the bee sting) as possible.
d
Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs. For which of the following conditions would these drugs be used? Choose all that apply. a) Respiratory conditions b) Fractures c) Liver failure d) Allergic disorders e) Acute cardiovascular disorders
• Acute cardiovascular disorders • Respiratory conditions • Allergic disorders Explanation: Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs in the treatment of acute cardiovascular, respiratory, and allergic disorders. (less)
When caring for a patient receiving adrenergic drugs, the nurse would establish with him or her which of the following goals? Choose all that are appropriate. a) Receive or self-administer drugs accurately. b) Demonstrate knowledge of adverse drug effects. c) Self-administer combinations of adrenergic drugs. d) Comply with instructions for safe drug use. Submit your answer
• Receive or self-administer drugs accurately. • Demonstrate knowledge of adverse drug effects. • Comply with instructions for safe drug use. Correct Explanation: All the goals are appropriate except for combining adrenergic medications. The patient needs to always consult with the physician prior to mixing adrenergics