PrepU Chapter 29: Drug Therapy for Shock and Hypotension

Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?

β2 receptors

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?

0.0625 mg

The nursing instructor has completed teaching a group of students about the adrenergic nervous system. The instructor determines the class is successful when the students correctly choose which types of receptors are utilized by this system? Select all that apply.

Alpha and Beta

What does the basic nursing care of patients with shock require?

An ongoing systematic assessment

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.

You are admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. You know that an early sign that accompanies initial shock is what?

Cool, clammy skin In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patient's skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases.

Which would the nurse identify as a naturally occurring catecholamine?

Dopamine Naturally occurring catecholamines: norepinephrine, epinephrine, and dopamine.

While sitting outside, a client at a long-term care reports feeling a stinging sensation on the arm. Shortly thereafter, the client begins to cough, has trouble breathing, and is flushed. What drug would the nurse most likely administer?

Epinephrine Epinephrine is the drug of choice for the management of anaphylactic shock because of its rapid onset of action and antiallergic effects.

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 Epinephrine is an alpha- and beta-adrenergic agonist.

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 Adrenergic drugs are used in cardiac arrest for their cardiac stimulant and peripheral vasoconstrictive effects.

When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?

Ineffective Tissue Perfusion

The nursing instructor is discussing shock with the senior nursing students. The instructor tells the students that shock is a life-threatening condition. What else should the instructor tell the students about shock?

Occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate

A client presents to the emergency department with reports of itching and throat tightness. On assessment the nurse notes urticaria and flushing. Which nursing diagnosis will the nurse determine is most appropriate for this client?

Risk for Allergy Response

You are caring for an 88-year-old client who was admitted to the ICU. The patient is suspected of being in cardiogenic shock. Which of the following observations could indicate that the patient is in shock?

Systolic blood pressure of 80 mm Hg When monitoring patients for signs of shock, the nurse should check blood pressure, skin temperature, urine output, heart rate, orientation, and respiration. Patients in shock may exhibit a significant decrease in blood pressure (e.g., systolic blood pressure < 90 mm Hg), tachycardia, decreased respiratory rate and urine output (e.g., < 30 mL/hr), disorientation, and cold, clammy skin.

The nurse is caring for a client receiving an adrenergic agent. Which approach would the nurse expect when the client's status improves and the medication is to be discontinued?

Titrate reduced doses over 2-4 days.

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately?

Vital signs When a client is to receive an adrenergic agent for shock, obtain the blood pressure, pulse rate and quality, and respiratory rate and rhythm.

An 80-year-old client has been brought to the emergency department in shock. The client is receiving dopamine. The nurse should prioritize the assessment for what potentially serious adverse effect?

cardiac arrhythmia Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older clients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes. Blood dyscrasias, hepatic toxicity, and renal insufficiency are not commonly associated with dopamine use. In fact, at lower doses, dopamine increases renal perfusion.

The nurse is serving a breakfast tray to the client receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the client's diet when finding what on the tray?

coffee Clients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death.

Your 69-year-old patient is started on IV dopamine for management of hypotension following open-heart surgery. As you care for the patient, you monitor him for adverse effects of the drug, including

tachycardia Potential adverse effects of dopamine include tachycardia, arrhythmia, and angina.

Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels?

α1 receptors