Pharm AQ2 Practice

The health care provider has prescribed lidocaine with epinephrine for injection to be administered before obtaining a biopsy. The nurse will question the prescription after the patient makes which statement? "I am taking a new medicine for high blood pressure." "I break out in a rash when I take antibiotics." "I get faint when I see needles." "I'm getting over a cold I've had for 3 days."

"I am taking a new medicine for high blood pressure." Rationale Epinephrine is an adrenergic agonist that causes vasonconstriction and raises blood pressure. The nurse should bring the patient's high blood pressure to the health care provider's attention, so appropriate precautions can be taken. Lidocaine with epinephrine is not an antibiotic. There is no chance of cross-sensitivity. The nurse can provide reassurance to calm the patient's fear of needles. Fear is not a contraindication to local anesthesia. Recovering from a virus is not a contraindication to receiving lidocaine with epinephrine. p. 202

The nurse recognizes that the patient who is taking an adrenergic blocking drug understands the importance of avoiding other substances that may interact with the medication when the patient makes which statement? "I should limit my fluid intake while taking this medication." "One glass of red wine with meals will not interfere with the medication." "I should avoid drinking my morning coffee while taking this drug." "There's no need to stop eating chocolate while I'm on this medication."

"I should avoid drinking my morning coffee while taking this drug." Rationale The patient should increase his fluid intake to prevent constipation. Alcohol and caffeine such as that in coffee and chocolate should be avoided while on the medication. Alcohol ingestion should be avoided because it causes vasodilation, increasing the risk of hypotension. Caffeine should be avoided because it can further irritate the cardiac and central nervous systems. p.204

The patient has been ordered two drugs of the same class to be used for treatment of asthma. The patient asks the nurse, "Why do I have to use more than one medication to treat this? Isn't one enough?" What is the nurse's most appropriate response? "You need to ask your health care provider questions like that." "No, in this case, one drug is not enough to do what's needed for you." "Sometimes use of more than one drug will give a combined therapeutic effect." "I will arrange for the pharmacist to do a presentation for you."

"Sometimes use of more than one drug will give a combined therapeutic effect." Rationale Although the patient can gain information from both the health care provider and the pharmacist, the nurse should explain that a better therapeutic response can be gained from use of more than one drug. p. 205

The nurse is caring for several patients who are being treated with adrenergic drugs to treat various conditions. Which patient is at greatest risk to experience an adverse reaction to the medication? A 72-year-old patient who has an ophthalmic condition A 55-year-old patient with cardiac symptoms A 32-year-old patient with sinusitis A 17-year-old patient with bronchial asthma

A 72-year-old patient who has an ophthalmic condition Rationale The elderly and the very young may react with increased sensitivity to the adrenergic drugs. p. 203

Which patient with angina would be at increased risk for adverse effects after the administration of beta blockers? A patient with diabetes mellitus A patient with a myocardial infarction (MI) A patient with a wrist injury A patient with hyperactivity disorder

A Patient with diabetes mellitus Rationale Beta blockers mask the tachycardia in diabetic patients, which occurs due to hypoglycemia. The diabetic patients may be unable to tell when their blood glucose levels fall too low. Therefore, beta blockers are contraindicated in a patient with diabetes mellitus. A patient with MI will benefit from beta blockers, because the drugs block the harmful effects of the catecholamines that increase the heart rate after an MI. A patient with a wrist injury is not at risk, because it is a minor injury. A patient with hyperactivity disorder may sometimes be prescribed beta blockers as a treatment therapy. p. 207

Which patient is an unsuitable candidate for a sympathomimetic agent? A patient who has insomnia A patient who has asthma A patient who has hypertension A patient who has a common cold

A patient with hypertension Rationale A patient who has hypertension is an unsuitable candidate for the administration of a sympathomimetic agent. Administration of a sympathomimetic agent in a hypertensive patient may cause further increase in blood pressure. Administering it to a patient who has hypertension increases the chances of heart failure. Patients who have insomnia, glaucoma, or a common cold are suitable candidates for administration of a sympathomimetic agent. p. 201

A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/70 mm Hg to 130/80 mm Hg. What is the nurse's priority action? Assess hourly blood pressure readings. Assess the patient's electrocardiogram and slow the infusion. Assess the patient's respiratory rate and measure arterial blood gases. Assess the patient's intake and output and decrease intravenous fluids.

Assess hourly blood pressure readings. Rationale The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect. pp. 201, 205

The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is prescribed carvedilol (Coreg). What is the nurse's primary intervention? Assess the heart rate before administration. Maintain the patient on intake and output. Make sure the patient is on telemetry monitoring. Call the health care provider to request a different medication.

Call the health care provider Rationale Carvedilol (Coreg) is a nonselective beta blocker used primarily in the treatment of heart failure but is also beneficial for hypertension and angina. Patients with a history of asthma, emphysema, bronchitis, or any condition with increased airway resistance or bronchoconstriction cannot take nonselective or beta 2-blocking drugs without experiencing further bronchoconstriction and negative effects on their underlying disease condition. The patient could receive a selective beta blocker instead. The nurse should make the health care provider aware of the patient's history of respiratory disease. p.206

The nurse is administering dopamine intravenously. What is the most important action on the part of the nurse? Verify that the patient understands why the medication is being given. Determine that the medication is infusing at the proper rate. Check the patient's intravenous site hourly for infiltration. Verify that the medication is mixed with the proper diluent.

Check the patient's intravenous site hourly for infiltration. Rationale Although it is important for the patient to know why he or she is receiving the medication that is administered and for the nurse to verify that the medication is mixed properly and infusing accurately, the most important action for the nurse when working with dopamine is to check the intravenous site hourly for evidence of infiltration. 206

In order to produce a sympathomimetic response, the nurse may administer which medication that is only available as a synthetic substance? Epinephrine Norepinephrine Dopamine Dobutamine

Dobutamine Rationale Dobutamine is a synthetic catecholamine. Epinephrine, norepinephrine, and dopamine are available as both endogenous and exogenous (synthetic) substances. p. 201

The patient is prescribed a beta blocker medication and is also taking a diuretic as part of the treatment regimen. The nurse anticipates that this interaction will result in which of the following? Increased hypertension Decreased urination Increased hypotension Decreased heart block

Increased hypotention Rationale The interaction of both a beta blocker and a diuretic is likely to result in increased hypotension for the patient. p. 206

The nurse knows that which is an effect of beta 1-adrenergic receptor stimulation? Increased renin secretion Vasoconstriction Ejaculation Mydriasis

Increased renin secretion Rationale Beta1-adrenergic receptor stimulation causes increased renin secretion. Vasoconstriction, ejaculation, and mydriasis are the result of alpha 1-adrenergic receptor stimulation. p. 200

Which outcome would be most appropriate to establish for patients taking beta 1 agonists? Relaxation of uterine smooth muscle Relaxation of bronchial smooth muscle Increased resistance of peripheral vessels Increased contractility of myocardium

Increased contractility of myocardium Rationale Stimulation of beta 1 receptors in the "fight-or-flight" response results in stronger ventricular contraction owing to increased contractility of myocardium. Beta 2 agonist stimulation results in vasodilation and decreased resistance of peripheral vessels. Beta 1 agonists act most specifically on the heart; relaxation of uterine smooth muscle is a result of taking alpha 1 antagonists. Bronchial smooth muscle is affected by beta 2 agonists. p. 200

The nurse is caring for a patient who is scheduled to begin treatment with one of the adrenergic drugs. During the admission assessment the patient tells the nurse that he is undergoing treatment for mental illness with a monoamine oxidase inhibitor (MAOI) medication. Based on this information, the nurse will perform which action? Monitor the patient closely during treatment for evidence of side effects. Administer the adrenergic drug as prescribed. Plan for the health care provider decreasing the dose of the adrenergic drug. Hold the dose of the adrenergic drug and notify the health care provider of the use of the MAOI medication.

Hold the dose of the adrenergic drug and notify the health care provider of the use of the MAOI medication. Rationale Administration of adrenergic drugs with monoamine oxidase inhibitors may cause a potentially life-threatening hypertensive crisis. p. 209

A client with a new prescription for propranolol (Inderal) tells the nurse he has a history of asthma. The nurse's priority action is to: teach the client how to take his blood pressure. tell the client to change positions slowly. inform the client to carry a rescue inhaler at all times. notify the client's health care provider.

Notify the clients health care provider Rationale Inderal is a nonselective beta blocker which can result in bronchoconstriction. The health care provider (HCP) needs to be notified about the client's history of asthma. Teaching the client how to take the blood pressure, teaching the client to change positions slowly, and informing the client to carry a rescue inhaler are all important; but notifying the HCP is the priority to ensure safety and prevent bronchoconstriction. p. 206

The nurse is caring for a patient who has been prescribed an adrenergic drug to treat asthma. When assessing the patient prior to administering the first dose of the drug, the nurse finds that the patient's blood pressure is 160/90 mm Hg. What is the nurse's highest priority action? Hold the initial dose of the medication until the patient's blood pressure decreases. Notify the health care provider of the patient's elevated blood pressure reading. Administer the medication as usual because the patient's hypertension is not new onset. Administer the medication but monitor the blood pressure closely for the first hour.

Notify the health care provider Rationale Adrenergic drugs are contraindicated in the case of severe hypertension, so the health care provider should be notified of the finding. p. 205

The patient has been placed on the medication propranolol (Inderal). While the nurse is updating the patient's medical history, the patient reports a history of bronchial asthma. The highest priority action on the part of the nurse should be to: plan to monitor the patient's respiratory status frequently while the patient is taking the drug. anticipate that the patient will be placed on a lower than usual dose of the drug. instruct the patient on how to monitor the respiratory rate at home after discharge. notify the prescribing physician because this is a contraindication for the patient.

Notify the health care provider Rationale Use of propranolol (Inderal) with the patient who has a history of bronchial asthma is contraindicated. p. 206

What is the most accurate outcome criteria for the nurse to use when determining if a patient is responding appropriately to use of an adrenergic drug? Patient is able to correctly state three side effects of the medication. Patient is alert to time, person, and place and makes coherent conversation. Patient's respiratory rate is 16 breaths/minute and blood pressure is 130/72 mm Hg. Patient awakens easily during nurse's morning rounds and states, "I feel fine."

Patient's respiratory rate is 16 breaths/minute and blood pressure is 130/72 mm Hg Rationale The blood pressure and respiratory readings will give the most accurate information for outcomes criteria; the other information is vague and subjective. pp. 207-208

The patient is an older adult who has been placed on a beta-adrenergic agonist. The patient complains to the nurse about experiencing headaches after being on the drug for several days. What is the nurse's highest priority action? Reassure the patient that this is an expected side effect of the medication. Question the patient about what over-the-counter medications he or she uses to treat headaches. Notify the prescribing health care provider about the information provided by the patient. Instruct the patient to maintain a symptom diary documenting the incidence of the headaches.

Notify the provider Rationale Although it is important to gain as much information as possible from the patient such as use of over-the-counter medications and details provided in a symptom diary. The likelihood that beta-adrenergic agonists will affect blood pressure and pulse rate, the prescribing health care provider should be notified of incidence of chest pain, palpitations, headaches, or seizures. p. 205

The nurse observes redness and swelling on the forearm where epinephrine was injected intravenously (IV). The nurse anticipates administration of which medication to counteract the effects on the surrounding tissue at the IV site? Phentolamine Norepinephrine Doxazosin Labetalol

Phentolamine Rationale Phentolamine is an alpha blocker effective at vasodilation and counteracting the effects, such as tissue necrosis, of injected epinephrine extravasation. Redness and swelling at the IV site are signs of extravasation. Norepinephrine is an adrenergic receptor agonist and would aggravate the client's symptoms. Doxazosin is an alpha blocker as well, but is given by mouth for other indications. Labetolol is a nonselective beta blocker indicated for heart related problems. p. 207

The nurse recognizes that which medication is classified as an alpha-adrenergic agonist? Ephedrine (Pretz-D) Terbutaline (Brethine) Dobutamine (Dobutrex) Phenylephrine (Neo-Synephrine)

Phenylephrine (Neo-Synephrine) Rationale Phenylephrine (Neo-Synephrine) works almost exclusively on the alpha-adrenergic receptors. It is used primarily for short-term treatment to raise blood pressure in patients in shock in order to control some dysrhythmias (supraventricular tachycardias), and to produce vasoconstriction in regional anesthesia. p. 205

The nurse is caring for a patient who has been ordered the adrenergic blocking drug phentolamine. The patient tells the nurse during the admission assessment that his primary health care provider has been including an erectile dysfunction drug as part of his treatment regimen. The nurse anticipates that the interaction of these medications will result in the patient experiencing which of the following? Increased effect of the phentolamine Increased effect of the erectile dysfunction drug Profound hypertension Profound hypotension

Profound hypotension Rationale The interaction of phentolamine and an erectile dysfunction drug will usually produce profound hypotension. p. 207

Which medication is used in the treatment of angina? Propranolol (InnoPran XL) Pravastatin (Pravachol) Propofol (Diprivan) Propoxyphene (Darvon)

Propranolo Rationale Propranolol (Inderal) may be used to treat angina, whereas pravastatin is used for hyperlipidemia. Propofol is a central nervous system depressant that is used for inducing or maintaining anesthesia. Propoxyphene (Darvon) is an opioid that is used to treat mild to moderate pain. p.206

A patient who has been taking a prescription antihypertensive receives a new prescription for a beta blocker to treat a cardiac arrhythmia. Which side effects would the nurse include in the patient teaching? Select all that apply. Fatigue Bradycardia Constipation Orthostatic hypotension Non-exercise-related tachycardia

Rationale The combination of an antihypertensive medication and a beta blocker may cause orthostatic hypotension, bradycardia, dizziness, and fatigue. Non-exercise-related tachycardia is not a side effect since a beta blocker slows the heart rate. Constipation is not a side effect as these drugs do not have anticholinergic effects. pp. 207-208

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's priority action? Apply a cold pad to the site. Pull the IV immediately. Elevate the patient's extremity. Stop the infusion then infuse phentolamine (Regitine)

Rationale The nurse's first action is to stop the infusion, followed by infusing phentolamine (Regitine) into the area to counteract vasoconstrictive effects of the dopamine. p. 203

The nurse is reviewing a patient's medical history and recognizes which conditions as usual contraindications to the use of adrenergic medications? Select all that apply. Pregnancy Hypertension Drug allergy Migraines Diverticulitis

Rationale The only usual contraindications to the use of adrenergic drugs are known drug allergy and severe hypertension. p. 205

The nurse is monitoring a patient's vital signs on each visit that the patient makes to a health clinic. The patient has started treatment with an adrenergic blocking drug. What is the nurse's highest priority? Count the patient's respiratory rate for one minute. Take the patient's temperature by both the oral and axillary routes. Measure both supine and standing blood pressures. Count the radial pulse for one full minute.

Rationale When the patient is taking an adrenergic blocking drug, blood pressure should be monitored both supine and standing because of the tendency toward orthostatic hypotension. Also, the apical pulse should be counted for one full minute. Assessment of temperature and respiratory rate, although important, is not as paramount in this case. p.206

When teaching an 83-year-old patient about the effects of adrenergic agonists, the nurse will advise the patient to avoid which activity? Daily walk around the block Visiting wife in long-term care facility Taking prescribed herbal supplements Slow jog in summer

Slow job in the summer Rationale If unusual demands are placed on the aging heart, problems and complications may arise. Examples of unusual demands include strenuous activities, excess stress, heat, and medication use. The stress heat from slow jogging may lead to significant increases in blood pressure and pulse rate. The older adult may then react negatively with a diminished ability to compensate adequately for these changes. A short daily walk and visiting a family member are not considered strenuous activities. Older adults are already at risk for polypharmacy and should not take any over-the-counter medications or herbal supplements without a prescription from the health care provider. pp. 203

During IV administration of dopamine, the nurse notes a bruise, "bluish in color," and edema at the IV insertion site on the patient's right arm. What is the nurse's priority action? Stop the dopamine infusion. Notify the health care provider. Start a second IV line in the left hand. Elevate the right arm above heart level.

Stop the infusion Rationale Bruising and edema are signs of dopamine infiltration. The infusion should be stopped immediately to prevent further harm to the patient. After stopping the IV infusion, the health care provider can be notified. Another IV line will likely need to be started. However, the dopamine must be stopped first. After the dopamine is stopped, the arm will need to be elevated to reduce swelling. p. 203

The teaching plan for a patient taking midodrine (ProAmatine) should include which instruction? Take your blood pressure frequently while on this medication. Check your pulse before taking this medication. Take your temperature at the same time each day. Count your respirations before taking this medication.

Take your blood pressure frequently Rationale Midodrine, an alpha 1 agonist, is used mainly in the treatment of symptomatic orthostatic hypotension, so the nurse should teach the patient to take blood pressure before and after the patient stands as a means of evaluating the therapeutic effectiveness of the drug. Midodrine should not affect the temperature or respiratory rate. Reflex tachycardia may occur after taking the medication, so patients might be instructed to evaluate pulse after dosing. p. 206

The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol (Tenormin). What is the nurse's primary intervention? Assess the patient's lungs. Teach the patient about beta blockers. Call the health care provider. Ask the patient if he has a history of any respiratory disease.

Teach the patient about beta blockers. Rationale At therapeutic dosages, atenolol selectively blocks only the beta 1 receptors in the heart, not the beta 2 receptors located in the lungs. It is not necessary to determine specifically the history of respiratory disease. Although the nurse should assess the patient overall on a regular basis, the assessment should include all body systems, not only the lungs. It is not necessary to notify the health care provider prior to administration of the first dose of the medication. p.209

The patient is taking a beta blocker and begins to experience episodes of dizziness. In response to this the patient should: stop the medication ignore the symptom notify the provider start a symptom diary

notify the provider Rationale: Some of the beta blocker medications are known to produce dizziness as a side effect. However, the primary health care provider should be notified of this to ensure that the symptom is only a harmless side effect and not indicative of a worsening of the cardiac condition.

Sotalol (Betapace) is prescribed for a client experiencing ventricular dysrhythmias. The nurse prepares to administer this medication by: obtaining a normal saline flush. selecting a 23-gauge 1½-inch needle and 3-mL syringe. refilling the client's water pitcher. choosing a 25-gauge ¼-inch needle and 1-mL syringe.

refilling the clients water pitcher Rationale Sotalol (Betapace) is available only in oral form. Therefore, preparing to offer the client a drink of water to take with this medication is most appropriate. Obtaining a saline flush implies that the medication is about to be given IV. Selecting needles and syringes indicates the medication is about to be given parenterally. p. 208