Pharm EAQ 2

A nurse is teaching a class about the parasympathetic nervous system (PNS) and transmitters. Which image will the nurse use in the teaching session? 1 2 3 4

(picture) 1 All preganglionic and postganglionic neurons of the PNS release acetylcholine as their transmitter; thus, the image with acetylcholine at both synapses should be used. All preganglionic neurons release acetylcholine, but postganglionic neurons can release acetylcholine, norepinephrine, or epinephrine for the sympathetic nervous system. Motor neurons are part of the somatic motor system.

The nurse evaluates the effect of the adrenergic (sympathomimetic) drug that a patient has been receiving. Which finding will be of greatest concern to the nurse? 1 Weak peripheral pulses and decreased heart rate 2 Stable blood pressure and increased cardiac output 3 Increased peripheral pulses and increased heart rate 4 Heart rate of 95 beats/min and strong peripheral pulses

1 Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate, contractility (positive inotropic effect), and conductivity. The nurse would be most concerned that the pulses remained weak and the heart rate decreased after receiving this drug because the therapeutic effect is not being achieved.

A patient who is taking beta blockers reports hunger, fatigue, and difficulty concentrating. Vital signs are within normal parameters. What is the nurse's priority action? 1 Obtain a blood glucose level 2 Take apical pulse for 1 full minute 3 Offer the patient a cup of orange juice 4 Check blood pressure in sitting and lying positions

1 Beta blockers can mask signs of hypoglycemia such as tachycardia, tremors, and perspiration. As a result, it is important to assess for factors tied to other physiologic responses (e.g., hunger, fatigue, and poor concentration). The nurse should first check this patient's blood glucose level before offering orange juice. Assess before intervening per the nursing process. Checking a blood glucose level takes priority over obtaining further blood pressure readings and an apical pulse.

Which medication would the nurse anticipate administering to a patient in cholinergic crisis? 1 Atropine 2 Pralidoxime 3 Dobutamine

1 Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors.

Which is the most important initial nursing action for a patient with myasthenia gravis who is beginning a new prescription of oral neostigmine? 1 Assess the patient's ability to swallow. 2 Teach the patient to wear a Medic Alert bracelet. 3 Check the patient's deep tendon reflexes (DTRs). 4 Obtain a measurement of the plasma level of neostigmine.

1 Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.

Which is not a reason for the decline in hepatic drug metabolism with age? 1 Poor diet 2 Reduced liver mass 3 Reduced hepatic blood flow 4 Decreased activity of some hepatic enzymes

1 Rates of hepatic drug metabolism tend to decline with age. Diet is important but is not a principal reason for reduced hepatic drug metabolism. Principal reasons are reduced liver mass, reduced hepatic blood flow, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.

The nurse working with elderly patients is concerned about the number of medications each patient is taking. Which should the nurse assess as the highest priority for the patients related to polypharmacy? 1 Drug interactions 2 Cost of medications 3 Schedule of medications 4 Nonadherence to drug regimen

1 The highest priority for patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications a patient takes, the higher is the risk of drug interactions. The cost, schedule, and degree of nonadherence are not priorities with regard to polypharmacy

The patient who takes insulin has just been prescribed a beta blocker drug. The nurse recognizes that the interaction of the beta blocker and the insulin may have which result? 1 Masked signs of hypoglycemia 2 Masked signs of hyperglycemia 3 Enhanced activity of the beta blocker drug 4 Decreased activity of the beta blocker drug

1 The interaction of insulin and a beta blocker drug is known to result in masking of the signs of hypoglycemia. Insulin neither enhances nor decreases the activity of beta blockers.

A patient receiving inhalant anesthesia and succinylcholine suddenly develops muscle rigidity and a temperature of 105°F. Which nursing action is the priority? 1 Prepare to administer dantrolene. 2 Administer normal saline at 50 mL/hr. 3 Administer morphine sulfate to relieve pain. 4 Prepare for intubation and mechanical ventilation.

1 The patient is showing symptoms of malignant hyperthermia, a rare and potentially fatal complication of combined use of succinylcholine and inhalation anesthesia. Treatment includes discontinuation of succinylcholine and anesthesia, application of cooling blankets and ice packs, and intravenous administration of dantrolene, a muscle relaxant. Patients receiving succinylcholine, an inhalant anesthesia, will already be intubated because they are paralyzed and anesthetized. Neither morphine sulfate nor intravenous normal saline, especially at a rate of 50 mL/hr, is indicated, nor would they help resolve the patient condition.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply. 1 Heart failure 2 Hypertension 3 Angina pectoris 4 Sinus bradycardia 5 Cardiogenic shock 6 Chronic obstructive pulmonary disease

1,2,3 Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade also has been shown to reduce mortality in patients with heart failure.

The nurse is preparing to give epinephrine by the intravenous (IV) push route. Which actions are essential before giving this drug? Select all that apply. 1 Assess the vital signs. 2 Check IV drug compatibilities. 3 Assess the patency of the IV line. 4 Obtain insulin from the medication cart. 5 Check the blood urea nitrogen and creatinine levels.

1,2,3 Epinephrine can cause tissue necrosis with extravasation, so the first priority is to assess the patency of the IV line before beginning administration. Assessing the vital signs, particularly the heart rate and blood pressure, is important as well. Before administering an IV medication, the nurse should be aware of any incompatibilities that may affect the patency of the line. Although epinephrine can cause hyperglycemia in patients with diabetes, it is not necessary to obtain insulin based on the information present in this question. It is not necessary to check the patient's blood urea nitrogen and creatinine levels before IV push administration, which is likely in an emergent situation.

The nurse teaches a group of student nurses the overall primary functions of the autonomic nervous system (ANS). Which of these are functions of the ANS? Select all that apply. 1 Regulation of gastric glands 2 Regulation of bronchial glands 3 Regulation of the blood vessels 4 Regulation of muscles of the bronchi 5 Regulation of the skeletal muscle movement

1,2,3,4 Functions of the ANS include regulation of the heart, gastric glands, bronchial glands, muscles of the bronchi, and the blood vessels. The somatic nervous system regulates skeletal muscle movement.

Which receptors are considered adrenergic receptors? Select all that apply. 1 Beta 1 2 Beta 2 3 Alpha 1 4 Alpha 2 5 Dopamine 6 Muscarinic 1

1,2,3,4,5 Alpha, beta, and dopamine receptors are part of the sympathetic system and therefore are adrenergic receptors. Muscarinic receptors are part of the parasympathetic system and are cholinergic.

The nurse is administering isoproterenol, a beta 1 and beta 2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? Select all that apply. 1 Bronchial dilation 2 Increased heart rate 3 Excessive drowsiness 4 Decreased cardiac output 5 Decreased glucose levels 6 Increased force of heart contraction

1,2,6 Activation of beta1 and beta2 receptors results in dilation of the bronchi, increased cardiac output (by increasing the heart rate and force of contraction), and elevation of the blood glucose level. Activation of beta 1 and beta 2 receptors does not result in excessive drowsiness, decreased cardiac output, or decreased glucose levels.

The nurse is responsible for dispensing medications to a child younger than 1 year old. What characteristics of children this age have a significant impact on dosage of drugs? Select all that apply. 1 Decreased acid in stomach 2 Risk of excessive hydration 3 Limited protein-binding capacity 4 Immature liver and kidney function 5 Thin skin with reduced permeability

1,3,4 Pediatric patients lack acid production in the stomach and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not be adequately dissolved in the stomach. Very young patients have limited capacity for protein binding, which affects distribution. They also have an immature liver and kidneys, which impairs drug metabolism and excretion. Pediatric patients are at risk of dehydration because of a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily.

Which one of these statements is true regarding the effects of the drug dopamine? Select all that apply. 1 At low therapeutic doses, dopamine acts on dopamine receptors only. 2 MAO inhibitors decrease the effects of dopamine on the heart and blood vessels. 3 Dopamine is a catecholamine whose receptor specificity is highly dose dependent. 4 At moderate doses, dopamine activates beta 1 receptors in addition to dopamine receptors. 5 At high doses, dopamine activates alpha 1 receptors along with beta 1 receptors and dopamine receptors.

1,3,4,5 Dopamine is a catecholamine whose receptor specificity is highly dose dependent. At low therapeutic doses, dopamine acts on dopamine receptors only. At moderate doses, dopamine activates beta 1receptors in addition to dopamine receptors. At high doses, dopamine activates alpha 1 receptors along with beta 1 receptors and dopamine receptors. Monoamine oxidase inhibitors intensify, not decrease, the effects of dopamine on the heart and blood vessels.

Which factors may contribute to unintentional nonadherence? Select all that apply. 1 Forgetfulness 2 Unpleasant side effects 3 Inability to pay for medications 4 Belief that the drug is not needed 5 Failure to comprehend instructions

1,3,5 Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

Which statements should the nurse include when educating a breast-feeding patient about her medications? Select all that apply. 1 "Drugs taken by lactating women can be excreted in breast milk." 2 "There is a lot of research regarding drugs taken by lactating women." 3 "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs." 4 "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." 5 "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant."

1,4,5 Drugs taken by lactating women can be excreted in breast milk. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Unfortunately, very little systematic research has been done on this issue. Although nearly all drugs can enter breast milk, the extent of entry varies greatly.

Which statement is true about dopamine? 1 Dopamine is used to treat asthma. 2 Dopamine is a catecholamine with dose dependent receptor sensitivity. 3 Dopamine is a noncatecholamine that produces selective activation of beta 2 receptors. 4 Dopamine deactivates alpha 1 receptors along with beta 1receptors and dopamine receptors.

2 Dopamine is a catecholamine whose receptor specificity is highly dose dependent. Dopamine is not a noncatecholamine that produces selective activation of beta 2 receptors. Albuterol is used to treat asthma. Dopamine activates, not deactivates alpha 1 receptors along with beta 1 receptors and dopamine receptors.

A nurse is teaching a group of co-workers about the effects of drugs on receptors. Which comment by a co-worker would need correction? 1 "Agonist drugs increase receptor activation." 2 "Agonist drugs decrease receptor activation." 3 "Antagonist drugs decrease receptor activation." 4 "Local anesthetics suppress axonal conduction."

2 Drugs that directly activate receptors are called agonists, whereas drugs that prevent receptor activation are called antagonists. Local anesthetics are drugs that work by altering/suppressing axonal conduction.

During intravenous (IV) administration of norepinephrine, the nurse notes extravasation at the IV insertion site on the patient's right arm. What is the nurse's priority action? 1 Notify the healthcare provider. 2 Stop the norepinephrine infusion. 3 Start a second IV line in the left hand. 4 Elevate the right arm above heart level.

2 Extravasation is a sign of norepinephrine infiltration. The infusion should be stopped immediately to prevent further harm to the patient. After stopping the IV infusion, the healthcare provider can be notified. Another IV line will likely need to be started. However, the norepinephrine must be stopped first. After the norepinephrine is stopped, the arm will need to be elevated to reduce swelling and an alpha-adrenergic antagonist, phentolamine, will need to be infiltrated into the region to minimize injury.

A nurse is teaching a group of students about pharmacologic effects of the feedback loop on the autonomic nervous system. What will the nurse teach is the most important feedback loop? 1 Autonomic tone 2 Baroreceptor reflex 3 Patterns of innervation 4 Sensor and effector response

2 From a pharmacologic perspective, the baroreceptor reflex is the most important feedback loop of the autonomic nervous system. This reflex is important because it frequently opposes our attempts to modify blood pressure with drugs. Autonomic tone is the steady, day-to-day influence exerted by the autonomic nervous system on a particular organ or organ system. Innervation refers to how nerves affect systems in the body and are not directly related to pharmacologic effects. Sensor and effector response are processes within every feedback loop.

The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in monitoring for adverse effects of this drug? 1 Lung sounds 2 Cardiac rhythm 3 Blood urea nitrogen 4 Central nervous system tremor

2 Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias. Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, tissue necrosis after extravasation, and hyperglycemia.

A patient with a new prescription for propranolol tells the nurse he has a history of asthma. Which action is the nurse's priority? 1 Tell the patient to change positions slowly. 2 Notify the patient's healthcare provider (HCP). 3 Teach the patient how to check blood pressure. 4 Inform the patient to carry a rescue inhaler at all times.

2 Propranolol is a nonselective beta blocker that can result in bronchoconstriction. The HCP needs to be notified about the patient's history of asthma. Teaching the patient how to take the blood pressure, explaining the need to change positions slowly, and informing the patient to carry a rescue inhaler are all important; however, notifying the HCP is priority to ensure safety and prevent bronchoconstriction first.

The nurse is preparing to give a drug that stimulates the parasympathetic nervous system (PNS). Which patient response is an expected outcome of this drug? 1 Diarrhea stool count decreases. 2 Heart rate decreases to 60 beats per minute. 3 Wheezing decreases because of bronchodilation. 4 Oxygenation improves because of bronchodilation.

2 Stimulation of the parasympathetic nervous system (PNS) causes slowing of the heart rate. The PNS would facilitate peristalsis and thus would not decrease diarrhea. The PNS is associated with constriction of bronchial smooth muscle causing wheezing. Oxygenation is not improved because bronchoconstriction, not bronchodilation, occurs.

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process stimulates this response? 1 Baroreceptor reflex 2 Sympathetic system 3 Parasympathetic system 4 Predominant tone of the organs

2 Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure. The parasympathetic system is the predominant tone of the organs, resulting in "rest and digest" and overall baseline function of organ systems.

The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient? 1 Obtain blood glucose 2 Assess the heart rate 3 Apply a pulse oximeter 4 Observe for lower leg edema

2 The cardiac effects of diltiazem and atenolol are the same. Both reduce heart rate, suppress aortic valve conduction, and suppress myocardial contractility. When these drugs are administered together, excessive cardiosuppression may result.

Which is the primary effect of neuromuscular (NM) blockers? 1 Hypotension 2 Flaccid paralysis 3 Reduction in pain 4 Loss of consciousness

2 The primary effect of NM blockers is relaxation of skeletal muscle, causing a state known as flaccid paralysis. Some neuromuscular blockers can lower blood pressure. Neuromuscular blockers do not diminish perception of pain or loss of consciousness—even when administered in doses that produce complete paralysis.

The patient is being treated with a dopamine intravenous (IV) drip. In order to monitor for infiltration of the site, what action is most important for the nurse to perform? 1 Apply a pressure dressing to the IV site 2 Check the site every hour for evidence of swelling 3 Encourage the patient to call if the site becomes painful 4 Encourage the patient to keep the arm with the IV straight

2 The site should be monitored every hour for evidence of infiltration to prevent extravasation.

Using a series of images, the nurse is conducting a teaching session on neuronal response. Which concept does the image represent? 1 Steps in synaptic transmission 2 How neurons regulate other cells 3 Reuptake into the nerve terminal 4 Diffusion away from the neuronal gap

2 There are two basic steps in the process by which neurons elicit responses from other cells: (1) axonal conduction and (2) synaptic transmission (T, neurotransmitter). The image represents the entire process. The steps in synaptic transmission occur only at site 2. Reuptake and diffusion occur at termination of transmission.

The nurse is teaching a pharmacology class to nursing students. Which processes are mediated by beta 2 receptors? Select all that apply. 1 Bronchial constriction 2 Glycogenolysis in liver 3 Enhanced skeletal muscle contraction 4 Relaxation of the uterine smooth muscle 5 Vasodilation of the arterioles in the heart

2,3,4,5

How can the nurse enhance effective medication use in an older adult? Select all that apply. 1 Provide oral rather than written instruction. 2 Explain the purpose and importance of each drug. 3 Educate the patient about the side effects of each drug. 4 Develop a chart that includes the time to take each drug. 5 Encourage family members to monitor the patient's drug regimen.

2,3,4,5 The nurse should develop a chart that includes the time to take each drug, so the older adult is not confused; explain the purpose and importance of each drug to the patient to prevent confusion; encourage family members to monitor the patient's drug regimen, so the patient does not skip any doses; and educate the patient about the side effects of each drug, so the patient reports any discomfort immediately to the primary healthcare provider. The older adult may forget some instructions related to drug use. Therefore, the nurse should provide written instructions to the patient to reinforce teaching.

The nurse is caring for a patient who exhibits symptoms related to the regulatory function of the parasympathetic nervous system. Select the expected responses to parasympathetic nervous system stimulation. Select all that apply. 1 Dilating the pupil 2 Emptying of the bowel 3 Slowing of the heart rate 4 Decreasing gastric secretion 5 Contracting bronchial smooth muscle

2,3,5 Slowing of the heart rate, emptying of the bowel and bladder, and contracting bronchial smooth muscle are functions of the parasympathetic nervous system. In addition, gastric secretion is increased and the pupil will constrict.

There are three main neurotransmitters used by the peripheral nervous system (PNS). What is the neurotransmitter employed at most junctions of the peripheral nervous system? 1 Dopamine 2 Epinephrine 3 Acetylcholine 4 Norepinephrine

3 Acetylcholine is the transmitter employed at most junctions of the PNS. Norepinephrine is released by the postganglionic neurons. Epinephrine is released by the adrenal medulla. The role of dopamine has not been demonstrated conclusively.

The nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? 1 Sympathetic activity would increase. 2 Respiratory centers would be depressed. 3 Parasympathetic activity would increase. 4 Parasympathetic signals would be depressed.

3 Acetylcholinesterase is an enzyme that metabolizes acetylcholine. When acetylcholine is not broken down, it continues to send its message. Acetylcholine is associated mostly with the parasympathetic nervous system; therefore, this system would be stimulated (not depressed) by acetylcholine-inhibiting drugs. The sympathetic activity is innervated by the sympathetic, not parasympathetic, nervous system, which also drives the respiratory center.

Before administering an adrenergic agonist, what is the most important assessment for the nurse to complete? 1 Temperature 2 Skin integrity 3 Blood pressure 4 Respiratory rate

3 An adrenergic agonist causes vasoconstriction, leading to high blood pressure. Temperature, skin integrity, and respiratory rate are not directly affected by adrenergic agonists. Blood pressure is the most important assessment because of the detrimental effects of high blood pressure, such as stroke, which can be life threatening.

The nurse is administering medication to an older adult with altered renal function. This patient's renal system will likely have which effect on the medication? 1 The medication will be excreted quicker. 2 The medication will be metabolized quicker. 3 The medication will be excreted more slowly. 4 The medication will be metabolized more slowly.

3 As a result of a decrease in renal function, older adults excrete drugs more slowly than younger patients. Metabolism and excretion are not accelerated in older adults. The liver is responsible for metabolizing medications, not the renal system.

The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? 1 Treatment of tachycardias 2 Prevention of urinary retention 3 Use as a preanesthesia medication 4 Reduction of intraocular pressure in glaucoma

3 Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It is often administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.

The nurse determines that a postoperative patient has bladder atony. Which cholinergic drug would the nurse expect to be prescribed to the patient? 1 Donepezil 2 Cevimeline 3 Bethanechol 4 Succinylcholine

3 Bethanechol is a direct-acting cholinergic drug that is used to treat atony of the bladder. It is the only direct-acting cholinergic drug that is administered orally. Succinylcholine, donepezil, and cevimeline are not useful for treating atony of the bladder. Succinylcholine is used in general anesthesia as a neuromuscular blocker. Donepezil is an indirect-acting cholinergic drug that is used to treat Alzheimer's disease. Cevimeline is a direct-acting cholinergic drug used in the treatment of xerostomia (dry mouth) secondary to Sjögren's syndrome.

The nurse studies the physiology of the peripheral nervous system (PNS). Which statement is correct regarding the receptor specificity of adrenergic transmitters? 1 Norepinephrine can activate beta 2 and dopamine receptors. 2 Epinephrine cannot activate any of the subtypes of receptors. 3 Dopamine can activate alpha 1, beta 1, and dopamine receptors. 4 Epinephrine can activate dopamine but not alpha and beta receptors.

3 Dopamine has the ability to activate alpha 1, beta 1, and dopamine receptors. Epinephrine can activate all alpha and beta receptors but cannot activate dopamine. Norepinephrine can activate alpha 2 and beta 1 receptors but not beta 2 or dopamine receptors.

Which statement about drug use among older adults is true? 1 Older adults require higher doses of most drugs. 2 Older adults experience fewer adverse drug reactions. 3 Drug use among older adults is disproportionately high. 4 Older patients are less sensitive to drugs than younger adults.

3 Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions. Because of declining function of the organs that metabolize and excrete medications, older adults require lower doses of most drugs.

When the patient develops anaphylactic shock, which drug does the nurse expect to administer? 1 Ephedrine 2 Isoproterenol 3 Epinephrine 4 Norepinephrine

3 Epinephrine is administered in emergencies and is one of the primary vasoactive drugs used in anaphylactic shock emergencies. Norepinephrine is similar to epinephrine but it does not activate beta 2receptors. It is used in hypotensive states and cardiac arrest. Isoproterenol acts only at beta-adrenergic receptors. It is used to manage atrioventricular heart block and improve outcomes in cardiac arrest to increase cardiac output during shock. Ephedrine promotes beta 2-mediated bronchodilation, so it is beneficial to asthma patients.

What is the advantage of patients having multiple types of receptors to regulate bodily functions? 1 Lower therapeutic index 2 Improved maximal efficacy 3 Higher degree of selectivity 4 Reduction of side effects and toxicity

3 Selectivity is one of the most desirable qualities a drug can have. Many neuropharmacologic drugs are highly selective because the nervous system works through multiple receptors to regulate processes under its control. Having multiple drug receptors does not cause drugs to have a lower therapeutic index, does not improve efficacy, and does not reduce side effects or the risk of toxicity.

A 79-year-old patient who received a beta-adrenergic agonist complains of chest pain. What is the nurse's priority action? 1 Take the patient's temperature 2 Count the patient's respiratory rate 3 Take the patient's blood pressure and pulse 4 Obtain a 12-lead electrocardiogram (ECG) at the bedside

3 Severe physiologic changes occur in the cardiovascular system of the older adult. Therefore, close monitoring is required when administering adrenergic medications. The nurse should first assess the chest pain and take vital signs, especially blood pressure and pulse. The patient's temperature and respiratory rate are less affected by adrenergic medications than blood pressure and pulse. After obtaining vital signs and assessing the pain, the nurse should notify the healthcare provider for further orders such as obtaining an ECG.

A patient takes more than one cholinergic agonist that stimulates muscarinic receptors. Which parameter does the nurse make a priority to monitor to help prevent serious adverse effects of therapy? 1 Lacrimation 2 Bowel pattern 3 Blood pressure 4 Urinary pattern

3 The adverse effects of cholinergic therapy that stimulate muscarinic receptors include orthostatic hypotension. Hence, the nurse monitors the patient's blood pressure for early detection of hypotension. Although muscarinic poisoning is likely to cause increased lacrimal secretion, diarrhea, and urinary frequency, these problems are less important than hemodynamic changes.

The nurse advises a patient who is taking cholinergic drugs to avoid standing quickly and to rise to an upright position slowly. Which complication associated with the drug is the nurse trying to prevent? 1 Dyspnea 2 Muscle cramps 3 Postural hypotension 4 Nausea and vomiting

3 The main adverse effect of cholinergic drugs in the patient is postural hypotension, which results in dizziness and fainting. This effect can be decreased by changing positions slowly when standing. These drugs do not affect muscular function, gastrointestinal function, or respiratory function. Therefore, muscle cramps, nausea or vomiting, and dyspnea are not adverse effects related to cholinergic drugs.

The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? 1 Inhaled albuterol 2 Topical phenylephrine 3 Intravenous epinephrine 4 Subcutaneous terbutaline

3 When beta 1 receptors are activated, cardiac contraction is stimulated. When a beta 1 agonist is indicated, epinephrine (given intravenously) is the preferred drug. Beta 1 agonist drugs (e.g., epinephrine), which are kept on the emergency cart, may be injected directly into the heart during an arrest. Alpha 1 activation causes hemostasis, nasal decongestion, vasoconstriction, and mydriasis. Alpha 2 activation reduces sympathetic outflow to the heart and blood vessels and relieves severe pain. Beta 2 activation causes bronchodilation and relaxation of uterine smooth muscle. Topical phenylephrine (alpha 1activation) is helpful for nasal congestion. Terbutaline (beta 2activation) is indicated for preterm labor and/or asthma. Albuterol (beta 2 activation) is indicated for asthma.

For a drug to be a proven teratogen, which criteria must be met? Select all that apply. 1 The drug should be tested in pregnant women. 2 The drug causes malformation in animal testing. 3 The drug must cause a characteristic set of malformations. 4 The drug must act only during a specific window of vulnerability. 5 The incidence of malformations should increase with increasing dosage and duration of drug exposure.

3,4,5 To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (e.g., weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. Drugs are not tested in pregnant women. Studies in animals may be of limited value, in part because teratogenicity may be species-specific.

Which changes occur in the absorption process because of aging in elderly patients? Select all that apply. 1 Decreased gastric pH 2 Increase in the absorptive surface area 3 Reduced motility in the gastrointestinal tract 4 Increased motor activity in smooth muscles 5 Reduced blood flow to the gastrointestinal tract

3,5 Many age-related changes in the absorptive process occur in elderly patients. There is reduced motility of the gastrointestinal tract due to loss of muscle tone and motor activity or reduction in blood flow of up to 50% to the gastrointestinal tract. The gastric pH is raised as a result of a decrease in acid secretion. The absorptive surface area is reduced secondary to flattening of the villi. The motor activity and the muscle tone of the smooth muscles are reduced.

Which receptors mediate responses to the neurotransmitter acetylcholine? Select all that apply. 1 Beta 2 2 Alpha 1 3 Nicotinic 4 Dopamine 5 Muscarinic

3,5 Receptors that mediate the responses to the neurotransmitter acetylcholine are nicotinic and muscarinic. Beta 2, alpha 1, and dopamine receptors respond to other neurotransmitters, but not acetylcholine.

The nurse is caring for a patient who is taking a cholinergic drug. Which assessment finding indicates that the medication is having the anticipated effect? 1 Mydriasis 2 Urinary retention 3 Vasoconstriction 4 Increased gastrointestinal motility

4

For his asthma, a patient is prescribed albuterol in the form of an inhalant. The patient tells the nurse that the medication causes shakes and hand tremors. What is the nurse's best response? 1 "I will contact your provider about your problem." 2 "The tremors are probably not related to the medication." 3 "I will contact the respiratory therapist about your problem." 4 "Tremors are the most common side effect of this inhalant and will usually fade over time."

4 "Tremors are the most common side effect of this inhalant and will usually fade over time" is the nurse's best response. Initiating therapy at lower doses also can help alleviate tremors. It is important to contact the respiratory therapist and physician if the patient is having any adverse effects that do not subside.

Which clinical indicators should the nurse monitor when a patient takes a cholinesterase inhibitor? 1 Urinary retention 2 Increased heart rate 3 Decreased gastric secretion 4 Increased bronchial constriction

4 By preventing the breakdown of acetylcholine by cholinesterase, cholinesterase inhibitors increase muscarinic receptor activation. This causes bronchoconstriction. Muscarinic stimulation also increases bladder tone (but relaxes urinary sphincters promoting urination), increases gastric secretion, and slows the heart rate.

The nurse assesses a patient who is on cholinergic drug therapy. The nurse finds that the patient has diarrhea, abdominal cramps, and respiratory distress, with a heart rate of 48 beats/min and blood pressure of 98/74 mm Hg. The patient denies taking any other medications. What is the likely reason for the patient's condition? 1 The patient had a drug interaction. 2 The patient had consumed alcohol. 3 The patient had an allergic reaction. 4 The patient had an overdose of the drug.

4 Cholinergic drugs mimic the effects of acetylcholine by binding to cholinergic receptors. An overdose of cholinergic drugs acts directly on the parasympathetic nervous system and activates the nicotinic receptors. An overdose of the drug shows its adverse effect in increased gastrointestinal secretions, which cause abdominal cramps. This drug reduces the heart rate considerably, thereby leading to hypotension. This may also cause atrioventricular block, leading to cardiac arrest. The patient has no history of coadministering medications; therefore, a drug interaction is not the most likely scenario. Alcohol does not interact with cholinergic drugs.

The nurse is preparing to administer a dose of clonidine. Which is the bestdescription of the action of this drug? 1 It depletes sympathetic neurons of norepinephrine. 2 It directly blocks alpha and beta receptors in the periphery. 3 It causes peripheral activation of alpha 1 and alpha 2receptors. 4 It selectively activates alpha 2 receptors in the central nervous system.

4 Clonidine is an alpha 2 adrenergic agonist that causes selective activation of alpha 2 receptors in the central nervous system (CNS). This in turn reduces sympathetic outflow to the blood vessels and the heart. Although the body's responses are similar to those from a peripheral adrenergic blocker, clonidine's action occurs in the CNS.

A nurse is caring for a patient prescribed doxazosin for hypertension. Safety is a priority because of which associated adverse effect? 1 Heart palpitations 2 Reflex tachycardia 3 Cardiac dysrhythmias 4 Orthostatic hypotension

4 Doxazosin is an alpha1 blocker and can cause orthostatic hypotension. Common symptoms include dizziness or lightheadedness on standing, which may impair the patient's balance and increase the risk of a fall. Heart palpitations, reflex tachycardia, and cardiac dysrhythmias are less likely to cause falls.

Which clinical indicators will the nurse monitor as a means of observing the activation of muscarinic receptors? 1 Urinary retention 2 Increased heart rate 3 Decreased gastric secretion 4 Increased bronchial secretion

4 Muscarinic receptor activation causes an increase in secretions from the pulmonary system. Muscarinic stimulation causes contraction of smooth muscle in the bronchi, increases bladder tone (but relaxes urinary sphincters), increases gastric acid secretions, and slows the heart rate.

A patient reports some adverse effects after taking beta blockers. What is the priority complaint the nurse should address? 1 "I check my sugar more often because it has been high." 2 "I feel dizzy when standing quickly, so I have to get up slowly." 3 "I notice that my heart rate doesn't speed up as much when I exercise." 4 "I stopped taking my medicine yesterday because it made me feel tired."

4 Some of the most serious undesirable effects can be caused by acute withdrawal of the drug. For example, such sudden withdrawal may exacerbate underlying angina, precipitate a myocardial infarction, or cause rebound hypertension, which are the most life-threatening, priority effects. Feeling dizzy when standing too quickly is expected because of the cardiac effects. Getting up slowly is the usual recommendation. Blood sugar elevation is expected when taking beta blockers. If exercise intolerance develops as a result of lowered heart rate, the type of activity or the drug can be adjusted; thus, this is not as great a priority as is the risk of problems secondary to suddenly stopping the drug.

Which condition can be managed by administration of succinylcholine? 1 Relief of status epilepticus 2 Pain relief after major surgery 3 Loss of consciousness during surgery 4 Facilitation of endotracheal intubation

4 Succinylcholine is an ultrashort-acting neuromuscular blocker used to facilitate insertion of an endotracheal tube for mechanical ventilation. Because an intact gag reflex can fight tube insertion past the glottis and into the trachea, reflexes can be suppressed temporarily by this short-acting agent. It is not indicated for the treatment of status epilepticus. It does not provide pain relief or loss of consciousness.

Which clinical intervention must be completed before the nurse initiates a continuous intravenous infusion of vecuronium? 1 A Foley catheter has been inserted. 2 A nasogastric tube is in place for suction. 3 Hourly blood glucose levels have been ordered. 4 The patient has been intubated and is on mechanical ventilation.

4 Vecuronium, a neuromuscular blocking agent, can cause respiratory arrest. The nurse must ensure that the patient has an established airway and assisted oxygenation and ventilation before starting the continuous intravenous infusion. A Foley catheter would help prevent incontinence but is not necessary. A nasogastric tube is not essential before initiation of the continuous infusion, but insertion may be considered afterward for gastric suctioning or feeding. Hourly blood glucose levels are unnecessary, because hyperglycemia and hypoglycemia are not adverse effects of vecuronium.