Pharmacology: Chapter 30: Adrenergic Agonists

A client has been unable to lose weight through dietary changes and has inquired about the use of ephedra for this purpose. What should the nurse teach the client?

"Ephedra is known to have a lot of serious risks. Confirm with your provider, but it's likely best avoided."

The nurse is assessing a client who has been prescribed midodrine and learns that the client has a history of chronic renal failure. What should the nurse do?

Ensure that the prescriber is aware of this

A client has been treating his seasonal rhinitis with an adrenergic agonist that he has been purchasing at his local pharmacy. Which medication may the client be using?

Ephedrine

The nurse is preparing discharge teaching for four clients. Which client should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided?

A 47-year-old woman with hypertension

The client has been taking clonidine and is now being changed to another antihypertensive drug. How should the nurse instruct the client regarding discontinuing the clonidine?

"Reduce clonidine gradually over 2 to 4 days." Feedback: Do not discontinue clonidine abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper drug over 2 to 4 days. It is not necessary to teach the patient to check blood pressure and pulse every 2 to 4 hours, discuss plans for changing medications with the family, or prepare the patient for severe headaches.

A client with primary hypertension has been prescribed clonidine. What should the nurse teach the client about potential adverse effects?

"There's a possibility that this drug might give you strange dreams."

The clinic nurse is teaching a client about transdermal clonidine, which has just been prescribed. What information should the nurse teach the client?

-"Rotate the site where the patch is placed." -"Monitor your blood pressure at least once per day." -"Keep your provider informed of any new diagnoses or medications."

The nurse is preparing to administer a client's scheduled ophthalmic adrenergic agonist. What actions should the nurse perform?

-Perform hand hygiene prior to administration -Instruct the client not to rub the eyeball after administration of the drops

A 4-year-old girl is prescribed an albuterol inhaler for her asthma. What is the recommended safe dosage for this client?

1.25 to 2.5 mg b.i.d

The nurse receives a prescription to begin a dopamine infusion at 5 mcg/kg/minute. The client weighs 50 kg. Each milliliter of solution contains 3 mg of dopamine. How many mL/hour should the nurse set the pump to deliver?

5 mL/h Feedback: To calculate this dosage, multiply the ordered mcg by the weight (5 ×50 kg) to yield mcg/min (250 mcg/min) and then multiply this times 60 to get mcg/h (250 ×60 = 15,000 mcg/h). Convert mcg/h to mg/h (15,000/1,000 = 15 mg/h). Set up ratio (3 mg/1 mL = 15 mg/X mL) and cross multiply (3X = 15 mg). Divide both sides by 3 to yield 5 mL/h to deliver 5 mg/kg/min.

A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The client weighs 12.5 kg. What would be the minimum effective dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV?

62.5 mcg

What client would be most likely to benefit from the administration of a beta 2-specific adrenergic agonist?

A client who is having an exacerbation of chronic bronchitis

What client receiving an adrenergic agonist should the nurse assess first?

A client who is receiving an isoproterenol infusion

What client is exhibiting an expected assessment finding after the administration of a sympathomimetic drug?

A client whose respiratory rate has changed from 9 to 18 breaths/minute

A nurse is reviewing the therapeutic use of adrenergic agonists. When reviewing their use in clients of differing ages, what principle should guide the nurse's actions?

Adrenergic agonists can be used for varied indications across the lifespan

The nurse calculates the infusion rate for administering dopamine to a premature infant in the neonatal intensive care unit who is in cardiogenic shock secondary to a cardiac anomaly. What is the nurse's next priority action?

Ask another nurse to perform independent calculation

An older adult has been prescribed midodrine. What is the most important nursing action to include in the plan of care for this client?

Assess positional blood pressures

The nurse administered a hospital client's scheduled dose of clonidine PO 30 minutes ago. How should the nurse best assess for therapeutic effect?

Assess the client's blood pressure

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

A nurse receives an order for clonidine for a 25-year-old pregnant woman with poorly controlled hypertension. What is the nurse's priority action?

Consult with the prescriber about the order

The client with a complex health history has been medication affecting both alpha- and beta-receptor sites in the past. What medications would the nurse include in this category? Select all that apply. a. Dobutamine b. Epinephrine c. Dopamine d. Clonidine e. Albuterol

Dobutamine Epinephrine Dopamine

The nurse is writing a plan of care for a client receiving an alpha-specific adrenergic agonist. What is the priority component of client's plan of care?

Monitoring blood pressure and heart rate frequently

The perioperative nurse is caring for a client who is undergoing surgery. What drug should the nurse expect the client to be given if beta-specific adrenergic effects are desired to prevent bronchospasm during anesthesia?

Isoproterenol

The nurse is caring for a male client who is taking a monoamine oxidase inhibitor (MAOI). The client reports seasonal rhinitis, and the intern orders phenylephrine nasal spray. What is the nurse's priority action?

Question the order with the prescriber.

The nurse is preparing to administer a sympathomimetic drug to a client. The nurse is aware that this drug will achieve a therapeutic effect by:

Stimulating alpha- and beta-receptors.

When transcribing new orders for sympathomimetic medications prescribed for a geriatric client, the nurse expects the dosage will be what?

The lowest possible effective dosage Feedback: Older patients should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. Other options are incorrect.

The nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically?

The nurse gently rests the tip of the dropper against the lower eyelid Feedback: First, wash hands thoroughly. Do not touch the dropper to the eye or to any other surfaces. Have the patient tilt his or her head back or lie down and stare upward. Gently grasp the lower eyelid and pull the eyelid away from the eyeball. Instill the prescribed number of drops into the lower conjunctival sac and then release the lid slowly (Fig. 30.1). Have the patient close the eye and look downward. Apply gentle pressure to the inside corner of the eye for 3 to 5 minutes. Do not rub the eyeball and do not rinse the dropper. If more than one type of eyedrop is being used, wait 5 minutes before administering the next one.

The nurse is preparing to give isoproterenol parenterally. What should the nurse do to best protect the client's safety?

Wrong answer Confirm there is no immediate plan to intubate the client

A client in the cardiac intensive care unit has been prescribed a dobutamine infusion at 2.5 mcg/kg/minute. Knowing that the client weighs 62 kg and the medication is provided at a concentration of 1,000 mcg/mL, at what rate should the client's IV pump be set in mL/hour? Provide your answer to one decimal place.

Wrong answer 250

The nurse is admitting a client with a complex health history who will be prescribed midodrine. The nurse should call the provider to discuss the potentially dangerous combination of midodrine and what drug?

Wrong answer Hydrochlorothiazide

A client is admitted to the emergency department with signs and symptoms of cardiogenic shock. Isoproterenol is administered intravenously. What assessment should the nurse prioritize when monitoring for therapeutic effects?

blood pressure

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

A client in cardiogenic shock is receiving an infusion of dopamine when it is discovered that extravasation has occurred. What action is most appropriate? a.Discontinue the medication and administer a bolus of 250 mL of an isotonic solution b.Administer 4 to 6 mg acetylcysteine IV as prescribed to preserve tissue integrity c.Remove the IV cannula and irrigate the site with normal saline d.Administer dilute phentolamine to the site, as prescribed

d.Administer dilute phentolamine to the site, as prescribed

The nurse is caring for a client who is receiving an intravenous infusion of dobutamine. What nursing diagnosis has most likely prompted this intervention?

decreased cardiac output

An adult client has just been prescribed salmeterol. The nurse should teach the client to:

take one inhalation, twice per day.