test 2 pharm

9. A patient will begin taking albuterol (Proventil) to treat asthma. The patient has no other chronic medical conditions. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement.

ANS: A High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in patients without diabetes.

17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would warrant holding administration of the drug? a. Decreased bowel sounds b. Drooling c. Gastric upset d. Pain

ANS: A A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus.

10. A patient is taking doxazosin mesylate (Cardura) 1 mg/day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen? a. Changing to a beta-adrenergic blocker b. Decreasing the drug dose c. Increasing the drug dose d. Adding a diuretic

ANS: A Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well controlled.

2. A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because: a. muscarinic receptors are present in many different tissues. b. the action of cholinesterase alters the bioavailability at different sites. c. these drugs can also affect nicotinic receptors. d. they vary in their reversible and irreversible effects.

ANS: A Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors.

9. A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition? a. An anticholinergic b. A cholinergic esterase inhibitor c. A muscarinic agent d. A nicotinic agent

ANS: A Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms.

16. A patient who is intubated develops sinus bradycardia. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin) c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan)

ANS: A Atropine is most commonly used to decrease salivation and respiratory secretions preoperatively and to treat sinus bradycardia by increasing the heart rate.

1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect? a. Increased blood glucose b. Increased blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility

ANS: A Drugs that act on beta2 receptors activate gluconeogenesis in the liver, causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility.

13. Reserpine would be best categorized as which of the following? a. Adrenergic neuron antagonist b. Alpha blocker c. Beta blocker d. Alpha agonist

ANS: A Drugs that block the release of norepinephrine from the sympathetic terminal neurons are called adrenergic neuron antagonists (adrenergic neuron blockers). The clinical use is to decrease blood pressure. For example, reserpine is an antihypertensive agent that closely resembles alpha- and beta-adrenergic blockers; it also reduces the serotonin and catecholamine transmitters, depletion of which may lead to severe mental depression.

4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has: a. overused the albuterol. b. not been using albuterol. c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor.

ANS: A High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may overuse their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.

6. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient? a. Stop using the medication after 3 days. b. Spray the medication into the nose while lying supine. c. Use frequently since systemic side effects do not occur. d. Use the medication with any other over-the-counter medications

ANS: A Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications.

5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. "Excessive sweating is a normal reaction to this medication." b. "Excess salivation is a serious side effect." c. "I should get out of bed slowly while taking this drug." d. "I will not take the drug if my heart rate is less than 60 beats per minute."

ANS: A Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low

8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider? a. Absent bowel sounds b. Drowsiness c. Dry mouth d. Heart rate of 78 beats per minute

ANS: A These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful.

6. The nurse is caring for a male patient with myasthenia gravis who will begin taking neostigmine. When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection

ANS: A This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction. The severity of the benign prostatic hypertrophy would need to be investigated prior to administration.

The nurse caring for a patient who is taking an adrenergic agonist will expect which side effects? (Select all that apply.) a. Dilated pupils b. Increased heart rate c. Increase gastrointestinal motility d. Vasodilation e. Bronchospasm

ANS: A, B Adrenergic agonists stimulate the sympathetic nervous system, evoking the "fight or flight" response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the gastrointestinal tract, as digestion is not critical during a fight or flight response.

3. The nurse administers epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect which of the following? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting

ANS: B Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur.

2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be the safest to give this patient? a. Pindolol (Visken) b. Metoprolol (Lopressor) c. Nadolol (Corgard) d. Propranolol (Inderal)

ANS: B Metoprolol is a cardioselective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction.

13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson disease. When performing an assessment, which aspect of the patient's history would cause the nurse to hold the medication and notify the provider? a. Asthma b. Glaucoma c. Irritable bowel syndrome d. Motion sickness

ANS: B Patients who have glaucoma should not take anticholinergic medications.

4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patient's blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider.

ANS: B The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose

7. The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication? a. The drug must be taken twice daily. b. The patient must rise slowly from a chair or bed. c. The medication is safe to take during pregnancy. d. Use NSAIDs as needed for mild to moderate pain.

ANS: B The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided.

Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils

ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs.

All of the following are true about dopamine and dobutamine, except: A. They bind to both alpha- and beta-receptors B. They can increase heart rate and cause bronchoconstriction C. Dopamine is the sympathomimetic of choice for shock D. Administration of these drugs can put patients with peripheral cardiovascular disease into exacerbation

ANS: B. They can increase heart rate and cause bronchoconstriction Dopamine and dobutamine are alpha- and beta-receptors. They can increase the heart rate and cause bronchodilation as well as increasing the rate and depth of respirations. They can put patients with peripheral CV disease into exacerbation because of their vasoconstrictive effects. Lastly, dopamine is the sympathomimetic of choice for shock.

A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching? a. "Alpha-adrenergic antagonists block alpha1receptors on arterioles and veins." b. "Dilation of arterioles has a direct effect on arterial pressure." c. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output." d. "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure."

ANS: C Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha1receptors on arterioles and veins. When alpha1receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct effect on arterial pressure occurs. When alpha1receptors on veins are blocked by alpha-adrenergic antagonists, an indirect effect on arterial pressure occurs.

1. The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug: a. acts on muscarinic receptors. b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors.

ANS: C Agents that inhibit cholinesterase, which is the enzyme that breaks down acetylcholine, indirectly enhance the actions of acetylcholine.

14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patient's bladder. d. Reassess the patient in 15 minutes.

ANS: C Atropine can cause urinary retention. The patient's urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration.

12. A patient will be discharged home on a beta blocker. Which skill is essential for the nurse to teach the patient's family? a. How to prepare a low-sodium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness

ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

8. The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do? a. Hold the next dose until the provider can be notified of these side effects. b. Reassure the patient that these symptoms are common and not worrisome. c. Recommend that the patient discuss these effects with the provider. d. Suggest that the patient request a different beta-adrenergic blocker

ANS: C Beta-adrenergic blockers can cause these side effects, which are often dose related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose related, reassuring the patient is not correct. All beta blockers have similar side effects.

11. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimer disease? a. Ambenonium chloride (Mytelase) b. Benztropine (Cogentin) c. Donepezil HCl (Aricept) d. Neostigmine methylsulfate (Prostigmin)

ANS: C Donepezil is used to treat Alzheimer disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinson disease.

12. The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine. What information will the nurse include when teaching this patient? a. "Apply the patch as needed for nausea and vomiting." b. "Apply the patch to your upper arm." c. "Change the patch every 3 days." d. "Restrict fluids while using this patch."

ANS: C The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids.

The sympathomimetic found in many OTC cold products: A. salmeterol B. albuterol C. phenylephrine D. terbutaline

ANS: C. phenylephrine Phenylephrine is often found in OTC allergy and cold preparations so primary caregivers should be instructed to check labels for ingredients and not combine drugs with similar ingredients

11. A patient who has Raynaud's disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynaud's disease by causing: a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation.

ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disorders like Raynaud's disease because they cause vasodilation.

7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson disease. The nurse understands that this drug is used primarily for which purpose? a. To decrease drooling and excessive salivation b. To improve mobility and muscle strength c. To prevent urinary retention d. To suppress tremors and lessen muscle rigidity

ANS: D Anticholinergic drugs are used in Parkinson disease mainly to reduce tremors and muscle rigidity

10. The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication? a. "Check your heart rate frequently to monitor for bradycardia." b. "Drink extra fluids while you are taking this medication." c. "Rise from a chair slowly to avoid dizziness when taking this drug." d. "Use gum or lozenges to decrease dry mouth caused by this drug."

ANS: D Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not necessarily increase fluid intake.

3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure.

ANS: D Bethanechol treatment can result in hypotension. The nurse should hold the drug and notify the provider of the low blood pressure.

5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurse's initial action? a. Apply warm soaks to the area. b. Monitor the patient closely for hypertension. c. Obtain an order for an electrocardiogram. d. Notify the provider of a neeNd for phentolamine mesylate (Regitine).

ANS: D Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

15. A patient who has Parkinson disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson disease would be a contraindication for this drug? a. Drooling b. Muscle rigidity c. Muscle weakness d. Myasthenia gravis

ANS: D Myasthenia gravis is a contraindication for this drug.

15. The patient has been ordered to receive pseudoephedrine (Sudafed) to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for the nurse to take? a. Administer the medication as ordered. b. Contact the provider to discuss a lower dose. c. Give the medication and monitor serum glucose closely. d. Hold the medication and contact the provider.

ANS: D Sympathetic drugs should be used with caution in patients with diabetes. The nurse should verify the order with the provider before administration.

14. A patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak and fatigued. Which is the best response from the nurse? a. "I will hold your next dose of the medication." b. "You may need an increase in your next dose of the medication." c. "This is an adverse reaction to the medication. I will stop the drug." d. "This is a side effect of the medication. I will notify your physician."

ANS: D Weakness and fatigue can be a side effect of atenolol. Beta blockers should not be stopped abruptly.

A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching? a. "Catecholamines may be given orally." b. "Catecholamines often require continuous infusion to be effective." c. "Non-catecholamines do not cross the blood-brain barrier." d. "Non-catecholamines undergo rapid degradation by monoamine oxidase."

ANS:B Catecholamines undergo rapid degradation by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). Consequently, they have a brief duration of action, and continuous infusion often is required to maintain the drug's effects. Catecholamines cannot be used orally. Catecholamines do not cross the blood-brain barrier; non-catecholamines do

This drug is used to control hypertension and is used as an epidural infusion for patients suffering from cancer pain. A. midodrine B. clonidine C. albuterol D. isoproterenol

Ans: B. clonidine

Which of the following drugs can improve urine flow in males? A. prazosin B. nebivolol C. labetalol D. amiodarone

Answer: A. prazosin Prazosin, a selective alpha1-receptor adrenergic antagonist, can improve urine flow in male patients and are used as treatment for benign prostatic hypertrophy (BPH). This is because they can block smooth muscle receptors in the genitourinary tract which leads to relaxation of prostate and bladder.

A pregnant patient on 32 weeks age of gestation came rushing to the emergency complex because of increased watery discharge and frequent uterine contractions. Upon physical examination, patient was confirmed to have ruptured of membranes and is in preterm labor. Which of the additional PE findings will render beta-agonists contraindicated as part of her management for uterine relaxation? A. HbA1c of 6 B. blood pressure of 150/70 mmHg and +3 proteinuria C. BUN: 10 mg/dL D. few to many pus cells in urinalysis

Answer: B. blood pressure of 150/70 mmHg and +3 proteinuria

Which drug is a direct-acting sympathomimetic? a. Epinephrine b. Amphetamine c. Ephedrine d. Albuterol

a Rationale: A direct-acting sympathomimetic binds directly to the receptor and causes a physiologic response. Epinephrine is an example of a direct-acting sympathomimetic. An indirect-acting sympathomimetic causes the release of the catecholamine from the storage sites (vesicles) in the nerve endings; it then binds to the receptors and causes a physiologic response. Amphetamine and other related anorexiants are examples of indirect-acting drugs. A mixed-acting sympathomimetic both directly stimulates the receptor by binding to and indirectly stimulates the receptor by causing the release of the neurotransmitter stored in vesicles at the nerve endings. Ephedrine is an example of a mixed-acting adrenergic drug. Noncatecholamine adrenergic drugs such as phenylephrine, metaproterenol, and albuterol are structurally dissimilar to the endogenous catecholamines and have a longer duration of action than either the endogenous or synthetic catecholamines. The noncatecholamine drugs show similar patterns of activity.

Which adrenergic-blocking drugs block only the betal-receptors on the surface of the heart? a. Cardioselective betal-blockers b. Nonselective beta-blockers c. Beta-2-blockers d. Alpha-blockers

a Rationale: Beta-blockers that are selective for receptors located in the heart are called cardioselective beta-blockers or beta-1-blocking drugs. Cardioselective betal-blockers block the betal-receptors on the surface of the heart. Other beta-blockers inhibit both beta-1- and beta-2-adrenergic receptors and are referred to as nonselective beta-blockers. Beta-2-receptors are located primarily on the smooth muscles of the bronchioles and blood vessels. The alpha-adrenergic-blocking drugs, or alpha-blockers, interrupt stimulation of the sympathetic nervous system at the alphal-adrenergic receptors.

Which alpha-blocker is beneficial in the treatment of frostbite? a. Phenoxybenzamine b. Phentolamine c. Tamsulosin d. Propranolol

a Rationale: Phenoxybenzamine is an alpha-blocker that is beneficial in the treatment of frostbite (and other conditions), in which patients have increased endogenous alpha -ad renergic agonist activity, which results in vasoconstriction. Phentolamine (Regitine) is an alpha-blocker that reduces peripheral vascular resistance and is also used to treat hypertension. Tamsulosin (Flomax), also an alpha-blocker, is used primarily to treat benign prostatic hyperplasia and is indicated for male patients. Propranolol (Inderal) is the prototypical nonselective beta-1-and beta-2-blocking drug.

Which time range specifies the peak plasma concentration of sotalol? a. 2.5 to 4 hours b. 2 to 4 hours c. 3 to 6 hours d. 6 to 20 hours

a Rationale: Sotalol (Betapace) is nonselective beta-blocker that has very potent antidysrhythmic properties. Sotalol is available only for oral use, and its peak plasma concentration is 2.5 to 4 hours. Propranolol's peak plasma concentration is 2 to 4 hours for the intravenous route, 3 to 6 hours for the immediate-release oral formulation, and 6 to 20 hours for the extended-release oral formulation.

Which effect happens when beta blockers are coadministered with anticholinergics? a. Reduced beta-blocker effect b. Increased blood glucose levels c. Enhanced effect of anticholinergics d. Prolonged neuromuscular blockade

a Rationale: When beta blockers are coadministered with anticholinergics, antagonism occurs, leading to a reduced beta-blocker effect. Anticholinergics do not affect blood glucose levels. Beta blockers do not enhance the effect of anticholinergics. A prolonged neuromuscular blockade occurs when beta blockers interact with neuromuscular blocking drugs.

Where are beta-2-adrenergic receptors located in the body? Select all that apply. One, some, or all responses may be correct. a. Arterioles b. Bronchioles c. Visceral organs d. Bladder sphincter e. Pupillary muscles of the iris

a, b, c Rationale: Beta-2-adrenergic receptors are located in the arterioles, the smooth muscles of the bronchioles, and the visceral organs. Alphal receptors are located in the bladder sphincter and pupillary muscles of the iris.

Which is an example of endogenous catecholamines? Select all that apply. One, some, or all responses may be correct. a. Dopamine b. Epinephrine c. Dobutamine d. Phenylephrine e. Norepinephrine

a, b, e Rationale: Dopamine, epinephrine, and norepinephrine are endogenous catecholamines that are synthesized in the body. Dobutamine and phenylephrine are synthetic catecholamines that are administered into the body to treat disorders caused by the deficiency of endogenous catecholamines.

Which adrenergic receptors are primarily located in the heart? a. Alpha-1 b. Beta-1 c. Alpha-2 d. Beta-2

b Rationale: Adrenergic receptors are divided into alpha-adrenergic receptors and beta-adrenergic receptors, depending on the specific physiologic responses caused by their stimulation. Both types of adrenergic receptors have subtypes, designated 1 and 2, which control stimulation and blockade, vasoconstriction and vasodilation of blood vessels, and the increased and decreased production of various substances. The beta-adrenergic receptors are all located on postsynaptic effector cells. The betal-adrenergic receptors are primarily located in the heart. The alpha-1-adrenergic receptors are located on postsynaptic effector cells—the tissue, muscle, or organ that the nerve stimulates. The alpha-2-adrenergic receptors are located on the presynaptic nerve terminals. They control the release of neurotransmitters. The predominant alpha-adrenergic agonist response is vasoconstriction and central nervous system stimulation. The beta-2-adrenergic receptors are located in smooth muscle fibers of the bronchioles, arterioles, and visceral organs. A beta-adrenergic agonist response results in bronchial, gastrointestinal, and uterine smooth muscle relaxation, glycogenolysis, and cardiac stimulation.

Which black box warning is shared for beta-blockers? a. May cause tachycardia b. Should not be withdrawn abruptly but tapered over 1 to 2 weeks c. Accelerated recovery from hypoglycemia in patients with type 1 diabetes d. May cause diarrhea

b Rationale: All beta-blockers share a black box warning stating that therapy should not be withdrawn abruptly but should be tapered over 1 to 2 weeks. Nonselective beta-blockers are known to mask symptoms of tachycardia. Sudden withdrawal may exacerbate underlying angina, precipitate a myocardial infarction, or cause rebound hypertension. Beta-blockers also delay recovery from hypoglycemia in patients with type 1 diabetes. The most common adverse effects of beta-blockers include bradycardia, depression, impotence, constipation, and fatigue; diarrhea is not a side effect.

During a cardiopulmonary resuscitation emergency, the nurse expects to administer which injectable, fast-acting medication? a. Salmeterol b. Epinephrine c. Naphazoline d. Oxymetazoline

b Rationale: Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life-support protocols. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. Salmeterol is given via the respiratory tract because of its affinity for beta-2 receptors that act on the lungs.

Drugs in which class may interact with adrenergic drugs? a. Opioids b. Thyroid preparations c. Non-steroidal anti-inflammatory drugs d. Selective serotonin reuptake inhibitors

b Rationale: Thyroid preparations can increase the effects of adrenergic drugs. Opioids, selective serotonin reuptake inhibitors, and nonsteroidal antiinflammatory drugs do not have reported interactions with adrenergic drugs.

Which condition is an absolute contraindication to taking beta blockers? a. Pregnancy b. Heart failure c. Drug allergy d. Raynaud's disease

c Rationale: A drug allergy is an absolute contraindication due to the risk of anaphylaxis. Pregnancy, heart failure, and Raynaud's disease are not absolute contraindications but may be contraindications depending on the degree of symptoms due to the condition.

Which assessment would be completed prior to administering an adrenergic agonist? a. Skin integrity b. Temperature c. Blood pressure d. Respiratory rate

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

Which effect is a result of betal-adrenergic-receptor stimulation? a. Mydriasis b. Ejaculation c. Vasoconstriction d. Increased renin secretion

d Rationale: Beta-1-adrenergic-receptor stimulation causes increased renin secretion. Mydriasis, ejaculation, and vasoconstriction are the result of alphal-adrenergic-receptor stimulation.

Which response is elicited by the activation of betal receptors located on the sinoatrial node? a. Vasodilation b. Vasoconstriction c. Increased heart rate d. Increased contractility

c Rationale: Increased heart rate is the response elicited by the activation of beta receptors located on the sinoatrial node. Vasodilation is a response elicited by the activation of beta-2 receptors located on the blood vessels. Vasoconstriction is a response elicited by the activation of alpha-1 receptors located on the blood vessels. Increased contractility is a response elicited by the activation of beta-1 receptors of the cardiac muscle.

Which route is used to administer tamsulosin? a. Intravenous b. Intradermal c. Oral d. Subcutaneous

c Rationale: Tamsulosin is an alpha-blocker used primarily to treat benign prostatic hyperplasia and is available only for oral use. Phentolamine, also an alpha-blocker, reduces peripheral vascular resistance and treats hypertension; it is available for intravenous, intradermal, and subcutaneous injection.

Which primary location are the betal-adrenergic receptors found in? a. Muscle b. Tissue c. Heart d. Blood vessel

c Rationale: The beta-1-adrenergic receptors are located primarily in the heart. The alphal-adrenergic receptors are located on the tissue, muscle, or organ that a nerve is stimulating. The beta-2-adrenergic receptors are located primarily on the smooth muscles of the bronchioles and blood vessels.

The patient is prescribed a beta-blocker medication and takes it with an aluminum hydroxide- type antacid at the evening meal. This regimen will result in which interaction? a. Increased beta-blocker activity b. Increased effect of the antacid c. Decreased beta-blocker activity d. Decreased effect of the antacid

c Rationale: The interaction of a beta blocker and an aluminum hydroxide antacid is likely to result in a decrease in the activity of the beta-blocker medication.

Which effect may be seen when adrenergic drugs are administered with monoamine oxidase inhibitors (MAOIs)? a. Reduced therapeutic effects b. Increased risk for cardiac dysrhythmias c. Increased effects of adrenergic drugs d. Increased risk of hypertensive crisis

d Rationale: Numerous drug interactions can occur with adrenergic drugs. Administration of adrenergic drugs with MAOIs may cause a possibly life-threatening hypertensive crisis. When alpha- and beta-adrenergic drugs are given with adrenergic antagonists, such as some classes of antihypertensive drugs, the drugs directly antagonize each other, resulting in reduced therapeutic effects. Administration of adrenergics with anesthetic drugs may increase the risk for cardiac dysrhythmias. Antihistamines and thyroid preparations can also increase the effects of adrenergic drugs.

Which adrenergic-blocking drug is used for treating persistent migraines? a. Esmolol b. Carvedilol c. Metoprolol d. Propranolol

d Rationale: Propranolol is used to treat migraines. Esmolol is a very strong short-acting betal blocker. It is primarily used in acute situations to provide rapid, temporary control of the ventricular rate in patients with supraventricular tachydysrhythmias. Carvedilol has many effects, including acting as a nonselective beta blocker, an alphal blocker, a calcium channel blocker, and possibly an antioxidant. It is used primarily in the treatment of heart failure but is also beneficial for hypertension and angina. Metoprolol is a commonly used betal blocker that increases survival in patients who have experienced a myocardial infarction.