Karch - Adrenergic Module 2

A nurse is caring for a client who has been receiving an adrenergic medication. Which statement by the client alerts the nurse about an adverse effect of the medication and a reason to call the prescriber?

"I feel a "fluttering" feeling in my heart." Management of the client receiving an adrenergic agent varies and depends on the medication being used, the reason for administration, and the client's response to the drug. Nursing judgment is necessary when reporting adverse reaction. Report adverse effects such as the development of cardiac arrhythmias immediately regardless of the time of day or night. A report of a nervous feeling, or concern about the hospitalization need not be dealt with on an emergent basis. The client is not experiencing an allergic reaction.

Which client is most likely to benefit from the administration of an adrenergic agonist?

A man who is in cardiogenic shock following a myocardial infarction One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.

A client is being treated for asthma. What would the nurse expect to administer?

Beta-2-specific adrenergic agonist Most of the beta-specific adrenergic agonists are beta-2-specific adrenergic agonists, which are used to treat and manage bronchial spasm, asthma, and other obstructive pulmonary conditions.

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?

Beta-adrenergic blocking drugs Beta-adrenergic blocking drugs prevent epinephrine and norepinephrine from occupying receptor sites on cell membranes. Beta-adrenergic drugs stimulate epinephrine and norepinephrine release so that they can occupy more of the receptor sites. Beta Blocking agonist cause epinephrine to bind to sites causing airways to open. There is no such thing as beta-helping drugs.

A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective?

Bronchodilation A beta-specific agonist would lead to bronchodilation. A beta-specific agonist would cause an increased heart rate. Tremor is an adverse effect of a beta-specific agonist. A beta-specific agonist would increase cardiac conductivity.

A patient has been administered dobutamine HCL. Which adverse reactions should the nurse monitor for in the patient?

Cardiac arrhythmias The nurse should monitor for cardiac arrhythmias (bradycardia and tachycardia) because they are common adverse reactions observed in patients being administered dobutamine HCL. Dobutamine HCL does not cause urinary retention, elevated temperature, or sleeplessness.

A nurse is caring for an elderly patient who is to be administered isoproterenol. Which change monitored in the patient should the nurse report immediately to the primary health care provider?

Changes in pulse rate The nurse should report any changes observed in pulse rate or rhythm immediately. Changes in glucose level, appetite, or temperature need not be reported immediately to the primary care provider unless they are severe.

Which agent would the nurse identify as being available in a transdermal form?

Clonidine Clonidine is available in an oral and transdermal form. Midodrine is available in oral form only. Phenylephrine is available in parenteral forms, topical forms, and ophthalmic forms. Salmeterol is available in an inhalation form.

A nurse suspects that a client is experiencing shock based on which assessments? Select all that apply.

Cyanosis Disorientation Tachypnea Signs and symptoms of shock include cyanosis; cold, clammy skin; diaphoresis; a change in the level of consciousness such as disorientation; tachypnea; and a urine output less than 20 mL/hr.

Which would the nurse identify as a naturally occurring catecholamine?

Dopamine Dopamine is a naturally occurring catecholamine. Dobutamine, ephedrine, and metaraminol are synthetic catecholamines.

Which herbs has been removed from most weight-loss medications due to potential legal liability?

Ephedra Ephedra has serious adverse reactions, such as hypertension and irregular heart beat. These side effects have been associated with stroke and heart attacks. The Food and Drug Administration has warnings against taking weight-loss pills that have ephedra in them. Gingko, ginseng, and rose hips have not had these serious side effects.

An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist?

Epinephrine Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist.

Which would the nurse expect to be given to a client experiencing acute bronchospasm?

Epinephrine Epinephrine would be used to treat bronchospasm. Dopamine is indicated for the treatment of congestive heart failure. Metaraminol is used to treat shock if norepinephrine or dopamine cannot be used. Norepinephrine is used to treat shock and during cardiac arrest to promote sympathetic activity.

An increased dosage of digoxin would be needed if the patient is also taking midodrine.

False Midodrine can precipitate increased drug effects of digoxin; this combination should be avoided.

The nurse is reviewing the history of a patient who is to receive midodrine. Which would alert the nurse to a contraindication for the drug?

Glaucoma Glaucoma is a contraindication for the use of midodrine, an alpha-specific adrenergic agonist, because the condition could be exacerbated by the arterial constriction. Thyrotoxicosis requires cautious use of midodrine, an alpha specific adrenergic agonist. Diabetes requires cautious use of midodrine, an alpha specific adrenergic agonist. Vasomotor spasm requires cautious use of midodrine, an alpha-specific adrenergic agonist.

Adrenergic drugs produce which effect?

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

A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?

Inhalation Salmeterol, a beta-specific adrenergic agonist, is administered by inhalation.

The nurse would contact the health care provider before administering an adrenergic drug to a client who is also taking which drug?

MAO inhibitor Adrenergic drugs are contraindicated in clients taking MAO inhibitors. It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Concurrent use of MAO inhibitors and adrenergic drugs may lead to a danger of cardiac dysrhythmias, respiratory depression, and acute hypertensive crisis, with possible intracranial hemorrhage, convulsions, coma, and death.

Ephedrine and ephedra-containing herbal preparations are often abused as an alternative to amphetamines. What substances are identified as herbal preparations? (Select all that apply.)

Ma huang Herbal ecstasy Ephedrine and ephedra-containing herbal preparations (e.g., ma huang, herbal ecstasy) are often abused as an alternative to amphetamines.

The nurse is reviewing the medical record of a client who is taking an alpha- and beta adrenergic agonist. What would be of least concern to the nurse?

St. John's wort Alpha- and beta-adrenergic agonists interact with caffeine, ma huang, and OTC cold preparations, increasing the risk for hypertension. St. John's wort has not been shown to interact with these agents.

Which agent would the nurse expect to find when reviewing over-the-counter allergy products?

Phenylephrine Phenylephrine is found in many cold and allergy products because it is so effective in constricting topical vessels and decreasing the swelling and signs and symptoms of rhinitis.

Which would a nurse expect as a possible adverse effect when administering a beta-specific adrenergic agonist? (Select all that apply.)

Restlessness Headache Adverse effects of beta-specific adrenergic agonists include restlessness, tachycardia, headache, GI upset, muscle cramps, and pupil dilation.

The adrenergic branch of the autonomic nervous system is also known by which name?

Sympathetic nervous system The sympathetic nervous system is also known as the adrenergic branch.

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider?

Systolic blood pressure below 100 mm Hg The nurse must immediately report to the health care provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats per minute, and a temperature reading of 97.6°F are normal and need not be reported immediately.

Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.

True

Phentolamine is the agent used to treat extravasation of dobutamine.

True Maintain phentolamine on standby in case extravasation occurs.

While educating a client on the use of midodrine (ProAmatine) the nurse should tell the client to report which changes? (Select all that apply.)

Vision changes Bradycardia Difficulty urinating Client taking midodrine should be told by the nurse to report any of the following reactions: vision changes, pounding head when lying down, bradycardia, or difficulty urinating.

A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?

assess heart rate. The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would some need to check blood glucose, measure urinary output and respiratory although monitored it is not the priority measure.

Epinephrine causes relaxation of:

bronchioles Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.

Adrenergic drugs increase the potential risk for what adverse effect?

cardiac dysrhythmias Adrenergic drugs can cause possible irritable cardiac dysrhythmias due to beta1 activity. They have no appreciable effect on intestinal wall muscles and do not cause decreased level of consciousness. Adrenergic drugs can cause an increase, not decrease, in blood sugar levels.

Which medication will most likely be administered to a client experiencing anaphylaxis?

epinephrine Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine used to treat severe hypotension and shock that persists after adequate fluid volume replacement. Acetylcysteine is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.

A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:

increase blood pressure. For a client in shock, dopamine helps to increase blood pressure. The alpha stimulation produces increased peripheral resistance, raising the blood pressure as the dose of dopamine increases. The drug's dosage is titrated upward until adequate perfusion of vital organs is achieved. Beta-1 stimulation produces increased cardiac output by increasing the force of contraction and heart rate. The drug does not have a direct effect on body temperature.

An adrenergic drug would be prescribed to produce what physiological effect?

increased heart rate Adrenergic drugs cause an increase in heart rate and respiratory rate. They do not directly induce urinary incontinenceurine concentration, and they do not reduce blood pH.

A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?

increased vasoconstrictive effects Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction.

A client is taking an OTC allergy product. The nurse would expect to find that this product most likely contains:

phenylephrine Phenylephrine is a common agent found in many OTC cold and allergy products. Ephedra has been banned by the Food and Drug Administration as a drug. Neither epinephrine nor albuterol are found in OTC products.

Adrenergic drugs mimic the effects of stimulating what part of the nervous system?

sympathetic An adrenergic drug is an agent that produces effects like those produced by stimulation of the sympathetic nervous system and therefore has widespread effects on body tissues.

The nurse is teaching a client about safe use of adrenergic drugs. Which statement should be included in the teaching?

"Talk to your health care provider before taking any other medications." Clients taking adrenergic drugs should be instructed to take no other medications without their HCP's knowledge and approval. Many over-the-counter cold remedies and appetite suppressants contain adrenergic drugs, and use of these along with prescribed adrenergic drugs can result in overdose and serious cardiovascular or central nervous system problems. In addition, adrenergic drugs can interact with numerous other drugs to increase or decrease effects. Patients who are allergic to sulfites should alert their health care providers, since adrenergic drugs are contraindicated in that population.

A nurse is caring for a 25-year-old client who is being given an adrenergic drug for shock. Which action should the nurse do?

Continually assess the client for physiological changes and notify the primary care provider with changes. When caring for a client receiving an adrenergic medication for shock, the nurse will continually assess the client for changes in his vital signs, perfusion, and any adverse reactions. Telling a family that their loved one might die is not an appropriate nursing action at that time. Seizures, hypothermia, and dementia are not common side effects of adrenergic medications, and an adrenergic medication should not be abruptly stopped. The nurse needs to stay close to a client to do frequent assessments; sleep deprivation may occur, but it is not the primary concern when a client is in shock.

Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

A 47-year-old female with hypertension Phenylephrine is an alpha-1 adrenergic agonist and a drug commonly used topically for relief of nasal and nasopharyngeal mucosal congestion and to produce mydriasis for ophthalmologic procedures. Phenylephrine acts as a vasopressor causing vasoconstriction of the arterioles. The vasoconstriction from phenylephrine use can increase peripheral resistance and blood pressure. People with hypertension should not take over-the-counter cold and allergy preparations containing phenylephrine because it can further increase their already elevated blood pressure. Patients with diabetes and gout have not been identified as being at risk for adverse reactions from the use of phenylephrine. A patient with an upper respiratory infection may actually benefit from use of the drug.

In providing care to a client with wheezing, the nurse knows that a medication targets which receptors?

beta 2 Beta 2 receptors are found on the bronchial smooth muscles, and medications that stimulate beta 2 receptors cause bronchodilation. Alpha 1 receptors cause vasoconstriction of peripheral blood vessels. Alpha 2 receptors decrease tone, motility, and secretions of the GI tract. Beta 1 receptors increase heart rate and force of myocardial contraction.