pharm 2 exam 4

After teaching a client about a prescribed beta blocker therapy, the nurse determines that additional teaching is needed when the client relays which statement? "I should notify my doctor if I have trouble breathing." "I need to get up slowly from the bed or a chair." "I should learn how to check my blood pressure." "I can stop the drug anytime I feel any problems."

"I can stop the drug anytime I feel any problems."

True or False: A breast-feeding mother planning a sea cruise should be cautioned that scopolamine (Transderm Scop) may suppress lactation.

true

Which receptor does phenylephrine stimulate? Beta2 Alpha1 Alpha2 Beta1

Alpha1 Explanation: Phenylephrine stimulates alpha1 receptors.

________________ disease is a progressive disorder involving neural degeneration in the cortex that causes profound loss of memory and affects a person's ability to complete daily activities.

Alzheimer's

A client has come to get lab results at the cardiology clinic. The nurse notes that the digoxin level is elevated. The nurse knows that what other medication may be responsible for the increase in digoxin level? Zantac Carvedilol Ampicillin Prozac

Carvedilol

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 glucose level Changes in appetite Changes in pulse rate Changes in temperature

Changes in pulse rate Explanation: 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.

Chemicals that act at the same site as the neurotransmitter acetylcholine (ACh) are called _______________________ drugs.

Cholinergic

A nurse should observe which clients more carefully during the use of propranolol (Inderal) due to the increase likelihood of adverse reactions? (Select all that apply.) Clients with asthma Clients with migraine headaches Clients with diabetes Clients with peptic ulcer disease Clients with hyperlipidemia

Clients with asthma Clients with diabetes Clients with peptic ulcer disease

A client has been prescribed an adrenergic blocking drug for glaucoma. Which nursing interventions should the nurse include when teaching the client? Demonstrate the technique of eye drop instillation. Demonstrate the method of cleaning eyes. Inform the client about eye drop preservation. Suggest the client protect their eyes from exposure to sunlight.

Demonstrate the technique of eye drop instillation Explanation: The nurse should demonstrate the technique of eye drop installation while educating the client with glaucoma. Demonstrating the method of cleaning eyes, suggesting the client protect his eyes from exposure to sunlight, and informing the client about eye drop preservation are not related nursing interventions when teaching the client about the use of an adrenergic blocker for glaucoma.

A nurse is caring for a patient who is on a drug regimen of midodrine to treat hypotension. What would be an appropriate nursing diagnosis to include in the care plan of this patient? Impaired skin integrity related to dermatological effects Acute pain related to GI distress, cough, skin effects, and headache Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects

Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects Explanation: Nursing diagnoses related to drug therapy with might include ineffective tissue perfusion (total body) related to changes in cardiac output and disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects. Acute pain is a nursing diagnosis appropriate to a patient receiving an ARB. Support and encouragement is an implementation, not a nursing diagnosis. Impaired skin integrity is a nursing diagnosis for a patient taking an ACE inhibitor.

The sympathomimetic drug of choice to treat patients with shock is ___________.

Dopamine

True or False Atropine and scopolamine (Transderm Scop) are effective because they block the nicotinic receptors at the neuromuscular junction.

False

True or False Galantamine (Razadyne) is a cholinergic drug that is used to stop the progression of Alzheimer's disease.

False

True or False: A women taking terazosin may breast-feed because the drug does not enter the breast milk.

False

True or False: Beta-1 selective adrenergic blocking agents should not be used in patients with a history of asthma because they block the receptors responsible for bronchodilation.

False

True or False: Sympathomimetic drugs are not currently recommended for use in pediatric patients.

False

__________________________________ _________________________is a chronic muscular disease caused by a defect in neuromuscular transmission.

Myasthenia gravis

An example of an irreversible acetylcholinesterase inhibitor that leads to toxic accumulations of ACh at the cholinergic receptor sites and can cause muscle paralysis is ________________________ .

Nerve gas

Alpha and Beta adrenergic agonists CAUTIONS

PVD pregnancy lactation

The therapeutic effect of doxazosin (Cardura) comes from its ability to block the _______________ sites, which decreases vascular tone, causes vasodilation, and decreases blood pressure.

Postsynaptic alpha-1 receptors

The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving: Nadolol Sotalol Carteolol Propranolol

Propranolol

A nurse must recognize which class of medication a drug is part of in order to help in planning ongoing assessment and patient education. Which is an example of a drug in the class of beta-adrenergic blockers? (Select all that apply.) Labetalol (Trandate) Propranolol (Inderal) Carvedilol (Coreg) Atenolol (Tenormin) Metoprolol (Lopressor)

Propranolol Atenolol Metoprolol

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

True Explanation: Patients who are receiving alpha-specific adrenergic agents should not discontinue the drug abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper the drug over 2 to 4 days.

True or False: Adrenergic blocking agents decrease blood pressure and slow the heart rate by preventing the sympathetic stress reaction in the sympathetic nervous system.

True.

What would the nurse expect to assess in a client receiving an alpha- and beta-adrenergic agonist? Dyspnea Diarrhea Personality changes Hypotension

dyspnea

The adrenergic branch of the autonomic nervous system is also known by which name? Somatic nervous system Central nervous system Sympathetic nervous system Parasympathetic nervous system

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

Adrenergic blocking agents that lyse the effects of the sympathetic nervous system are classified as ______________ drugs.

Sympatholytic

True or False Edrophonium (Enlon) is used as a diagnostic agent to distinguish between a myasthenic crisis and a cholinergic crisis.

True

Alpha specific adrenergic agonists respond to:

alpha response little to no beta response

A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective? Decreased heart rate Slowed cardiac conductivity Bronchodilation Tremor

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.

Dobutamine use

congestive heart failure and cardiogenic shock

A nurse would instruct a patient to apply a clonidine patch at which frequency? Every other day Every 7 days Every day Every 5 days

every 7 days

True or False: Patients receiving anticholinergic drugs may report an increase in oral secretions and increased sweating.

false

SNS

fight or flight + neurotransmitters of acetylcholine, norepinephrine, epinephrine aldosterone is released to retain salt and H2O. POTASSIUM SPILLS IN THE URINE

Where can you not use epinephrine with lidocaine?

fingers toes penis nose

Anticholinergics are contraindicated in patients with __________ because of the possibility of increased pressure with pupil dilation.

glaucoma

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

phenylephrine. Explanation: 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.

Dopamine use

prototype for shock

phenylephrine use

prototype for shock. - eye drops for glaucoma to dilate eyes potent vasoconstrictor.

PNS

rest and digest with neurotransmitters of acetylcholine

ephedrine uses

rhinitis hypotensive episodes (think pseudophedrine; used to help with a stuffy or runny nose)

Agonist is ________ of a normal response.

stimulation

The teaching priority for a diabetic male client being treated with a non-specific beta-blocker would be to: take his own pulse. avoid smoke-filled rooms. understand signs and symptoms of hypo- or hyperglycemic reaction. weigh himself once a week at the same time of day.

understand signs and symptoms of hypo- or hyperglycemic reaction.

adrenergic agent dosages are calculated by ________ when given to children.

weight

A patient is to receive metoprolol. What would the nurse include in the teaching plan for this patient? "Take this drug with food to help promote its absorption." "This drug should have no effect on your sexual activity level." "This drug causes less dizziness than other similar drugs." "You should notice an increase in your energy level with this drug."

"Take this drug with food to help promote its absorption."

Beta 1 adrenergic agonists

(one heart, and cells of kidney that release renin): Increase BP, increase heart contractility **affects heart and kidneys

The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is taking dobutamine for congestive heart failure. What would be most important to monitor in this patient? Dietary intake Compliance with drug regimen Effectiveness of comfort measures Availability of caregivers

Compliance with drug regimen

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.

Which would the nurse identify as a naturally occurring catecholamine? Dobutamine Dopamine Ephedrine Metaraminol

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

True or False: Dobutamine is a naturally occurring catecholamine that increases cardiac oxygen demand.

False

A nurse is caring for a client in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the client's chart for indications of: history of acute myocardial infarction. peptic ulcer disease. diabetes mellitus. obesity.

History of acute myocardial infarction.

Which assessment finding would indicate to the nurse that the administered isoproterenol is effective? Decreased heart rate Uterine contraction Improved cardiac contractility Bronchoconstriction

Improved cardiac contractility

A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce? Increased bronchoconstriction Increased vasoconstrictive effects Decreased cerebral circulation Decreased coronary circulation

Increased vasoconstrictive effects Explanation: 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 has been prescribed labetalol IV for a pheochromocytoma. What is the expected effect of the medication? Decreases urinary output ordinally increased by the tumor Management of the resulting hypertension Shrinkage of the tumor Increase of the amount of norepinephrine released by the adrenal medulla

Management of resulting hypertension

True or False: Mydriatics are much less effect in African Americans than in the general population, and increased dosage may be required to achieve the desired effect.

True

A 35-year-old female has been diagnosed with hyperthyroidism. Her doctor has prescribed propranolol to achieve which effect? To decrease heart rate To promote bronchodilation To prevent respiratory depression To decrease systolic blood pressure

To decrease heart rate Explanation: Beta blockers, such as propranolol, are used to decrease heart rate, cardiac output, and tremors in hyperthyroidism.

A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action? monitor respiratory rate. assess heart rate. check blood glucose level. measure urine output.

assess heart rate. Explanation: The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would be no need to check blood glucose or measure urinary output, and though respiratory rate is monitored it is not the priority measure.

What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction? Beta-adrenergic blockers Narcotic antagonist Sympathomimetic agents Neuromuscular blocking agent

beta-adrenergic blockers

Antagonist is a ______ of a normal response.

block

Beta 2 adrenergic agonists

(two lungs, eyes, arteries of skeletal muscle): Dilates vessels to increase blood flow rich in oxygen **affects lungs

alpha and beta adrenergic agonists (nonspecific)

- DOPAMINE - dobutamine - ephedrine - epinephrine - norepinephrine

Alpha and Beta adrenergic agonists contraindications

- pheochromocytoma - tachyarrythmias or v-fib - hypovolemia - halogenated hydrocarbon general anesthetics

epinephrine use

- shock - glaucoma - bronchospasm - anaphylaxis - prolonged effect for local anesthetics

Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? A 17-year-old female with symptoms of an upper respiratory infection A 47-year-old female with hypertension A 52-year-old male with adult-onset diabetes A 62-year-old male with gout

A 47-year-old female with hypertension Explanation: 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.

Which client is most likely to benefit from the administration of an adrenergic agonist? A woman who is in labor and may require a cesarean section A man who is in cardiogenic shock following a myocardial infarction A man who has a diagnosis of primary hypertension A woman who has been admitted with a suspected ischemic stroke

A man who is in cardiogenic shock following a myocardial infarction

A client is experiencing urinary retention. The client has been prescribed terazosin (Hytrin). What condition contributes to the urinary retention? Benign prostatic hypertrophy Urinary tract infection Kidney cancer Bladder cancer

Benign prostatic hypertrophy

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes? Beta-helping drugs Beta-adrenergic drugs Beta-adrenergic blocking drugs Beta-blocking agonist

Beta-adrenergic blocking drugs

_____________ is approved for use in children older than 8 years of age for the treatment of neurogenic bladder.

Bethanechol

A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan? Hypertension may be a side effect of the medication. Allergic and adverse reactions are rare. Side effects are limited to inflammation of the conjunctiva. The drug is only absorbed locally.

Hypertension may be a side effect of the medication.

A 27-year-old client has been in the intensive care unit for two weeks following a car accident. The primary nurse is concerned that the client is not getting the rest needed for recovery. Which nursing diagnosis would be appropriate for this problem? Risk for Narcolepsy related to nighttime wakefulness Risk for Body Image Disturbance related to injuries Risk for Psychosis related to head injury Risk for Disturbed Sleep Pattern related to hospitalization

Risk for Disturbed Sleep Pattern related to hospitalization Explanation: Sleep patterns are disturbed constantly when a client is in the ICU. The client will have lots of noise around him, will be awoken for vital signs, turning, medications, etc. The room will not be completely dark. Adrenergic medications can make it difficult to sleep. All of these can lead to disturbed sleep patterns. Narcolepsy is a medical diagnosis that describes a client who falls asleep multiple times a day. The client's body image is not likely the issue with sleeping. There is no evidence in the above scenario that suggests psychosis or head injury.

True or False A woman with myasthenia gravis who is taking pyridostigmine (Mestinon) should be cautioned against becoming pregnant because the uterus may be stimulated and labor induced, resulting in a preterm birth.

True

True or False The treatment for nerve gas exposure includes the use of pralidoxime (Protopam Chloride), which is the antidote for irreversible acetylcholinesterase-inhibiting drugs, and atropine, which temporarily blocks cholinergic activity.

True

True or False The use of direct-acting cholinergic drugs is limited to primarily ophthalmic agents because of their profound negative systemic effects.

True

True or False: Because of K+ spilling and aldosterone released, we can have hypokalemia in patients receiving alpha and beta adrenergic agonists.

True

True or False: Dopamine increases blood pressure and stimulates the heart without compromising renal blood flow.

True

True or False: Epinephrine is one of the primary sympathomimetic drugs recommended for treatment of bronchospasm.

True

True or False: Halothane anesthetics, when combined with complete adrenergic blocking agents, may cause severe hypotension and should be used concurrently with caution.

True

True or False: Patients who are prescribed adrenergic agonists should limit caffeine intake to prevent adverse effects, including elevated blood pressure and stroke.

True

True or False: Propranolol (Inderal) is effective in preventing stage fright by blocking the beta-adrenergic receptors in the sympathetic nervous system.

True

First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect? Administer the drug at longer intervals than prescribed Administer the drug with food Administer half the prescribed dose Administer the dose at bedtime

administer the dose at bed time

Alpha and Beta adrenergic agonists A/E

all of these are associated with stimulation of SNS. arrhythmias, hypertension, palpitations, angina, dyspnea, N/V, constipation, HA, sweating, tension, anxiety

Propranolol (Inderal) is used extensively as treatment for what condition? Cluster headaches Prevent first MI Angina Hypotension

angina

What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago? calcium channel blockers (CCBs) cardiac glycosides angiotensin II receptor blockers (ARBs) beta-blockers

beta-blockers

Epinephrine causes relaxation of

bronchioles

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart? Constrict the heart Prevent normal sinus rhythm Decrease the heart rate Increase the heart rate

decrease the heart rate

Patients receiving isoproterenol should be monitored for adverse pulmonary effects including __________ , _______________ , ____________ , and severe ______________ .

difficulty breathing, coughing, bronchospasm, pulmonary edema.

Adrenergic agonists are used in ophthalmic preparations to _____________ the pupils.

dilate

Stimulation of the adrenergic receptor sites by sympathomimetic drugs is classified as either _________ or ____________.

direct, indirect

The drug __________ is widely used to decrease secretions before anesthesia or intubation.

glycopyrrolate (Robinul)

Dopamine a/e

hypertension (in high dose) hypotension (in low dose)

Patients taking both diabetic drugs and adrenergic blocking agents are at an increased risk for __________ and should be monitored closely.

hypoglycemia

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

The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result? increased heart rate vasoconstriction of the coronary arteries decreased heart muscle contractions decreased oxygen demand by the myocardium

increased heart rate Explanation: The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. Beta1 activation results in increased force of myocardial contraction, or a positive inotropic effect and increased speed of electrical conduction in the heart.

Which observation might indicate that timolol is achieving the desired effect in a client? heart rate increases temperature decreases intraocular pressure decreases blood pressure increases

intraocular pressure decreases

Adrenergic blocking agents act by preventing the release of __________ from the nerve terminal or adrenal medulla.

norepinephrine

When the ____________ system is blocked, a client's pupils will dilate, the heart rate will increase, and urinary bladder tone will decrease.

parasympathetic

Anticholinergic drugs that block the effects of acetylcholine are also called ___________ drugs.

parasympatholytic

A nursing instructor determines that a class on adrenergic blockers was successful when the students identify which medication is an alpha-adrenergic blocker? Atenolol Clonidine Metoprolol Phentolamine

phentolamine

Antidote for extravasation with dopamine

phentolamine 5-10mL with 10 ml Normal saline (this is an alpha blocker that causes vasodilation)

Many cold and allergy medications contain the alpha-agonist ____________, which helps constrict topical blood vessels, decreases swelling, and relieves the symptoms of rhinitis.

phenylephrine

Symptoms of motion sickness, including nausea and vomiting, may be decreased if patients use a __________ patch.

scopolamine

Norepinephrine uses

shock with cardiac arrest

True or False Symptoms of atropine toxicity are dose related and can progress to coma.

true