RNSG-1301 Pharmacology Ch 30: Adrenergic Agonist PrepU

A patient receives phenylephrine intravenously. The nurse would expect the drug to last for how long?

15 to 20 minutes Explanation: Phenylephrine, when given IV has a duration of action of 15 to 20 minutes.

After reviewing the topic of catecholamines, a group of students demonstrates the need for additional study when they identify which as a synthetic catecholamine?

Dopamine Explanation: Dopamine is a naturally occurring catecholamine. Dobutamine is a synthetic catecholamine. Ephedrine is a synthetic catecholamine. Metaraminol is a synthetic catecholamine.

Which would the nurse identify as a naturally occurring catecholamine?

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

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." Explanation: 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.

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 Explanation: One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.

Which condition is treated with an adrenergic agonist?

Anaphylaxis Explanation: Epinephrine, a prototype adrenergic agonist, is used to relieve the acute bronchospasm and laryngeal edema of anaphylactic shock. Since adrenergic agonists act as cardiac stimulants, some versions may be used to treat severe bradycardia or hypotension.

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

Beta-2-specific adrenergic agonist Explanation: 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.

What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?

Beta-adrenergic blockers Explanation: To counteract the effects of isoproterenol, a beta-specific adrenergic agonist, the nurse would administer a beta-adrenergic blocker.

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

Bronchodilation Explanation: 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 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 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.

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

Clonidine Explanation: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.

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?

Compliance with drug regimen Explanation: Monitor effectiveness of comfort measures and compliance with regimen. While it would be important to address all options given, it would be most important to monitor the patient's compliance with the drug regimen.

A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement?

Continually assess the client for physiological changes and notify the primary care provider with changes. Explanation: 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 would the nurse expect to be prescribed to a client experiencing acute bronchospasm?

Epinephrine Explanation: 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.

A client is experiencing anaphylaxis. What drug will the nurse most likely administer?

Epinephrine Explanation: 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.

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

False Explanation: 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 Explanation: 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.

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. Explanation: Ophthalmic preparations of adrenergic drugs should be used cautiously. For example, phenylephrine is used as a vasoconstrictor and mydriatic. Applying larger-than-recommended doses to the normal eye or usual doses to the traumatized, inflamed, or diseased eye may result in systemic absorption of the drug sufficient to cause increased blood pressure and other adverse effects.

The nurse is assessing a client who received epinephrine, an adrenergic drug, for the treatment of cardiac arrest. The nurse would expect to observe what effect of the drug?

Increased heart rate Explanation: Adrenergic drugs are used in cardiac arrest for their cardiac stimulant and peripheral vasoconstrictive effects. They do not directly impact respiratory rate, urination, or kidney perfusion.

Which is an effect of epinephrine?

Increased heart rate Explanation: Epinephrine increases heart rate and acts as a bronchodilator. It has peripheral vasoconstrictive effects and increases blood pressure.

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

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

Inhalation Explanation: 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 Explanation: 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 arrhythmias, respiratory depression, and acute hypertensive crisis, with possible intracranial hemorrhage, convulsions, coma, and death.

Epinephrine is contraindicated in clients with which diseases or disorders?

Narrow-angle (or closed-angle) glaucoma Explanation: Epinephrine and other adrenergic drugs are contraindicated in clients with narrow-angle glaucoma (closed-angle glaucoma) because the drugs increase intraocular pressure and mydriasis. Asthma, bronchoconstriction, and hypotension are among the disorders and diseases treated with adrenergic drugs.

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?

Olanzapine Explanation: Midodrine can precipitate increased drug effects of digoxin, beta-blockers, and many antipsychotics, such as olanzapine. Such combinations should be avoided. The other drug combinations do not pose any immediate concerns.

Epinephrine can be administered by multiple routes. Which is not an appropriate route?

Oral Explanation: Epinephrine is not given orally because enzymes in the gastrointestinal tract and liver destroy it. It may be given by inhalation, injection (intravenous, intramuscular, or subcutaneous), or topical application.

After reviewing the routes of administration for beta-specific adrenergic agonists, a group of students demonstrate the need for additional study when they identify isoproterenol as being administered by which route?

Oral Explanation: Isoproterenol is administered IV, IM, or subcutaneously. It is not administered orally.

A client who is in shock has been prescribed a dopamine intravenous infusion. What component of the client's existing medication regimen most increases the client's risk for adverse effects?

Phenelzine Explanation: Phenelzine is a monoamine oxidase (MAO) inhibitor; MAO is partially responsible for the deactivation of norepinephrine in synapses of the sympathetic nervous system and alterations in its levels can affect norepinephrine levels. Albuterol, levothyroxine and vitamin B6 are not reported to create a risk for drug-drug interactions.

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

Phenylephrine Explanation: 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.

What would be most important for the nurse to assess in a client receiving midodrine?

Positional blood pressure changes Explanation: Midodrine is associated with a serious supine hypertension. Therefore, monitoring blood pressure changes in different positions (standing, sitting, and supine) would be most important. The drug is not associated with respiratory adverse effects. Decreased urinary output and anorexia may occur, but these would not be as important as monitoring the changes in the client's blood pressure.

The nurse is reviewing the history of a client receiving isoproterenol. Which would the nurse identify as being a contraindication?

Pulmonary hypertension Explanation: Pulmonary hypertension would be a contraindication for isoproterenol because the drug could exacerbate the condition. Glaucoma would be a contraindication for the use of an alpha-specific adrenergic agonist. Pheochromocytoma and hypovolemia would be contraindications for the use of alpha- and beta-adrenergic agonists.

The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity?

Stimulates electrical and mechanical activity Explanation: A benefit of epinephrine in arrest situations due to asystole or pulseless electrical activity is the added ability to stimulate electrical and mechanical activity and produ

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

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

Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following?

Sympathomimetics

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 Explanation: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.

The adrenergic branch of the nervous system controls many functions in the body. The nurse knows that which body functions are controlled by the adrenergic branch?

The adrenergic branch of the nervous system controls heart rate, respiratory rate, and blood flow to the muscles. Muscle movement (fine or gross) is controlled by the somatic nervous system.

The nurse is administering epinephrine IV push. The nurse checks for patency of the IV prior to administration of the drug. The nurse realizes that if the IV is infiltrated, the medication will result in tissue extravasation. What is the reason for such an occurrence?

The medication causes vasoconstriction, limiting the blood flow to the area. Explanation: Extravasation can occur during parenteral administration; necrosis may result because of epinephrine's potent vasoconstrictive properties.

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

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.

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed with priority?

Vital signs Explanation: When a client is to receive an adrenergic agent for shock, obtain the blood pressure, pulse rate and quality, and respiratory rate and rhythm. Urinary output, pain, and the physical assessment are not a priority in shock.

A client is receiving dopamine intravenously in the right arm. The IV becomes dislodged from the vein, and dopamine has been being given in the surrounding tissue instead of the vein. What should the nurse do immediately after stopping the IV?

administer phentolamine to the site. Explanation: Phentolamine is used to treat/prevent dermal necrosis after IV administration of norepinephrine or dopamine. Placing ice causes vasoconstriction, which could increase the chance of necrosis. Wrapping the site tightly with gauze will not help the tissue absorb the dopamine. Beta-blockers will not prevent necrosis at the site of the dopamine infusion.

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. 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.

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

beta 2 Explanation: 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.

Epinephrine causes relaxation of:

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

A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize?

cardiac monitoring Explanation: The high potential for adverse effects that is associated with the use of dopamine necessitates vigilant cardiac monitoring. Respiratory assessment, ABGs, and monitoring of ICP are likely indicated by the patient's injuries, but these are not directly related to the use of dopamine

A home care nurse is visiting a patient to assess blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) in the kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine?

ethamphetamine production Explanation: Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.

The nurse is admitting a client with injuries following a bicycle crash. When reviewing the client's pre-admission medication regimen, the nurse reads that the client takes formoterol twice daily. When planning this client's care, the nurse should include:

frequent respiratory assessments. Explanation:Formoterol is given for the treatment of asthma, so the nurse should prioritize respiratory assessments. The inclusion of this particular medication does not create a need for increased cardiac, blood pressure or mental status assessments.

Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?

improved cardiac contractility Explanation: The desired effects of isoproterenol include improved contractility and conductivity, increased heart rate, bronchodilation, relaxation of the uterus, and increased blood flow to skeletal muscles and splanchnic beds.

The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result?

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.

Epinephrine can be administered by multiple routes. Which is not an appropriate route?

oral Explanation:Epinephrine is not given orally because enzymes in the gastrointestinal tract and liver destroy it. It may be given by inhalation, injection (intravenous, intramuscular, or subcutaneous), or topical application.

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

sympathetic Explanation: 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. These drugs do not mimic the effect of the parasympathetic nervous system. The autonomic nervous system comprises the sympathetic and parasympathetic systems.

Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?

β2 receptors Explanation: Vasodilation of peripheral vessels and bronchodilation are the result of stimulation of β2

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. Explanation: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.

The client is given epinephrine for an exacerbation of asthma. What response to the medication would the nurse expect?

increased ease of breathing and increased heart rate Explanation: Depending on the location and distribution of receptors, epinephrine exerts a variety of responses in different effector organs and tissues. In the cardiovascular system, epinephrine exerts positive inotropic and chronotropic effects on the myocardium by stimulating beta-1 adrenergic receptors. In the skin and viscera, epinephrine stimulates alpha-adrenergic receptors, causing vasoconstriction and vasodilation in skeletal muscle vessels. The overall effect is to increase systolic pressure and slightly decrease diastolic pressure. In the respiratory system, epinephrine causes bronchodilation by the stimulation of beta-2 adrenergic receptors and is used in this way to treat clients with asthma or to manage anaphylactic shock.

Which receptor does phenylephrine stimulate?

Alpha1 Explanation:Phenylephrine stimulates alpha1 receptors.

Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?

β1 receptors Explanation:β1 receptors are responsible for increased heart rate and increased force of myocardial contraction. Vasoconstriction of peripheral blood vessels occurs as the result of stimulation of α1 receptors. Stimulation of α2 receptors inhibits release of norepinephrine into synapses of sympathetic nervous system. Stimulation of β2 receptors leads to vasodilation of the peripheral vessels and also causes bronchodilation