Chapter 30: Adrenergic Agonists

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.

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.

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.

Phentolamine is the agent used to treat extravasation of dobutamine.

True Explanation: Maintain phentolamine on standby in case extravasation occurs.

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.

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

Cardiac arrhythmias Explanation: 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.

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

Ephedra Explanation: 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 Explanation: 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.

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.

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 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?

Methamphetamine 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.

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.

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.

Epinephrine causes relaxation of:

bronchioles. Explanation: 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 arrhythmias Explanation: Adrenergic drugs can cause possible irritable cardiac arrhythmias 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.

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

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

Which medication is a synthetic catecholamine prescribed for the treatment of bradycardia?

isoproterenol Explanation: Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors to stimulate heart rate. Neither pseudoephedrine, ephedrine, nor epinephrine is synthetic catecholamine.

A need for additional education on the administration of epinephrine is needed when a new nursing graduate indicates that epinephrine can be effectively administered by what route?

oral Explanation: Administration of epinephrine is by inhalation, injection, or topical application. Oral administration of the drug is not effective, because enzymes in the GI tract and liver destroy it.

Another name for adrenergic drugs is:

sympathomimetic drugs. Explanation: Adrenergic amines are drugs that stimulate the sympathetic nervous system (also called the adrenergic nervous system). These compounds are also called sympathomimetic drugs.

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 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.

What represents the two types of receptors that are found in the adrenergic nervous system? Select all that apply.

Alpha receptors Beta receptors Explanation: Alpha and beta receptors are the two types of adrenergic nervous system receptors.

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.

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.

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?

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.

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.

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 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.

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 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.

A male client is diagnosed with type 2 diabetes, asthmatic bronchitis, benign prostatic hyperplasia, and hyperlipidemia. He takes an adrenergic medication as part of his daily drug regimen. As part of his education plan, the nurse would teach the client to observe for which signs and symptoms?

Painful urination Explanation: Adrenergic drugs exert effects on the renal system that may cause problems for clients with renal impairment. For example, adrenergic drugs with alpha-1 activity cause constriction of renal arteries, thereby diminishing renal blood flow and urine production. These drugs also constrict urinary sphincters, causing urinary retention and painful urination, especially in men with prostatic hyperplasia.

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.

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.

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. 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 intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with:

phentolamine. Explanation: If extravasation occurs, the nurse should infiltrate the site with 10 mL of saline containing 5 to 10 mg of phentolamine. Hyaluronidase and sodium bicarbonate may be used for extravasation of certain antineoplastic agents. Lactated Ringer's solution would be inappropriate.

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

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.

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.

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 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 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.

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.

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.