PrepU - Chapter 27: Drug Therapy to Enhance the Adrenergic Response

A client is seen in the emergency department for third-degree burns over 50% of his body. The nurse knows that this client is experiencing what type of shock due to fluid loss?

Hypovolemic shock

When caring for a patient receiving adrenergic drugs, the nurse would establish with him or her which of the following goals? Choose all that are appropriate. -Receive or self-administer drugs accurately. -Demonstrate knowledge of adverse drug effects. -Self-administer combinations of adrenergic drugs. -Comply with instructions for safe drug use.

-Receive or self-administer drugs accurately. -Demonstrate knowledge of adverse drug effects. -Comply with instructions for safe drug use.

A client just received an EpiPen due to her newly found allergic reaction to shellfish. What teaching points should the nurse discuss with the client? Select all that apply. -Use only if contents in the "window" are clear. -Throw away the EpiPen as soon as it is used. -Hold the EpiPen with your hand over the orange or black tip. -Take the activation cap off only when you are ready to use it. -The orange or black tip will turn green once you have given the injection.

-Use only if contents in the "window" are clear. - Take the activation cap off only when you are ready to use it.

A 4-year-old is admitted to the Emergency Department in shock after a motor vehicle accident. The patient is found to be 12.5 kilograms. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005-0.01 mg/kg IV?

0.0625 mg

The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that OTC cold and allergy preparations contain phenylephrine and should be avoided?

A 47-year-old female with hypertension

The nurse is giving isoproterenol parenterally. Before starting to administer the drug, what would the nurse be sure to have on hand in case a severe reaction occurs?

A beta-adrenergic blocker

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

Beta-2-specific adrenergic agonist

Which patient is most likely to benefit from the administration of an adrenergic agonist? -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 woman who is in labor and may require a caesarean section

A man who is in cardiogenic shock following a myocardial infarction

Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs. For which of the following conditions would these drugs be used? Choose all that apply Acute cardiovascular disorders Respiratory conditions Allergic disorders Fractures Liver failure

Acute cardiovascular disorders Allergic disorders Respiratory conditions

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

Beta-adrenergic blockers

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

Beta-adrenergic blocking drugs

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

Bronchodilation

An 80-year-old patient has been brought to the Emergency Department in shock. The patient is receiving dopamine (Intropin). What potentially serious adverse effect will the nurse monitor for?

Cardiac arrhythmia

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

Compliance with drug regimen

A nurse is caring for a male 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 relevant changes.

Use of beta-adrenergic blocking drugs (e.g., propranolol) may have what effect?

Decreasing the effectiveness of epinephrine in cases of anaphylaxis

What are the three mechanisms of action for Adrenergic drugs?

Direct receptor stimulation Indirect receptor stimulation Mixed-acting receptor stimulation

A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most appropriate for this patient? -Imbalanced Nutrition: Less Than Body Requirements -Disturbed Sleep Pattern, Insomnia Related to CNS Excitation -Disturbed Sensory Perception -Ineffective Tissue Perfusion

Disturbed Sleep Pattern, Insomnia Related to CNS Excitation

The nurse is assessing a client in the emergency department who has taken an overdose of phenylephrine. What symptoms should the nurse be alert for in this client? (Select all that apply.) Dizziness Headache Polyuria Pulmonary edema Seizures

Dizziness Headache Seizures

What would the nurse identify as a naturally occurring catecholamine?

Dopamine

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

Ephedra

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

Anaphylaxis kits for clients allergic to bee stings would contain which medication?

Epinephrine

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

Epinephrine

______________ is the prototype of the adrenergic drugs.

Epinephrine (Adrenalin)

As part of the nursing process in caring for a patient using adrenergic drugs, a registered nurse would include which of the following in her assessment data? Choose all that apply. History of asthma Allergies History of angina or hypertension ABGs

History of asthma Allergies History of angina or hypertension ABGs

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.

A patient is admitted to the ED in shock. Isoproterenol (Isuprel) is administered. What would the nurse expect the effect of the isoproterenol (Isuprel) to be? Increased blood pressure Decreased blood pressure Increased body temperature Decreased heart rate

Increased blood pressure

Adrenergic drugs produce which effect? Increased heart rate Decreased respiratory rate Urinary retention Decreased kidney perfusion

Increased heart rate

Which is an effect of epinephrine?

Increased heart rate

Stimulation of beta1 adrenergic receptors in the heart results in:

Increased heart rate.

Excessive use of ephedrine and pseudoephedrine can lead to toxicity. Although hemoperfusion is not effective in clearing these drugs from the body, urinary acidification may enhance their elimination. Why is urinary acidification is not routinely used?

It presents the risk of renal damage.

The nurse would contact the physician before administering an adrenergic drug to a client who is also taking which drug? Antibiotic MAO inhibitor Diuretic Analgesic

MAO inhibitor

Epinephrine is contraindicated in patients with which diseases or disorders? -Asthma -Narrow-angle (or closed-angle) glaucoma -Hypotension -Bronchoconstriction

Narrow-angle (or closed-angle) glaucoma

What is the primary neurotransmitter of the sympathetic nervous system?

Norepinephrine

A client 16 years of age arrives at the emergency department (ED) saying she was stung by a bee and used her EpiPen prior to arriving in the ED. She is breathing well now. What would the nurse do next for this client?

Obtain from her, and those who were with her, as much information about the bee sting (and her physical reaction to the bee sting) as possible.

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

Oral

A 75-year-old male client is diagnosed with chronic obstructive lung disease; he also has a history of cardiac dysrhythmias, hyperlipidemia, and hypertension. His physician orders a metered-dose inhaler. The nurse will teach the client to report which symptom to the physician? Gastrointestinal upset Skin lesions Persistent edema Palpitations

Palpitations

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

Phenylephrine

What would be most important for the nurse to assess in a client receiving midodrine? Changes in respiratory rate Positional blood pressure changes Changes in urinary output Appetite changes

Positional blood pressure changes

A nurse is teaching a patient to self-administer inhaled epinephrine for bronchodilation. Which of the following topics should be included in the nurse's instruction? -Proper hand hygeine -Proper nasal wash technique -Preparation of the nose -Proper use of a nebulizer or inhaler

Proper use of a nebulizer or inhaler

Which of the following effects of epinephrine would be blocked by propanolol but not by phentolamine? -Decreased muscle glycogenolysis -Decreased rate of contraction of the heart muscle -Relaxation of visceral smooth muscle -Contraction of visceral smooth muscle

Relaxation of visceral smooth muscle

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

Sympathetic nervous system

The nurse is writing a plan of care for a patient receiving an adrenergic agonist. What should this plan of care include?

Taking the patient's blood pressure and heart rate every 2-4 hours

The nurse understands that local anesthetics containing adrenergics should not be used on which part of the body?

The fingers

A male client takes a nasal adrenergic medication for his allergic rhinitis. Part of the nurse's education plan should include information that overuse of adrenergic drugs may cause what effect?

Tolerance

The nurse encourages people to limit use of OTC epinephrine products to prevent the occurrence of what problem?

Tolerance

The nurse is aware that epinephrine may be administered in what ways?

Topical IV Inhalation

Activation of beta3-adrenergic receptors produces lipolysis and increased release of free fatty acids into the blood. True or false?

True

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

True

The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. True or False?

True

Epinephrine causes relaxation of:

bronchioles

Which adrenergic receptor is responsible for increased heart rate and increased force of myocardial contraction?

β1 receptors

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 Phenylephrine Albuterol Terbutaline

Epinephrine

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 -Temperatures reading of 97.6°F -Pulse rate of 60 beats per minute -A diastolic blood pressure of 75 mm Hg

Systolic blood pressure below 100 mm Hg