24 Adrenergic Drugs, 27 Cholinergic Blocking Drugs, 26 Cholinergic Drugs, 25 Adrenergic Blocking Drugs
A nurse would administer phentolamine cautiously to a client with which condition? Select all that apply. A) Recent MI❤️ B) Type 1 diabetes C) Renal failure❤️ D) Hepatic failure E) Peripheral artery disease
Ans: A, C Feedback: Phentolamine is an a-adrenergic blocker that should be used cautiously in clients who are pregnant or lactating, had a recent MI, or have renal failure or Reynaud's disease.
While assessing a client, the nurse observes hives and flushing. The client reports itching and a tightness in the throat. The nurse would identify which of the following nursing diagnoses? A) Risk for Allergy Response❤️ B) Ineffective Tissue Perfusion C) Decreased Cardiac Output D) Risk for Injury
Ans: A Feedback: The client is exhibiting signs and symptoms of an allergic reaction. Therefore, Risk for Allergy Response would be appropriate. Ineffective Tissue Perfusion and Decreased Cardiac Output would be appropriate if a client is experiencing hypotension and shock. Risk for Injury would be appropriate if the client was experiencing dizziness, weakness, confusion, or disorientation related to the drug therapy.
A client is receiving nadolol as part of the treatment plan for hypertension. The client reports dizziness on standing. The nurse checks the client's blood pressure lying, sitting, and standing and notes a significant drop in the readings. When developing this client's plan of care, which nursing diagnosis would the nurse most likely identify? A) Risk for Injury❤️ B) Ineffective Tissue Perfusion C) Impaired Comfort D) Decreased Cardiac Output
Ans: A Feedback: The client is experiencing orthostatic hypotension, placing the client at risk for falls and injury. Ineffective Tissue Perfusion would be appropriate if the client was experiencing more rapid changes in blood pressure and/or changes in pulse and heart rate. Impaired Comfort would apply if the client was complaining of other adverse reactions such as dry mouth or constipation. There is no information provided that would suggest decreased cardiac output.
A nurse is caring for a client with an arrhythmia. Which of the following would be most important for the nurse to do for a client with a life-threatening arrhythmia who is receiving an adrenergic blocking drug intravenously? A) Perform continuous cardiac monitoring.❤️ B) Obtain pulse rate readings every 6 to 8 hours. C) Assess respiratory rate every hour. D) Obtain body temperature readings every 15 minutes.
Ans: A Feedback: The patient with a life-threatening arrhythmia may receive an adrenergic blocking drug, such as propranolol, by the intravenous (IV) route. When these drugs are administered IV, cardiac monitoring is necessary. Patients not in a monitored unit are usually transferred to one as soon as possible. When these drugs are administered for a life-threatening arrhythmia, it is important to monitor the patient continually with cardiac, blood pressure, and respiratory rate monitoring frequently.
A nurse is reviewing the medication orders for a client and notes an adrenergic blocker that is to be applied transdermally. Which medication would the nurse be preparing to administer? A) Methyldopa B) Clonidine❤️ C) Guanabenz D) Guanfacine
Ans: B Feedback: Clonidine is available in a transdermal formulation. Methyldopa may be administered IV or orally. Guanabenz and guanfacine are administered orally.
A nurse is preparing to administer a centrally acting adrenergic blocker to a group of clients. The nurse would be especially cautious when administering the drug to which client? A) Client with diabetes B) Client with chronic bronchitis C) Client with renal function impairment❤️ D) Client with impaired hepatic function
Ans: C Feedback: The nurse should administer centrally acting adrenergic blockers cautiously to clients with renal function impairment. The a/b-adrenergic blocking drugs should be used cautiously in clients with diabetes, chronic bronchitis, and impaired hepatic function.
A group of nursing students are reviewing information about adrenergic blockers in preparation for an examination. The students demonstrate understanding of the information when they identify which of the following as an a/b-adrenergic blocker? Select all that apply. A) Phentolamine B) Bisoprolol C) Nadolol D) Carvedilol❤️ E) Labetalol❤️
Ans: D, E Feedback: Carvedilol and labetalol are a/b-adrenergic blockers. Phentolamine is an a-adrenergic blocker. Bisoprolol and nadolol are b-adrenergic blockers.
A client is to receive midodrine. Which of the following would the nurse include in the plan of care to ensure that the client doesn't develop supine hypertension? A) Administer midodrine during the day.❤️ B) Ensure that the client is lying in a supine position. C) Instruct the client to regularly shift positions. D) Assist the client when moving out of bed.
Ans: A Feedback: The nurse can minimize the risk of supine hypertension by administering the drug during the daytime. The nurse should ensure that the client is in an upright, not supine, position. Instructing the client to regularly shift positions or assisting the client when moving out of bed will not significantly reduce the risk of supine hypertension.
A nurse is monitoring the vital signs of a client who has received epinephrine. The nurse would report which of the following assessment findings? A) Systolic blood pressure below 100 mm Hg❤️ B) Temperatures reading of 97.6∞F C) Pulse rate of 60 beats/min D) A diastolic blood pressure of 75 mm Hg
Ans: A Feedback: The nurse must immediately report 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/min, and a temperature reading of 97.6∞F are normal and need not be reported immediately.
A nurse is caring for a client who has been prescribed propranolol for angina. After administering the drug, which of the following would the nurse do? A) Ask about relief of symptoms and record responses on the chart.❤️ B) Determine signs of infection in the client. C) Monitor for sudden decrease in urine output. D) Monitor for sudden increase in intraocular pressure.
Ans: A Feedback: The nurse should ask about the relief of symptoms and record the responses on the client's chart. Determining the signs of infection in the client is part of the nurse's preadministration assessment, not the ongoing assessment. The nurse need not monitor the client for a sudden decrease in urine output and a sudden increase in intraocular pressure for a client receiving propranolol therapy for angina.
A client is prescribed dopamine. Which of the following would the nurse include in the client's plan of care? A) Administering dopamine only via IV route❤️ B) Maintaining a fixed rate of administration C) Monitoring blood pressure every half hour D) Diluting dopamine with sodium bicarbonate
Ans: A Feedback: The nurse should ensure that dopamine is administered intravenously. The rate of administration of the drug should be adjusted according to the client's blood pressure, and it should not be fixed at any particular rate. The nurse should monitor blood pressure every 2 minutes, not every half hour, from the beginning of therapy until the desired blood pressure is achieved.
After administering dobutamine to a client, the nurse would assess the client closely for which adverse reaction? A) Cardiac arrhythmias❤️ B) Urinary retention C) Elevated temperature D) Sleeplessness
Ans: A Feedback: The nurse should monitor for cardiac arrhythmias (bradycardia and tachycardia) because they are common adverse reactions observed in clients receiving dobutamine HCL. Dobutamine HCL does not cause urinary retention, elevated temperature, or sleeplessness.
A client who is receiving a b blocker tells the nurse that he also takes ibuprofen for arthritis pain. The nurse would be alert for which of the following? A) Decreased effect of the b blocker❤️ B) Increased risk of bradycardia C) Increased risk of paradoxical hypertensive effect D) Increase risk of hypotension
Ans: A Feedback: The nurse should monitor for the decreased effect of the b blocker in the client who is receiving a b blocker along with NSAIDs. The nurse need not monitor for increased risk of bradycardia and paradoxical hypertensive effect or decreased risk of hypotension. There is an increase in the risk of paradoxical hypertensive effect when a b-adrenergic blocking drug is administered with clonidine. There is an increase in the risk of bradycardia when a b-adrenergic blocking drug is administered with antidepressants. There is an increased risk of hypotension when a b-adrenergic blocking drug is administered with loop diuretics.
A nurse is caring for a client with urinary retention who is receiving a cholinergic drug as part of the treatment plan. After administering the drug, the nurse would notify the primary health care provider if the assessment reveals which of the following? A) Failure to void after drug administration❤️ B) Frequent vomiting after drug administration C) Increase in abdominal pain after drug administration D) Occurrence of blood in urine after drug administration
Ans: A Feedback: The nurse should notify the primary health care provider if the client fails to void after drug administration. Frequent vomiting, increase in abdominal pain, and occurrence of blood in urine are not usually observed when urinary retention is treated with cholinergic therapy.
A nurse is caring for a client who has been given a centrally acting antiadrenergic drug. The nurse knows that under which of the following conditions is the use of a centrally acting antiadrenergic drug contraindicated? A) Active hepatic disease❤️ B) Active peptic ulcer C) Ulcerative colitis D) Mental depression
Ans: A Feedback: The use of a centrally acting antiadrenergic drug is contraindicated in clients with active hepatic disease. The use of a centrally acting antiadrenergic drug is not contraindicated in clients with active peptic ulcer, ulcerative colitis, or mental depression. In clients with active peptic ulcer, ulcerative colitis, or mental depression, the use of peripherally acting antiadrenergic drug is contraindicated.
A client uses levodopa for treatment of Parkinson's disease. The client is now prescribed an adrenergic blocking agent. The nurse would assess the client for which of the following? A) Decreased effect of levodopa❤️ B) Increased effect of adrenergic blocker C) Increased risk of levodopa toxicity D) Decreased risk of psychotic behavior
Ans: A Feedback: When levodopa and adrenergic blockers are administered together, the effect of the levodopa is decreased. Therefore, the client's Parkinson's disease may not be controlled as effectively as before. The effect of the adrenergic blocker is not increased, nor is the risk for levodopa toxicity. The client is not experiencing psychotic behavior.
When describing the adrenergic nervous system, which of the following would the instructor describe as two types of receptors that are found in this system? Select all that apply. A) Alpha receptors❤️ B) Beta receptors❤️ C) Delta receptors D) Gamma receptors E) Omega receptors
Ans: A, B Feedback: Alpha and beta receptors are the two types of adrenergic nervous system receptors.
The nurse identifies a nursing diagnosis of Diarrhea for a client being started on cholinergic drug therapy. Which of the following would the nurse most likely include in the client's plan of care? Select all that apply. A) Ensure that the client has readily available access to the bathroom.❤️ B) Evaluate the number, frequency, and consistency of the stools.❤️ C) Contact the primary health care provider for an order to switch to another cholinergic drug. D) Limit the client's fluid intake to 1000 mL per day. E) Maintain the client on strict bed rest.
Ans: A, B Feedback: When a cholinergic drug is administered, the client may experience diarrhea. This reaction will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse needs to ensure that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist in the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse should document fluid intake and output and track the number, consistency, and frequency of stools if diarrhea is present. Since diarrhea occurs with any cholinergic drug, switching to another would be of no help. The client needs to replace fluids lost with diarrhea, so limiting fluid intake would be inappropriate. Ambulating to assist with the passage of flatus would be appropriate, while strict bed rest would not be necessary.
A nurse is caring for a client with benign prostatic hypertrophy (BPH). Which of the following would the nurse expect to be prescribed as treatment? Select all that apply. A) Doxazosin (Cardura)❤️ B) Alfuzosin (Uroxatral)❤️ C) Tamsulosin (Flomax)❤️ D) Prazosin (Minipress) E) Mecamylamine (Inversine)
Ans: A, B, C Feedback: Doxazosin, alfuzosin, and tamsulosin are peripherally acting adrenergic blocking drugs used in the treatment of BPH.
A nurse withholds a cholinergic blocking drug prescribed for an older adult client based on which assessment finding? Select all that apply. A) Excitement❤️ B) Mental confusion❤️ C) Urinary retention❤️ D) Drowsiness❤️ E) Agitation❤️
Ans: A, B, C, D, E Feedback: A nurse should withhold a cholinergic blocking drug from an older adult client who is excited, agitated, mentally confused, drowsy, or experiencing urinary retention or other adverse effects.
Ma huang is an herbal product that has been used to relieve cold symptoms and for weight loss. The nurse would instruct a client receiving which of the following to avoid products containing ma huang? Select all that apply. A) Digoxin (Lanoxin)❤️ B) Phenelzine (Nardil)❤️ C) Guanethidine (Ismelin)❤️ D) Oxytocin (Pitocin)❤️ E) Halothane (Avestan)❤️
Ans: A, B, C, D, E Feedback: Clients taking digoxin, phenelzine, guanethidine, oxytocin, halothane, or St. John's wort should not take ma huang.
The nurse instructs the client and family about possible visual and mental adverse reactions that can occur. Which of the following would the nurse include in the teaching to reduce the client's risk for injury? Select all that apply.❤️All A) Removing throw rugs B) Moving furniture against the wall C) Making sure floors are dry D) Avoiding having the floors waxed E) Removing electrical cords from walkways
Ans: A, B, C, D, E Feedback: Objects or situations that may cause falls, such as throw rugs, electrical cords, footstools, furniture, and wet or newly waxed floors, are removed or avoided whenever possible.
A client is prescribed benztropine. The nurse would administer the drug cautiously and monitor the client closely if the client also had a diagnosis of which of the following? Select all that apply. A) Hyperthyroidism❤️ B) Hepatic disease❤️ C) Renal disease❤️ D) Epilepsy E) Hypertension❤️
Ans: A, B, C, E Feedback: Cholinergic blocking drugs, like benztropine (Cogentin), are used cautiously in clients with hypertension, GI infection, benign prostatic hypertrophy, urinary retention, hyperthyroidism, and hepatic or renal disease.
A nurse may be asked to administer adrenergic drugs to clients with which of the following conditions? Select all that apply. A) Hypovolemic shock❤️ B) Respiratory distress❤️ C) Severe hypertension D) Allergic reactions❤️ E) Cardiac arrest❤️
Ans: A, B, D, E Feedback: A nurse may be asked to administer adrenergic drugs to clients with hypovolemic shock, respiratory distress, severe hypotension, allergic reactions, and cardiac arrest. These drugs would not be used to treat severe hypertension.
When conducting client teaching with a client and his family about the prescribed cholinergic therapy for myasthenia gravis, which of the following would be most important to include? Select all that apply. A) How to adjust dosage❤️ B) Indications of drug underdosage❤️ C) The need to monitor blood glucose levels D) How to keep a record of response to therapy❤️ E) The need to wear medical identification❤️
Ans: A, B, D, E Feedback: Client and family teaching should include signs and symptoms associated with under- and overdosage, instructions on how to adjust the dosage up or down, how to keep a record of the response to therapy, and the importance of wearing medical identification. There is no need for the client and family to monitor blood glucose levels.
1. When describing the different cholinergic blockers, which of the following would a nursing instructor include as affecting only the muscarinic receptors? Select all that apply. A) Darifenacin (Enablex)❤️ B) Oxybutynin (Ditropan)❤️ C) Benztropine (Cogentin) D) Biperiden (Akineton) E) Tolterodine (Detrol)❤️
Ans: A, B, E Feedback: Antispasmodic cholinergic blocking drugs, like darifenacin (Enablex), oxybutynin (Ditropan), and tolterodine (Detrol), only affect muscarinic receptors in the parasympathetic nervous system and have no effect on nicotinic receptors.
When describing drugs that block or inhibit the sympathetic nervous system, the nurse includes which of the following? Select all that apply. A) Antiadrenergic drugs❤️ B) Adrenergic blocking drugs❤️ C) Adrenergic stimulating drugs D) Adrenergic drugs E) Sympatholytics❤️
Ans: A, B, E Feedback: Drugs that block or inhibit the sympathetic nervous system are known as antiadrenergic drugs, adrenergic blocking drugs, and sympatholytics.
The nurse is preparing to administer a cholinergic drug. The nurse understands that the drug would be appropriate for which condition? Select all that apply. A) Urinary retention❤️ B) Overactive bladder C) Myasthenia gravis❤️ D) Parkinson's disease E) Graves' disease
Ans: A, C Feedback: Cholinergic drugs can be used to treat urinary retention, myasthenia gravis, and glaucoma.
The nurse should monitor clients taking which of the following medications closely for decreased efficacy if a cholinergic blocking drug is initiated? Select all that apply. A) Fluconazole (Diflucan)❤️ B) Meperidine (Demerol) C) Haloperidol (Haldol)❤️ D) Amitriptyline (Elavil) E) Digoxin (Lanoxin)
Ans: A, C Feedback: The nurse should monitor clients taking fluconazole (Diflucan) and haloperidol (Haldol) closely for decreased efficacy if a cholinergic blocking drug is initiated.
A nurse would closely monitor which client for an increase in possible adverse reactions after administering propranolol? Select all that apply. A) Clients with asthma❤️ B) Clients with hyperlipidemia C) Clients with diabetes❤️ D) Clients with peptic ulcer disease❤️ E) Clients with migraine headaches
Ans: A, C, D Feedback: A nurse should carefully observe clients with asthma (bronchospasm can result with the use of nonselective b blockers) and diabetes (b blockers can mask the symptoms of hypoglycemia) during the use of propranolol (Inderal), a nonselective b blocker. The drug also should be used cautiously in clients with peptic ulcer disease.
A nurse is monitoring a client who is receiving dopamine. The nurse should be alert for which of the following adverse reactions? Select all that apply. A) Headache❤️ B) Hypotension C) Cardiac arrhythmias❤️ D) Nausea❤️ E) Diarrhea
Ans: A, C, D Feedback: Adrenergic drugs like dopamine can cause the following adverse reactions: cardiac arrhythmias, headache, nausea, vomiting, and hypertension.
A nurse is conducting discharge teaching with a client being discharged on clonidine (Catapres). The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Dry mouth❤️ B) Bradycardia C) Sedation❤️ D) Anorexia❤️ E) Tachypnea
Ans: A, C, D Feedback: Adverse reactions associated with the use of centrally acting antiadrenergic drugs like clonidine (Catapres) include dry mouth, drowsiness, sedation, anorexia, rash, malaise, and weakness.
The nurse is reviewing the medical records of several clients. The nurse integrates knowledge of the drug isoproterenol, understanding that this drug would be contraindicated in a client with which condition? Select all that apply. A) Digitalis toxicity❤️ B) Type 2 diabetes C) Ventricular arrhythmias❤️ D) Angina pectoris❤️ E) Narrow-angle glaucoma
Ans: A, C, D Feedback: Isoproterenol (Isuprel) is contraindicated in clients with tachyarrhythmias, tachycardia, or heart block caused by digitalis toxicity, ventricular arrhythmias, and angina pectoris.
A nurse is preparing to administer a sympathomimetic drug. Which of the following might the nurse be preparing to give? Select all that apply. A) Clonidine (Catapres) B) Isoproterenol (Isuprel)❤️ C) Midodrine (ProAmatine)❤️ D) Epinephrine (EpiPen)❤️ E) Reserpine (Serpalan)
Ans: B, C, D Feedback: Isoproterenol, midodrine, and epinephrine are examples of sympathomimetic drugs.
In which of the following situations would a nurse caring for a hospitalized client hold the dose of propranolol (Inderal)? Select all that apply. A) Pulse less than 60 bpm❤️ B) Blood glucose less than 100 mg/dL C) Irregular pulse❤️ D) Systolic pressure less than 90 mm Hg❤️ E) Diastolic pressure greater than 90 mm Hg
Ans: A, C, D Feedback: The nurse should hold the dose of propranolol (Inderal) for clients experiencing any of the following: pulse less than 60 bpm, any irregularity in the client's heart rate or rhythm, or systolic pressure less than 90 mm Hg.
1. When describing the autonomic nervous system to a group of nursing students, the instructor determines that the teaching was successful when the students identify which body function as being controlled by this system? Select all that apply. A) Heart rate❤️ B) Muscle movement C) Blood pressure❤️ D) Glandular secretions❤️ E) GI activity❤️
Ans: A, C, D, E Feedback:
Before administering dobutamine to a client, the nurse should assess which of the following? Select all that apply. A) Blood pressure❤️ B) Blood glucose C) Respiratory rate❤️ D) Pulse❤️ E) Level of consciousness❤️
Ans: A, C, D, E Feedback: Prior to administering dobutamine to a client, the nurse should assess the client's blood pressure, respiratory rate, pulse, and level of consciousness.
A nurse identifies a nursing diagnosis of Constipation related to the effects of the prescribed cholinergic blocking drug. Which of the following would the nurse expect to include in the client's plan of care? Select all that apply. A) Encouraging the intake of a diet high in fiber❤️ B) Decreasing the dosage of the cholinergic blocking medication C) Increasing client's fluid intake to at least 2000 mL daily❤️ D) Withholding the drug until the client resumes usual bowel pattern E) Encouraging ambulation and exercise as appropriate❤️
Ans: A, C, E Feedback: Appropriate interventions include encouraging a high-fiber diet, increasing fluid intake, and encouraging ambulation and exercise. It is not the nurse's decision to decrease the dosage. Withholding the drug until the client's bowel patterns return would be inappropriate.
A nurse would administer phentolamine to a client diagnosed with which condition? Select all that apply. A) Pheochromocytoma-induced hypertension❤️ B) Benign hypertension C) Preoperative hypertension❤️ D) Increased intraocular pressure E) Treatment of dopamine extravasation tissue damage❤️
Ans: A, C, E Feedback: Phentolamine is an a-adrenergic blocker used in the treatment of pheochromocytoma-induced hypertension and preoperative hypertension and in the prevention and treatment of tissue damage caused by extravasation of dopamine.
A nurse has administered dopamine to a client taking phenytoin (Dilantin) for a seizure disorder. The nurse would closely monitor the client for which adverse reaction? Select all that apply. A) Hypotension❤️ B) Hypoglycemia C) Bradycardia❤️ D) Tachypnea E) Seizures❤️
Ans: A, C, E Feedback: When dopamine is administered to a client taking phenytoin, there is an increased risk of seizures, hypotension, and bradycardia.
A nurse would be alert for an increase in cholinergic effects if a client who is prescribed a cholinergic drug is also receiving which medication? Select all that apply. A) Prednisone❤️ B) Oxycodone C) Diclofenac D) Dexamethasone❤️ E) Ibuprofen
Ans: A, D Feedback: Cholinergic drugs administered concomitantly with corticosteroids, like prednisone and dexamethasone, can result in increased adverse effects of the cholinergic drug.
A client has a nursing diagnosis of Impaired Comfort related to xerostomia from the daily administration of a cholinergic blocking drug. When assessing the client, the nurse would be alert for which of the following? Select all that apply. A) Dysphagia❤️ B) Tooth decay C) Gingivitis D) Impeded speech❤️ E) Gingival hyperplasia
Ans: A, D Feedback: Dry mouth caused by daily use of cholinergic blocking drugs can result in dysphagia and impeded, difficult-to-understand speech. Tooth decay, gingivitis, and gingival hyperplasia are not associated with dry mouth.
Prior to administering bethanechol to a client, the nurse would assess which of the following? Select all that apply. A) Palpation of the bladder❤️ B) Palpation of the thyroid C) Blood glucose D) Blood pressure❤️ E) Pulse rate❤️
Ans: A, D, E Feedback: Bethanechol is used to treat urinary retentions. The nurse's preadministration assessment should include palpation of the bladder, blood pressure, and pulse rate prior to its administration to a client.
Which of the following is a condition that may result in distributive shock? Select all that apply. A) Central line infection❤️ B) Acute myocardial infarction C) Congestive heart failure D) Spinal cord injury❤️ E) Allergic drug reaction❤️
Ans: A, D, E Feedback: Central line infection, spinal cord injury, and allergic drug reactions can result in one of the different types of distributive shock.
1. A nursing instructor is planning a class for a group of nursing students about cholinergic drugs. When describing the enzyme acetylcholinesterase, which of the following would the instructor most likely include about this enzyme? Select all that apply. A) Makes the parasympathetic nervous system function differently❤️ B) Inactivates the neurotransmitter serotonin C) Activates the neurotransmitter acetylcholine D) Inactivates the neurotransmitter norepinephrine E) Results in the prevention of nerve synapses to continue nerve impulses❤️
Ans: A, E Feedback: Acetylcholinesterase makes the parasympathetic nervous system function differently by inactivating the neurotransmitter acetylcholine, thereby preventing the nerve synapse from continuing the nerve impulse.
A client with a peptic ulcer visits a health care facility. The physician has prescribed belladonna as part of the treatment. Before administering this drug, the nurse would assess which of the following? A) Saliva B) Stools❤️ C) Urine pH D) Blood glucose level
Ans: B Feedback: Before administering belladonna, the nurse should check the stools of the client who has a peptic ulcer along with performing additional assessments such as color and signs of occult blood. The nurse need not check saliva, urine pH, or blood glucose level.
A nurse recognizes the class of medication being administered to help plan ongoing assessment and client education. The nurse would identify which drug as an example of a b-adrenergic blocker? Select all that apply. A) Carvedilol (Coreg) B) Propranolol (Inderal)❤️ C) Metoprolol (Lopressor)❤️ D) Atenolol (Tenormin)❤️ E) Labetalol (Trandate)
Ans: B, C, D Feedback: Propranolol, metoprolol, and atenolol are b-adrenergic blockers, but carvedilol and labetalol are a/b-adrenergic blockers.
A client is experiencing photophobia secondary to the administration of a cholinergic blocking drug. Which of the following would be most appropriate? A) Keeping the client's room brightly lit B) Limiting the use of overhead lights❤️ C) Encouraging the client to use sunscreen D) Suggesting the client avoid watching television
Ans: B Feedback: If photophobia is a problem, the patient may need to wear shaded glasses when going outside, even on cloudy days. Rooms are kept dimly lit and curtains or blinds closed to eliminate bright sunlight in the room. Those with photophobia may be more comfortable in a semi-darkened room, especially on sunny days. It is a good idea to use overhead lights as little as possible. Sunscreen would be appropriate for photosensitivity, not photophobia. Avoiding television would be appropriate if the client experienced mydriasis and cycloplegia.
A nurse is teaching a client about the increased risk of heat prostration during the hot summer months related to his prescribed scopolamine therapy. The nurse determines that the teaching was successful when the client identifies which of the following as a sign of this condition? A) Dry mouth B) Fever❤️ C) Skin rash D) Urinary retention
Ans: B Feedback: Signs of heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion.
A nurse is teaching a client how to use an auto-injector as treatment for an allergic reaction. Which statement by the client indicates the need for additional teaching? A) I should not touch the orange or black tip on the small end. B) I should administer the dose and then call 9-1-1 if I'm alone.❤️ C) I should inject the black tip into my outer thigh. D) I need to massage the site after removing the device.
Ans: B Feedback: The client should call the emergency number first and then administer the dose if he or she is alone. The client should not touch the orange or black tip on the end. The dose is administered into the outer thigh and the site is massaged for 10 seconds after removing the device.
A nurse is caring for a client with urinary retention who is prescribed bethanechol. The nurse would administer this drug cautiously if the client has which of the following? A) Raynaud's disease B) Bradycardia❤️ C) Coronary artery disease D) Hyperthyroidism
Ans: B Feedback: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Cautious use is not necessary if the client has Raynaud's disease, coronary artery disease, or hyperthyroidism.
A client has been administered dobutamine. The client is also receiving a beta-adrenergic blocking drug. The nurse would monitor the client for the development of which of the following resulting from the use of these two drugs? A) Bradycardia B) Hypertension❤️ C) Depression D) Dehydration
Ans: B Feedback: The nurse should assess for hypertension in a client who is being administered dobutamine and beta-adrenergic blocking drugs. Combining dobutamine and beta-adrenergic blocking drugs does not increase the risk of bradycardia, depression, or dehydration.
A nurse is caring for a client admitted to the health care facility. The client is receiving a cholinergic blocking drug as treatment for bladder overactivity. Which intervention would be most appropriate for the nurse to include as part of the client's ongoing assessment? A) Assessment of the client's medical history B) Evaluation of symptoms related to the client's diagnosis❤️ C) Monitoring of the client's vital signs every 24 hours D) Observation for behavioral changes in the client
Ans: B Feedback: The nurse should evaluate the symptoms and complaints related to the client's diagnosis during the ongoing assessment of the treatment. The nurse should assess the medical history of the client before administration of the drug as part of the preadministration assessment. The vital signs of the client should be monitored regularly instead of every 24 hours. The nurse need not observe for behavioral changes in the client based on the client's diagnosis and condition.
A client with cardiac arrhythmia is treated with a centrally acting antiadrenergic drug. The nurse would assess the client for which of the following as a possible adverse reaction? A) Lightheadedness B) Malaise❤️ C) Bradycardia D) Weakness
Ans: B Feedback: The nurse should monitor the client for malaise as a generalized reaction with antiadrenergic drugs that are centrally acting when administered to clients with cardiac arrhythmias. Lightheadedness, bradycardia, and weakness are the adverse reactions associated with peripherally acting antiadrenergic drugs.
A nurse is administering a cholinergic blocking drug preoperatively to a client. What intervention should the nurse perform after administering the drug to the client? A) Provide cold milk to the client. B) Raise the side rails of the bed.❤️ C) Tell the client to lie completely flat in bed. D) Provide frequent sips of water.
Ans: B Feedback: The nurse should raise the side rails of the client's bed after administration of the drug. The nurse need not provide cold milk or provide frequent sips of water as fluids cannot be given after administering the drug. The client needs to remain in bed, but he or she can assume a position of comfort. There is no need to lie completely flat.
A group of nursing students are reviewing information about the parasympathetic nervous system. The students demonstrate understanding of the information when they identify that which type of receptor is involved with stimulating smooth muscle in the parasympathetic nervous system? A) Nicotinic B) Muscarinic❤️ C) Alpha D) Beta
Ans: B Feedback: There are two types of receptors in the parasympathetic nervous branch: muscarinic receptors (which stimulate smooth muscle) and nicotinic receptors (which stimulate skeletal muscle). Alpha and beta receptors are found in the sympathetic nervous system.
1. After teaching a group of nursing students about sympatholytic drugs, the instructor determines that the teaching was successful when the students identify which of the following as an example? Select all that apply. A) Angiotensin-converting enzyme inhibitors B) a-adrenergic blockers❤️ C) b-adrenergic blockers❤️ D) Angiotensin receptor blockers E) Loop diuretics
Ans: B, C Feedback: a- and b-adrenergic blockers are classified as sympatholytic drugs.
As part of the teaching plan for a client receiving midodrine, the nurse would instruct the client to report which of the following? Select all that apply. A) Fine tremors B) Pounding headache❤️ C) Bradycardia❤️ D) Difficulty urinating❤️ E) Constipation
Ans: B, C, D Feedback: Clients taking midodrine should be told to report any of the following reactions: pounding headache when lying down, bradycardia, or difficulty urinating.
A nurse is caring for a client who has recently suffered an acute myocardial infarction. The nurse would closely monitor this client for which of the following that would suggest that the client is developing shock? Select all that apply. A) Increased blood pressure B) Decreased urinary output❤️ C) Hypoxia❤️ D) Tachypnea❤️ E) Bradycardia
Ans: B, C, D Feedback: Signs and symptoms of shock include cold and clammy skin, sweating, hypotension, tachycardia, hypoxia, tachypnea, and decreased urinary output.
A nurse should notify the physician immediately if a client taking a cholinergic drug develops which of the following? Select all that apply. A) Hypoglycemia B) Excessive salivation❤️ C) Severe abdominal cramping❤️ D) Muscle rigidity❤️ E) Muscle spasms❤️
Ans: B, C, D, E Feedback: A client receiving a cholinergic drug is at risk for a cholinergic crisis. The signs of cholinergic crisis include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Any of these symptoms should be reported to the physician immediately.
A nurse is administering glycopyrrolate to a client with a peptic ulcer. The nurse would assess the client for which of the following as a possible GI system adverse reaction? Select all that apply. A) Diarrhea B) Dry mouth❤️ C) Constipation❤️ D) Nausea❤️ E) Dysphagia❤️
Ans: B, C, D, E Feedback: A nurse administering glycopyrrolate to a client with a peptic ulcer should monitor the client for dry mouth, nausea, vomiting, constipation, and dysphagia.
Based on the nurse's understanding of which body systems are affected by cholinergic drug adverse reactions, the nurse would be alert for adverse reactions involving which body system? Select all that apply. A) Endocrine B) Circulatory❤️ C) Respiratory❤️ D) Gastrointestinal❤️ E) Central nervous❤️
Ans: B, C, D, E Feedback: Cholinergic drug adverse reactions affect the circulatory, respiratory, gastrointestinal, and central nervous systems.
The nurse should observe elderly clients taking metoprolol (Lopressor) for which of the following adverse effects as they are more likely to occur in elderly clients? Select all that apply. A) Hyperglycemia B) Heart failure❤️ C) Peripheral vascular insufficiency❤️ D) Confusion❤️ E) Worsening angina❤️
Ans: B, C, D, E Feedback: The nurse should observe elderly clients taking metoprolol (Lopressor) for confusion, heart failure, worsening angina, shortness of breath, and peripheral vascular insufficiency.
Which of the following adverse reactions would the nurse include in the teaching plan for a client who is prescribed labetalol? Select all that apply. A) Hypoglycemia B) Insomnia❤️ C) Drowsiness❤️ D) Tachycardia E) Fatigue❤️
Ans: B, C, E Feedback: Adverse effects from the use of a/b-adrenergic blockers like labetalol include fatigue, dizziness, hypotension, drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain, bradycardia, and skin rash.
The nurse administers isoproterenol (Isuprel) to a client. Which of the following would most likely occur? Select all that apply. A) Decreased heart rate B) Increased use of glucose❤️ C) Decreased gastric motility❤️ D) Constriction of coronary blood vessels E) Wakefulness❤️
Ans: B, C, E Feedback: Isoproterenol (Isuprel) will most likely cause increased heart rate, increased use of glucose, decreased gastric motility, dilation of coronary blood vessels, and wakefulness.
After administering a cholinergic blocking drug to a client, assessment of which of the following would lead the nurse to suspect that the client is experiencing a visual adverse reaction to the drug? Select all that apply. A) Miosis B) Photophobia❤️ C) Mydriasis❤️ D) Diplopia E) Cycloplegia❤️
Ans: B, C, E Feedback: Possible adverse effects include blurred vision, mydriasis, photophobia, cycloplegia, and increased ocular tension.
After teaching a group of nursing students about the parasympathetic nervous system, the instructor determines that the teaching was successful when the students identify which of the following as an action? Select all that apply. A) Decreased salivary gland production B) Vasodilation❤️ C) Increased peristalsis❤️ D) Bronchodilation E) Pupillary constriction❤️
Ans: B, C, E Feedback: Stimulation of the parasympathetic nervous system results in the opposite reactions to those triggered by the adrenergic system: blood vessels dilate, sending blood to the gastrointestinal (GI) tract; secretions and peristalsis are activated and salivary glands increase production; the heart slows and pulmonary bronchioles constrict; the smooth muscle of the bladder contracts; and the pupils of the eyes constrict.
A nurse would monitor a client receiving a cholinergic blocking drug for an increased effect when the drug is administered with which of the following? Select all that apply. A) Fluconazole (Diflucan) B) Meperidine (Demerol)❤️ C) Haloperidol (Haldol) D) Amitriptyline (Elavil)❤️ E) Digoxin (Lanoxin)
Ans: B, D Feedback: A nurse may notice an increased effect of the cholinergic blocking drug when it is administered with meperidine (Demerol) and amitriptyline (Elavil) because meperidine and tricyclic antidepressants increase the effect of the cholinergic blockers. If given with fluconazole, an antifungal agent, the effectiveness of the antifungal agent decreases. If given with haloperidol, haloperidol's effectiveness is decreased. If given with digoxin, the risk for digoxin toxicity increases.
A nurse administers atenolol (Tenormin) to a client suffering an acute MI based on the understanding that this drug will result in which of the following changes in the client? Select all that apply. A) Increase the heart's excitability B) Decrease the heart's workload❤️ C) Increase the heart's oxygen consumption D) Decrease heart rate❤️ E) Constrict blood vessels
Ans: B, D Feedback: Atenolol (Tenormin) is a b-adrenergic blocking drug. Blockade of b-adrenergic receptors results in decreased heart rate, dilation of blood vessels, a decrease in the heart's excitability, and a decrease in cardiac workload and oxygen consumption and provides membrane-stabilizing effects.
When assessing a client receiving a cholinergic drug, the nurse would assess the client for increased neuromuscular blocking effects if the client is also receiving which of the following? Select all that apply. A) Amoxicillin B) Tobramycin❤️ C) Cephalexin D) Neomycin❤️ E) Clarithromycin
Ans: B, D Feedback: Cholinergic drugs administered concomitantly with aminoglycoside antibiotics, like tobramycin and neomycin, can result in increased neuromuscular blocking effects.
A client is prescribed ambenonium. The nurse would assess the client closely if the client has a history of which of the following? Select all that apply. A) Diabetes B) Hypertension❤️ C) Tachycardia D) Epilepsy❤️ E) Megacolon
Ans: B, D Feedback: Cholinergic drugs, like ambenonium, are used cautiously in clients with hypertension, epilepsy, cardiac arrhythmias, bradycardia, recent coronary occlusion, and megacolon.
A nurse is administering cholinergic eye drops to a client. The nurse would be alert for which of the following as a possible adverse reaction? Select all that apply. A) Nausea B) Headache❤️ C) Nasal congestion D) Decreased visual acuity❤️ E) Decreased auditory acuity
Ans: B, D Feedback: Cholinergic eye drops are used to treat glaucoma. Topical administration usually produces few adverse reactions, but a temporary reduction of visual acuity and headache may occur.
A nurse suspects that a client who has received scopolamine is experiencing an idiosyncratic reaction to the drug based on assessment of which of the following? Select all that apply. A) Drowsiness B) Restlessness❤️ C) Hypotension D) Insomnia❤️ E) Dry mouth
Ans: B, D Feedback: Excitement, delirium, restlessness, and insomnia represent idiosyncratic reactions to scopolamine.
If a cholinergic blocking drug is administered prior to surgery, which of the following would be most appropriate? Select all that apply. A) Encourage the client to void after the drug is given. B) Tell the client that his mouth may feel dry.❤️ C) Allow the client to take sips of fluids. D) Have the client remain in bed after drug administration.❤️ E) Encourage the client to sit in the chair for about 30 minutes.
Ans: B, D Feedback: If a cholinergic blocking drug is administered prior to surgery, the nurse instructs the client to void before the drug is given, that an extremely dry mouth is normal but that no fluid should be ingested, and that the client should remain in bed, not sit in a chair.
A client is prescribed pyridostigmine. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? Select all that apply. A) Constipation B) Nausea❤️ C) Dry mouth D) Skin flushing❤️ E) Muscle rigidity
Ans: B, D Feedback: Pyridostigmine is an oral cholinergic medication used in the treatment of myasthenia gravis. General adverse reactions associated with oral administration include nausea, diarrhea, abdominal cramping, salivation, skin flushing, cardiac arrhythmias, and muscle weakness.
A nurse understands that while most b-adrenergic receptors are found in the heart, they are also commonly found in which other organs? Select all that apply. A) Pancreas B) Eyes❤️ C) Liver D) Lungs❤️ E) Skin
Ans: B, D Feedback: b-adrenergic receptors are also found in the eyes and lungs. The blockage of these receptors can be beneficial in treatment of glaucoma or cause adverse reactions in the lungs (bronchospasms).
A client is prescribed metaraminol. The nurse demonstrates understanding of this drug, identifying that it can be administered by which route? Select all that apply. A) Orally B) Subcutaneously❤️ C) Topically D) Intramuscularly❤️ E) Intravenously❤️
Ans: B, D, E Feedback: Metaraminol may be administered subcutaneously, intramuscularly, and intravenously.
A nurse is reviewing the different types of shock that may occur. The nurse demonstrates understanding of the information when the nurse identifies which of the following as a type of distributive shock? Select all that apply. A) Cardiogenic-obstructive shock B) Septic shock❤️ C) Hypovolemic shock D) Anaphylactic shock❤️ E) Neurogenic shock❤️
Ans: B, D, E Feedback: Septic shock, anaphylactic shock, and neurogenic shock are types of distributive shock. Cardiogenic and hypovolemic are other types of shock.
A client comes to the clinic for a follow-up visit. It is a hot July afternoon. The client has been prescribed a cholinergic blocking drug. Which of the following would lead the nurse to suspect that the client is experiencing heat prostration? Select all that apply. A) Chills B) Flushing❤️ C) Bradycardia D) Cool, moist skin E) Mental confusion❤️
Ans: B, E Feedback: Cholinergic blocking drugs can cause decreased sweating, increasing a client's risk for heat prostration. The signs of heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion.
A nurse is providing care to a client with COPD. The nurse anticipates that which of the following would be appropriate to be prescribed for this client? Select all that apply. A) Darifenacin (Enablex) B) Ipratropium (Atrovent)❤️ C) Benztropine (Cogentin) D) Biperiden (Akineton) E) Tiotropium (Spiriva)❤️
Ans: B, E Feedback: Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).
After teaching a group of nursing students about adrenergic drugs and their effects, the instructor determines that the teaching was successful when the students identify which of the following as an effect of these drugs? A) Decreased myocardial contractility B) Vasodilation C) Increased cardiac output❤️ D) Improved airway clearance
Ans: C Feedback: Adrenergic drugs improve hemodynamic status by improving myocardial contractility and increasing heart rate, which results in increased cardiac output. Peripheral resistance is increased by vasoconstriction. The drugs do not improve airway clearance.
A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department complaining of abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which of the following? A) Underdosage of the drug B) Tolerance to the drug C) Cholinergic crisis❤️ D) Underlying infection
Ans: C Feedback: Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing. Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing. There is no information to suggest that the client has an underlying infection.
When caring for a client who is receiving acebutolol (Sectral), the nurse would ensure that which of the following is avoided to promote optimal effectiveness of acebutolol? Select all that apply. A) Sertraline (Zoloft) B) Phenelzine (Nardil) C) Naproxen (Naprosyn)❤️ D) Oxaprozin (Daypro)❤️ E) Fluoxetine (Prozac)
Ans: C, D Feedback: NSAIDs (naproxen and oxaprozin) can result in decreased effects of b blockers such as acebutolol.
A nurse is reviewing the effects of adrenergic drugs on the body. The nurse demonstrates understanding of this group of drugs by identifying that which of the following would occur if the drug stimulates beta-1 receptors? A) Vasoconstriction of peripheral blood vessels B) Decreased gastrointestinal tract secretions C) Increased force of myocardial contractions❤️ D) Bronchodilation
Ans: C Feedback: Stimulation of beta-1 receptors leads to an increase in heart rate and an increase in the force of myocardial contraction. Peripheral vasoconstriction occurs when alpha-1 receptors are stimulated. Decreased gastrointestinal motility and secretions occur when alpha-2 receptors are stimulated. Bronchodilation occurs when beta-2 receptors are stimulated.
A nurse is caring for a client who has been prescribed belladonna for the treatment of prolonged diarrhea. Which of the following nursing interventions should the nurse perform before administering the drug? A) Check stools of the client. B) Monitor for abdominal pain. C) Assess weight of the client.❤️ D) Monitor vital signs every 2 hours.
Ans: C Feedback: The nurse should assess the client's weight when caring for this client with prolonged diarrhea. The nurse should check the stools of the client who has been administered belladonna alkaloids for the treatment of peptic ulcer. The nurse need not monitor for abdominal pain or monitor the client's vital signs every 2 hours when caring for a client with diarrhea.
A nurse is caring for a client receiving cholinergic blocking drug therapy. The client complains of a cotton-mouth feeling. Which of the following would be most appropriate? A) Inspect the throat for signs of an infection. B) Suggest the client avoid ingesting water before taking the drug. C) Check the oral cavity daily for soreness or ulcerations.❤️ D) Suggest the client avoid the use of ice or cold beverages.
Ans: C Feedback: The nurse should check the oral cavity daily for soreness or ulcerations when caring for a client with severe mouth dryness. The nurse should encourage the client to take a few sips of water before and while taking the drug and to sip water at intervals during meals. If allowed, hard candy slowly dissolved in the mouth and frequent sips of water during the day may help relieve persistent oral dryness. There is no need to inspect the throat for infection or to avoid ice and cold beverages.
A nurse is assigned to care for a client with biliary colic in a health care facility. The client has been prescribed atropine. The nurse reviews the client's medical record and determines that the client should not receive this drug because the client has a history of which of the following? A) Hepatic disease B) Benign prostatic hypertrophy C) Myocardial infarction❤️ D) Urinary retention
Ans: C Feedback: The nurse should know that the use of atropine is contraindicated in clients with myocardial infarction. Other contraindications include myasthenia gravis, tachyarrhythmia, and congestive heart failure (unless bradycardia is present). Hepatic disease, benign prostatic hypertrophy, and urinary retention are conditions requiring cautious administration and are not contraindications for use.
A nurse is caring for a 60-year-old client with a peptic ulcer. The client is prescribed belladonna. The nurse would closely monitor this client for which of the following? A) Disorientation B) Lightheadedness C) Blurred vision❤️ D) Mydriasis
Ans: C Feedback: The nurse should monitor for blurred vision in the client after administration of the belladonna alkaloid drug. The other conditions observed are drowsiness, tachycardia, dry mouth, and urinary hesitancy. Disorientation, lightheadedness, and mydriasis are adverse reactions associated with the administration of trihexyphenidyl.
A nurse is caring for a client with myasthenia gravis at a health care facility. The client is receiving ambenonium. The nurse suspects that the dosage is insufficient based on assessment of which of the following? A) Clenching of the jaw B) Muscle spasms C) Difficulty breathing❤️ D) Abdominal cramping
Ans: C Feedback: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Clenching of the jaw and muscle spasms are symptoms of drug overdosage. Abdominal cramping may occur in the client who is receiving guanidine.
A client with an overactive bladder has been prescribed solifenacin by the physician. The client is also taking digoxin for the treatment of a cardiac condition. The nurse should monitor the client for an increase in which of the following resulting from the interaction of these two drugs? A) Increased neuromuscular blocking effect B) Increased effectiveness of digoxin C) Increased serum levels of digoxin❤️ D) Increased effectiveness of solifenacin
Ans: C Feedback: The nurse should monitor for increased serum levels of digoxin that occur due to the interaction of solifenacin and digoxin. Increased neuromuscular blocking is an effect of the interaction of aminoglycoside antibiotics with cholinergic drugs. Increased effectiveness of digoxin and solifenacin are not the effects associated with the interaction of solifenacin and digoxin.
The nurse is developing a teaching plan for a client who is receiving outpatient therapy with a cholinergic drug. Which of the following would be appropriate for the nurse to include? A) Instructions to avoid fiber-rich food during therapy B) Importance of adopting a self-monitoring blood pressure program C) Review of the purpose of the drug therapy with the client and family❤️ D) Evaluation of the client's previous history of disorders
Ans: C Feedback: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client receiving outpatient therapy with a cholinergic drug. Instructing the client to avoid fiber-rich food during therapy, suggesting the client adapt a self-monitoring blood pressure program, and evaluating the client's previous history of disorders would be inappropriate to include in the teaching plan.
A nurse is preparing to administer propranolol to a client for the treatment of cardiac arrhythmias. The nurse checks the client's apical pulse rate and blood pressure before administration and notes that the pulse rate is below 60 bpm. Which of the following would the nurse do next? A) Provide proper ventilation to the client. B) Delay drug administration for some time. C) Withhold the drug and contact the primary health care provider.❤️ D) Immediately give oxygen via face mask.
Ans: C Feedback: The nurse should withhold the drug and contact the primary health care provider if the pulse rate of the client is below 60 bpm. Providing proper ventilation to the client, delaying drug administration for some time, or providing oxygen support to the client would be inappropriate for this client.
Which of the following would the nurse assess before administering ambenonium to a client? Select all that apply. A) Palpation of the bladder B) Palpation of the thyroid C) Evidence of muscle weakness❤️ D) Signs of difficulty breathing❤️ E) Drooping of eyelids❤️
Ans: C, D, E Feedback: Ambenonium is used to treat myasthenia gravis. The nurse's preadministration assessment should include assessment for signs of muscle weakness, such as drooling, inability to chew and swallow, drooping eyelids, inability to perform repetitive movements, difficulty breathing, and extreme fatigue.
A nursing instructor is conducting a class for a group of nursing students about cholinergic blocking drugs. The instructor determines that the teaching was successful when the students identify which of the following as a cholinergic blocking drug used to treat Parkinson's disease? Select all that apply. A) Fesoterodine B) Trospium C) Benztropine mesylate❤️ D) Biperiden❤️ E) Trihexyphenidyl❤️
Ans: C, D, E Feedback: Cholinergic blocking drugs used to treat Parkinson's disease include benztropine mesylate, biperiden, and trihexyphenidyl. Fesoterodine and trospium are cholinergic blocking antispasmodics.
A nurse is reviewing the medical record of a client who is to be prescribed a cholinergic drug. Which condition, if found, would alert the nurse to a possible contraindication to the prescribed therapy? Select all that apply. A) Pancreatitis B) Diabetes C) Asthma❤️ D) Hyperthyroidism❤️ E) Peptic ulcer disease❤️
Ans: C, D, E Feedback: The use of cholinergic drugs is contraindicated in clients with known hypersensitivity to the drugs, asthma, peptic ulcer disease, coronary artery disease, and hyperthyroidism.
A client is prescribed norepinephrine IV. Which of the following would be appropriate for the nurse to do? Select all that apply. A) Administer the drug via a gravity infusion. B) Dilute the drug with sterile saline. C) Continuously monitor the client's blood pressure.❤️ D) Check the IV insertion site for leakage.❤️ E) Assess the client's urinary output hourly.❤️
Ans: C, D, E Feedback: When giving norepinephrine IV, the nurse should use an electronic infusion pump, not dilute the norepinephrine solution, continuously monitor the client's blood pressure, check the IV site for leakage or extravasation, restart the IV in another location if extravasation occurs and institute extravasation protocol according to the facility's policy, and assess the client's urine output hourly.
A client with motion sickness is prescribed transdermal scopolamine. The nurse would instruct the client to apply the patch at which frequency? A) Every 8 hours B) Every 24 hours C) Every 48 hours D) Every 72 hours❤️
Ans: D Feedback: A scopolamine patch is applied 4 hours before travel every 3 days or every 72 hours.
After teaching a group of nursing students about cholinergic drugs, the instructor determines a need for additional teaching when the students identify which drug as being administered orally? A) Ambenonium B) Bethanechol C) Pyridostigmine D) Edrophonium❤️
Ans: D Feedback: Edrophonium is a cholinergic drug that is administered intravenously. Ambenonium, bethanechol, and pyridostigmine are administered orally.
A nurse is preparing to administer a prescribed adrenergic agent to a client who is in shock. Before administering the drug, the nurse would assess for and document which of the following as a sign of shock? A) Increased temperature B) Reddish/pinkish skin C) Dry, dehydrated skin D) Changes in consciousness❤️
Ans: D Feedback: Symptoms of shock, such as a change in the level of consciousness, should be recorded by the nurse as part of the preadministration assessment. Cool skin, not elevated temperature, is another symptom of shock. The nurse also needs to record signs of diaphoresis and cyanosis, not reddish/pinkish or dry, dehydrated skin.
A client with a cardiac problem is treated with b-adrenergic blocking drugs. Which of the following should the nurse identify as a cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client? A) Vomiting B) Hyperglycemia C) Nausea D) Vertigo❤️
Ans: D Feedback: The nurse should identify vertigo as the cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client. Vomiting, nausea, and hyperglycemia are not cardiac reactions; they are gastrointestinal reactions that are observed when the client is administered b-adrenergic blocking drugs.
A nurse is providing care to a client who is receiving an ophthalmic cholinergic drug. When reviewing the client's medical history, which of the following, if found, would the nurse identify as a contraindication? A) Cataracts B) Diabetic retinopathy C) Megacolon D) Corneal abrasion❤️
Ans: D Feedback: The nurse should know that ophthalmic cholinergic drugs are contraindicated in clients with corneal abrasions. The use of ophthalmic cholinergic drugs is not contraindicated in clients with cataracts, diabetic retinopathy, or megacolon. Cholinergic drugs are used cautiously in clients with megacolon.
A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which of the following? A) Seizure disorder B) Reduction of visual acuity C) Abdominal discomfort D) Cardiac arrhythmias❤️
Ans: D Feedback: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol chloride for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol chloride and not pyridostigmine.
A nurse is caring for an older adult client who is prescribed isoproterenol. After administering the drug, the nurse would immediately report which of the following changes to the primary health care provider? A) Blood glucose level B) Appetite C) Temperature D) Pulse rate❤️
Ans: D Feedback: 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.
The nurse administers a prescribed oral dose of bethanechol to a client with urinary retention at 9:30 a.m. The nurse would notify the primary health care provider if the client has not voided by which time? A) 9:45 a.m. B) 10 a.m. C) 10:30 a.m. D) 11 a.m.❤️
Ans: D Feedback: When bethanechol is administered orally, the client should void within 30 to 90 minutes. Therefore, if the client has not yet voided by 11 a.m., the nurse should notify the primary health care provider.
A nurse is reviewing the medical record of a client who is to receive a cholinergic blocking drug. Which of the following would the nurse identify, if found, as contraindicating the use of the drug? Select all that apply. A) Pancreatitis B) Diabetes C) Asthma D) Glaucoma❤️ E) Myocardial infarction❤️
Ans: D, E Feedback: The use of a cholinergic blocking drug is contraindicated in clients with known hypersensitivity to the drugs, glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction, and congestive heart failure (unless bradycardia is present).