Chapter 13
Which condition would alert the nurse of the need to use beta adrenergic blockers cautiously?
A) Hypertension B) Raynauds phenomenon C) Emphysema D) Cardiac dysrhythmias Answer:C Emphysema Explanation: OBJ: 9 TOP: Nursing Process Step: Assessment
Synapse
junction between one neuron and the next
The prescriber orders Phenytoin (Dilantin) suspension, 150mq q8h Available: Dilantin suspension, 125 mg/5 mL Calculate the correct dose to the nearest whole number: Give ____________mL every________ hours
1. (6 mL every 8 hours) Rationale: 125 mg/5 mL = 150 mg/x 5 × 150 = 125x 750 = 125x 750/125 = x x = 6 mL every 8 hours
Norepinephrine (NE)
Mainly excitatory; involved in arousal and mood
Adrenergic blocking agents
inhibit the adrenergic system
Which condition would alert the nurse of the need to use beta adrenergic blockers cautiously? Multiple Choice A) Hypertension B) Raynauds phenomenon C) Emphysema D) Cardiac dysrhythmias
B) The symptoms will tend to resolve with continued therapy. Explanation: Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive central nervous system (CNS) stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy. The therapeutic level can only be determined by analyzing a blood sample. These are common symptoms and should only be reported if they persist. Symptoms of toxicity are chest pain, persistent palpitations, and tachycardia.
Dopamine
influences movement, learning, attention, and emotion
Noncatecholamines
-act in similar way but more selective for certain types of receptors
efferent nerves
Also called motor nerves; nerves that carry information out of the brain and spinal cord to other areas of the body.
vasoconstrictor
Some drugs have both effects of bronchodilator and vasoconstrictor; terbutaline is a uterine relaxant used in premature labor, as well as a bronchodilator
What nursing assessment is done before starting a patient on a beta adrenergic blocking agent? A. Complete blood count (CBC) and sedimentation rate B. Liver enzymes C. Blood pressure and heart rate D. Blood urea nitrogen (BUN) and creatinine levels
C. Blood pressure and heart rate A baseline level of blood pressure and heart rate should be obtained because beta adrenergic blocking agents affect both of these functions. Beta adrenergic blocking agents do not affect CBC and sedimentation rate, liver enzymes, or BUN and creatinine levels.
Two broad classes of drugs
Catecholamines, Noncatecholamines •Noncatecholamines do not work as quickly as catecholamines, are more selective for certain types of receptors, are not quite as long-acting, and have a longer duration.
A patient who has recently been prescribed a beta-adrenergic blocking drug presents to the emergency department with a serious adverse effect. Which adverse effect is the patient likely exhibiting? 3. Bronchoconstriction
Nonselective beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockade produces severe bronchoconstriction and may aggravate wheezing, especially during the pollen season. · Page 200
Glutamic acid
amino acid that is used by almost all living beings in the biosynthesis of proteins
cholinergic drugs
cause effects in the body similar to those produced by acetylcholine
Adrenergic drugs
cause effects similar to those produced by the adrenergic neurotransmitter
Glycine
contributes to cellular growth and health
A patient who has recently experienced a heart attack is prescribed a beta-adrenergic blocking agent. Which symptom of this therapy would be of concern to the nurse? A. Decrease in heart rate from 88/min to 46/min B. Decrease in blood pressure from 146 mm Hg systolic to 110 mm Hg systolic C. Decrease in temperature from 37.6º to 37.2º C D. Decrease in respirations from 26/min to 20/min
•Answer: A Rationale: Beta-adrenergic blocking agents are commonly used to decrease heart rate, blood pressure, and oxygen demand of the heart. A heart rate decrease from 88 to 46/min is a significant drop below what is expected and warrants a full assessment
What common adverse effect are adrenergic drugs known to cause? A. Drowsiness B. Cardiac dysrhythmias C. Tremors D. Bradycardia
•Answer: C •Rationale: Adverse effects such as occasional palpitations, tachycardia, skin flushing, dizziness, and tremors are common and expected with adrenergic drugs. They tend to be mild and resolve with continued therapy. If more severe symptoms occur such as sustained cardiac dysrhythmias, severe blood pressure fluctuations, chest pain, nausea, or vomiting, the patient should stop the medication and immediately notify the health care provider.
Which term describes the collective symptoms of blurred vision; constipation; urinary retention; and dry nose, mouth, and throat? A. Dehydration B. Toxic effects C. Anticholinergic effects D. Cholinergic action
•Answer: C •Rationale: This combination of symptoms is commonly referred to as anticholinergic effects, which are common adverse effects of many medications.
A patient has been prescribed an anticholinergic drug for irritable bowel syndrome (IBS). For which adverse effect must the nurse teach the patient to be aware when beginning this drug? A. Rhinitis (runny nose) B. Drowsiness C. Diarrhea D. Orthostatic hypotension
•Answer: D •Rationale: The patient must be made aware of orthostatic hypotension with anticholinergic drug therapy, which may occur when getting up too quickly from a lying position. This may be accompanied by weakness and dizziness. The patient should be instructed to rise slowly and sit down if feeling faint.
Review
•Medications that mimic the sympathetic system are known as adrenergic drugs. •Medications that mimic the parasympathetic system are known as cholinergic drugs. •The sympathetic system inhibits adrenergic blocking agents. •The parasympathetic system inhibits anticholinergic agents.
Catecholamines
-three occur naturally in the body and can be synthetically manufactured •Norepinephrine •Epinephrine •Dopamine
Beta-Adrenergic Blocking Agents
drugs that, at therapeutic levels, selectively block the beta-receptors of the sympathetic nervous system Benefits include treatment for -Hypertension -Angina pectoris -Cardiac dysrhythmias -Hyperthyroidism Examples -atenolol (Tenormin) -carvedilol (Coreg) -metoprolol (Lopressor, Toprol XL)
Acetylcholine (ACh)
enables muscle action, learning, and memory
Peripheral nervous system
-Afferent nerves—transmit signals to the spinal cord and brain -Efferent nerves—carry impulses from CNS to other parts of body. Divided into two parts •Motor nervous system—controls skeletal muscle contractions •Autonomic nervous system—regulates certain body functions •Name some of the body functions that the autonomic nervous system regulates. (Heart rate, blood pressure, temperature, light regulation by the eyes)
Central and Autonomic Nervous Systems
-Made up of brain and spinal cord -CNS receives signals from sensory receptors (vision, pressure, pain, cold, warmth, touch, smell) via afferent nerves -CNS processes these signals and responds via efferent nerves -Peripheral nervous system is composed of efferent and afferent nerves •Think of how a person's world would be different if he or she were missing one of these signals, such as vision or pain.
Neurotransmitters
-chemical substances that cause transmission of nerve signals or impulses -Activate receptors at end organ such as heart, glands, smooth muscles •For the neuron: hold out your arm and spread your fingers. Your hand represents the cell body (also called the soma); your fingers represent dendrites bringing information to the cell body; your arm represents the axon, taking information away from the cell body. •The synapse is the space between your hand and another person's hand.
Neurons
-segments that make up each nerve of the central and peripheral nervous systems
Prior to the administration of metoprolol, a beta adrenergic blocking agent, which is most important for the nurse to assess? Multiple Choice A) Blood pressure B) Lung sounds C) Mental status D) Urine output
A) Blood pressure Explanation: Beta adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect, but is not the most important assessment prior to the administration of a beta adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta adrenergic blocking agent.
A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) A. Palpitations B. Dizziness C. Orthostatic hypotension D. Hypoglycemia E. Tremors F. Bradycardia
A, B, C, E Explanation: Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient.
Drug Class: Anticholinergic Agents
Actions -Block action of acetylcholine in the parasympathetic nervous system Uses -Treat Parkinson's disease, GI and ophthalmic disorders, bradycardia, genitourinary disorders Common adverse effects -Blurred vision; constipation; urinary retention; dryness of the mucosa of the mouth, nose, and throat Serious adverse effects -Confusion, depression, hallucinations, nightmares, glaucoma, palpitations, dysrhythmias •Known as cholinergic blocking agents or parasympatholytic agents.
Drug Class: Alpha- and Beta-Adrenergic Blocking Agents
Actions -Block alpha or beta receptors Uses -Treat hypertension Common adverse effects -For diabetic patients—hypoglycemia symptoms may be masked Serious adverse effects -Bradycardia, peripheral vasoconstriction, heart failure, bronchospasm, wheezing •Stimulation of alpha-1 catecholamine receptors constricts blood vessels, thereby increasing blood pressure. •Alpha blockers are used with diseases associated with vasoconstriction. Beta blockers are used extensively to treat hypertension
Which nerve endings liberate norepinephrine? Multiple Choice A) Cholinergic B) Adrenergic C) Anticholinergic D) Muscarinic
B) Adrenergic Explanation: Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.
Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynauds disease? Multiple Choice A) Adrenergic agents B) Alpha adrenergic blocking agents C) Beta adrenergic blocking agents D) Cholinergic agents
B) Alpha adrenergic blocking agents Explanation: Alpha adrenergic blocking agents interfere with the stimulation of alpha 1 and alpha 2 receptors. Because the primary action of alpha receptor stimulation is vasoconstriction, alpha adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.
Which condition is dopamine commonly used to treat? (Select all that apply.) A. Asthma B. Hypertension C. Shock D. Stroke
B. Hypertension C. Shock Dopamine, an adrenergic agent, is commonly used to treat shock as well as hypertension. Adrenergic agents albuterol (Proventil) and terbutaline (Brethine) are commonly used to treat asthma. Adrenergic agents are not used to treat stroke.
For a patient receiving adrenergic agents, the nurse assesses for concurrent use of which medications that may inhibit therapeutic activity? (Select all that apply.) A. Diphenhydramine (Benadryl) B. Propranolol (Inderal) C. Bretylium tosylate (Bretylate) D. Omeprazole (Prilosec) E. Aspirin
B. Propranolol (Inderal) C. Bretylium tosylate (Bretylate) Concurrent use of bretylium tosylate or beta adrenergic blocking agents, such as propranolol, with adrenergic agents is not recommended because these drugs can inhibit the therapeutic activity of adrenergic agents. Omeprazole, diphenhydramine, and aspirin are not known to inhibit the therapeutic activity of adrenergic agents
The autonomic nervous system can be subdivided into which types of adrenergic receptors? Multiple Choice A) Nicotinic and muscarinic B) Afferent and efferent C) Alpha and beta D) Agonists and antagonists
C) Alpha and beta Explanation: The autonomic nervous system can be subdivided into alpha and beta adrenergic receptors. Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function.
What is the primary response to alpha 1 receptor stimulation? Multiple Choice A) Bronchodilation B) Tachycardia C) Vasoconstriction D) Uterine relaxation
C) Vasoconstriction Explanation: Stimulation of the alpha 1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha 1 receptor stimulation causes bronchoconstriction. Alpha 1 receptor stimulation does not cause tachycardia. Beta 2 receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.
Which data in the patients history and physical examination cause the nurse to question a preoperative medication order for atrophine sulfate and morphine before administrator? 4. Prostatic enlargement
Check the patient for a history of enlarged prostate. If this condition is present, anticholinergic agents may cause the patient to have a temporary inability to void. · Page 210
Adrengeric agents
Common adverse effects -Palpitations, tachycardia, skin flushing, dizziness, tremors, orthostatic hypotension Serious adverse effects -Dysrhythmias, chest pain, severe hypotension, hypertension, anginal pain, nausea, vomiting Adverse effects are usually dose-related and resolve when the drug is reduced or discontinued
A nurse assessing a patient who presented to the clinic with complaints of dizziness and weakness after starting amitriptyline for sleep. The nurse knows that over-the-counter medications may increase therapeutic effects and even cause toxic effects. Which medication that the patient reports taking would be the most concerning? 3. Cold remedies
Monoamine oxidase inhibitors, tricyclic antidepressants, atropine, and halothane anesthesia may increase both therapeutic and toxic effects. Many over-the-counter medications, such as cold remedies and appetite suppressants, contain adrenergic medications that can have an additive effect when they are taken with a prescribed adrenergic agent. Monitor patients for tachycardia, serious dysrhythmias, hypotension, hypertension, and chest pain. · Page 204
Epinephrine
Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.
Gamma-aminobutyric acid (GABA)
Neurotransmitter that reduces activity across the synaptic cleft and thus inhibits a range of behaviors and emotions, especially generalized anxiety.
Autonomic Nervous System
-Controls most tissue function -Maintains constant internal environment (homeostasis) and responds to emergency situations -Made up of two major neurotransmitters *Norepinephrine—liberated by adrenergic fibers *Acetylcholine—liberated by cholinergic fibers •The two systems of the autonomic nervous system are sympathetic nervous system (SNS) and parasympathetic nervous system (PNS). •Autonomic nervous system is sometimes referred to as the involuntary nervous system.
Neurotransmitter(s) include: (Select all that apply.) A. gamma aminobutyric acid. B. acetylcholine. C. serotonin. D. glucose. E. histamine. F. epinephrine.
A, B, C, E, F Explanation: The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the bodys main source of energy.
Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) A. Nausea B. Hypertension C. Dizziness D. Bradycardia E. Constipation
A, C, D Explanation: Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping.
Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.) A. Blood pressure B. Skeletal muscle contraction C. GI secretion D. Body temperature E. Urination
A, C, D, E Explanation: Blood pressure, GI secretion, body temperature, and urinary bladder function are body functions controlled by the autonomic nervous system. The autonomic nervous system maintains control over most tissue function, with the exception of skeletal muscle.
A patient is taking an anticholinergic agent. For which common adverse effects does the nurse monitor this patient? (Select all that apply.) A. Blurred vision B. Urinary retention C. Dryness of mouth D. Chills
A. Blurred vision B. Urinary retention C. Dryness of mouth Blurred vision may occur with the use of anticholinergic agents, and appropriate suggestions should be made for the patient's safety. If the patient develops urinary hesitancy with the use of anticholinergic agents, he or she should be assessed for bladder distention and the health care provider contacted for further evaluation. Mucosa dryness may occur with the use of anticholinergic agents, and may be alleviated by sucking hard candy or ice chips or by chewing gum. Constipation, not diarrhea, is a common adverse effect of anticholinergic agents. Chills are not a common adverse effect of anticholinergic agents.
Patients with which conditions are potentially more sensitive to the effects of adrenergic agents? (Select all that apply.) A. Impaired hepatic function B. Lung disease C. Thyroid disease D. Heart disease E. Hypotension
A. Impaired hepatic function C. Thyroid disease D. Heart disease Patients who are potentially more sensitive to adrenergic agents include those with impaired hepatic function, thyroid disease, and heart disease. Patients with lung disease are not known to be more sensitive to the effects of adrenergic agents. Patients with hypertension, not hypotension, are known to be more sensitive to the effects of adrenergic agents.
Body functions such as blood pressure, heart rate, and temperature are regulated by which nervous system?
A.Autonomic B. Motor C. Sensory D. Peripheral •Answer: A Rationale: The autonomic nervous system helps maintain homeostasis or a balance of functions and regulates levels of blood pressure, heart rate, thermal control, light regulation by the eyes, and many other activities in an effort to maintain a healthy state
Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) A. Take the medication with meals. B. Increase fluids daily. c. Decrease fiber in the diet. D. Suck on candy or ice chips. E. Monitor blood glucose.
B, D Explanation: OBJ: 10 TOP: Nursing Process Step: Implementation
Drug Class: Cholinergic Agents
Actions -Stimulate parasympathetic nervous system; inhibit enzyme that metabolizes acetylcholine (acetylcholinesterase) Uses -Treat myasthenia gravis, reverse muscle relaxants Common adverse effects -Nausea, vomiting, diarrhea, abdominal cramping, dizziness, hypotension Serious adverse effects -Bronchospasm, wheezing, bradycardia •Known as parasympathomimetic agents— produce effects similar to those of acetylcholine. Mnemonic for recalling the drug effects of cholinergics is SLUDGE: Salivation, Lacrimation, Urinary incontinence, Diarrhea, Gastrointestinal cramps, and Emesis
afferent nerves
Also called sensory nerves; nerves that carry information about the external environment to the brain and spinal cord via sensory receptors.
A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta adrenergic blocking agent. Which statement by the patient indicates a need for further teaching? Multiple Choice A) This medication should not be discontinued suddenly. B) This medication lowers my blood pressure by helping me get rid of fluid. C) I may not have my usual symptoms of a hypoglycemic reaction while on this drug. D) This medication may take a few weeks to work.
B) This medication lowers my blood pressure by helping me get rid of fluid. Explanation: Beta adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta adrenergic blocking agents may mask symptoms of hypoglycemia. Beta adrenergic blocking agents may take several days to weeks to show optimal improvement.
Which statement(s) is/are true about efferent nerves? (Select all that apply.) A. They transmit signals to the spinal cord and brain. B. They leave the CNS to carry impulses to other body parts. C. They are part of the peripheral nervous system. D. They transmit signals that control contractions of smooth and skeletal muscle. E. They transmit signals that control contractions of some glandular secretions.
B, C, D, E Explanation: Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.
For which patients does the nurse expect an anticholinergic agent to be ordered? (Select all that apply.) A. Patient with tachycardia B. Patient with nocturnal enuresis C. Patient with Parkinson's disease D. Patient who needs an endotracheal tube E. Patient with hypertension
B. Patient with nocturnal enuresis Correct C. Patient with Parkinson's disease Correct D. Patient who needs an endotracheal tube Correct Anticholinergic agents are used clinically in the treatment of Parkinson's disease and genitourinary disorders like nocturnal enuresis. Anticholinergic agents are used to prevent vagal stimulation from skeletal muscle relaxants or placement of an endotracheal tube. Anticholinergic agents are used clinically in the treatment of bradycardia, not tachycardia. Beta adrenergic blocking agents are used extensively to treat hypertension.
What will a medication that stimulates the beta 2 receptors cause? A. Bronchoconstriction B. Relaxation of the uterus C. Vasoconstriction of peripheral blood vessels D. Increase in heart rate
B. Relaxation of the uterus Stimulation of beta 2 receptors causes relaxation of smooth muscle in the uterus, as well as in the smooth muscle in the bronchi (bronchoconstriction). Stimulation of beta 2 receptors causes relaxation of smooth muscle in the peripheral arterial blood vessels (vasodilation). Stimulation of beta 1 receptors causes an increase in the heart rate.
A patient taking albuterol (Proventil) has also started taking an over the counter (OTC) cold medication. What symptom does the nurse monitor for in this patient? A. Increased occurrence of bronchospasms B. Tachycardia C. Bradycardia D. Increased fluid retention
B. Tachycardia The concurrent use of albuterol and OTC cold medications may have an additive effect and cause tachycardia as well as chest pain. The OTC medication will not have an effect on the bronchi. The concurrent use of albuterol and OTC cold medication will not decrease heart rate or increase fluid retention.
Anticholinergic agents
Block or inhibit cholinergic activity by blocking the action of acetylcholine.
A patient with Parkinsons disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? Multiple Choice A) These drugs help you urinate. B) These drugs will decrease your eye pressure. C) These drugs inhibit the action of acetylcholine. D) These drugs will assist in lowering your heart rate.
C) These drugs inhibit the action of acetylcholine. Explanation: Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinsons disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate.
Why are beta blockers used cautiously in patients with respiratory conditions? Multiple Choice A) They mask the signs and symptoms of acute hypoglycemia. B) They cause extensive vasodilation and cardiac overload. C) They may produce severe bronchoconstriction. D) They increase hypertensive episodes.
C) They may produce severe bronchoconstriction. Explanation: Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta 2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.
A long term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to: Multiple Choice A) report development of alterations to the charge nurse. B) assess blood glucose. C) provide for residents safety. D) medicate with antianxiety medication.
C) provide for residents safety. Explanation: Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.
Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) A. Glaucoma B. Benign prostatic hypertrophy C. Bradycardia D. Parkinsons disease E. Preparation for surgery F. Stimulation of the vagus nerve
C, D, E Explanation: Anticholinergic drugs are used to treat bradycardia and Parkinsons disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.
What does the nurse teach a patient about taking a beta adrenergic blocking agent? A. The drug may be stopped when the patient begins to have better blood pressure readings. B. The medication must be taken with meals. C. If the medication is stopped abruptly, it may cause an exacerbation of anginal symptoms. D. The drug may be taken with cimetidine without any adverse reactions.
C. If the medication is stopped abruptly, it may cause an exacerbation of anginal symptoms. Stopping beta adrenergic blocking agents may exacerbate anginal symptoms and lead to myocardial infarction. Individuals who are placed on beta adrenergic blocking agents should not discontinue them without consulting a health care professional. Beta adrenergic blocking agents are not required to be taken with meals. Taking a beta adrenergic blocking agent with cimetidine may require the beta blocker dosage to be higher because the cimetidine may interfere with the medication's metabolism.
Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? Multiple Choice A) Hypertension B) Infectious diseases C) Diabetes D) Closed angle glaucoma
D) Closed angle glaucoma Explanation: The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.
An older adult patient is to receive atenolol, a beta adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? Multiple Choice A) Determine the therapeutic blood level. B) Encourage the patient to decrease water intake. C) Elevate the patients legs. D) Withhold the medication.
D) Withhold the medication. Explanation: OBJ: 9 TOP: Nursing Process Step: Assessment
A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling dizzy and weak. The most appropriate action for the nurse is to: Multiple Choice A) immediately notify the physician. B) teach the patient to move slowly from standing to sitting. C) discontinue the adrenergic blocker. D) monitor the blood pressure in both the supine and standing positions
D) monitor the blood pressure in both the supine and standing positions. Explanation: Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.
The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to: Multiple Choice A) provide the next dose of the cholinergic agent immediately. B) assess heart rate and blood pressure. C) reposition the patient. D) withhold the next dose and notify the physician.
D) withhold the next dose and notify the physician. Explanation: Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a health care provider.
A patient taking labetalol (Normodyne) has also been prescribed procainamide (Procanbid). What symptom does the nurse monitor for in this patient? A. Increased blood pressure B. Tachycardia C. Seizures resulting from decreased sodium and potassium levels D. Bradycardia
D. Bradycardia This combination of medications may significantly decrease the patient's heart rate. This combination of medications will not cause an increase in the patient's blood pressure or heart rate and should not have an effect on sodium or potassium levels.
Which beta stimulant is used for bronchodilation and to stop premature labor? A. Metaproterenol (Alupent) B. Albuterol (Proventil) C. Phenylephrine (Neo Synephrine) D. Terbutaline (Brethine)
D. Terbutaline (Brethine) Terbutaline has been shown to be effective in the treatment of asthma and premature labor. Metaproterenol is used to decrease bronchospasms. Albuterol is used in the treatment of asthma, but not premature labor. Phenylephrine is used as a nasal decongestant.
A patient with closed-angle glaucoma can safely receive drugs from which classification? 3. Cholinergic agents
Patients with closed-angle glaucoma can safely receive cholinergic agents. All patients should be screened for closed-angle glaucoma because anticholinergic agents may precipitate an acute attack. Patients with open-angle glaucoma can safely use anticholinergic agents in conjunction with miotic therapy. · Page 210
Common neurotransmitters affecting the CNS
•Neurotransmitter regulation by pharmacologic agents is a major mechanism for controlling diseases caused by either an excess of or deficiency of neurotransmitters. There are at least 30 different types of neurotransmitters. •Parkinson's disease is affected by neurotransmitter regulation. -Acetylcholine -Norepinephrine -Epinephrine -Dopamine -Glycine -Gamma-aminobutyric acid (GABA) -Glutamic acid
