pharm 2 exam 4 megaset
fertility medication
-clomiphene citrate
beta specific adrenergic agonists cautions
-diabetes, thyroid disease, vasomotor problems, heart disease, stroke, severe renal disease
nonselective adrenergic blocking adverse effects
-dizziness, arrhythmias, hypotension, CHF, pulmonary edema, depression, vertigo, cough, rhinitis, rash
alpha and beta adrenergic agonists non-specific drugs
-dobutamine and *dopamine*
fesoterodine
-used over active bladder
Biggest causes of osteoporosis before menopause
1. smoking 2. diet soda
A client is receiving phenylephrine via intramuscular injection. The nurse would expect the drug to begin acting in approximately which amount of time?
10 to 15 minutes
5- alpha reductase inhibitors: Finasteride (Proscar) use
Benign prostate hyperplasia male-pattern baldness (androgenetic alopecia)
The sympathomimetic drug of choice to treat patients with shock is ___________.
Dopamine
Which would the nurse identify as a naturally occurring catecholamine?
Dopamine
Which would the nurse identify as a naturally occurring catecholamine? Dobutamine Dopamine Ephedrine Metaraminol
Dopamine Explanation: Dopamine is a naturally occurring catecholamine. Dobutamine, ephedrine, and metaraminol are synthetic catecholamines.
Which herbs has been removed from most weight-loss medications due to potential legal liability?
Ephedra
Dinoprostone can be used to terminate a pregnancy after 20 weeks. True False
False Rationale: Dinoprostone is used to terminate pregnancies ranging from 12 to 20 weeks' gestation
what are hormonal contraceptives
-combo of estrogen plus progestin or progestin only
adverse effects of dopamine
-hypo and hypertension (not therapeutic doses)
elderly considerations for adrenergic antagonists
-increased adverse effects -start low and go slow -bisoprolol is drug of choice for elderly
estrogen adverse effects
-increased risk for thromboembolic conditions and endometrial hyperplasia (cancer) -dementia -breast cancer -PO form can cause nausea and vomiting
action of adrenergic antagonists
-prevents norepinephrine from activating the receptor, blocks the SNS -the higher the dose the greater of loss of specificity
True or False Testosterone is not recommended for use in women because of the adverse androgenic effects.
False
True or False: A women taking terazosin may breast-feed because the drug does not enter the breast milk.
False
True or False: Beta-1 selective adrenergic blocking agents should not be used in patients with a history of asthma because they block the receptors responsible for bronchodilation.
False
True or False: Halothane anesthetics, when combined with complete adrenergic blocking agents, may cause severe hypotension and should be used concurrently with caution.
True
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action? monitor respiratory rate. assess heart rate. check blood glucose level. measure urine output.
assess heart rate. Explanation: The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would be no need to check blood glucose or measure urinary output, and though respiratory rate is monitored it is not the priority measure.
Sildenafil s/e:
hypotension priapism (erection lasting longer than 4 hr) vision impairment (NAION) hearing loss headache flushing dyspepsia nasal congestion dizziness
A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:
increase blood pressure
A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:
increase blood pressure.
Symptoms of motion sickness, including nausea and vomiting, may be decreased if patients use a __________ patch.
scopolamine
A client with a recent history of benign prostatic hypertrophy (BPH) will soon begin treatment with finasteride. Before beginning this course of therapy, the nurse should caution the client to be aware of what potentially adverse effect? urinary retention tinnitus photosensitivity sexual dysfunction
sexual dysfunction Explanation: Adverse effects of finasteride include various sexual dysfunctions, such as impotence, gynecomastia, reduced libido, and ejaculatory disorders. It relieves urinary retention cause by BPH, rather than exacerbating the problem. It does not cause photosensitivity or tinnitus.
5-alpha reductase inhibitors (Finasteride) s/e
sexual dysfunction gynecomastia reduced libido ejaculatory disorders
Norepinephrine uses
shock with cardiac arrest
hormone replacement therapy
- can help prevent osteoporosis - available in pills, patches, sprays, creams, injections - can increase the risk of stroke, MI, and breast cancer
On Combo pills:
- don't smoke -> stroke, DVT, PE, MI - don't take while pregnant - breast cancer tumors can grow - blood sugar can increase in DM patients
Progestins uses
- improves dysmenorrhea - combination birth control - breakthrough bleeding - endometriosis - emergency contraception
Estrogens s/e
- increased risk of thromboembolic conditions - endometrial hyperplasia - dementia - breast cancer
Alpha and Beta adrenergic agonists contraindications
- pheochromocytoma - tachyarrythmias or v-fib - hypovolemia - halogenated hydrocarbon general anesthetics
Who should not use combination birth control pills
- preexisting CAD - HTN - smokers
Phosphodieterase type 5 (PDE5) inhibitors: Sildenafil (Viagra) uses:
- sexual dysfunction - pulmonary hypertension in women in the ICU
epinephrine use
- shock - glaucoma - bronchospasm - anaphylaxis - prolonged effect for local anesthetics
Sildenafil instructions:
- take 1 hour before sex - come to the ER if erection lasts more than 4 hours
beta selective adrenergic blocking drugs
-**atenolol**, bisoprolol
anticholinergic meds
-**atropine**, fesoterodine, flavoxate, ipratropium
nonselective adrenergic blocking drugs
-**labetalol
alpha specific adrenergic agonists drugs
-*phenylephrine* and midodrine
tamsulosin uses
-BPH
nonselective alpha adrenergic blockers contraindications
-CAD, MI
alpha selective adrenergic blocking cautions
-CHF or renal failure (can lower BP and exacerbate conditions
alpha specific adrenergic agonists cautions
-CVD, vasomotor spasms, thyrotoxicosis, diabetes,
dinoprostone
-IM, IV
misoprostol
-IM, IV
oxytocin
-IM, IV, nasal -nasal form used to stimulate milk "letdown" in lactating women
estrogen
-IM, PO, topical -use lowest effective dose for the shortest amount of time due to increased risk for blood clots and cancer
labetalol
-IV and oral -used for hypertension, pheochromocytoma, clonidine withdrawl -used with diuretics
isoproterenol
-IV, IM for shock, cardiac arrest, heart block, prevention of bronchospasm with anesthesia, treatment of acute hyperkalemia
Adrenergic medications such as epinephrine and dopamine are commonly used for in the treatment of clients in which places? Select all that apply.)
Dentist's office Intensive care unit Emergency department
True or False: Epinephrine is one of the primary sympathomimetic drugs recommended for treatment of bronchospasm.
True
True or False: Patients who are prescribed adrenergic agonists should limit caffeine intake to prevent adverse effects, including elevated blood pressure and stroke.
True
True or False: Propranolol (Inderal) is effective in preventing stage fright by blocking the beta-adrenergic receptors in the sympathetic nervous system.
True
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?
β1 receptors
True or False: Mydriatics are much less effect in African Americans than in the general population, and increased dosage may be required to achieve the desired effect.
True
midodrine
-increases vascular tone and raises BP for orthostatic hypotension
hormonal contraceptives
-inhibits ovulation and helps make cervical mucus resistant to penetration by sperm
alprostadil
-injected into the penis or as a pellet inserted into urethral opening -used for insufficient response to other ED medications
clomiphene citrate contraindications
-liver disease, thyroid or adrenal disease, ovarian cysts, abnormal uterine bleeding
pyridostigmine
-longer duration -used to tx MG -antidote -increases survival rate after exposure to nerve gas
finasteride uses
-male pattern baldness, BPH (shrinks prostate)
progestins
-medroxyprogesterone acetate -norethindrone -megestrol acetate -progesterone
considerations for adrenergic agonists
-monitor BP, HR, O2 -use guard rails on pumps
considerations for children on anticholinergics
-more sensitive to AE -dicyclomine is not recommended
adult considerations for anticholinergics
-mostly teaching -teach to void before taking, increasing fluids, avoid hot temperatures
neostigmine, pyridostigmine, and edrophonium is used for
-myasthenia gravis
sildenafil nursing considerations
-need a thorough history to screen for causes of ED, such as DM, sex life, BP medications
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) used for myasthenia gravis
-neostigmine, pyridostigmine, edrophonium
Donepezil
-once a day dosing at bedtime
clomiphene citrate adverse effects
-ovarian enlargement, hot flashes, breast pain and tenderness -uterine bleedings, visual disturbances, abdominal discomfort, headache
clomiphene citrate
-ovarian stimulator and selective estrogen receptor -increases the amount of FSH and LH secreted by the pituitary gland, inducing ovulation
oxytocic drugs
-oxytocin, dinoprostone, methylergonovine, misoprostol
non-selective alpha adrenergic blocking drugs
-phentolamine
alpha and beta adrenergic agonists contraindications
-pheochromocytoma (tumor) -v-fib -halogenated hydrocarbon general anesthetics
alpha 1 adrenergic antagonist adverse effects
-postural hypotension, weakness, sleepiness, congestion, sore throat, blurred vision
phenylephrine
-potent vasoconstrictor -PO, SQ, IV -IV: shock -gtt form used for glaucoma to dilate the eyes
direct acting cholinergic agonists drugs
-pralidoxime, **bethanechol**, cevimeline, pilocarpine
nonselective alpha adrenergic blockers caution
-pregnancy and lactation
hormonal contraceptive uses
-prevent pregnancy, plus everything listed under estrogen and progesterone
Sildenafil adverse effects
-priapism, HA, facial flushing, dyspepsia, nasal congestion, dizziness
nonselective beta adrenergic blockers prototype
-propranolol
The client has been prescribed a cholinergic agonist. Which statement is true concerning the administration of cholinergic agonists? The sympathetic nervous system is stimulated by these medications. These medications are rarely administered. The parasympathetic nervous system is stimulated by these medications. Acetylcholine (ACh) is not affected by these medications.
The parasympathetic nervous system is stimulated by these medications. Explanation: The parasympathetic nervous system is stimulated by these medications. Acetylcholine is the substance that transmits nervous impulses across the parasympathetic branch of the autonomic nervous system. The sympathetic nervous system is not stimulated by these medications and they are administered frequently.
True or False: Because of K+ spilling and aldosterone released, we can have hypokalemia in patients receiving alpha and beta adrenergic agonists.
True
Sildenafil cautions
- no grapefruit juice - do not take if taking Nitrates (nitroglycerin)
salmeterol
-COPD
beta selective adrenergic blocking cautions
-COPD, diabetes, thyroid disease, pregnancy
beta specific adrenergic agonists teaching
-can mask signs of diabetes so check blood sugar more often
megestrol acetate
-powder that can be mixed with water for cancer patients who cannot eat (stimulates appetite)
A patient is to receive metoprolol. What would the nurse include in the teaching plan for this patient? "Take this drug with food to help promote its absorption." "This drug should have no effect on your sexual activity level." "This drug causes less dizziness than other similar drugs." "You should notice an increase in your energy level with this drug."
"Take this drug with food to help promote its absorption."
The nurse is teaching a client about safe use of adrenergic drugs. Which statement should be included in the teaching?
"Talk to your health care provider before taking any other medications."
Beta 1 adrenergic agonists
(one heart, and cells of kidney that release renin): Increase BP, increase heart contractility **affects heart and kidneys
bisoprolol
-hypertension
A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration? 30 to 90 minutes 2 to 4 hours 5 to 15 minutes 12 to 24 hours
30 to 90 minutes Explanation: A nurse caring for a client receiving bethanechol (Urecholine) for urinary retention should advise the client that voiding usually occurs 30 to 90 minutes after an oral dose is administered. The time frame of 5 to 15 minutes does not allow enough time for the medication to be absorbed and distributed. The time frame of 2 to 4 hours indicates that the medication will not work and the time frame of 12 to 24 hours indicates that the client will have bladder distention and that an insertion of a catheter may need to be placed to relieve the pressure exerted on the bladder.
The "morning after" or emergency contraception dosing regimen must be started within ______________ hours after unprotected intercourse, and a follow-up dose of the same number of pills must be taken hours ___________ after the first dose.
72 12
The nurse administers atropine intramuscularly at 9:00 AM. At which time would the nurse expect the drug's peak effects to occur? 9:45 AM 10:00 AM 9:30 AM 9:15 AM
9:30 AM Explanation: When given intramuscularly, atropine peaks in approximately 30 minutes; for this situation, the peak effects would be noted at approximately 9:30 AM.
Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A 47-year-old female with hypertension
Which client is most likely to benefit from the administration of an adrenergic agonist?
A man who is in cardiogenic shock following a myocardial infarction
Anticholinergic Side Effects Mneumonic
ABCDS Anorexia/Agitation Blurred vision Constipation Dry mouth Sedation/Stasis of urine/Sweating
________________ is the term for drugs that are designed to evacuate the uterus by stimulating intense uterine contractions.
Abortifacient
When describing the parasympathetic nervous system to a group of students, which substance would the nursing instructor discuss as being responsible for transmission of nerve impulses across this system? Serotonin Acetylcholine Dopamine Norepinephrine
Acetylcholine Explanation: Acetylcholine is the substance responsible for transmission of nerve impulses across the parasympathetic nervous system. Norepinephrine, dopamine, and serotonin are not involved.
Effectiveness of combo pills
Almost 100% effective if taken properly (patient needs education regarding drug regimen)
Which receptor does phenylephrine stimulate?
Alpha1
Which receptor does phenylephrine stimulate? Beta2 Alpha1 Alpha2 Beta1
Alpha1 Explanation: Phenylephrine stimulates alpha1 receptors.
What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?
Beta-adrenergic blockers
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?
Beta-adrenergic blocking drugs
The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes? Beta-helping drugs Beta-adrenergic drugs Beta-adrenergic blocking drugs Beta-blocking agonist
Beta-adrenergic blocking drugs
_____________ is approved for use in children older than 8 years of age for the treatment of neurogenic bladder.
Bethanechol
The client has been diagnosed with urinary retention. The nurse expects the client to receive which medication for this condition? Benadryl Guanidine Ambenonium Bethanechol
Bethanechol Explanation: Bethanechol is the only medication listed that is used to treat urinary retention. Ambenonium and guanidine are used to treat myasthenia gravis. Benadryl is an antihistamine.
A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication? Bradycardia Dehydration Hypertension Tachycardia
Bradycardia Explanation: Anticholinergic drugs are given preoperatively to prevent anesthesia-associated complications such as bradycardia, excessive respiratory secretions, and hypotension.
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective?
Bronchodilation
The nurse is administering an adrenergic agonist to a client. The nurse realizes that this medication will cause stimulation of the sympathetic nervous system. Which effects will it produce? Select all that apply.
Bronchodilation Decreased bladder tone
Anticholinergic saying
Can't see, can't pee, can't spit, can't shit.
An 80-year-old patient with chronic renal insufficiency is advised to undertake anabolic steroid therapy for the management of anemia associated with renal insufficiency. Which risk increases in elderly patients undergoing anabolic steroid therapy? Hypotensive shocks Cancer of the prostate Serious cardiac disease Hypoglycemic attacks
Cancer of the prostate Explanation: Elderly patients undergoing anabolic steroid therapy are at an increased risk of developing cancer of the prostate gland. Therefore, anabolic steroid therapy needs to be administered cautiously in these patients. Hypoglycemic attacks, serious cardiac disease, and hypotensive shocks are not seen in elderly patients on anabolic steroid therapy.
A female client asks the nurse about the use of progestins. The nurse shares with the client that clients who take this medication are at an increased risk for what serious adverse effect? Renal failure Cardiovascular complications Respiratory difficulties Seizures
Cardiovascular complications Explanation: Clients who use progestins are at an increased risk for cardiovascular complications. This adverse effect is similar for both estrogens and progestins.
The nurse is reviewing the history of a client who is to receive testosterone. Which of the following would alert the nurse to the need for close monitoring of the client? Myasthenia gravis Asthma Cardiovascular disease Stomach cancer
Cardiovascular disease Explanation: Clients with a history of cardiovascular disease need to be monitored closely when receiving testosterone because the disorder could be exacerbated by the hormone's effect. None of the other options have that concern.
A client has come to get lab results at the cardiology clinic. The nurse notes that the digoxin level is elevated. The nurse knows that what other medication may be responsible for the increase in digoxin level? Zantac Carvedilol Ampicillin Prozac
Carvedilol
A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following? Acetylcholinesterase crisis Status epilepticus Cholinergic crisis Hypertensive emergency
Cholinergic crisis Explanation: Symptoms of cholinergic crisis include severe abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, and clenching of the jaw. In acetylcholinesterase crisis, a pronounced muscular weakness and respiratory paralysis caused by excessive acetylcholine, often a result of overmedication with anticholinesterase drugs. Hypertensive emergency includes retinal hemorrhage, increased intracranial pressure resulting in headache and/or vomiting, and kidney organ failure. Status epilepticus is a medical emergency and can be of different types and caused by brain trauma, infection, or stroke.
A nurse is caring for a 25-year-old client who is being given an adrenergic drug for shock. Which action should the nurse do?
Continually assess the client for physiological changes and notify the primary care provider with changes.
A client has been prescribed an adrenergic blocking drug for glaucoma. Which nursing interventions should the nurse include when teaching the client? Demonstrate the technique of eye drop instillation. Demonstrate the method of cleaning eyes. Inform the client about eye drop preservation. Suggest the client protect their eyes from exposure to sunlight.
Demonstrate the technique of eye drop instillation Explanation: The nurse should demonstrate the technique of eye drop installation while educating the client with glaucoma. Demonstrating the method of cleaning eyes, suggesting the client protect his eyes from exposure to sunlight, and informing the client about eye drop preservation are not related nursing interventions when teaching the client about the use of an adrenergic blocker for glaucoma.
A patient suffers from bronchial asthma. Which medication is a mixed-acting adrenergic drug?
Ephedrine
An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist?
Epinephrine
Which would the nurse expect to be given to a client experiencing acute bronchospasm?
Epinephrine
Esterified estrogen
Estradiol (IM, PO, topical)
Estrogen receptor modulators are designed to produce the positive effects of ___________ replacement while limiting the _____________ effects.
Estrogen; adverse
A client is using a scopolamine patch for treatment of motion sickness. The nurse would instruct the client to change the patch at which frequency?
Every 3 days Explanation: A scopolamine patch is changed every 3 days.
The nurse is reviewing the history of a patient who is to receive midodrine. Which would alert the nurse to a contraindication for the drug?
Glaucoma
A nurse is caring for a client in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the client's chart for indications of: history of acute myocardial infarction. peptic ulcer disease. diabetes mellitus. obesity.
History of acute myocardial infarction.
A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan?
Hypertension may be a side effect of the medication.
A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan? Hypertension may be a side effect of the medication. Allergic and adverse reactions are rare. Side effects are limited to inflammation of the conjunctiva. The drug is only absorbed locally.
Hypertension may be a side effect of the medication.
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective? Decreased heart rate Uterine contraction Improved cardiac contractility Bronchoconstriction
Improved cardiac contractility
A client with symptomatic bradycardia has been receiving atropine for the past 4 days and the client reports constipation. What is the most important suggestion the nurse could give the client? Promote oral care. Increase bulk in the diet. Suck on hard candies. Avoid driving at night.
Increase bulk in the diet. Explanation: Constipation is a troubling adverse effect that may be managed by adding fiber to the diet, increasing hydration, and exercising moderately. Sucking on hard candies may help prevent a dry mouth but would not prevent constipation; the suggestions of avoiding driving at night or being attentive to oral care will help the client prevent other adverse effects of the therapy.
Which is an effect of epinephrine?
Increased heart rate
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce? Increased bronchoconstriction Increased vasoconstrictive effects Decreased cerebral circulation Decreased coronary circulation
Increased vasoconstrictive effects Explanation: Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction.
The client is menopausal but refuses to take estrogen because she fears having a stroke. She is currently on hydrochlorothiazide for hypertension. She asks if taking a natural herb, such as cohosh, would be safe. In addition to referring her to her medical care provider for further information, the nurse's best response would be: She should take estrogen instead, as the herb may lead to strokes. There is no difference between taking the herbal supplement or estrogen. Blood pressure is not affected by herbal supplements. It must be used cautiously as the herb may increase the hypotensive effects of antihypertensive drugs.
It must be used cautiously as the herb may increase the hypotensive effects of antihypertensive drugs. Explanation: Adverse effects may include nausea, vomiting, dizziness, hypotension, and visual disturbances. Blood pressure should be monitored closely in hypertensive patients because the herb may increase the hypotensive effects of antihypertensive drugs.
A client has been prescribed labetalol IV for a pheochromocytoma. What is the expected effect of the medication? Decreases urinary output ordinally increased by the tumor Management of the resulting hypertension Shrinkage of the tumor Increase of the amount of norepinephrine released by the adrenal medulla
Management of resulting hypertension
A male patient is receiving therapy to stimulate spermatogenesis. Which agent would most likely be used? Ganirelix Follitropin beta Chorionic gonadotropin Menotropins
Menotropins (Rationale: Menotropins are used to stimulate spermatogenesis in men. Chorionic gonadotropin is used to stimulate ovulation in women. Ganirelix is used to inhibit premature LH surges in women receiving ovarian hyperstimulation for infertility. Follitropin beta is used to stimulate follicular development.)
An example of an irreversible acetylcholinesterase inhibitor that leads to toxic accumulations of ACh at the cholinergic receptor sites and can cause muscle paralysis is ________________________ .
Nerve gas
A nurse is reviewing the medication history of a client. The nurse understands that a PDE5 inhibitor would be inappropriate for a client taking: Nitroglycerin. Ketoconazole. Indinavir. Erythromycin.
Nitroglycerin The PDE5 inhibitors cannot be taken in combination with any organic nitrates or alpha-adrenergic blockers because serious cardiovascular effects may occur, including death. Increased PDE5 inhibitor levels and effects may be seen with ketoconazole, indinavir, and erythromycin; the dosage of the inhibitor would need to be reduced.
After reviewing the routes of administration for beta-specific adrenergic agonists, a group of students demonstrate the need for additional study when they identify isoproterenol as being administered by which route?
Oral
The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs? Cardiovascular system Genitourinary system Parasympathetic nervous system Sympathetic nervous system
Parasympathetic nervous system Explanation: Cholinergic drugs act on the parasympathetic nervous system. Cholinergic agonists stimulate cholinergic receptors; cholinergic antagonists block these receptors and prevent the neurotransmitter acetylcholine from binding to them. Cholinergic drugs do not act of the sympathetic nervous system, the cardiovascular system for the genitourinary system.
For which category of patients should the nurse take precautions when administering anti-adrenergic drugs? Patients with renal function impairment Patients with diabetes Patients with impaired hepatic function Patients with chronic bronchitis
Patients with impaired hepatic function
The nurse is assessing a patient who is receiving clonidine. Which might the nurse assess?
Photophobia
Which adverse effect might a client receiving clonidine exhibit? (Select all that apply.)
Photophobia Personality changes Difficulty urinating
Levonorgesteral, megestrol acetate, norethinodrone acetate, progesterone side effects
SE: increased risk of cardiovascular complicatons; stroke, MI, hypertension weight gain rash bone loss migraines mental depression loss of vision
The adrenergic branch of the autonomic nervous system is also known by which name?
Sympathetic nervous system
The adrenergic branch of the autonomic nervous system is also known by which name? Somatic nervous system Central nervous system Sympathetic nervous system Parasympathetic nervous system
Sympathetic nervous system Explanation: The sympathetic nervous system is also known as the adrenergic branch.
Adrenergic blocking agents that lyse the effects of the sympathetic nervous system are classified as ______________ drugs.
Sympatholytic
A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider?
Systolic blood pressure below 100 mm Hg
A nurse is preparing a class on the various drugs used to treat erectile dysfunction. Which would the nurse include? Testosterone Oxandrolone Tadalafil Danazol
Tadalafil Explanation: Tadalafil is a PDE 5 inhibitor used to treat erectile dysfunction. Testosterone is an androgen used as replacement therapy in hypogonadism. Danazol is an androgen used to prevent ovulation in women. Oxandrolone is an anabolic steroid.
Which would the nurse expect to administer as a depot injection? Methyltestosterone Testosterone Fluoxymesterone Danazol
Testosterone Explanation: Testosterone is administered IM, transdermally, and in long-acting depository (depot injection) forms. Danazol is administered orally only. Methyltestosterone is administered orally. Fluoxymesterone is administered orally.
The nurse is discussing the plan of care another nurse has developed with the client. What is an appropriate outcome that the nurse and the client may decide on? Set appointments for monitoring of drug effects. Provide client teaching for drug therapy. The client can verbalize an understanding of preventable adverse drug effects. Assist the client in obtaining follow-up health care when indicated.
The client can verbalize an understanding of preventable adverse drug effects. Explanation: Provide thorough client teaching, including steps to take if a dose is missed or lost, measures to avoid adverse effects, warning signs of signs and symptoms that may indicate a problem, and the need for regular evaluation, to enhance client knowledge about drug therapy and to promote compliance.
The nurse is administering epinephrine IV push. The nurse checks for patency of the IV prior to administration of the drug. The nurse realizes that if the IV is infiltrated, the medication will result in tissue extravasation. What is the reason for such an occurrence?
The medication causes vasoconstriction, limiting the blood flow to the area.
A 35-year-old female has been diagnosed with hyperthyroidism. Her doctor has prescribed propranolol to achieve which effect? To decrease heart rate To promote bronchodilation To prevent respiratory depression To decrease systolic blood pressure
To decrease heart rate Explanation: Beta blockers, such as propranolol, are used to decrease heart rate, cardiac output, and tremors in hyperthyroidism.
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True
Phentolamine is the agent used to treat extravasation of dobutamine. T/F
True
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly. False True
True Explanation: Patients who are receiving alpha-specific adrenergic agents should not discontinue the drug abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper the drug over 2 to 4 days.
True or False: Adrenergic blocking agents decrease blood pressure and slow the heart rate by preventing the sympathetic stress reaction in the sympathetic nervous system.
True.
Prior to beginning therapy with an adrenergic agent, the nurse would expect to obtain what assessments? (Select all that apply.)
Vital signs Urinalysis Blood glucose
How do combination pills work
Works by inhibiting ovulation and helps make cervical mucus resistant to penetration by sperm.
First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect? Administer the drug at longer intervals than prescribed Administer the drug with food Administer half the prescribed dose Administer the dose at bedtime
administer the dose at bed time
Alpha and Beta adrenergic agonists A/E
all of these are associated with stimulation of SNS. arrhythmias, hypertension, palpitations, angina, dyspnea, N/V, constipation, HA, sweating, tension, anxiety
Alpha specific adrenergic agonists respond to:
alpha response little to no beta response
The _______________ are types of testosterone that are responsible for the growth and development of male sex organs and maintenance of secondary sex characteristics.
androgens
anticholinergics serve as
antidote to cholinergic toxicity and poisoning by mushrooms
The nurse is reviewing the medication history of a client who is receiving drug therapy for Alzheimer's disease. What medication should the nurse question? rivastigmine memantine atropine donepezil
atropine Explanation: Medications that may be beneficial in slowing the progression of Alzheimer's disease include rivastigmine, donepezil, and memantine. Atropine is not used for this purpose.
A 78-year-old client is admitted to the Emergency Department (ED) and is diagnosed with bradycardia. The client tells the nurse that the client is taking donepezil (Aricept), a cholinergic agent, for Alzheimer's disease. The nurse knows that the drug of choice for bradycardia is: pseudoephedrine. atropine. propranolol. bethanechol.
atropine. Explanation: Maintain atropine sulfate on standby as an antidote in case of overdose or severe cholinergic reaction.
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective? Decreased heart rate Slowed cardiac conductivity Bronchodilation Tremor
bronchodilation A beta-specific agonist would lead to bronchodilation. A beta-specific agonist would cause an increased heart rate. Tremor is an adverse effect of a beta-specific agonist. A beta-specific agonist would increase cardiac conductivity.
Clonidine
can be used to induce ovulation in women without regular menstrual cycles s/e: ovarian enlargement, hot flashes, breast tenderness, uterine bleeding, headaches, ovarian cysts
Terbutaline
can be used when someone has a hyperstimulated uterus or right before a version (turning the baby) beta blocker causes tachycardia also used in asthma patients
Dobutamine use
congestive heart failure and cardiogenic shock
Penile erectile dysfunction occurs when the ________ fails to fill with blood, preventing penile erection.
corpus cavernosum
A client who is going on a cruise is concerned about motion sickness and sees the health care provider, who prescribes scopolamine. The nurse informs the client that using scopolamine may cause the client to experience: drowsiness. pupil constriction. urinary incontinence. diarrhea.
drowsiness. Explanation: Scopolamine at therapeutic doses produces CNS depression characterized by drowsiness, euphoria, amnesia, fatigue, and dreamless sleep resulting from decreased periods of rapid eye movement.
The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication? wheezing heart rate 50 bilateral constricted dry mucous membranes
dry mucous membranes Explanation: Anticholinergic medications block the actions of the endogenous neurotransmitters of the parasympathetic stimulation. The medication would lead to drying of mucous membranes, a desired effect for a preoperative drug. The other listed responses of wheezing, which is because of bronchoconstriction; heart rate of 50, which is bradycardia; and pupils' constriction and increase in mucous secretions would be present when a client receives a cholinergic medication resulting from the activation of the parasympathetic nervous system.
Anticholinergics are contraindicated in patients with __________ because of the possibility of increased pressure with pupil dilation.
glaucoma
A client is prescribed androgen therapy to be given by IM injection. The nurse would select which site for administration? vastus lateralis gluteal muscle rectus femoris deltoid
gluteal muscle Explanation: When androgens are administered IM, the injection is administered by deep IM injection into the gluteal muscle. The other muscles are not as large.
The drug __________ is widely used to decrease secretions before anesthesia or intubation.
glycopyrrolate (Robinul)
Beta 1 affects
heart and kidneys
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to: hypotension related to increased sympathetic response. heat stroke related to decreased perspiration. diarrhea related to increased peristalsis. urinary frequency related to CNS effects.
heat stroke related to decreased perspiration. Explanation: By blocking cholinergic receptors, anticholinergic drugs reduce sweating, which decreases heat loss and increases the risk of hyperthermia and heat stroke.
An adrenergic drug would be prescribed to produce what physiological effect?
increased heart rate
The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result? increased heart rate vasoconstriction of the coronary arteries decreased heart muscle contractions decreased oxygen demand by the myocardium
increased heart rate Explanation: The predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. Beta1 activation results in increased force of myocardial contraction, or a positive inotropic effect and increased speed of electrical conduction in the heart.
What is the expected outcome when phenylephrine is administered? Select all that apply.
increased systolic blood pressure increased diastolic blood pressure decreased renal perfusion
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
increased vasoconstrictive effects
Estradiol increases the risk of:
increases risk of breast and endometrial cancer, DVT, stroke
oxytocin uses
induces contractions
Which observation might indicate that timolol is achieving the desired effect in a client? heart rate increases temperature decreases intraocular pressure decreases blood pressure increases
intraocular pressure decreases
beta 2 affects
lungs
A nurse is caring for a 28-year-old patient who is taking exogenous testosterone for treatment of cryptorchidism. What statement by this patient would lead the nurse to believe that patient teaching has been ineffective? "I may grow more body hair." "My sexual desire may increase." "My voice may become deeper." "My sperm count should increase."
my sperm count should increase The effects of testosterone include increased body hair, thickening of the skin, deepening of the voice, and increased sexual desire. The medication isn't expected to increase sperm count.
A client is taking an OTC allergy product. The nurse would expect to find that this product most likely contains:
phenylephrine
Many cold and allergy medications contain the alpha-agonist ____________, which helps constrict topical blood vessels, decreases swelling, and relieves the symptoms of rhinitis.
phenylephrine
Nifedipine
prevent contractions stop contractions calcium channel blocker
Dopamine use
prototype for shock
True or False Symptoms of atropine toxicity are dose related and can progress to coma.
true
True or False: Progesterone can be used by itself for dysfunctional uterine bleeding.
true
True or False: A breast-feeding mother planning a sea cruise should be cautioned that scopolamine (Transderm Scop) may suppress lactation.
true
The teaching priority for a diabetic male client being treated with a non-specific beta-blocker would be to: take his own pulse. avoid smoke-filled rooms. understand signs and symptoms of hypo- or hyperglycemic reaction. weigh himself once a week at the same time of day.
understand signs and symptoms of hypo- or hyperglycemic reaction.
fertility shots
very expensive shots, every day shots
A client asks the nurse about a word they heard from the health care provider. The word was "andropause". The client asks what that is. Which is the nurse's best response? "A medication used to treat changes in the androgens in the body." "A change in hormone production in women." "No change in the level of testosterone in the body." "A gradual change, related to age, that occurs in the testes."
"A gradual change, related to age, that occurs in the testes." Explanation: Andropause occurs in men and the changes occur gradually. Aging changes in the male reproductive system occur primarily in the testes. Like the ovary, testicular tissue diminishes; what is different between the sexes is that the male sex hormone levels of testosterone remain relatively constant. Andropause is not a medication but a condition that occurs in the body.
A 52-year-old male client has made an appointment with his primary care provider and has reluctantly admitted that his primary health concern is erectile dysfunction (ED). He describes the problem as increasing in severity and consequent distress. Which of the nurse's assessment questions is most likely to address a common cause of ED? "Are you taking any medications for high blood pressure?" "How has this problem been affecting your relationship with your wife?" "Have you suffered any injuries of any kind in the last several months?" "How would you describe your overall level of health?"
"Are you taking any medications for high blood pressure?" Explanation: Causes of ED may include drugs such as antidepressants, antihypertensive agents, and histamine receptor antagonists. Injuries are a rare cause. Addressing the impact of the problem and the client's perceptions of health are important, but neither question addresses causation.
bethanechol
-PO, SQ -tx of non-obstructive post-op and postpartum urinary retention -also treats neurogenic bladder -effects last longer bc acetylcholinesterase isnt destroyed
Rivastigmine
-PO, TD patch -solution to aid in swallowing
antidote for dopamine extravasation
-Phentolamine (causes vasodilation) -5-10 ml with 10 ml of NS
methylergonovine
-PO, IV, IM
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?
β2 receptors
prostaglandin drug
-alprostadil
The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil? Antiarrhythmics Antivirals Antibiotics Antidiuretics
Antiarrhythmics Explanation: Vardenafil is the only PDE5 inhibitor that prolongs the QT interval and should not be used with other drugs with similar effect, particularly class I and II antiarrhythmics.
The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching? Anticholinesterase drugs should be taken on an empty stomach to decrease the risk of gastric distress and ulceration. Anticholinesterase drugs need to be started at a very high dose and titrated to effect. Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. Anticholinesterase drugs should be taken at bedtime to prevent nausea.
Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. Explanation: All anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. These drugs are taken at bedtime to avoid the risks associated with dizziness and vertigo, not to prevent nausea. These drugs are not started at very high doses, though doses may be increased after several weeks if initial dosing doesn't achieve the desired effect.
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine? Phentolamine Edrophonium Atropine Naloxone
Atropine Explanation: Atropine is used to counteract the severe effects of an indirect acting cholinergic agonist. Naloxone is used to reverse opioid toxicity. Edrophonium is used as the antidote for nondepolarizing NMJ blockers. Phentolamine is used as treatment for extravasation of IV norepinephrine or dopamine.
The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack? Atropine Bethanechol Donepezil Neostigmine
Atropine Explanation: In the case of a nerve gas attack, atropine is the antidote.
After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.) Blood pressure Temperature Respiratory rate Pulse Blood glucose
Blood pressure Pulse Respiratory rate
A patient has been administered dobutamine HCL. Which adverse reactions should the nurse monitor for in the patient?
Cardiac arrhythmias
A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize?
Cardiac monitoring
A nurse is caring for an elderly patient who is to be administered isoproterenol. Which change monitored in the patient should the nurse report immediately to the primary health care provider?
Changes in pulse rate
A client is taking androgens and warfarin. What effect will these two medications have on the client's coagulation? The RBC will be decreased. Coagulation will not be affected. Coagulation will be decreased. Coagulation will be increased.
Coagulation will be decreased. Explanation: Concurrent use of androgens and warfarin will increase the concentration of warfarin in the blood; thus, the coagulation will be decreased, placing the client at risk for hemorrhage. The medications will not decrease coagulation or cause it to be unaffected. The red blood cell count will not be decreased unless bleeding results.
After teaching a female client who is prescribed a scopolamine patch, the nurse determines that the teaching was successful when the client states that she will change the patch in which time frame? Every day Every 7 days Every other day Every 3 days
Every 3 days Explanation: Scopolamine patch is changed every 3 days.
A patient with diabetes who receives an alpha-specific adrenergic agonist is at risk for hypoglycemia. (T/F)
FALSE
Alpha- and beta-specific adrenergic agonists are primarily used to treat obstructive pulmonary conditions. (T/F)
FALSE
An increased dosage of digoxin would be needed if the patient is also taking midodrine. (T/F)
FALSE
True or False A lactating mother prescribed an abortifacient may continue to breast-feed while taking the medication.
False
True or False Atropine and scopolamine (Transderm Scop) are effective because they block the nicotinic receptors at the neuromuscular junction.
False
True or False Fertility drugs are used to stimulate ovulation in women with primary and secondary ovarian failure.
False
A nurse is caring for a client who has just been started on an anticholinergic medication as adjunct therapy for peptic ulcers. In writing this client's plan of care, an appropriate nursing diagnosis would be: Increased cardiac output related to cardiovascular effects. Risk for hyperthermia related to increased ability to sweat. Chronic pain related to GI, CNS, genitourinary, and cardiovascular effects. Impaired urinary elimination related to bladder relaxation.
Impaired urinary elimination related to bladder relaxation. Explanation: Nursing diagnoses related to drug therapy might include impaired urinary elimination related to bladder relaxation effects, acute pain related to GI, CNS, genitourinary, and cardiovascular effects, and decreased cardiac output related to cardiovascular effects.
Which is expected after the administration of an adrenergic medication such as epinephrine? (Select all that apply.)
Increased heart rate Vasoconstriction
Which would the nurse identify as a contraindication to the use of an anticholinesterase inhibitor? Asthma Peptic ulcer disease Intestinal obstruction Parkinsonism
Intestinal obstruction Explanation: Intestinal obstruction would be a contraindication to the use of anticholinesterase inhibitors. Asthma, peptic ulcer disease, and parkinsonism would require cautious use and close monitoring.
Oral contraceptives are available as ______, ____________, and ___________ preparations.
Monophasic Biphasic Triphasic
__________________________________ _________________________is a chronic muscular disease caused by a defect in neuromuscular transmission.
Myasthenia gravis
True or False Edrophonium (Enlon) is used as a diagnostic agent to distinguish between a myasthenic crisis and a cholinergic crisis.
True
Alpha and Beta adrenergic agonists CAUTIONS
PVD pregnancy lactation
A client who is taking estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse suspects the client is experiencing what adverse reaction related to estrogen therapy? Pulmonary embolism Deep vein thrombosis Skeletal pain Breast pain
Pulmonary embolism Explanation: Sudden, sharp chest pain that may or may not include hemoptysis is a sign of pulmonary embolism. It may begin as a deep vein thrombosis but the symptoms that the client describes are related to the lungs. Breast tenderness and skeletal pain do not indicate a visit to the emergency department.
Anticholinergic drugs are used in ophthalmology because they produce which effect? Pupil constriction Decreased lacrimal secretions Sedation Pupil dilation
Pupil dilation Explanation: Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.
True or False Estrogens are female sex hormones that are important in the development of the female reproductive system.
True
A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment? Pyridostigmine Edrophonium Rivastigmine Cevimeline
Rivastigmine Explanation: Rivastigmine is used to treat Alzheimer's disease. Cevimeline is used to treat dry mouth associated with Sjogren syndrome. Edrophonium is used to diagnose myasthenia gravis. Pyridostigmine is used to manage myasthenia gravis.
Alpha 1 Adrenergic Blockers s/e
SE: postural hypotension, weakness, sleepiness, congestion, sore throat, blurred vision
A female client expresses the desire to suppress her female sex characteristics to facilitate a transition to being male. Which androgen does the nurse anticipate the provider will prescribe? Progesterone Dihydrotestosterone (DHT) Testosterone Estrogen
Testosterone Explanation: Prescribers may order male sex hormones for women to antagonize or reduce the effect of female sex hormones. Administration of androgen (DHT) or anabolic steroids to women causes suppression of menstruation and atrophy of the endometrial lining of the uterus. Progesterone and estrogen are common androgens of the female client and so would not facilitate transition to male sex characteristics.
True or False Androgens require a prescription and are class III controlled substances.
True
Medroxyprogesterone acetate is indicated for the treatment of women with what disorder? Ovarian cancer Cervical cancer Fibromyalgia Uterine bleeding
Uterine bleeding Explanation: Health care providers use progestins to suppress ovarian function in dysmenorrhea, endometriosis, endometrial cancer, and uterine bleeding. Progestins are not normally used to treat cervical cancer, ovarian cancer, and fibromyalgia.
An older adult client's current medication regimen includes tamsulosin and sildenafil. The combination of these two medications should prompt what action by the nurse? arranging for the client to have a screening cystoscopy arranging for the client to have blood clotting diagnostic samples drawn assessing the need to insert an indwelling urinary catheter assessing the client regularly for signs of orthostatic hypotension
assessing the client regularly for signs of orthostatic hypotension Explanation: Combining an alpha1-adrenergic blocker with a phosphodiesterase type 5 inhibitor creates a risk for orthostatic hypotension. There is no particular need for tests of hemostasis, cystoscopy, or the insertion of a urinary catheter.
What drug is prescribed for mushroom poisoning? pralidoxime bethanechol neostigmine atropine
atropine Explanation: Accidental or intentional ingestion of these mushrooms results in intense cholinergic stimulation and is potentially fatal. Atropine is the specific antidote for mushroom poisoning.
nonselective beta adrenergic blockers
decrease cardiac workload
A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart? Constrict the heart Prevent normal sinus rhythm Decrease the heart rate Increase the heart rate
decrease the heart rate
A group of nursing students are reviewing information about hormonal therapy for cancer. The students demonstrate understanding of the information when they identify which medication as a gonadotropin-releasing hormone analog? Select all that apply. estramustine abiraterone bicalutamide leuprolide degarelix
degarelix leuprolide Rationale:Degarelix and leuprolide are examples of gonadotropin-releasing analogs. Abiraterone and bicalutamide are antiandrogens. Estramustine is an estrogen.
Patients receiving isoproterenol should be monitored for adverse pulmonary effects including __________ , _______________ , ____________ , and severe ______________ .
difficulty breathing, coughing, bronchospasm, pulmonary edema.
Adrenergic agonists are used in ophthalmic preparations to _____________ the pupils.
dilate
Stimulation of the adrenergic receptor sites by sympathomimetic drugs is classified as either _________ or ____________.
direct, indirect
What would the nurse expect to assess in a client receiving an alpha- and beta-adrenergic agonist? Dyspnea Diarrhea Personality changes Hypotension
dyspnea
Which medication will most likely be administered to a client experiencing anaphylaxis?
epinephrine
type of estrogen we need to know
estradiol
A nurse would instruct a patient to apply a clonidine patch at which frequency?
every 7 days
A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would likely identify this as which condition? urge incontinence overactive bladder syndrome neurogenic bladder stress incontinence
overactive bladder syndrome Explanation: Overactive bladder syndrome involves conditions of urgency, frequency, and nocturia, with or without incontinence. Stress incontinence involves losing urine without meaning to during physical activity. Urge incontinence involves the strong, sudden need to void due to bladder spasms or contractions. Neurogenic bladder refers to impaired bladder function caused by a nervous system abnormality.
When the ____________ system is blocked, a client's pupils will dilate, the heart rate will increase, and urinary bladder tone will decrease.
parasympathetic
Hypogonadism requires replacement therapy with _______________ , which is the primary natural androgen.
testosterone
Alpha 1 Adrenergic Blockers : uses Tamsulosin (Flomax), Uroxatral, Doxazosin
urinary retention related to BPH Relaxes the muscles of the prostate and bladder neck, enabling the patient to pass urine more easily.
Prostaglandins (alprostadil) use - injection into the penis or as a pellet inserted into the urethral opening.
used for insufficient response to other ED medications
Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect? dehydration hypotension polydipsia water intoxication
water intoxication Explanation: Water intoxication is an adverse effect caused by all uterine stimulants because of their antidiuretic effect. Dehydration occurs when the body does not have enough fluid to sustain homeostasis. Hypotension can result in pregnancy with uterine rupture and loss of circulating blood volume. Polydipsia is seen in diabetes as well as pregnancy-induced diabetes.
True or False: Dobutamine is a naturally occurring catecholamine that increases cardiac oxygen demand.
False
what are androgens used for:
- Hypogonadism - Sex hormone deficiency (delayed puberty) - Androgen deficiency - Palliation of breast cancer in women
beta specific adrenergic agonists contraindications
-pulmonary hypertension, eclampsia, uterine hemorrhage, intrauterine death, pregnancy, lactation
Estrogens are used for:
- birth control (CV risk in women >35) - menopause symptoms (given in the lowest dose for the shortest amount of time) - hormone replacement therapy - hormone imbalances
cholinergic crisis vs myasthenic crisis
-cholinergic: need less cholinergic agonists (or antidote) -myasthenic: need more cholinergic agonists
dobutamine uses
-chronic heart failure
A new client telephones the clinic requesting a renewal prescription for contraceptives she has been taking for 4 years. It has been more than a year since her last health care visit, but she is unable to come into the clinic until next month. She insists she is "doing fine" on this medication and must have her prescription now. Considering the circumstances and related safety issues, how should the clinic nurse respond? "Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended." "If you have a physical within 2 years, I can get your medication refilled." "Before estrogen based drugs are prescribed, you must see the health care provider to get an order for a mammogram." "Since you are doing well on this regimen, I'll arrange to get the prescription filled for a month to last until your clinic appointment."
"Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended." Explanation: Because estrogens, progestins, and hormonal contraceptives are often taken for years and may cause adverse reactions, clients taking these drugs need continued supervision by a health care provider. Before the drugs are prescribed, a complete medical history; a physical examination including breast and pelvic examinations and a Pap test; urinalysis; and weight and blood pressure measurements are recommended. These examinations should be repeated at least annually if the client is taking the drugs.
A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response? "Bethanechol is a medication that increases the amount of water that is produced by the kidneys, causing one to void." "Bethanechol is a diuretic that works in the loop of Henle, blocking the reuptake of sodium, which causes one to void." "Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine." "Bethanechol is an indirect-acting cholinergic drug that causes the bladder to constrict."
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine." Explanation: Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine. Bethanechol is not an indirect acting cholinergic drug nor is it a diuretic. It does not increase water production in the kidneys; kidneys do not produce water.
A client alerts the nurse that they have been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective? "There is an increase in the gonadotropins." "The menstrual cycle becomes irregular." "Estrogen and progesterone diminish." "Hot flashes and night sweats are prominent."
"Estrogen and progesterone diminish." Explanation: During menopause, estrogen and progesterone diminish causing the menstrual cycle to become more irregular and then stops altogether. Symptoms of the decrease in estrogen and progesterone are hot flashes, night sweats, vaginal dryness, and sleep problems. There is not an increase of gonadotropins during menopause.
progestin adverse effects
-increased risk of CV effect, weight gain, rash, bone loss, migraines, depression
The nurse is caring for a client who has been prescribed vardenafil. What question should the nurse ask when assessing for therapeutic effects of the drug? "Do you feel like you're beginning to show more masculine characteristics?" "Has vardenafil helped increase and stabilize your libido?" "Have you been having less urinary frequency than before you started on vardenafil?" "Have you found that you're better able to get and maintain erections?"
"Have you found that you're better able to get and maintain erections?" Explanation: Vardenafil is a PDE5 inhibitor; erectile dysfunction is the sole indication for use.
After teaching a client about a prescribed beta blocker therapy, the nurse determines that additional teaching is needed when the client relays which statement? "I should notify my doctor if I have trouble breathing." "I need to get up slowly from the bed or a chair." "I should learn how to check my blood pressure." "I can stop the drug anytime I feel any problems."
"I can stop the drug anytime I feel any problems."
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching? "I should eat plenty of fiber to prevent constipation." "I should avoid driving if I feel light-headed or dizzy." "I need to exercise frequently outside in the warm weather." "I should make sure that I drink plenty of fluids."
"I need to exercise frequently outside in the warm weather." Explanation: The client should avoid temperature extremes and exertion in warm temperatures because of possible heat intolerance, which could be more severe in older clients. Drinking fluids is important to maintain hydration and prevent heat intolerance. Avoiding driving is an appropriate safety measure. Constipation may occur with an anticholinergic; therefore, increased fiber intake would be appropriate.
After teaching a client who is prescribed sildenafil about using the drug, the nurse determines that the teaching was successful when the client states: "I can take the pill in the morning before I engage in sex later in the day." "I should take the medication just before I start having sex." "I should take the pill after dinner if I'm planning to have sex later that night." "I need to take the pill about an hour before any sexual stimulation."
"I need to take the pill about an hour before any sexual stimulation." Explanation: Sildenafil should be taken approximately 1 hour before sexual stimulation.
A nurse is caring for a 25-year-old clinic client who is starting on birth control pills. What statement by the client indicates that she needs further teaching? "I may gain or lose weight while I am taking these pills." "I know my nausea is common, but it should subside in a few weeks." "I will monitor my weight and have my blood pressure checked in 3 months." "I will exercise more if I experience chest or leg pain."
"I will exercise more if I experience chest or leg pain." Explanation: Chest or leg pain may be indicative of a thrombus, and medical care should be sought immediately. The other options are correct statements but do not address the question asked.
The nurse is educating an adult male client diagnosed with erectile dysfunction about the prescribed sildenafil. Which statement made by the client establishes the need for further clarification? "If I have an erection lasting longer than 4 hours, I need to seek medical attention because it could cause permanent damage to my penis." "Sildenafil taken with nitrates can lead to extremely low blood pressure, dizziness, passing out, heart attack, or stroke." "If I lose vision or hearing after taking the drug, I will seek medical attention and notify my prescriber immediately." "If I eat a fatty meal I will need to take two pills instead of one, so the drug will take effect faster."
"If I eat a fatty meal I will need to take two pills instead of one, so the drug will take effect faster." Explanation: The nurse needs to clarify the statement that the client made regarding doubling the dosage after eating a fatty meal. Fatty foods delay the action of the drug. Taking two tablets could lead to excessive dosing and the adverse effect, priapism. The other statements are correct. If the client develops priapism for longer than 4 hours, medical attention is needed to prevent permanent damage to the penis. A rare event, non-arteritic ischemic optic neuropathy (NAION) is an adverse effect of the drug, which leads to the obstruction of circulation to the optic nerve resulting in irreversible loss of vision in one or both eyes. Also, a rare adverse effect, permanent loss of hearing with ringing in the ears, or tinnitus may occur. A client taking sildenafil should not take nitrates because it can cause a serious drop in blood pressure, dizziness, syncope, heart attack, or stroke.
A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's best statement? "It works by relaxing the smooth muscle of the prostate and the bladder neck." "It stimulates the bladder to increase the urge to urinate." "It decreases the desire to have sexual relations." "It prevents the conversion of testosterone into the androgen DHT."
"It works by relaxing the smooth muscle of the prostate and the bladder neck." Explanation: Terazosin is an alpha adrenergic blocker and works by relaxing the smooth muscle of the prostate and the bladder neck. By blocking norepinephrine, the muscles relax, and this allows urine to flow to the bladder. Terazosin does not prevent the conversion of testosterone or stimulates the bladder to void. Terazosin does not affect the desire for sexual relations.
The nurse is on the phone with a woman who is taking an antispasmodic for overactive bladder syndrome. The woman states that her mouth is very dry, but she is afraid to drink because she does not want the urge to urinate to increase. What is the nurse's best response to this client? "When your mouth is dry, rinse it with strong mouthwash." "You shouldn't restrict your fluid intake because it will only make your bladder problems worse." "To ensure that you don't have to go to the bathroom all the time, you should chew gum." "You will just have to put up with the dry mouth if you want to take this medication."
"You shouldn't restrict your fluid intake because it will only make your bladder problems worse." Explanation: Dry mouth related to antispasmodics can be treated with sugarless hard candy, pieces of ice, or sugarless lozenges. The client may also perform frequent mouth care but strong mouthwash may cause oral irritation. The client shouldn't limit the amount of fluid because it will only make the urinary symptoms worse.
On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which response by the nurse is most appropriate? "We'll have to check your bone density first, because if it's too low then it's not safe to start HRT." "Actually, most of the current research is suggesting that HRT may not be all that effective in treating the symptoms of menopause." "HRT might be quite beneficial to you, and it carries the additional benefit of modest protection against breast cancer." "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke"
"It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" Explanation: Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis.
A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client? "Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." "Some women get some pain in their chest or abdomen when they take oral contraceptives, but this will pass as your body gets used to them." "You need to carefully consider whether you might want to get pregnant later in your life." "It will take 10 to 12 weeks before the birth control pills will actually prevent pregnancy, so be vigilant with other contraceptives until then."
"Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." Explanation: An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10- to 12-week time span between the initiation of oral contraceptives use and the prevention of pregnancy.
A woman who is at 31 weeks' gestation comes to the clinic in labor. The health care provider decides to use terbutaline therapy before transferring the woman to the hospital. The client is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be: "This drug helps induce uterine contractions and milk ejection for breast-feeding." "The drug that you are being given will prevent and control postpartum bleeding." "The drug provides sufficient time for other medications to be given to improve your baby's outcome." "This drug will make your delivery in a few days less painful."
"The drug provides sufficient time for other medications to be given to improve your baby's outcome." Explanation: Delivery can be delayed with the use of a tocolytic. This delay provides sufficient time to transfer the client to an acute care facility or administer essential drugs such as corticosteroids. Corticosteroids reduce the risk of neonatal death as a result of respiratory distress syndrome. Delaying the delivery does not ensure a painless delivery. Oxytocin is administered to induce uterine contractions and mild ejection for breast-feeding and to prevent and control postpartum hemorrhage if the drug is administered via IV infusion or IM injection.
A school nurse is educating a group of adolescents on the dangers of anabolic steroids. What statement by the nurse would explain why they are dangerous specifically to this age group? "Anabolic steroids have ergogenic properties." "They are as popular as illegal drugs." "These drugs can damage the heart, liver, and kidneys." "They are schedule 3 controlled substances."
"These drugs can damage the heart, liver, and kidneys." Explanation: Anabolic steroids are considered even more dangerous for teens than for adults because teens are still growing. Anabolic steroids can stop bone growth and damage the heart, kidneys, and liver of adolescents. Anabolic steroid use causes an increase in muscular work capacity (ergogenic), which is what makes these agents popular as performance-enhancing drugs. While anabolic steroids are schedule 3 drugs and illegal without a prescription, the specific danger to teens is potential damage to developing organs.
Beta 2 adrenergic agonists
(two lungs, eyes, arteries of skeletal muscle): Dilates vessels to increase blood flow rich in oxygen **affects lungs
alpha and beta adrenergic agonists (nonspecific)
- DOPAMINE - dobutamine - ephedrine - epinephrine - norepinephrine
alpha specific adrenergic agonists drug to drug
-MAOIs with phenylephrine and TCA can cause severe hypertension, hyperpyrexia -digoxin, beta blockers -antipsychotics with midodrine can increase effects of other meds
atenolol
-MI, angina, hypertension
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) drug to drug
-NSAID, anticholinergic drugs
cevimeline and pilocarpine
-PO -dry mouth associated with Sjogren syndrome -give before meals for saliva and easy swallowing
alpha and beta adrenergic agonists drug to drug interactions
-TCA and MAOI -anything that causes hypertension (caffeine, adrenergic antagonists)
Bethanechol
-Used in postoperative and neurogenic bladder - Direct cholinergic agonist -Activates bowel and bladder smooth muscle -Resistant to AChE
direct acting cholinergic drug to drug interactions
-acetylcholinesterase inhibitors, result in the same effects and increase risk of cholinergic crisis
testosterone adverse effects
-acne, libido changes, hair loss, headache, bitter taste, hypercalcemia, jaundice -edema, priapism, reduced sperm count, increased cholesterol, increased risk for BPH (primary complaint "difficulty starting urinations)
direct acting cholinergic agonists actions
-act at cholinergic receptors in the peripheral nervous system to mimic the effects of Ach and parasympathetic stimulation
nonselective alpha adrenergic blockers drug to drug
-alcohol with phentolamine can cause hypotension
alpha selective adrenergic blocking contraindications
-allergies, lactation, hepatic impairment can result in toxicity
oxytocic contraindications
-allergy, unfavorable fetal position, cephalopelvic disproportion, early pregnancy, complete uterine atony
what can lower effectiveness of hormonal contraceptives
-antibiotics and antiseizure
pralidoxime
-antidote for irreversible indirect acting cholinergic agonists and agents -used for reversal from poisoning associated with organophosphate pesticides
neostigmine
-antidote for toxicity from neuromuscular junction blockers
alpha specific adrenergic agonists adverse effects
-anxiety, restlessness, depression, fatigue, blurred vision, strange dreams, decreased urinary output
direct acting cholinergic contraindications
-any condition exacerbated by parasympathetic effects -PUD, intestinal obstruction or recent GI surgery -asthma -bladder obstruction -dehydration -swallowing difficulties with risk of aspiration -epilepsy, parkinsonism
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) cautions
-any condition that can be exacerbated by cholinergic stimulation -asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, parkinsonism
anticholinergic contraindications
-any condition that could be exacerbated by blocking the PNS -glaucoma, PUD, paralytic ileus, GI obstruction, severe UC, toxic megacolon, prostatic hypertrophy, bladder obstruction, cardia arrhythmias, tachycardia, myocardial ischemia, MG, impaired liver/kidney
anticholinergic drug to drug
-any drug with anticholinergic activity (antihistamine, antiparkinsonism, MAOI, TCA, phenothiazines, herbal, OTC, teas
alpha and beta adrenergic agonists adverse effects
-associated with SNS stimulation -arrhythmias, hypertension, palpitations, angina, dyspnea, N/V, constipation, HA, sweating, tension, anxiety
antidote for isoproerenol
-beta adrenergic blocker -should be at bedside -tele and vitals ON, 1 on 1 monitor
estrogen uses
-birth control, menopause symptoms, replacement therapy, osteoporosis, hormonal imbalances, reoccurring UTI's in elderly
what do adrenergic antagonists do
-block a normal response, lower BP, HR, RR -called sympatholytic drugs due to blocking sympathetic effects
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) actions
-blocks acetylcholine at the synaptic cleft, which allows the accumulation of acetylcholine released from the nerve endings and leads to increased and prolonged stimulation of acetylcholine
anticholinergic actions
-blocks the effects of acetylcholone, therefore blocking the effects of the PNS -when decreasing PNS, SNS dominates
anticholinergic adverse effects
-blurred vision, mydriasis, cycloplegia, increased IOP -bradycardia (low doses), tachycardia (high doses) -dry mouth, altered taste, nausea, heartburn, -decreased sweating, predisposition to heat
nonselective adrenergic blocking contraindications
-bradycardia, heart block, shock, CHF, asthma, norepi
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) contraindications
-bradycardia, intestinal or urinary tract obstruction
nonselective adrenergic blocking cautions
-bronchospasms, diabetes, pregnancy
education on sildenafil
-call provider if erection lasts longer then 4 hours -no nitrates or BP medications -no grapefruit juice -take one hour before intercourse
how do hormonal contraceptives affect blood sugar
-can increase blood glucose levels
hormonal contraceptive teaching
-can start pill any day -take every day at the same time -take a missed pill as soon as you remember -never take three pills together -use condoms with missed pills
beta selective adrenergic blocking drug to drug
-clonidine, NSAIDS, rifampin, barbiturates caused decreased antihypertensive effects -Epi caused hypertension followed by bradycardia -prazosin can cause orthostatic hypotension
teaching for adrenergic antagonists
-counsel on use of OTC, herbal, supplements, and teas -ginseng, sage have increase antihypertensive effects and can result in severe hypotension and increase CNS effects
atropine
-decrease secretions, bradycardia, antidote for cholinergics
indications for anticholinergic drugs
-decrease secretions, restore cardiac rate and BP, dilate pupils, COPD maintenance, nocturia, dysuria, motion sickness
normal actions of direct acting cholinergic
-decreased HR, decreased myocardial cont-decreased HR, decreased myocardial contractility, vasodilation of vessels,
medroxyprogesterone acetate
-depo shot (every 3 months) -can lead to bone loss long term -indicated in tx of dysfunctional uterine bleeding
nonselective beta adrenergic blockers contraindications
-diabetes because meds blocks normal signs and symptoms of hypoglycemia
edrophonium
-diagnostic agent for MG or to see if MG or cholinergic crisis -given during cholinergic crisis makes it worse -given during myasthenic crisis improves it
alpha selective adrenergic blocking adverse effects
-dizziness, weakness, abdominal pain, diarrhea, hypotension, edema, drowsiness, depression, rhinitis, red eyes, nasal congestion, priaprism
what to do if hypertension occurs while on hormonal contraceptives
-do not give BP medication, just take patient off of pill
teaching for alpha specific adrenergic agonists
-do not stop abruptly -can have rebound effects on HR and BP, arrhythmias, flushing, death -taper over 2-4 days or longer depending on patient and dose
nonselective adrenergic blocking teaching
-do not stop abruptly, can cause MI, stroke, arrhythmia -taper over 2 weeks or longer -check orthostatic vitals
beta selective adrenergic blocking teaching
-do not stop abruptly, can cause severe HTN, angina, MI, stroke
progestin uses
-dysmenorrhea, birth control, breakthrough bleeding, endometriosis, emergency contraception -can also be used to help maintain pregnancy
nonselective adrenergic blocking drug to drug interactions
-enflurane, halothane, isoflurane anesthetics can cause excessive hypotension -diabetic agents with any of these drugs can result in hypoglycemia
sildenafil uses
-erectile dysfunction, ICU for pulmonary hypertension
methylergonovine adverse effects
-ergotism (nausea, BP changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, coma)
beta selective adrenergic blocking adverse effects
-fatigue, dizziness, sleep disturbances, memory loss, rhinitis, dyspnea, gastric pain, colitis, decreased libido, impotence, dysuria
5-alpha reductase inhibitor drugs
-finasteride, dutasteride
drugs used for alzheimers
-galantamine, rivastigmine, **donepezil**
acetylcholinesterase inhibitors (indirect acting cholinergic agonists) used for alzheimers
-galantamine, rivastigmine, donepezil
anticholinergic nursing considerations
-give physostigmine every 1-2 hours for atropine toxicity -give a barbiturate if seizures develop -physostigmine is also used to reverse effects of scopolamine, antihistamine, and some antidepressants
nursing considerations for direct acting cholinergics
-have atropine available
when not to use estrogen
-history of breast or endometrial cancer -history of smoking, patients over 35 years old, patients with BMI over 35
hormonal contraceptive adverse effects
-hypertension, increased risk for DVT, breakthrough bleeding -fluid retention, libido changes, fatigue, mood swings, weight gain
what to watch for in alpha and beta adrenergic agonists
-hypokalemia due to release of aldosterone with SNS stimulation, can be dilutional or actual loss
nonselective alpha adrenergic blockers adverse effects
-hypotension, orthostatic, angina, MI, CVA, flushing, tachycardia, arrhythmias, weakness, dizziness, HA, N/V/D
children considerations for cholinergic drugs
-increase AE in gi, diarrhea, increase salivation that could lead to choking -bethanechol is approved for tx of neurogenic bladder -neostigmine and pyridostigmine is used in MG and reversal of neuromuscular junction blockers
what do adrenergic agonists cause
-increase HR, BP, RR, pupil size -our fight -mimic sympathetic system
beta specific adrenergic agonists actions
-increase HR, conductivity, and contractility of the heart -increase blood flow to the skeletal muscles -relax the uterus
anticholinergic effects on PNS
-increase HR, decrease GI activity, decrease urinary bladder tone and function, pupils dilate, cycloplegia
cholinergic drugs
-increase the activity of the acetylcholine receptor sites throughout the body. they are not limited to a specific site -mimic parasympathetic system
direct acting cholinergic uses
-increase tone of destructor muscle of the bladder and relax the bladder sphincter -increases production of saliva and tears, pupil constriction
child considerations for adrenergic antagonists
-increased adverse effects -difficulty breathing -changes in glucose metabolism -safety is not established under 18 years old
direct acting cholinergic adverse effects
-rest and digest -NVD, cramps, increased salivation, involuntary defecation -urinary urgency -bradycardia, heart block, hypotension, cardiac arrest -flushing, increased sweating
cholinergic agonists actions
-rest and digest -increases motility and secretions of GI, bladder, rest the heart, lowers HR and decreases contractility. -constricts the bronchi with increase secretions -pupil constriction
beta specific adrenergic agonists adverse effects
-restlessness, anxiety, fear, tremors, fatigue, tachycardia, angina, SOB, cough, pulmonary edema, hypokalemia, sweating, pupil dilation, rash
beta specific adrenergic agonists drugs
-salmeterol, **isoproterenol**
testosterone
-scheduled controlled substance -used for hypogonadism, DM1, low testosterone, delayed puberty
alpha specific adrenergic agonists contraindications
-severe hypertension or tachycardia, narrow-angle glaucoma, pregnancy
finasteride adverse effects
-sexual dysfunction (reduced testosterone levels), gynecomastia, reduced libido, ejaculatory disorders
dopamine uses
-shock
phosphodiesterase type 5 inhibitor drugs
-sildenafil
-beta selective adrenergic blocking contraindications
-sinus bradycardia, heart block, cardiogenic shock, CHF, hypotension, lactation
who are beta selective adrenergic blocking preferred for
-smokers, asthma, or COPD -do not block beta 2 receptor sites (lungs)
elderly considerations for adrenergic agonists
-start low and go slow -teaching to avoid OTC meds, teas, herbal supplements (can contain phenylephrine)
when to stop taking hormonal contraceptives
-stop using with blood clots or hypertension
tocolytic uses
-stops contractions
clomiphene citrate teaching
-take basal temperature 5-10 days following administration -increased temp=ovulation
alpha selective adrenergic blocking drugs
-tamsulosin
alpha 1 adrenergic antagonist drugs
-tamsulosin, doxazosin
adult considerations for adrenergic antagonists
-teaching for hypo and hyperglycemia since usual symptoms are blocked
elderly considerations for anticholinergics
-teaching to avoid heat and safety precautions
tocolytic medications
-terbutaline, hydroxyprogesterone caproate, nifedipine, indomethacin, magnesium sulfate
androgen drug
-testosterone
action of alpha selective adrenergic blocking drugs
-they all have affinity of alpha one receptors causing a decrease in vascular tone and vasodilation, lowering the BP
symptoms of toxicity in adrenergic agonists
-tremors, HA, insomnia, decreased appetite, anxiety, sweating, flushing, vision changes, palpitations, light sensitivity, difficulty voiding, SOB, dizziness
alpha 1 adrenergic antagonist uses
-urinary retention related to BPH -relaxes the muscles of the prostate and bladder neck, enabling the patient to pass urine more easily
phentolamine
-used after extravasation of IV norepi or dopamine -used in severe HTN caused by manipulation of the pheochromocytoma before and during surgery -diagnosis of pheochromocytoma
ipratropium
-used for copd, nasal rhinitis, bronchospasms
flavoxate
-used for relief of dysuria, urgency, nocturia
Galantamine
-used to slow progression of dementia
oxytocic adverse effects
-uterine hypertonicity and spasms, uterine rupture, post partum hemorrhage, decrease FHR -GI upset, nausea, dizziness, headache
alpha selective adrenergic blocking drug to drug
-vasodilators and antihypertensives drugs can cause increased hypotensive effects (no nitrates, Ca channel blockers, erectile dysfunction meds, ACE and ARBS)
oxytocin adverse effects
-water intoxication with coma and maternal death if used for prolonged period -cardiac arrythmias, hypertension, fetal bradycardia, uterine rupture, pelvic hematoma, uterine hypertonicity, anaphylaxis
teaching for testosteron
-will need x-rays of hands and wrists every 6 months
teaching for finasteride
-women should not touch the drug
True or False: Sympathomimetic drugs are not currently recommended for use in pediatric patients.
False
A client is receiving propantheline as adjunctive therapy for peptic ulcers. The nurse instructs the client to take the medication at which time? Only as needed for symptom relief During a meal 30 minutes before meals 1 hour after meals
30 minutes before meals Explanation: A client receiving propantheline as an adjunctive therapy for peptic ulcers should take the medication 30 minutes before meals and at bedtime. One hour after meals will interfere with the action of the medication. Only as needed does not produce therapeutic effects and giving this medication during meals will interfere with the action of the medication.
Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? A 17-year-old female with symptoms of an upper respiratory infection A 47-year-old female with hypertension A 52-year-old male with adult-onset diabetes A 62-year-old male with gout
A 47-year-old female with hypertension Explanation: Phenylephrine is an alpha-1 adrenergic agonist and a drug commonly used topically for relief of nasal and nasopharyngeal mucosal congestion and to produce mydriasis for ophthalmologic procedures. Phenylephrine acts as a vasopressor causing vasoconstriction of the arterioles. The vasoconstriction from phenylephrine use can increase peripheral resistance and blood pressure. People with hypertension should not take over-the-counter cold and allergy preparations containing phenylephrine because it can further increase their already elevated blood pressure. Patients with diabetes and gout have not been identified as being at risk for adverse reactions from the use of phenylephrine. A patient with an upper respiratory infection may actually benefit from use of the drug.
Which client is most likely to benefit from the administration of an adrenergic agonist? A woman who is in labor and may require a cesarean section A man who is in cardiogenic shock following a myocardial infarction A man who has a diagnosis of primary hypertension A woman who has been admitted with a suspected ischemic stroke
A man who is in cardiogenic shock following a myocardial infarction
________________ disease is a progressive disorder involving neural degeneration in the cortex that causes profound loss of memory and affects a person's ability to complete daily activities.
Alzheimer's
The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition? Cerebrovascular dementia Alzheimer's disease Musculoskeletal cancer Muscular dystrophy
Alzheimer's disease Explanation: Indirect-acting cholinergic or anticholinesterase drugs are indicated to treat myasthenia gravis and Alzheimer's disease.
Decreased acetylcholine levels are characteristic of what disorder? multiple sclerosis. Huntington's disease. Parkinson's disease. Alzheimer's disease.
Alzheimer's disease. Explanation: In normal brain function, acetylcholine is an essential neurotransmitter and plays an important role in cognitive functions, including memory storage and retrieval. Alzheimer's disease, the most common type of dementia in adults, is characterized by acetylcholine abnormalities. Multiple sclerosis (MS) is a disease of the central nervous system. Protecting the nerve fibers of the central nervous system is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. Huntington's disease is a genetic neurologic disorder characterized by abnormal body movements called chorea and a lack of coordination; it also affects a number of mental abilities and some aspects of behavior. There is no specific test or marker for Parkinson's disease (PD); diagnosis is by a health care provider and depends on the presence of at least two of the three major signs: tremor at rest, rigidity, and bradykinesia, as well as the absence of a secondary cause, such as antipsychotic medications or multiple small strokes in the regions of the brain controlling movement.
________ steroids are synthetic testosterone preparations that have tissue-building effects.
Anabolic
A client being treated for myasthenia gravis is receiving neostigmine. When the client's pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia? Pseudoephedrine Atropine Propranolol Bethanechol
Atropine Explanation: Atropine will reverse the muscarinic effects of cholinergic crisis, including bradycardia. Neither pseudoephedrine nor propranolol will affect the bradycardia. Bethanechol will likely increase the bradycardia.
The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?
Atropine Explanation: Edrophonium is a cholinergic agonist administered by a provider to diagnose myasthenia gravis. Use of this drug requires that an antidote, typically atropine, be on hand in case of cholinergic overdose.
A 4-year-old girl is brought to the emergency department by her mother. The mother reports the child has been vomiting, The nurse notes the child's face is flushed and is diaphoretic. The mother thinks the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which drug would be administered? Acetylcholine Atropine Cevimeline Nicotine
Atropine Explanation: Acetylcholine and cevimeline are both cholinergic agonists, and, like carbachol, would be contraindicated in this client. Administration of either of these drugs could be fatal. Nicotine is a direct-acting nicotinic agonist and is not indicated in cholinergic poisoning. Atropine is considered the antidote for cholinergic poisoning. The actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility.
A client is experiencing urinary retention. The client has been prescribed terazosin (Hytrin). What condition contributes to the urinary retention? Benign prostatic hypertrophy Urinary tract infection Kidney cancer Bladder cancer
Benign prostatic hypertrophy
A client is being treated for asthma. What would the nurse expect to administer?
Beta-2-specific adrenergic agonist
A male client, age 75, is started on flavoxate . What adverse effect should the client be made aware of? Blurred vision Urinary incontinence Weight gain Skin rash
Blurred vision Some adverse effects of flavoxate include blurred vision, urinary retention, pupil dilation, photophobia, cycloplegia, increased intraocular pressure, dry mouth, constipation, and decreased sweating. Skin rash and weight gain are not noted as adverse effects of flavoxate.
From puberty onward, androgens continue to aid in the development and maintenance of secondary sex characteristics that include what characteristics? (Select all that apply.) Epiphyseal growth Muscle development Glucose metabolism Body fat distribution Body hair
Body fat distribution Muscle development Body hair
A young male patient, age 14, has been prescribed testosterone for delayed onset of puberty. Follow-up care includes a visit to the clinic at least every 6 months for ongoing assessment. It will be most important for the nurse to monitor: Bone growth Hemoglobin levels Fluid intake and output Sodium and potassium levels
Bone growth Explanation: When testosterone is used in prepubescent boys to treat hypogonadism or delayed onset of puberty, the premature closure of the long bones may lead to stunted growth. To monitor the action of testosterone on the patient, radiographs should be taken every 6 months to assess bone age. Radiographs help document bone maturation and the effect of testosterone on the epiphyseal centers. Although it is important to assess a patient's fluid intake and output, hemoglobin and hematocrit levels, and sodium and potassium levels, in this situation assessing bone growth would be the most important.
Mark, age 42, is prescribed sildenafil for the treatment of pulmonary hypertension. The nurse caring for Mark would explain that sildenafil works by what mechanism? Increasing systemic vascular resistance Decreasing arterial blood flow Decreasing the function of the right ventricle Causing vasodilation in the pulmonary vascular bed
Causing vasodilation in the pulmonary vascular bed Explanation: When sildenafil is used to treat pulmonary arterial hypertension, it stabilizes patients clinically as well as improves their exercise capacity and the function of the right ventricle. The drug causes vasodilation of the pulmonary vascular bed and, to a lesser degree, vasodilation in the systemic circulation.
A nurse is caring for an elderly patient who is to be administered isoproterenol. Which change monitored in the patient should the nurse report immediately to the primary health care provider? Changes in glucose level Changes in appetite Changes in pulse rate Changes in temperature
Changes in pulse rate Explanation: The nurse should report any changes observed in pulse rate or rhythm immediately. Changes in glucose level, appetite, or temperature need not be reported immediately to the primary care provider unless they are severe.
Chemicals that act at the same site as the neurotransmitter acetylcholine (ACh) are called _______________________ drugs.
Cholinergic
A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following? Cholinergic crisis Hypertensive emergency Acetylcholinesterase crisis Status epilepticus
Cholinergic crisis Explanation: Symptoms of cholinergic crisis include severe abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, and clenching of the jaw. In acetylcholinesterase crisis, a pronounced muscular weakness and respiratory paralysis caused by excessive acetylcholine, often a result of overmedication with anticholinesterase drugs. Hypertensive emergency includes retinal hemorrhage, increased intracranial pressure resulting in headache and/or vomiting, and kidney organ failure. Status epilepticus is a medical emergency and can be of different types and caused by brain trauma, infection, or stroke.
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy? An increase in bronchial secretions in her infant Stimulation of sphincters in her infant Cholinergic stimulation in her infant An increase in airway resistance in her infant
Cholinergic stimulation in her infant Explanation: The therapy for closed-angle glaucoma should be continuously assessed for cholinergic stimulation in the patient's infant. If such stimulation occurs, the drug should be discontinued immediately. The assessment for cholinergic stimulation would include assessing for an increase in the airway resistance, bronchial secretions, and stimulation of sphincters; these are all cholinergic effects. It would not be advisable to assess only one of these factors. Therefore, assessing for cholinergic stimulation is the best answer.
A nurse should observe which clients more carefully during the use of propranolol (Inderal) due to the increase likelihood of adverse reactions? (Select all that apply.) Clients with asthma Clients with migraine headaches Clients with diabetes Clients with peptic ulcer disease Clients with hyperlipidemia
Clients with asthma Clients with diabetes Clients with peptic ulcer disease
A group of students are reviewing the various fertility drugs that are available. The students demonstrate understanding when they identify which drug as being administered orally? Follitropin alfa Cetrorelix Ganirelix Clomiphene
Clomiphene Explanation: Clomiphene is administered orally. Cetrorelix, follitropin alfa, and ganirelix are administered parenterally.
Which agent would the nurse identify as being available in a transdermal form?
Clonidine
The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is taking dobutamine for congestive heart failure. What would be most important to monitor in this patient? Dietary intake Compliance with drug regimen Effectiveness of comfort measures Availability of caregivers
Compliance with drug regimen
A nurse suspects that a client is experiencing shock based on which assessments? Select all that apply.
Cyanosis Disorientation Tachypnea
Cholinergic Side Effects Mneumonic
DUMBBBELL Diaphoresis Urination Miosis (pin point pupil) Bradycardia Bronchospasm Bronchial secretion increase Emesis Lots of tears and saliva Loose stool
Which results with the administration of testosterone? Decreased production of red blood cells Decreased retention of sodium Decreased protein catabolism Decreased retention of nitrogen
Decreased protein catabolism Explanation: Protein catabolism decreases. Red blood cell production increases. Retention of nitrogen increases. Retention of sodium increases.
Medroxyprogesterone acetate
Depo-Provera commonly used form of injectable birth control used every 3 months: can lead to loss of bone mass long term. Provera: indicated in the treatment of Dysfunctional uterine bleeding
Which adverse effects might a nurse assess in a patient receiving bethanechol? (Select all that apply.) Diarrhea Dehydration Diaphoresis Tachycardia Pallor
Diarrhea, dehydration, diaphoresis Diarrhea is a possible adverse effect of bethanechol. Dehydration is possible due to the adverse effect of diarrhea. Increased sweating is a possible adverse effect of bethanechol. Bradycardia would occur with bethanechol. Flushing is a possible adverse effect of bethanechol. Flushing is a possible adverse effect of bethanechol. Bradycardia would occur with bethanechol.
A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The provider orders bethanechol. The nurse is aware that bethanechol is included in which drug classification? Indirect-acting anticholinergic medication Direct-acting cholinergic drug Anticholinergic medication Indirect-acting cholinergic drug
Direct-acting cholinergic drug Explanation: The direct-acting cholinergic drug bethanechol is used to treat urinary retention due to urinary bladder atony and postoperative abdominal distention due to paralytic ileus.
A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the health care provider to take? Decrease the cholinergic medication to alleviate the symptom of confusion. Discontinue the cholinergic medication secondary to the diagnosis of bradycardia. Increase the cholinergic medication to increase cardiac contractility. Increase the cholinergic medication to increase oxygenation to the heart through vasodilation.
Discontinue the cholinergic medication secondary to the diagnosis of bradycardia. Explanation: People with coronary artery disease should not take cholinergics because they can result in bradycardia, vasodilation, and hypotension.
What nursing interventions are most important if the nurse has concerns that the client is developing fluid overload while receiving oxytocin? (Select all that apply.) Increase the client's maintenance IV. Discontinue the oxytocin infusion. Measure the client's output hourly. Encourage the client to force fluids. Administer oxytocin intranasally.
Discontinue the oxytocin infusion. Measure the client's output hourly.
A nursing mother is being prepared for an eye condition which requires a prescription for atropine. What nursing intervention should the nurse implement to assure safe and effective atropine therapy? Discuss an alternative feeding method until the atropine is no longer prescribed Discuss pumping and then warming the breast milk before bottle feeding the baby Discuss feeding the baby prior to taking the prescribed atropine Discuss the mother's need to be well hydrated to minimize the amount to atropine in the breastmilk
Discuss an alternative feeding method until the atropine is no longer prescribed Explanation: Because of the potential for serious adverse effects on the baby, nursing mothers should be assisted in finding another method of feeding the baby if an anticholinergic drug is needed. None of the other options effectively manage the safety risk to the infant.
A nurse is caring for a patient who is on a drug regimen of midodrine to treat hypotension. What would be an appropriate nursing diagnosis to include in the care plan of this patient? Impaired skin integrity related to dermatological effects Acute pain related to GI distress, cough, skin effects, and headache Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects
Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects Explanation: Nursing diagnoses related to drug therapy with might include ineffective tissue perfusion (total body) related to changes in cardiac output and disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects. Acute pain is a nursing diagnosis appropriate to a patient receiving an ARB. Support and encouragement is an implementation, not a nursing diagnosis. Impaired skin integrity is a nursing diagnosis for a patient taking an ACE inhibitor.
A client is receiving androgen therapy. Which would cause the nurse the greatest concern? Decreased thyroid function Increased creatinine level Elevated liver enzyme levels Increased creatinine clearance
Elevated liver enzyme levels Explanation: Elevated liver enzyme levels indicate impaired hepatic function that could be related to the development of hepatocellular cancer—a potential and life-threatening effect associated with androgen therapy. Decreased thyroid function and increased creatinine and creatinine clearance levels are not associated with disease states and can last for up to 2 weeks after discontinuing therapy.
True or False Galantamine (Razadyne) is a cholinergic drug that is used to stop the progression of Alzheimer's disease.
False
True or False Progestins are male sex hormones that are responsible for the continued production of sperm.
False
A student asks the pharmacology instructor what effect the administration of androgens can have on a fetus if administered during pregnancy. What should the instructor respond? Increased growth of fetus Female child may have masculinized features Sex of child will be female Sex of child will be male
Female child may have masculinized features Explanation: Androgens and anabolic steroids are contraindicated during pregnancy because of possible masculinizing effects on a female fetus.
A client is experiencing urgency, nocturia, and frequency secondary to cystitis. What might the health care provider prescribe? Glycopyrrolate Dicyclomine Methscopolamine Flavoxate
Flavoxate Explanation: Flavoxate may be ordered to provide symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis. Dicyclomine is used to treat irritable or hyperactive bowel. Glycopyrrolate is used to decrease secretions before surgery or intubation and as an adjunct for treatment of ulcers. Methscopolamine is used as an adjunct treatment for peptic ulcers.
The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia? Regional Local General Topical
General Explanation: Cholinergic blocking agents are used to decrease respiratory secretions that pool in the lungs when the client's cough and swallowing reflexes are lost during general anesthesia. It would not be used prior to other forms of anesthesia unless there was the possibility of the loss of the swallowing reflexes.
Clients with what disorder should not be given anticholinergic drugs? Severe anxiety or hyperactivity Glaucoma Attention deficit disorder Epilepsy
Glaucoma Explanation: Anticholinergic drugs are contraindicated for patients with benign prostatic hypertrophy, myasthenia gravis, hyperthyroidism, glaucoma, tachyarrhythmia, myocardial infarction, heart failure, or conditions associated with esophageal reflux.
The client is scheduled for surgery in two hours. The physician orders preoperative administration of glycopyrrolate and meperidine. These drugs might be contraindicated for the client if the client had what disorder? Diabetes mellitus Diverticulitis Asthma Glaucoma
Glaucoma Explanation: Glaucoma is frequently listed as a contraindication to anticholinergic drugs (e.g., glycopyrrolate) because the drugs impair outflow of aqueous humor and may cause an acute attack of glaucoma by increasing intraocular pressure.
Which drugs are used to decrease secretions prior to surgery and are classified as cholinergic blocking drugs? Select all that apply. Glycopyrrolate (Robinul) Lorazepam (Ativan) Hydroxyzine (Vistaril) Atropine Fentanyl (Sublimaze)
Glycopyrrolate (Robinul) Atropine Atropine and glycopyrrolate(Robinul) are cholinergic blocking agents and are used to decrease respiratory secretions. Hydroxyzine (Vistaril) is an anxiolytic with antiemetic properties. Lorazepam (Ativan) is an anxiolytic. Fentanyl (Sublimaze) is an opioid.
A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? Cholesterol level Hand and wrist epiphyseal growth plates LFT Vision
Hand and wrist epiphyseal growth plates Arrange for radiographs of the long bones of children every 3 to 6 months, so that the drug can be discontinued if bone growth reaches the norm for the child's age. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision.
Which would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a client taking estrogen? Amenorrhea Headaches Breast tenderness Cholestatic jaundice
Headaches Pain in the groin, headaches, dizziness, and chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone.
The nurse should observe clients receiving a cholinergic blocking drug during the hot summer months because these clients are at increased risk of which adverse effect? Heat prostration Dehydration Heart attack Sunburn
Heat prostration Explanation: The nurse should observe clients receiving a cholinergic blocking drug during the hot summer months because these clients are at increased risk of heat prostration. Sunburn is not an adverse reaction for cholinergic blocking drugs. Clients receiving atropine for third-degree heart block may develop tachycardia or arrhythmias, not specifically heart attack. Cholinergic blockers decrease sweating, so dehydration is not seen.
A client is prescribed oxybutynin in a transdermal form. The nurse would instruct the client to apply the patch to which area? Select all that apply. upper arm abdomen hip thigh buttocks
Hip abdomen buttocks Explanation: The transdermal form should be applied to a clean, dry area of the hip, abdomen, or buttocks. The upper arm site can be dislodged with clothing and activity, the same as with the thigh.
The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms? Improve cholinergic neurotransmission to the brain Improve medication absorption through the blood-brain barrier Improve anticholinergic neurotransmission to the brain Cause vasodilation of the cerebral arteries
Improve cholinergic neurotransmission to the brain Explanation: Indirect-acting cholinergic medications for Alzheimer's disease are widely distributed, including to the central nervous system. Thus, indirect-acting cholinergic drugs are able to improve cholinergic neurotransmission in the brain.
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?
Improved cardiac contractility
A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors? Increase in the level of acetylcholine in CNS Increase in the level of adenosine tri-phosphate in the blood Increase in the level of cholinesterase in the blood Decrease in the level of neurotoxins in the brain
Increase in the level of acetylcholine in CNS Explanation: Administration of cholinesterase inhibitors results in an increase in the level of acetylcholine in CNS. Administration of cholinesterase inhibitors does not decrease the neurotoxins in the brain or increase the level of adenosine tri-phosphate in the blood. Cholinesterase inhibitors do not increase the level of cholinesterase in the blood.
A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient? Increased risk of theophylline toxicity Decreased effectiveness of anticholinergics Decrease GI absorption of the drug Increased risk of GI bleeding
Increased risk of GI bleeding Explanation: The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding, which should be monitored for. Interaction of anticholinergics with cholinesterase inhibitors causes decreased effectiveness of anticholinergics. Interaction of theophylline with cholinesterase inhibitors causes increased risk of theophylline toxicity. Interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors does not decrease the GI absorption of the drug.
The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect? Increased tears Increased gastric motility Increased bladder tone Increased voiding
Increased voiding Explanation: Micturition is another term for urination; therefore, medications given to increase micturition should increase voiding.
A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?
Inhalation
Hydroxprogesterone caproate
Injectable progesterone to prevent preterm delivery. Given weekly.
A 70-year-old client is taking a cholinergic blocking drug. The family has noticed the client is a confused, excited, and not voiding normally. What would be the appropriate action by the nurse in this situation? Instruct the client's family to increase the dose of the medication to combat these symptoms. Instruct the client's family to take the client to the emergency department immediately. Instruct the client's family to continue the medication and ignore the symptoms. Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider.
Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider. Explanation: Older clients taking cholinergic blocking medications may exhibit symptoms such as excitement, mental confusion, and urinary retention. If a client is exhibiting these symptoms, the medication should be withheld for the next dose and the nurse should contact the prescribing provider. Ignoring symptoms is not advised because they could become worse. Increasing the dose would probably increase the symptoms and it is not appropriate for the nurse to change medication dosage without a provider order. It is not a medical emergency, so going to the emergency department is not necessary. The family is given the instruction due to the fact the client is confused.
A client diagnosed with myasthenia gravis is experiencing rhinorrhea. Which medication should not be administered to the client? Azelastine hydrochloride Fexofenadine Nedocromil sodium Ipratropium
Ipratropium Explanation: Ipratropium is administered for rhinorrhea but is contraindicated in clients who have been diagnosed with myasthenia gravis because of its anticholinergic effects. Azelastine hydrochloride, fexofenadine, and nedocromil sodium are not contraindicated for clients with myasthenia gravis.
Which cholinergic-blocking drugs are used in the treatment of chronic obstructive pulmonary disease (COPD)? (Select all that apply.) Darifenacin (Enablex) Benztropine (Cogentin) Tiotropium (Spiriva) Ipratropium (Atrovent) Biperiden (Akineton)
Ipratropium (Atrovent) Tiotropium (Spiriva) Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic-blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).
A client is administered atropine to increase the heart rate. What is the action of atropine? It exacerbates the parasympathetic vagal stimulation. It provides long-acting antihistamine blockage. It blocks the parasympathetic vagal stimulation. It blocks cell wall synthesis of gram-negative bacilli.
It blocks the parasympathetic vagal stimulation. Explanation: Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is opposite to the effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.
A postmenopausal woman is receiving raloxifene as part of a treatment plan for osteoporosis. The nurse would instruct the patient that this drug is administered by which route? Transdermal Intravaginal Oral Intramuscular
Oral Explanation: Raloxifene is administered only by the oral route.
A postmenopausal woman is administered estradiol for the purpose of preventing which condition? Osteoporosis Uterine cancer Amenorrhea Endometriosis
Osteoporosis Explanation: Conjugated estrogens are used to prevent osteoporosis in postmenopausal women. Conjugated estrogens are not administered in postmenopausal women to treat endometriosis, amenorrhea, or uterine cancer.
Estropipate is sometimes administered to postmenopausal women to prevent which condition? Endometriosis Uterine cancer Dysfunctional uterine bleeding Osteoporosis
Osteoporosis Explanation: Estropipate and other estrogens are sometimes prescribed to postmenopausal women to prevent or treat osteoporosis associated with hormone deficiency. However, given the potentially significant risks associated with hormone replacement therapy, this use is not currently considered a first-line treatment.
The anabolic steroid indicated for the treatment of anemias in adults is __________________.
Oxymetholone (Anadrol-50)
Drugs that are used to stimulate contraction of the uterus are called ________________.
Oxytocic
Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the health care provider? Pain in one leg Breast tenderness Abnormal menstrual bleeding Weight gain
Pain in one leg Explanation: Pain in one leg could indicate a thrombus formation. Common side effects of progesterone are abnormal menstrual bleeding, including spotting; breast tenderness; and weight gain.
While obtaining the client's history, the nurse assesses the client for a deviation in behavior patterns. Which would the nurse identify as indicating decline? Select all that apply. answering questions appropriately monotone speech crying at a humorous statement poor eye contact answering questions incompletely
Poor eye contact, crying at a humorous statement, monotone speech, answering questions incompletely Explanation: When taking the history, the nurse would observe the client for any behavior patterns that appear to deviate from normal. Examples of deviations include poor eye contact, failure to answer questions completely, inappropriate answers to questions, monotone speech pattern, and inappropriate laughter, sadness, or crying, signifying varying stages of decline.
The therapeutic effect of doxazosin (Cardura) comes from its ability to block the _______________ sites, which decreases vascular tone, causes vasodilation, and decreases blood pressure.
Postsynaptic alpha-1 receptors
A teenage client who is using testosterone to treat a hormone deficiency calls the clinic to report acne-like skin eruptions on the face. How should the nurse counsel this client? Stop taking this drug immediately. Make an immediate appointment with a dermatologist. Gradually decrease the dose of testosterone. Practice frequent and thorough skin cleansing.
Practice frequent and thorough skin cleansing. Explanation: Teenage clients who use testosterone often report acne. The best practice is for clients to practice frequent and thorough skin cleansing. It is not necessary to see the dermatologist again but the client should not stop or decrease the dosage of the medication without first having a discussion with the dermatologist.
Conjugated estrogens
Premarin Cenestin Enjuvia
A client is started on terbutaline therapy. What would indicate that the therapy has been successful? Premature birth is avoided for at least 24 hours. The mother does not experience adverse effects. There has been less or no bleeding in the delivery. The mother did not require any labor induction.
Premature birth is avoided for at least 24 hours. Explanation: Terbutaline drug therapy is considered effective when all the following have been achieved: the premature contractions decrease in intensity and frequency; the woman and fetus do not experience adverse effects; and premature birth is avoided for at least 24 hours so that administered corticosteroids can exert their beneficial effects. Terbutaline is not to be given for labor induction but to stop preterm labor.
The nurse knows that for a client who still has her ovaries intact, estrogen must be paired with what other drug when used to treat menopausal symptoms? Antispasmodics Androgen hormone inhibitors Progestins Aromatase inhibitors
Progestins When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, progestins must also be used to decrease the risk of endometrial cancer. Antispasmodics are used to treat issues of the bladder. Androgen hormone inhibitors are used to treat benign prostatic hypertrophy. Aromatase inhibitors are used to treat breast cancer.
The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving: Nadolol Sotalol Carteolol Propranolol
Propranolol
A nurse must recognize which class of medication a drug is part of in order to help in planning ongoing assessment and patient education. Which is an example of a drug in the class of beta-adrenergic blockers? (Select all that apply.) Labetalol (Trandate) Propranolol (Inderal) Carvedilol (Coreg) Atenolol (Tenormin) Metoprolol (Lopressor)
Propranolol Atenolol Metoprolol
The nurse is preparing to apply testosterone gel (AndroGel) to a male client who has a low testosterone level. What is the nurse's top priority action before administering this medication? Put on gloves. Moisten the skin with water. Shave the client's chest. Apply to the client's scrotum.
Put on gloves When the nurse is applying testosterone gel, gloves must be used to prevent the nurse from receiving any of the medication. The gel is applied to clean, dry, intact skin of the shoulders, upper arms, or abdomen. It should not be used on the client's genitals.
A 27-year-old client has been in the intensive care unit for two weeks following a car accident. The primary nurse is concerned that the client is not getting the rest needed for recovery. Which nursing diagnosis would be appropriate for this problem? Risk for Narcolepsy related to nighttime wakefulness Risk for Body Image Disturbance related to injuries Risk for Psychosis related to head injury Risk for Disturbed Sleep Pattern related to hospitalization
Risk for Disturbed Sleep Pattern related to hospitalization Explanation: Sleep patterns are disturbed constantly when a client is in the ICU. The client will have lots of noise around him, will be awoken for vital signs, turning, medications, etc. The room will not be completely dark. Adrenergic medications can make it difficult to sleep. All of these can lead to disturbed sleep patterns. Narcolepsy is a medical diagnosis that describes a client who falls asleep multiple times a day. The client's body image is not likely the issue with sleeping. There is no evidence in the above scenario that suggests psychosis or head injury.
A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client? Imbalanced Nutrition: More Than Body Requirements Risk for Injury related to being confined to the Alzheimer's unit Risk for Injury related to dizziness and fatigue Learning Impairment related to decreased hearing
Risk for Injury related to dizziness and fatigue Explanation: Exelon has the side effects of dizziness and fatigue, which can contribute to falls and injuries. Being confined to an Alzheimer's unit is done to prevent injuries that might happen as a result of being confused. Most clients taking Exelon are at risk of losing, not gaining, weight. Nothing was said about the client being deaf or hard of hearing.
A female client is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe, debilitating seasickness in the past. What would the nurse expect the health care provider to order? Dexamethasone Palonosetron Scopolamine Ondansetron
Scopolamine Explanation: Scopolamine is an anticholinergic drug that is effective in relieving nausea and vomiting associated with motion sickness and radiation therapy for cancer.
A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately? Dizziness Shortness of breath Weight gain Abdominal bloating
Shortness of breath Explanation: Estrogens are associated with the development of thrombi and emboli. Reports of shortness of breath may indicate a possible pulmonary embolism necessitating emergency treatment. Abdominal bloating, weight gain, and dizziness are common adverse effects of estrogen therapy that should be reported, but it is not necessary to report them immediately.
A group of students are reviewing the drugs available for treating penile erectile dysfunction. The students demonstrate understanding when they identify which drug as a PDE5 inhibitor? Oxandrolone Sildenafil Danazol Alprostadil
Sildenafil Explanation: Sildenafil is a PDE5 inhibitor used to treat penile erectile dysfunction. Alprostadil is a prostaglandin. Oxandrolone is an anabolic steroid. Danazol is an androgen.
A woman is diagnosed with pulmonary hypertension. The nurse explains the drug prescribed and the patient states, "That's a drug that used to treat erectile dysfunction." Which drug would this most likely be? Sildenafil Vardenafil Tadalafil Alprostadil
Sildenafil Explanation: Sildenafil is used to treat pulmonary hypertension in females.
The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity?
Stimulates electrical and mechanical activity
A client diagnosed with benign prostatic hypertrophy (BPH) is prescribe tamsulosin. The client communicates with the nurse about a friend that was prescribed sildenafil for his BPH. Which is the nurse's best response regarding the difference in the use of the two drugs for BPH? Tamsulosin is recommended for long-term therapy of BPH. Sildenafil is recommended for initial therapy of BPH. Tamsulosin relaxes muscles in the prostate and bladder and increases ability to urinate. Sildenafil activates nerves in the head and neck and decreases blood pressure.
Tamsulosin relaxes muscles in the prostate and bladder and increases ability to urinate. Explanation: The alpha-1 adrenergic blockers (tamsulosin) are recommended over PDE5 inhibitors (sildenafil) for initial monotherapy for the treatment of BPH. Alpha-1 adrenergic blockers (tamsulosin) provide immediate therapeutic benefits, while PDE5 inhibitors (sildenafil) require long-term treatment (6-12 months) before symptom improvement. Tamsulosin relaxes muscles in the prostate and bladder and increases the client's ability to urinate. Sildenafil improves ED by a vasodilatory effect in the smooth muscle of the corpus cavernosum.
The nurse is developing a care plan for a client who will receive donepezil in the home setting. How can the nurse best facilitate safe and effective administration of the medication? Assess the client's need for home care. Teach the client's caregiver to administer the medication in a timely and safe manner. Have the client explain the rationale for drug therapy repeatedly before discharge. Provide a detailed drug monograph to the client and the client's spouse and offer to answer any questions.
Teach the client's caregiver to administer the medication in a timely and safe manner. Explanation: It is important for the home care nurse to work with responsible family members/caregivers in such cases to ensure accurate drug administration. Assessing the family's need for home care may be warranted, but this action does not necessarily ensure safe drug administration. The presence of moderate Alzheimer's disease may preclude effective client teaching. Written teaching materials must normally be supplemented by other forms of teaching.
A client is using a transdermal system for androgen administration. Which drug would the client most likely be using? Danazol Testosterone Methyltestosterone Fluoxymesterone
Testosterone Explanation: Testosterone is available in a transdermal form. Fluoxymesterone, danazol, and methyltestosterone are administered orally.
A male adolescent is prescribed testosterone. In order to help the client deal with the added social stress that the medication may cause, the nurse should discuss which possible adverse effect? The development of acne Deepening of the voice Weight loss Dry skin
The development of acne Explanation: Adolescents who are prescribed androgens should be alerted to the potential for increased acne and oily skin. Deepening of the voice may occur but it is not likely to be viewed negatively by a male client. Weight gain is a commonly recognized adverse reaction associated with this medication.
A 37-year-old woman has just experienced the end of a long-term relationship and has expressed a desire to begin using oral contraceptives. What aspect of this woman's current health status would contraindicate this treatment? The woman has a family history of breast cancer. The woman has asthma and uses inhaled corticosteroids and bronchodilators. The woman takes an antiplatelet medication for coronary artery disease. The woman has a diagnosis of type 2 diabetes.
The woman takes an antiplatelet medication for coronary artery disease. Explanation: Coronary artery disease is a contraindication to the use of oral contraceptives. Diabetes and asthma do not necessarily contraindicate this treatment. A family history of breast cancer is relevant but would not absolutely contraindicate oral contraceptive use.
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response? They block nicotinic receptors. They act to block the effects of the parasympathetic nervous system. They increase norepinephrine at the neuromuscular junction. They compete with serotonin for muscarinic acetylcholine receptor sites.
They act to block the effects of the parasympathetic nervous system. Explanation: Anticholinergic drugs block the effects of the parasympathetic nervous system. Atropine is the only widely used anticholinergic drug. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response? They compete with serotonin for muscarinic acetylcholine receptor sites. They increase norepinephrine at the neuromuscular junction. They block nicotinic receptors. They act to block the effects of the parasympathetic nervous system.
They act to block the effects of the parasympathetic nervous system. Explanation: Anticholinergic drugs block the effects of the parasympathetic nervous system. Atropine is the only widely used anticholinergic drug. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.
The nurse is preparing a client for pacemaker surgery. The health care provider orders atropine to be given 30 minutes before the client is taken to the operating room. The nurse knows this medication is ordered for what reason? To dry up respiratory secretions to prevent aspiration during surgery To increase the heart rate to prevent complication prior to the pacemaker being inserted To cause bladder relaxation during surgery so that the client will not have the urge to void during surgery To relax the bowel to prevent the client from having a bowel movement during surgery
To dry up respiratory secretions to prevent aspiration during surgery Explanation: Atropine is an anticholinergic agent. The principal actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility. The reason this client is given the medication preoperatively is to dry up secretions to prevent aspiration during surgery.
True or False A woman with myasthenia gravis who is taking pyridostigmine (Mestinon) should be cautioned against becoming pregnant because the uterus may be stimulated and labor induced, resulting in a preterm birth.
True
True or False Birth control pills (with estrogen) can elevate blood pressures and increase risk of DVT.
True
True or False Common effects of patients taking androgens may include acne, edema, hirsutism, weight gain, and decreased breast size.
True
True or False Men taking alprostadil should avoid nitrates or alpha-blockers due to the potential dangerous cardiovascular effects.
True
True or False Oral contraceptives can increase a diabetic's blood sugars.
True
True or False Priapism is a prolonged, often painful penile erection, a potential side effect of alprostadil.
True
True or False The treatment for nerve gas exposure includes the use of pralidoxime (Protopam Chloride), which is the antidote for irreversible acetylcholinesterase-inhibiting drugs, and atropine, which temporarily blocks cholinergic activity.
True
True or False The use of direct-acting cholinergic drugs is limited to primarily ophthalmic agents because of their profound negative systemic effects.
True
True or False Tocolytics are used to relax the uterine smooth muscle and prevent premature labor and delivery.
True
True or False Unopposed estrogen increases the chance of endometrial cancer and breast cancer.
True
True or False: Dopamine increases blood pressure and stimulates the heart without compromising renal blood flow.
True
A young man has received a diagnosis of androgen deficiency and has been prescribed testosterone. At clinic follow-up appointments, the nurse should prioritize which assessment? Weight and measurement of blood pressure Hearing assessment and abdominal girth measurement Deep tendon reflexes and random blood glucose testing Bladder ultrasound and urine testing for glucose and ketones
Weight and measurement of blood pressure Explanation: For clients who are being treated with androgens, the nurse should regularly assess the client's blood pressure and body weight, as these may be affected by androgens. Urine testing and bladder ultrasound are generally unnecessary. It is prudent to monitor blood glucose levels, but assessment of DTRs is not required.
When considering serious adverse effects, oral contraceptive use would most likely be contraindicated in which client? a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day a 40-year-old client who is taking a cholesterol-lowering medication a 20-year-old client who has a family history of hypofunction of the pituitary gland a 25-year-old client whose mother died of pancreatic cancer
a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day Explanation: Oral contraception contains estrogen as an active ingredient. The most serious adverse effect of estrogen use is the increased risk of thromboembolic conditions. Thromboembolic disorders are most likely to occur in women older than 35 years of age who take oral contraceptives and smoke cigarettes, postmenopausal women taking long-term estrogen and progestin therapy, and men or women who receive large doses of estrogens for cancer treatment. None of the other clients have unusually high risks for thromboembolic conditions.
A client has an IV of dopamine administered in the right arm. The IV becomes dislodged from the vein and dopamine has been being given in the surrounding tissue instead of the vein. The nurse should stop the IV and:
administer phentolamine (an alpha adrenergic blocking drug) to the site to minimize necrosis.
Propranolol (Inderal) is used extensively as treatment for what condition? Cluster headaches Prevent first MI Angina Hypotension
angina
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?
assess heart rate.
The nurse is providing education to a client who has been recently diagnosed with myasthenia gravis. During teaching, the nurse would describe it as what type of disorder? chronic inflammatory connective tissue autoimmune genetic
autoimmune Explanation: Myasthenia gravis is a neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine. None of the other options describe the disorder.
Sildenafil has been prescribed to a client in his 60s, and the nurse is providing health education about the safe and effective use of the drug. The nurse should teach the client to: avoid taking sildenafil if he experiences heartburn. take the drug every 30 minutes if necessary, to a maximum of three doses. avoid taking the drug more than once in any 24-hour period. take the drug on an empty stomach.
avoid taking the drug more than once in any 24-hour period. Explanation: It is important not to take sildenafil more than once in a 24-hour period. A recent high-fat meal may delay drug action, but it is not essential to take it on an empty stomach. Heartburn is not a common adverse effect and would not necessarily require discontinuing treatment.
An adult client is suspected of having an androgen deficiency and has spoken with his primary care provider about the possibility of treatment with testosterone. The use of testosterone would be most complicated by the presence of what preexisting health problem? type 2 diabetes benign prostatic hypertrophy urinary incontinence chronic renal failure
benign prostatic hypertrophy Explanation: Disorders of the prostate contraindicate testosterone use because men with an enlarged prostate may have additional enlargement. Incontinence, diabetes, and kidney disease are not absolute contraindications to the use of testosterone.
What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction? Beta-adrenergic blockers Narcotic antagonist Sympathomimetic agents Neuromuscular blocking agent
beta-adrenergic blockers
What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago? calcium channel blockers (CCBs) cardiac glycosides angiotensin II receptor blockers (ARBs) beta-blockers
beta-blockers
The health care provider is preparing to write a prescription for a client diagnosed with urinary retention. Which medication does the nurse expect to be prescribed? donepezil ambenonium neostigmine bethanechol
bethanechol Explanation: Bethanechol is a sympathomimetic agent that acts at the cholinergic receptors in the urinary and GI tracts to increase muscle tone. The increased tone of the detrusor muscle in the urinary bladder allows for bladder emptying. Neostigmine and ambenonium are used to treat myasthenia gravis. Donepezil is used to treat Alzheimer's disease.
Antagonist is a ______ of a normal response.
block
When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment? chest auscultation heart rate and rhythm skin integrity blood pressure
blood pressure Explanation: Oral contraceptives can result in increased blood pressure. Regular monitoring is consequently indicated. It is not normally necessary to assess skin integrity or respiration. These drugs have adverse effects influencing the cardiovascular system, but such effects are unlikely to result in alterations in rate and rhythm.
Epinephrine causes relaxation of
bronchioles
What is the primary goal for prescribing an anticholinergic agent for a preoperative client? prevent tachycardia decrease respiratory secretions decrease gastric motility relaxation of the detrusor muscle
decrease respiratory secretions Explanation: In preoperative clients, the nurse assesses for diminished secretions, particularly when an anticholinergic is administered for head and neck surgery. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.
A client with Alzheimer's disease is taking Exelon along with an anticholinergic drug to decrease the amount of secretions. What should the nurse be concerned about? decreased effectiveness of the anticholinergic rise in blood glucose increased effectiveness of the anticholinergic drop in blood pressure
decreased effectiveness of the anticholinergic Explanation: Interactions may occur when a cholinesterase inhibitor is given with another agent. When it is given with an anticholinergic there is sometimes a decreased effect of the anticholinergic drug.
A nurse would instruct a patient to apply a clonidine patch at which frequency? Every other day Every 7 days Every day Every 5 days
every 7 days
Androgens (testosterone) are:
excreted in response to luteinizing hormone; many potential side effects.
True or False: Patients receiving anticholinergic drugs may report an increase in oral secretions and increased sweating.
false
SNS
fight or flight + neurotransmitters of acetylcholine, norepinephrine, epinephrine aldosterone is released to retain salt and H2O. POTASSIUM SPILLS IN THE URINE
Where can you not use epinephrine with lidocaine?
fingers toes penis nose
Which is an example of an androgen that can be used to treat hypogonadism? oxymetholone fluoxymesterone dutasteride nandrolone
fluoxymesterone Explanation: Fluoxymesterone is an androgen that can be used to treat hypogonadism. Nandrolone is an anabolic steroid used to treat anemia of renal insufficiency, and human immunodeficiency virus (HIV) wasting syndrome. Dutasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is the androgen primarily responsible for the initial development and subsequent enlargement of the prostate gland. Oxymetholone is an anabolic steroid used to treat anemia associated with renal insufficiency.
The nurse is admitting a client with injuries following a bicycle crash. When reviewing the client's pre-admission medication regimen, the nurse reads that the client takes formoterol twice daily. When planning this client's care, the nurse should include:
frequent respiratory assessments.
Dopamine a/e
hypertension (in high dose) hypotension (in low dose)
Patients taking both diabetic drugs and adrenergic blocking agents are at an increased risk for __________ and should be monitored closely.
hypoglycemia
A client is prescribed oxytocin to stimulate the milk ejection reflex. The nurse would expect this drug to be administered by which route? intranasally intramuscularly topically orally
intranasally Explanation: The nurse should administer oxytocin intranasally to a client to stimulate the milk ejection reflex. Oxytocin can be given intramuscularly (IM) during the third stage of labor (period from the time the baby is born until the placenta is expelled) to produce uterine contractions and control postpartum bleeding and lessen hemorrhage potential. The other uterine stimulants may be given orally, rectally, or IM during the postpartum period to reduce the possibility of postpartum hemorrhage and to prevent relaxation of the uterus. Oxytocin is not given topically.
Avanafil (Stendra)
newest PDE5 inhibitor that is fast-acting and highly selective; can be used with patient's who no longer respond as rapidly to (Sildenafil) or other PDE5 inhibiitors.
BPH can cause: (3)
nocturia urinary frequency urinary retention
Adrenergic blocking agents act by preventing the release of __________ from the nerve terminal or adrenal medulla.
norepinephrine
The nurse is providing education to a client who has been prescribed donepezil. The nurse should instruct the client to take the medication according to what schedule? every 2nd day on an empty stomach three times a day with meals each morning with food once daily at bedtime
once daily at bedtime Explanation: Administration of donepezil should occur at bedtime each day.
he nurse is providing education to a client who has been prescribed donepezil. The nurse should instruct the client to take the medication according to what schedule? each morning with food three times a day with meals once daily at bedtime every 2nd day on an empty stomach
once daily at bedtime Explanation: Administration of donepezil should occur at bedtime each day.
Anticholinergic drugs that block the effects of acetylcholine are also called ___________ drugs.
parasympatholytic
Hemabate cannot be given to
patients with asthma
Methylergonovine cannot be given to
patients with hypertension
A nursing instructor determines that a class on adrenergic blockers was successful when the students identify which medication is an alpha-adrenergic blocker? Atenolol Clonidine Metoprolol Phentolamine
phentolamine
The intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with:
phentolamine
Antidote for extravasation with dopamine
phentolamine 5-10mL with 10 ml Normal saline (this is an alpha blocker that causes vasodilation)
A client is taking an OTC allergy product. The nurse would expect to find that this product most likely contains: ephedra. albuterol. epinephrine. phenylephrine.
phenylephrine. Explanation: Phenylephrine is a common agent found in many OTC cold and allergy products. Ephedra has been banned by the Food and Drug Administration as a drug. Neither epinephrine nor albuterol are found in OTC products.
A nurse is explaining the drug oxytocin to a client. When describing this drug, the nurse notes that oxytocin is an endogenous hormone produced by which? corpus luteum adrenal gland posterior pituitary gland uterus
posterior pituitary gland Explanation: Oxytocin is an endogenous hormone produced by the posterior pituitary gland. The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. The uterus is part of the female reproductive system where the fetus grows until term; it does not produce hormones, but oxytocin stimulates the smooth muscle to contract. The corpus luteum is a temporary endocrine structure in female ovaries that is involved in the production of relatively high levels of progesterone, moderate levels of estradiol and inhibin A.
phenylephrine use
prototype for shock. - eye drops for glaucoma to dilate eyes potent vasoconstrictor.
PNS
rest and digest with neurotransmitters of acetylcholine
ephedrine uses
rhinitis hypotensive episodes (think pseudophedrine; used to help with a stuffy or runny nose)
Agonist is ________ of a normal response.
stimulation
A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the client's request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the client's: knowledge of sexual health. vigilant adherence to the drug regimen. current health status. risk factors for adverse effects.
vigilant adherence to the drug regimen. Explanation: It is necessary to assess each client's need and desire for contraception, as well as her willingness to comply with the prescribed regimen. Compliance is essential for effective contraception. Health status, knowledge, and risk factors are all valid focuses for health education, but these do not primarily determine success of therapy.
adrenergic agent dosages are calculated by ________ when given to children.
weight
Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels?
α1 receptors
