Sherpath Pharmacology Ch. 15 EAQ
The nurse is teaching a patient about the administration of an adrenergic blocking medication. Which statement by the patient indicates teaching was effective?
"I should avoid drinking my morning coffee while taking this drug." Alcohol and caffeine, such as that in coffee and chocolate, should be avoided while on the medication. Caffeine should be avoided because it can further irritate the cardiac and central nervous systems. The patient should increase fluid intake to prevent constipation. Alcohol ingestion should be avoided because it causes vasodilation, increasing the risk for hypotension. p. 182
Which condition is an indication for the use of propranolol? Select all that apply. One, some, or all responses may be correct.
Tremor, Migraine, Hypertension In addition to its use after a myocardial infarction and for hypertension, propranolol has been used for the treatment of tachydysrhythmias associated with cardiac glycoside intoxication and for the treatment of hypertrophic subaortic stenosis, pheochromocytoma, thyrotoxicosis, migraine headache, essential tremor, and many other conditions. Contraindications to the use of beta blockers include known drug allergies and may include uncompensated heart failure, cardiogenic shock, heart block or bradycardia, pregnancy, severe pulmonary disease, and Raynaud disease p. 179-180
A patient with a history of insomnia, hypertension, and vertigo who is prescribed metoprolol tartrate expresses concerns regarding sexual performance. Which response by the nurse most appropriately addresses the patient's concern?
"Typically, patients on this medication do not experience sexual dysfunction; however, you should report any worsening of your vertigo and insomnia." Because this patient has a history of insomnia and vertigo, adrenergic blockers such as metoprolol tartrate should be used with caution. These medications can cause sleep disturbances and nightmares as well as dizziness, fatigue, and hypotension. Sexual dysfunction is not a side effect of this particular adrenergic blocker so there is no reason for concern and the patient should be made aware of this. Therefore the most appropriate answer would be one that alerts the patient to possible side effects and what to report and addresses any concerns the patient may have. Simply letting the patient know sexual dysfunction is not a side effect does not fully explain the importance of what to report and expect. Making a comment about how insignificant the side effects may be is irresponsible because the patient should be made aware of what to look for. p. 179
A patient recently diagnosed with hypertension complains of dizziness when standing. Which question would the nurse ask?
"Which medications are you currently taking?" Adrenergic blocking agents can be prescribed for hypertension and have side effects such as dizziness and syncope. Because the patient was recently diagnosed with hypertension, the patient has most likely been prescribed new medication, such as an adrenergic blocking agent. Assuming that the patient has been drinking alcohol is not the most important and relevant question at this point. If the patient has been prescribed an adrenergic blocking medication, the sauna or any other excessive heat could exacerbate the symptoms of vasodilation. The nurse should first determine exactly what medications the patient is taking. p. 171-173
Which statement describes how the therapeutic effect of atenolol differs from the therapeutic action of prazosin in decreasing blood pressure? Select all that apply. One, some, or all responses may be correct.
Alpha 1 antagonist causes vasodilation; Beta 1 antagonist decreases heart rate and cardiac output; Beta 1 antagonist decreases cardiac contractility and conduction velocity The beta 1 antagonist atenolol decreases blood pressure by decreasing heart rate, cardiac output, cardiac contractility, and conduction velocity. The alpha 1 antagonist prazosin decreases blood pressure by causing vasodilation. The beta 1 antagonist does not cause vasodilation, and the alpha antagonist does not decrease heart rate, cardiac output, cardiac contractility, or conduction velocity. p. 179
Which condition is an indication for taking beta blockers? Select all that apply. One, some, or all responses may be correct.
Angina, Heart failure, Hypertension, Dysrhythmias Indications for beta blockers include angina, myocardial infarction, cardiac dysrhythmias, hypertension, and heart failure. Beta blockers decrease the demand for Bradycardia Heart failure Hypertension Angina Diabetes Heart failure Hypertension Dysrhythmias oxygen consumption by the heart, a desired effect in heart failure and angina. Beta blockers slow the conduction in the SA node, resulting in a decreased heart rate and slow conduction through the AV node in the treatment of dysrhythmias. Recent studies have shown the benefits of using beta blockers such as metoprolol and carvedilol to treat heart failure. Beta blockers are not indicated for diabetes. Beta blockers may mask the tachycardia that results in hypoglycemia. p. 179
Stimulation of which receptor will cause an increased heart rate?
Beta 1 Beta 1 receptors are located primarily in the heart but are also found in the kidneys; stimulation results in increased heart rate and increased myocardial contractility. Alpha 1 receptors are located in vascular tissues of muscles and when stimulated cause arterioles and venules to constrict, which increases peripheral resistance and blood return to the heart. Alpha 2 receptors are located in the postganglionic sympathetic nerve endings and inhibit release of norepinephrine when stimulated. Beta 2 receptors are located mostly in the lungs and gastrointestinal tract, liver, and uterine muscles. Stimulation of beta 2 receptors results in a decreased gastrointestinal tone and motility, activation of glycogenolysis in the liver, elevated glucose, and relaxation of the uterine muscles. p. 173
Before administering an adrenergic agonist, which assessment is important for the nurse to complete?
Blood pressure An adrenergic agonist causes vasoconstriction, leading to high blood pressure. Skin integrity, temperature, and respiratory rate are not directly affected by adrenergic agonists. Blood pressure is the most important assessment because of the detrimental effects of high blood pressure, such as stroke, which can be life threatening. p. 178
Which assessment finding would indicate propranolol is having a therapeutic effect?
Blood pressure 130/75 mm Hg Propranolol is nonselective; it blocks both beta and beta receptors at therapeutic doses. The medication is administered to treat hypertension. Clear lung sounds indicate that the patient is not having respiratory side effects. Nonselective beta blockers are not typically given for cardiac dysrhythmias. Strong peripheral pulses are an indication that circulation and cardiac output may be strong; however, it is not related to the drug action. The patient's blood pressure is within normal limits, which indicates a therapeutic effect. p. 181
Which assessment finding would indicate propranolol is having a therapeutic effect?
Blood pressure 130/75 mmHg Propranolol is nonselective; it blocks both beta and beta receptors at therapeutic doses. The medication is administered to treat hypertension. Clear lung sounds indicate that the patient is not having respiratory side effects. Nonselective beta blockers are not typically given for cardiac dysrhythmias. Strong peripheral pulses are an indication that circulation and cardiac output may be strong; however, it is not related to the drug action. The patient's blood pressure is within normal limits, which indicates a therapeutic effect. p. 181
Which condition is an indication for the use of norepinephrine bitartrate?
Cardiogenic shock Norepinephrine is directly metabolized to dopamine and is used primarily in the treatment of hypotension and shock. The beta agonists are helpful in treating Epinephrine Terbutaline Dobutamine Phenylephrine Asthma Anaphylaxis Hypertension Cardiogenic shock 2 conditions such as asthma. Hypertension is a contraindication to the use of norepinephrine. Epinephrine is used in the treatment of anaphylaxis. p. 171
Which adrenergic blocking drug would the nurse anticipate administering to a patient being treated for heart failure?
Carvedilol Carvedilol is used to treat heart failure, angina, and hypertension. Esmolol is used to treat supraventricular tachydysrhythmia and hypertension. Metoprolol is used to treat decreased pulse rate and blood pressure. Nadolol is used to treat hypertension and angina. p. 180
The nurse provides care for a patient receiving beta-adrenergic antagonist therapy with the goals of a reduction in systolic and diastolic blood pressure and stable cardiac output and pulse rate. Which nursing intervention would the nurse include in the plan of care for this patient?
Check for orthostatic hypotension; Assess for hypoglycemia in diabetic patients; Observe for drowsiness, fatigue, and weakness; Monitor for effects on the heart, especially with exertion; Assess vital signs and observe for signs of bradycardia, heart failure, or pulmonary edema. The priority nursing interventions for a patient receiving beta-adrenergic antagonist therapy include monitoring for orthostatic hypotension because beta blockers cause orthostatic hypotension. In addition, the nurse will assess for hypoglycemia in diabetic patients because beta blockers may lower blood glucose levels. The nurse will also observe for drowsiness, fatigue, and weakness because these are side effects of beta blockers. It is also crucial to monitor for effects on the heart, especially with exertion, because beta blockers can decrease cardiac output. Assessing vital signs and observing for signs of bradycardia, heart failure, or pulmonary edema is important because beta blockers decrease heart rate and cardiac output. It is not necessary to maintain strict monitoring of intake and output measurements because these are not critical concerns for a patient who is taking a beta blocker. p. 181
The patient is being treated with a dopamine intravenous drip. Which action would the nurse perform to prevent infiltration of the site?
Check intravenous site frequently for evidence of swelling. The nurse would monitor the site frequently for evidence of infiltration, such as swelling. The nurse would assess the blood pressure in the patient's other arm; however, this measure will not prevent infiltration of the site. While the nurse would encourage the patient to press the call light, the nurse would not depend on the patient to notify the staff of infiltration. Encouraging the patient to keep the arm completely straight will not prevent infiltration. p. 180
Which action is most important for the nurse to take when administering dopamine intravenously?
Check the patient's IV site frequently for infiltration. Although it is important for the patient to know why he or she is receiving the medication that is administered and for the nurse to verify that the medication is mixed properly and infusing accurately, the most important action for the nurse when working with dopamine is to check the intravenous site frequently for evidence of infiltration p. 177
A patient with a history of which condition would be at an increased risk for adverse effects after the administration of beta blockers?
Diabetes mellitus In patients with diabetes, beta blockers mask the tachycardia, which occurs due to hypoglycemia. Patients with diabetes may be unable to tell when their blood glucose levels fall too low. Therefore beta blockers are contraindicated in a patient with diabetes mellitus. A patient with a wrist injury is not at risk, because it is a minor injury. A patient with hyperactivity disorder may sometimes be prescribed beta blockers as a treatment therapy. A patient with MI will benefit from beta blockers, because the drugs block the harmful effects of the catecholamines that increase the heart rate after an MI. p. 180
To which class of sympathomimetics does albuterol sulfate belong?
Direct-acting Albuterol sulfate belongs to the direct-acting class of sympathomimetics, which directly stimulates the adrenergic receptor and activates only the beta receptors of smooth muscles in the lungs. Albuterol does not belong to the mixed-acting (both direct- and indirect-acting) sympathomimetics, which stimulate the adrenergic Propofol Pravastatin Propranolol Propoxyphene Direct-acting Mixed-acting Nonselective Indirect-acting 2 receptor sites and stimulate the release of norepinephrine from the terminal nerve endings because it only stimulates the beta -adrenergic receptor sites. Albuterol is not nonselective because it is only selective for beta -adrenergic receptors; it does not affect different adrenergic receptors. Albuterol does not belong to the indirect-acting class of sympathomimetics, which stimulate the release of norepinephrine from the terminal nerve endings because it directly acts on the adrenergic receptor. p. 175
To which class of sympathomimetics does dopamine hydrochloride belong with respect to its action of stimulating both alpha 1 and beta 1 receptors in the heart and blood vessels?
Direct-acting Dopamine belongs to the direct-acting class of sympathomimetics, which directly stimulates the adrenergic receptor and results in heart stimulation and vasoconstriction. Dopamine does not belong to the indirect-acting class of sympathomimetics, which stimulate the release of norepinephrine from the terminal nerve endings because it directly acts on the adrenergic receptor. Dopamine does not belong to the mixed-acting (both direct- and indirect-acting) sympathomimetics, which stimulate the adrenergic receptor sites and stimulate the release of norepinephrine from the terminal nerve endings. Dopamine is not selective; it is nonselective because it stimulates alpha 1 - and beta 1 -adrenergic receptors p. 177
A patient who has been taking a prescription antihypertensive receives a new prescription for a beta blocker to treat a cardiac arrhythmia. Which side effect would the nurse include when teaching the patient about administration of the beta blocker? Select all that apply. One, some, or all responses may be correct.
Dizziness, Bradycardia, Hypotension The combination of an antihypertensive medication and a beta blocker may cause dizziness, hypotension, and bradycardia. Constipation is not a side effect as these drugs do not have anticholinergic effects. Non-exercise-related tachycardia is not a side effect since a beta blocker slows the heart rate. p. 181
Which substance is a synthetic catecholamine?
Dobutamine Dobutamine is a synthetic catecholamine. Dopamine, epinephrine, and norepinephrine are available as both endogenous and exogenous (synthetic) substances. p. 177
During a cardiopulmonary resuscitation emergency, the nurse would expect to administer which injectable, fast-acting medication?
Epinephrine Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Salmeterol is given via the respiratory tract because of its affinity for beta receptors that act on the lungs. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. p. 173
The nurse anticipates a patient with supraventricular tachydysrhythmias would be placed on which medication?
Esmolol Esmolol is being used to treat supraventricular tachydysrhythmias. Atenolol and labetalol are used to treat hypertension. Carvedilol is used to treat hypertension and heart failure. p. 181
A patient being treated with an alpha blocker drug reports to the nurse blacking out recently when getting up from a nap. Which event would the nurse suspect has occurred?
Expected side effect Orthostatic hypotension can occur with any dose of the alpha blocker drugs; patients must be warned to get up slowly from the supine position. It is not indicative of overdose, an allergic reaction, or unexpected adverse reaction. p. 179
A patient with asthma completed an albuterol nebulizer treatment and tells the nurse, "I feel like my heart is fluttering, and my hands are very shaky." Which action would the nurse take?
Explain this sensation as a side effect Albuterol is a beta 2 agonist that predominantly acts on beta receptors in the lungs to cause bronchodilation. Side effects include tachycardia and jitteriness, because the medication is not 100% selective on beta 2 receptors. It is not necessary to notify the health care provider because the patient is describing side effects of the medication. The next treatment should not be held because the patient's breathing takes priority over side effects. A decreased dose of albuterol is not necessary. p. 173
Which body part is controlled and regulated by the autonomic nervous system? Select all that apply. One, some, or all responses may be correct.
Eyes, Heart, Urinary bladder, Respiratory system Gastrointestinal (GI) tract The autonomic nervous system acts on smooth muscles and glands. Its functions include control and regulation of the eyes, heart, urinary bladder, respiratory system, and GI tract. It is an involuntary nervous system over which humans have little or no control; humans breathe, their hearts beat, and peristalsis continues without them realizing it. The skeletal system is not controlled by the autonomic nervous system because humans have voluntary control over it. p. 171
A patient undergoing treatment for a mental health disorder with a monoamine oxidase inhibitor (MAOI) medication is prescribed an adrenergic drug. Which action would the nurse take?
Notify the HCP of the use of MAOI medication. Administration of adrenergic drugs with monoamine oxidase inhibitors may cause a potentially life-threatening hypertensive crisis; therefore the nurse would notify the health care provider and the medication would not be administered (even at a decreased dosage). p. 176
When auscultating the lungs of a patient receiving albuterol the nurse hears little improvement of wheezing. Which question would the nurse ask the patient to further determine drug efficacy? Select all that apply. One, some, or all responses may be correct
How often are you using your inhaler?; Do you have any pressure in your chest?; Have you experienced any numbness in your fingers or toes?; Are you currently taking any OTC medications? When assessing the patient for efficacy of drug therapy, it is important to ask the patient questions to determine subjective information that can help provide a complete assessment. The nurse will use aspects of care and patient response to evaluate the effectiveness of drug therapy. If wheezing is still heard, the patient may be taking over-the-counter cold medication, which inhibits full effectiveness of the drug. The nurse will evaluate the effectiveness of drug therapy by monitoring for adverse effects including gastrointestinal upset, respiratory changes, and cardiovascular changes as indicated by chest pressure and tingling in the fingers and toes. Although use of the EpiPen is important information to place in the patient's chart, its use does not aid in determining drug efficacy because it is used for a different condition. p. 178
A patient exhibiting which condition would be an unsuitable candidate for a sympathomimetic agent?
Hypertension A patient who has hypertension is an unsuitable candidate for the administration of a sympathomimetic agent. Administration of a sympathomimetic agent in a hypertensive patient may cause further increase in blood pressure or increase risk for heart failure. Patients who have insomnia, asthma, or a common cold are suitable candidates for administration of a sympathomimetic agent. p. 173
Which outcome would be appropriate to establish for patients taking beta 1 agonists?
Increased contractility of myocardium Stimulation of beta 1 receptors in the "fight-or-flight" response results in stronger ventricular contraction owing to increased contractility of myocardium. Beta 1 agonists act most specifically on the heart; relaxation of uterine smooth muscle is a result of taking alpha 1 antagonists. Bronchial smooth muscle is affected by beta 2 agonists. Beta 2 agonist stimulation results in vasodilation and decreased resistance of peripheral vessels. p. 172
Which assessment finding would indicate that a patient receiving intravenous epinephrine is experiencing the expected therapeutic effect?
Increased heart rate Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. Epinephrine causes bronchial dilation, not constriction. Epinephrine does not have an impact on bowel sounds. Epinephrine does not decrease blood pressure; at high doses, intravenous epinephrine increases blood pressure. p. 171
Which occurrence is an effect of beta 1 -adrenergic receptor stimulation?
Increased renin secretion Beta 1-adrenergic receptor stimulation causes increased renin secretion. Mydriasis, ejaculation, and vasoconstriction are the result of alpha -1 adrenergic receptor stimulation. p. 179
The administration of a beta blocker and insulin may have which result?
Masked signs of hypoglycemia The interaction of insulin and a beta blocker drug is known to result in masking of the signs of hypoglycemia, thus resulting in delayed recovery from the hypoglycemia, not hyperglycemia. There is not a decreased or enhanced activity of the beta blocker. p. 180
The nurse at the health clinic is monitoring the vital signs of a patient who was recently prescribed an adrenergic blocking drug. Which action would the nurse take?
Measure both supine and standing blood pressures. When the patient is taking an adrenergic blocking drug, blood pressure should be monitored both supine and standing because of the tendency toward orthostatic hypotension. Also, the apical pulse should be counted for one full minute, not the radial. Assessment of temperature and respiratory rate, although important, are not as paramount in this case. p. 179-181
Which assessment does the nurse include in the plan of care for the patient receiving clonidine to control hypertension? Select all that apply. One, some, or all responses may be correct.
Monitor urine output; Establish baseline physical assessment; Evaluate patient for nausea and constipation; Assess level of orientation, affect, reflexes, and vision; Determine blood pressure and pulse. Clonidine specifically stimulates alpha receptors of the central nervous system (CNS) leading to decreased CNS outflow of norepinephrine, which helps to control hypertension. An adverse effect is hypotension. Therefore the nurse monitors urine output to ensure adequate perfusion to the kidneys. A baseline physical assessment allows the nurse to detect changes in patient status. Nausea and constipation are side effects of clonidine and should be included in the assessment. Level of orientation, affect, reflexes, and vision changes can indicate adverse effects of clonidine. Blood pressure and pulse are integral to the assessment of the patient taking clonidine for hypertension. Blood glucose levels are not affected by clonidine; in the absence of preexisting diabetes, this is an unnecessary assessment. p. 178
A patient with a history of which condition would likely be prescribed a beta blocker?
Myocardial infarction The beta blockers block all the harmful effects of the circulating catecholamines that increase the heart rate after a myocardial infarction. Beta blockers are not used in patients with asthma because they cause bronchoconstriction and increased airway resistance. Beta blockers would not be beneficial for patients with back pain. Beta blockers can also compromise cerebral or peripheral blood flow in patients with peripheral vascular disease. p. 180
A 68-year-old patient being treated with propranolol hydrochloride for hypertension reports shortness of breath and dizziness. The nurse reviews the patient's medical record and immediately reports which condition to the HCP? Health hx: Asthma, HTN, GERD, seasonal allergies, SR propranolol 120 mg PO daily, Montelukast sodium 10 mg PO daily, Famotidine 10 mg PO daily Assessment findings: Temp 98.6F, HR 108 bpm, RR 20/min slightly labored, BP 140/90 mmHg, O2 92%, Wheezing in lungs bilaterally, 2+ pitting edema in feet bilaterally, weight gain of 3 lbs over 24 hours
New onset heart failure The nurse suspects that the patient is developing heart failure based on the patient's history of hypertension and the current findings of tachycardia, increased blood pressure, labored breathing, wheezing, and weight gain and the patient's report of shortness of breath and dizziness. The symptoms of an allergic reaction would include rash, itching, swelling, dizziness, and trouble breathing. The signs of an expected adverse reaction could include headache, depression, confusion, dizziness, nightmares, and hallucinations. Technically, new onset heart failure (and thus the patient's symptoms) are an unexpected adverse effect of the drug, but the nurse should be more specific in the report of concerns. p. 181
A patient who was started on a beta-adrenergic agonist reports to the nurse experiencing heart palpitations after being on the drug for several days. Which action would the nurse take?
Notify the HCP about the information provided by the patient. Although it is important to gain as much information as possible from the patient, such as use of over-the-counter medications and details provided in a symptom diary, because of the likelihood that beta-adrenergic agonists will affect blood pressure and pulse rate, the prescribing health care provider should be notified of incidence of chest pain, palpitations, headaches, or seizures. p. 179
When assessing a patient before administering the first dose of an adrenergic drug to treat asthma, the nurse obtains a blood pressure reading of 160/90 mm Hg. Which action would the nurse take?
Notify the HCP of the patient's elevated blood pressure reading. Adrenergic drugs are contraindicated in the case of severe hypertension, so the health care provider should be notified of the finding. The medication should not be administered and the nurse should notify the health care provider rather than simply waiting for the patient's blood pressure to decrease and then administering the mediction. p. 177
A patient with a new prescription for propranolol tells the nurse of a history of asthma. Which action would be a priority for the nurse to take?
Notify the health care provider Propranolol is a nonselective beta blocker that can result in bronchoconstriction. The health care provider (HCP) needs to be notified about the patient's history of asthma. Teaching the patient to change positions slowly, how to take the blood pressure, and informing the patient to carry a rescue inhaler are all important, but notifying the HCP is the priority to ensure safety and prevent bronchoconstriction. p. 179
When assessing a patient before administering the first dose of an adrenergic drug to treat asthma, the nurse obtains a blood pressure reading of 160/90 mm Hg. Which action would the nurse take?
Notify the health care provider of the patient's elevated blood pressure reading. Adrenergic drugs are contraindicated in the case of severe hypertension, so the health care provider should be notified of the finding. The medication should not be administered and the nurse should notify the health care provider rather than simply waiting for the patient's blood pressure to decrease and then administering the mediction. p. 177
A patient with diabetes who is also taking beta blockers exhibits the following signs: blood pressure 130/75, pulse 80, respirations 18, tremors, irritability, and diaphoresis. Which action would the nurse take first?
Obtain a blood glucose level Beta blockers can mask signs of hypoglycemia, such as tachycardia. Other signs of hypoglycemia include tremors, irritability, and diaphoresis. The nurse should first check this patient's blood glucose level before offering orange juice. Assess before intervening per the nursing process. Checking a blood glucose level takes priority over obtaining apical pulse and blood pressure. p. 179
Which outcome criteria would the nurse use when determining whether a patient is responding appropriately to use of an adrenergic drug?
Patient's respiratory rate is 16 bpm and blood pressure is 130/72 mm Hg. The blood pressure and respiratory readings will give the most accurate information for outcomes criteria. The patient being able to state three side effects does not demonstrate the patient's response to the medication. The patient's orientation status does not demonstrate the patient's response to the medication. p. 182
The nurse observes redness and swelling on the forearm where Which medication would the nurse anticipate administering next?
Phentolamine Phentolamine is an alpha blocker effective at vasodilation and counteracting the effects, such as tissue necrosis, of injected epinephrine extravasation. Redness and swelling at the IV site are signs of extravasation. Norepinephrine is an adrenergicreceptor agonist and would aggravate the patient's symptoms. Doxazosin is an alpha blocker as well, but is given by mouth for other indications. Labetalol is a nonselective beta blocker indicated for heart related problems p. 180
Which medication is classified as an alpha-adrenergic agonist?
Phenylephrine Phenylephrine works almost exclusively on the alpha-adrenergic receptors. It is used primarily for short-term treatment to raise blood pressure in patients in shock to control some dysrhythmias (supraventricular tachycardias) and to produce vasoconstriction in regional anesthesia. Epinephrine is an adrenergic blocker. Terbutaline is a beta-adrenergic receptor agonist. Dobutamine is a direct-acting inotropic agent. p. 173, 180
Which medication is used in the treatment of angina?
Propranolol Propranolol may be used to treat angina, whereas pravastatin is used for hyperlipidemia. Propofol is a central nervous system depressant that is used for inducing or maintaining anesthesia. Propoxyphene is an opioid that is used to treat mild to moderate pain. p. 179
Which medication can be used to treat migraines?
Propranolol Propranolol may be used to treat migraines. Esmolol is used to treat supraventricular tachydysrhythmias. Carvedilol is used to treat heart failure and hypertension. Metoprolol is used to treat hypertension. p. 181
The nurse is providing care for a patient with an exacerbation of asthma and bronchial spasms who is receiving an infusion of terbutaline. Which nursing intervention is vital for this patient? Select all that apply. One, some, or all responses may be correct.
Provide comfort measures; Monitor pulse and blood pressure carefully during administration; Provide patient education about drug effects and warning signs to report. The nurse will provide comfort measures to help the patient cope with the drug effects. The nurse will also monitor pulse and blood pressure carefully during administration to arrange to discontinue the drug at any sign of toxicity. The nurse will provide patient education about drug effects and warning signs to report to promote understanding and compliance. The nurse will not evaluate the patient for nausea and constipation or maintain strict intake and output measurements because these are not priority nursing interventions for a patient related to the administration of terbutaline. p. 178
The nurse would expect which assessment finding for a patient taking a selective beta 1- receptor blocker?
Pulse 62 Blocking of selective beta receptors results in a decrease in heart rate, conduction, and contractility with no bronchoconstriction, which results in a lowered pulse. Wheezing is not expected, because this sign indicates bronchoconstriction. A bounding pulse is not expected if contractility is decreased, and the pulse is expected to be regular. p. 181
Which response is a result of sympathetic nervous system stimulation?
Pupillary dilation Stimulation of the sympathetic nervous system results in pupillary dilation. Stimulation of the parasympathetic nervous system results in bronchial constriction, increased peristalsis, and decreased heart rate. p. 172
Which action would the nurse take before administering sotalol?
Refill the patient's water pitcher. Sotalol is available only in oral form. Therefore preparing to offer the patient a drink of water to take with this medication is most appropriate. Obtaining a saline flush implies that the medication is about to be given intravenously. Selecting needles and syringes indicates the medication is about to be given parenterally. p. 181
Which action would the nurse take before administering sotalol?
Refill the patient's water pitcher. Sotalol is available only in oral form. Therefore preparing to offer the patient a drink of water to take with this medication is most appropriate. Obtaining a saline flush implies that the medication is about to be given intravenously. Selecting needles and syringes indicates the medication is about to be given parenterally. p. 181
While providing discharge instructions to a patient with a new prescription of terbutaline sulfate, which information would the nurse include? Select all that apply. One, some, or all responses may be correct.
Report any palpitations to the HCP immediately; Nausea may be experienced but does not need to be reported unless there is fear of dehydration; Monitor fluid intake and urine output and ensure adequte output is being produced; Headaches are a common side effect but should be reported if unrelieved by OTC pain meds. The nurse will tell the patient which side effects to expect and when to report them to the health care provider. Adverse effects of dobutamine include dysrhythmia, tachycardia, angina, palpitations, headache, nausea, hypertension, hypokalemia, and dyspnea. Palpitations, severe headaches, and dehydration from vomiting should be reported. Fluid intake and output should be monitored to ensure proper kidney function and monitor for hypokalemia. Body temperature is unaffected by dobutamine and does not need to be monitored; moreover, there is no need to report a temperature of 99.9° F because it is considered within normal limits. p. 179
When teaching an older patient about the effects of adrenergic agonists, the nurse will advise the patient to avoid which activity?
Slow job in summer If unusual demands are placed on the aging heart, problems and complications may arise. Examples of unusual demands include strenuous activities, excess stress, heat, and medication use. The stress heat from slow jogging may lead to significant increases in blood pressure and pulse rate. The older adult may then react negatively with a diminished ability to compensate adequately for these changes. A short daily walk and visiting a family member are not considered strenuous activities. Older adults are already at risk for polypharmacy and should not take any over-the-counter medications or herbal supplements without discussing with the health care provider. p. 177-178
During an intravenous (IV) administration of dopamine, the nurse notes a bruise, "bluish in color, " and edema at the IV insertion site on the patient' s right arm. Which action would be the priority for the nurse to implement?
Stop the dopamine infusion. Bruising and edema are signs of infiltration. The infusion should be stopped immediately to prevent further harm to the patient. After stopping the IV infusion, the health care provider can be notified. Another IV line will likely need to be started. However, the dopamine must be stopped first. After the dopamine is stopped, the arm will need to be elevated to reduce swelling. p. 177-178
By which route would the nurse administer phentolamine to treat a dopamine extravasation?
Subcutaneous injection Phentolamine is administered as a series of injections subcutaneously in a circle around the extravasation. Phentolamine is not administered via tablet, ointment, or intramuscular injection. p. 180
Which equipment would the nurse utilize when preparing to administer phentolamine?
Syringe for subcutaneous injection Phentolamine is administered by subcutaneous injection when given to treat extravasation of a vasoconstricting drug. An IV start kit, normal saline, and syringe for intramuscular injection would not be utilized to administer phentolamine for treatment of extravasation. p. 180
The teaching plan for a patient taking midodrine would include which instruction?
Take your blood pressure frequently while on this medication. Midodrine, an alpha 1 agonist, is used mainly in the treatment of symptomatic orthostatic hypotension, so the nurse would teach the patient to take blood pressure before and after the patient stands as a means of evaluating the therapeutic effectiveness of the drug. Reflex tachycardia may occur after taking the medication, so patients might be instructed to evaluate pulse after dosing. Midodrine would not affect the temperature or respiratory rate. p. 177
Which action would the nurse take before administering the first dose of atenolol to a patient with hypertension?
Teach the patient about beta blockers. The nurse would teach the patient about the new medication including safe administration and side effects. Although the nurse should assess the patient overall on a regular basis, the assessment should include all body systems, not only the lungs and oxygenation status. At therapeutic dosages, atenolol selectively blocks only the beta receptors in the heart, not the beta 1 receptors located in the lungs. It is not necessary to determine specifically the history of respiratory disease. p. 180
A 62-year-old patient being treated with a low-dose dobutamine drip for heart failure reported feeling better but now has a sense of tightness in the chest, palpitations, and a sense of anxiety. Based on the patient's health history and assessment, which conclusion does the nurse make regarding the patient' s response to the medication? Health Hx: HF, CAD, Cardiogenic shock, GERD, PVD, seasonal allergies, Dobutamine IV tx 8mcg/kg/min Assessment findings: Temp 98.5F, HR 110 bpm, previously 86 bpm, RR 18/min was previously 14/min, BP 150/98 was previously 120/80 mmHg, O2 90%, Lungs clear to auscultation bilaterally, capillary refill >5 seconds, skin pale and cool to the touch
The medication may be causing a worsening of a preexisting cardiac disorder. The nurse's immediate concern for the patient is that the medication may be causing a worsening of a preexisting cardiac disorder because dobutamine is a vasoactive beta - adrenergic agonist that works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. Nevertheless, adrenergic drugs may worsen a preexisting cardiac disorder, such as by causing a myocardial infarction in a patient with coronary artery disease. An allergic reaction to dobutamine would be manifested by a rash; hives; itching; shortness of breath; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; swelling of the mouth, face, lips, tongue, or throat; high or low blood pressure; shortness of breath; a fast heartbeat; an abnormal heartbeat that is new or worse; a fever; or pain and irritation where dobutamine goes into the body. Increasing the dosage of the dobutamine to control the symptoms better is not appropriate because the current dose is already provoking a concerning response; increasing the dose at this time may evoke a stronger adverse response in the patient. p. 177
The patient demonstrates understanding of the effects of adrenergic agonist drugs that must be reported to the health care provider immediately when listing which effect? Select all that apply. One, some, or all responses may be correct.
Tremors, Dizziness, Palpitations, Tachycardia, Hypertension An appropriate outcome of adrenergic agonist drug therapy is that the patient states the conditions that may occur of which the prescriber must be informed of immediately. These conditions include tremors, dizziness, tachycardia, palpitations, and hypertension. p. 178
A patient is being discharged with a new prescription for atenolol. Which content would the nurse include when teaching the patient about self-administration and monitoring for adverse effects of this drug? Select all that apply. One, some, or all responses may be correct.
Watch for first-dose hypotension; Never stop taking this medication abruptly; Report weight gain of more than 2 lb in 1 day; Notify the HCP of a dizziness or fainting during exercise. The nurse is aware of the drug's therapeutic action and the crucial components of the patient education and should include that the patient should watch for first-dose hypotension, so the patient should change positions slowly to prevent or minimize postural hypotension. The nurse will tell the patient to never stop taking the medication abruptly because the patient might experience a significant rise in his or her blood pressure or experience symptoms of anxiety like heart palpitations, tremors, or sweating. A weight gain of more than 2 lb in a day should be reported because the patient may be experiencing heart failure. The patient should be instructed to notify the health care provider of dizziness or fainting during exercise because the patient's dosage of medication may need to be adjusted or decreased. The nurse would not instruct the patient to stop taking the beta-blocker medication once the symptoms subside because a significant rise of blood pressure could occur. p. 179
Which finding would be of concern to the nurse when assessing a patient receiving an adrenergic agent?
Weak peripheral pulses Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug because the therapeutic effect is not being achieved. Increased cardiac output, strong peripheral pulses, and a heart rate of 95 would not be of concern to the nurse as this would be indicative of the medication having a therapeutic effect. p. 171-173
