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week 12 Flashcards

1
Q

Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect?
a. Urinary retention
b. Bronchial constriction
c. Decreased intestinal motility
d. Increased heart rate and contractility

A

increased heart rate and contractility

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2
Q

The health care provider has prescribed dopamine to treat the patient’s hypovolemic shock secondary to severe blood loss. The nurse prepares what additional treatment to be completed with this medication administration?
a.Temporary pacing
b. Fluid replacement

A

fluid replacement

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3
Q

A patient weighing 176 lb is to receive a dopamine continuous intravenous (IV) infusion at 5 mcg/kg/min. The solution strength available is dopamine 400 mg in 500 mL D5W. The nurse will infuse the medication at which rate?
a. 20 mL/hr
b. 30 mL/hr
c. 40 mL/hr

A

30 mL/hr

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4
Q

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce which effect on the heart?
a. Positive inotropic, positive chronotropic, and positive dromotropic effect
b. Negative inotropic, positive chronotropic, and positive dromotropic effect

A

Positive inotropic, positive chronotropic, and positive dromotropic effect

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5
Q

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with which of the following drug classes?
a. Beta blockers
b. Alpha1 blockers
c. Direct renin inhibitors
d. Monoamine oxidase inhibitors (MAOIs)

A

Monoamine oxidase inhibitors (MAOIs)

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6
Q

The nurse assesses the patient’s IV site, and it has infiltrated during the infusion of dopamine. The nurse will prepare which medication to treat this infiltration?
a. Naloxone
b. Lidocaine
c. Nitroprusside
d. Phentolamine

A

phentolamine

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7
Q

The nurse has a prescription to infuse dobutamine intravenously at 3 mcg/kg/min in a pediatric patient with cardiac decompensation. The patient’s weight is 77 lb. What is the correct dosage to administer? _____

A

105 mcg/min

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8
Q

The nurse has a prescription to infuse dopamine intravenously at 30 mcg/kg/min in an adult patient for cardiopulmonary arrest. If the patient weighs 143 lb, what is the correct dosage to administer? ______

A

1950 mcg/min

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9
Q

Nonselective beta blockers may be used to treat hypertension and what other condition?
a. Heart failure
b. Heart block
c. Supraventricular dysrhythmias

A

Supraventricular dysrhythmias

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10
Q

The nurse knows which drug is an example of a cardioselective beta blocker?
a. Sotalol
b. Atenolol

A

atenolol

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11
Q

When teaching a patient about beta blockers such as atenolol and metoprolol, it is important for the nurse to instruct the patient about which drug information?
a. Alcohol intake is encouraged for its vasodilating effects.
b. Abrupt medication withdrawal may lead to a rebound hypertension.

A

Abrupt medication withdrawal may lead to a rebound hypertension.

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12
Q

Which is the pharmacological action of propranolol?
a. Beta1-adrenergic antagonist
b. Nonselective beta-adrenergic antagonist

A

Nonselective beta-adrenergic antagonist

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13
Q

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication?
a. Verapamil
b. Phentolamine

A

phentolamine

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14
Q

The nurse understands beta blockers produce which cardiovascular effects?
a. Positive inotropic, positive chronotropic, and positive dromotropic
b. Negative inotropic, negative chronotropic, and negative dromotropic

A

Negative inotropic, negative chronotropic, and negative dromotropic

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15
Q

What is the priority nursing diagnosis for a patient prescribed metoprolol?
a. Risk for injury related to possible adverse effects of the adrenergic blockers
b. Acute confusion related to adverse central nervous system effects of the drug
c. Risk for decreased cardiac tissue perfusion related to effects of medication

A

Risk for decreased cardiac tissue perfusion related to effects of medication

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16
Q

Which statement does the nurse include when completing discharge education for a patient prescribed metoprolol?
a. “If you become dizzy, do not take your medication for 2 days and then restart on the third day.”
b. “This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem.” Incorrect
c. “If you take your pulse and it is less than 60 beats/min, don’t take your medicine until call your health care provider for instructions.

A

“If you take your pulse and it is less than 60 beats/min, don’t take your medicine until call your health care provider for instructions.

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17
Q

The nurse is caring for a patient with a history of angina and hypertension who is diagnosed with moderate heart failure. The patient’s current medication regimen includes digoxin, furosemide, and quinapril. What medication would the nurse anticipate the health care provider adding to the patient’s medication regimen?
a. Carvedilol
b. Sotalol

A

carvedilol

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18
Q

Beta blockers are used to treat which conditions? (Select all that apply.)
a. Hypertension
b. Angina pectoris
c. Raynaud’s disease
d. Cardiac dysrhythmias
e. COPD

A

hypertension, angina pectoris, cardiac dysrhythmias

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19
Q

Cholinergic (parasympathomimetic) drugs have which therapeutic effect?
a. Blood vessel vasoconstriction
b. Increased gastrointestinal (GI) motility

A

increased gastrointestinal (GI) motility

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20
Q

Cholinergic (parasympathomimetic) drugs are indicated for management of what clinical condition?
a. Postoperative bradycardia
b. Glaucoma

A

glaucoma

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21
Q

The nurse is performing postoperative teaching for a patient prescribed bethanechol. The nurse is teaching based on understanding, the drug is being prescribed for what clinical condition?
a. Urinary atony
b. Ischemic colitis

A

urinary atony

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22
Q

The nurse is providing discharge education to patient who is prescribed bethanechol. What side effect would the nurse teach the patient might occur with this medication?
a. Headache
b. Tachypnea

A

headache

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23
Q

The nurse is administering donepezil to a patient with Alzheimer’s disease. What is the expected therapeutic action of this medication?
a. Relief of anxiety and restless behavior of the patient
b. Helps control associated urinary and fecal incontinence
c. Blocks the effect of norepinephrine at the presynaptic cell membrane
d. Increases levels of acetylcholine in the brain by blocking its breakdown

A

Increases levels of acetylcholine in the brain by blocking its breakdown

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24
Q

When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine is appropriate to include?
a. Instruct the patient to take the medication 30 minutes before meals.
b. Tell the patient to increase fluid and fiber in the diet to prevent constipation.

A

Instruct the patient to take the medication 30 minutes before meals.

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25
The health care provider prescribes donepezil for a patient. The patient states to the nurse, “I have no idea why I take this medication.” The nurse knows the administration of donepezil is commonly associated with what condition? a. Bladder retention b. Urinary retention c. Parkinson’s disease d. Alzheimer’s disease
Alzheimers disease
26
The nurse is providing education to a patient on the primary uses of cholinergic drugs. Which uses would the nurse include in the teaching? (Select all that apply.) a. Increase heart rate b. Stimulate peristalsis c. Dilate pulmonary airways d. Stimulate bladder emptying e. Decrease intraocular pressure
stimulate peristalsis, stimulate bladder emptying, decrease intraocular pressure
27
The nurse is providing care for a patient with a tricyclic antidepressant overdose. The health care provider prescribes physostigmine intravenously at 0.02 mg/kg repeated every 5 to 10 minutes to achieve the desired effect for the patient. The patient weighs 92 lb. What dose amount will the nurse administer every 5 to 10 minutes? _________
0.84
28
The nurse caring for an adult patient with symptomatic bradycardia prepares to administer which recommended dose of intravenous (IV) atropine? a. 2 mg b. 0.3 mg c. 0.5 mg
0.5 mg
29
An adult patient presents to the emergency department anticholinesterase inhibitor toxicity. The nurse prepares to administer which IV medication? a. Dicyclomine b. Scopolamine c. Atropine
atropine
30
The nurse is following up with a patient prescribed tolterodine. What does the nurse anticipate the patient to report as the outcome of starting this medication? a. Absence of salivation b. Increase in heart rate c. Decrease in urinary frequency
decrease in urinary frequency
31
The nurse is assessing therapeutic effects in a patient prescribed dicyclomine. What is the anticipated therapeutic effect? a. Decrease in sweating b. Dilation of the pupils c. Reduction in urinary frequency d. Decrease in GI motility
decrease in GI motility
32
What would be the priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs? a. Risk for injury related to excessive central nervous system stimulation b. Impaired gas exchange related to thickened respiratory secretions
Impaired gas exchange related to thickened respiratory secretions
33
Which would be the most appropriate application time for a patient prescribed a scopolamine transdermal medication patch for motion sickness? a. Just before bedtime b. Every 4 hours as needed c. 4 to 5 hours before travel
4 to 5 hours before travel
34
After administering oxybutynin to a patient with spina bifida, the nurse is assessing the patient for therapeutic effects. Which assessment finding indicates the drug has the desired therapeutic effect? a. Increase in heart rate b. Decrease in urinary frequency
decrease in urinary frequency
35
What are the expected adverse effects of anticholinergic (parasympatholytic) drugs? (Select all that apply.) a. Diarrhea b. Dry mouth c. Dilated pupils d. Urinary retention e. Increased sweating
dyr mouth, dilated pupils, urinary retention
36
A pediatric patient with neurogenic bladder has a prescription to administer oxybutynin 0.2 mg/kg/dose. The patient’s weight is 32 lb. The nurse would administer what dose? _______
2.9 mg
37
The health care provider has prescribed to administer IV atropine 0.02 mg/kg to a max of 0.5 mg for the treatment of bradycardia. The nurse assesses that the patient has a heart rate of 32 beats/min. If the patient’s weight is 78 lb, what dose of atropine will the nurse administer? _______
0.5 mg
38
how is the body's nervous system divided?
two major branches 1) CNS 2) PNS
39
what is the difference between sns and pns?
40
exogenous
synthetic
41
endogenous
produce din the body naturally
42
what are the body's catecholamines?
substances that stimulate the SNS
43
what happens at adrenergic receptor sites?
cause vessels of the renal, mesenteric, coronary, and cerebral arteries to dilate, which increase blood flow to these tissues,
44
where are the beta1 adrenregic receptors located?
heart
45
where are beta2 adrenergic receptors located?
smooth muscle
46
what are the effects of adrenergic drugs?
mimic the effects of the SNS neurotransmitters: noreepinephrine, epinephrine, and dopamine
47
what are endogenous drugs?
epinephrine, norepinephrine, dopamine
48
what are synthetic drugs?
dobutamine, phenylephrine - epinephrine, norepinephrine, dopamine
49
what are some non-catecholamine adrenergic drugs?
phenyleprine, metaproterenol, albuterol
50
How are catecholamine adrenergic drugs different from catecholamine drugs?
non-catecholamines have a longer duration
51
what are the two concentrations of epinephrine?
two strengths for IV uses: - 1 mg/ml - 0.1mg/ml
52
what are direct-acting sympathomimetics?
binds directly to the receptor and causes a physiologic response
53
what are indirect-acting sympathomimetics?
causes the release of the catecholamine fomr the storage sites (vesicles) in nerve endings; then binds to the receptors and cause a physiologic response
54
where are beta1 adrenergic receptors are located?
myocardium and the conduction system of the heart
55
beta1 adrenergic receptors result in
- positive inotropic effects - positive chronotropic effects - positive dromotropic effect
56
beta1 adrenergic function
increase HR
57
where are beta2 adrenergic receptors function
relaxes bornchi (bronchodilator) and uterus and also causes increased glycogenolysis (glucose release) form the liver
58
What are some common intranasal applications and their indications?
can cause constriction of dilated arterioles and a reduction in nasal blood flow, which thus decreases congestion
59
what are some ophthalmics
certain adrenergics, are applied to the surface of the eye. they work in must the same way as nasal decongestants excepts that they affect the vasculature of the eye
60
why ar eadrenergic drugs sued to treat HF?
have caridoselective effects are referred to as a vasoactive adrenergics and are used to support a failing heart or treat shock of orthostatic hypotension
61
what is a common beta3 agonist
mirabegron, relaxes the detrusor muscle during the strong phase of the bladder fill cycle which leads to an increase in bladder storage capacity - this new mechanism of action is an improvement over the drugs for overactive bladder
62
what are some adverse effects of alpha-adrenergic drugs?
headahce, restlessness, excitement, insomia, euphoria, chest pain, vasoconstriction, hypertnesion, tachycardia, dysrhyythmias, anorexia, dry mouth, nausea, vomiting, taste changes
63
what are toxic effect of adrenergic drugs?
seizures, hypotension, hypertension, dysrhythmias, palpitaitons, nrevousness, dizziness, fatigue, malaise, insomia, headache, dry mouth, nausea
64
what are some nursing considerations for adrenergic drugs?
cheeking package inserts for the types and mounts of dilution solutions to use with parenterla dosage forms, how to properly use nebulizer, use products as directed
65
what are some patient teaching for adrenergic drugs?
those with COPD, emphysema, asthma, bronchitis, need to avoid contact with others who may have infections, avoid respiratory irritants
66
what part of the nervous system do cholinergics stimulate?
parasympathetic nervous system
67
what is the primary NT in cholinergic?
acetycholine
68
how do indirect-acting cholinergic agonists work?
stimulate the release of acetylcholine at the receptor site.
69
what are reversible cholinesterase inhibitors?
bind to cholinesterase for a short peirod of time
70
what are irreversible cholinesterase inhibitors?
long duration of activity - body must generate new cholinesterase enzymes to override the effects of the irreversible drugs
71
stimulation of the intestine and bladder from cholinergic drugs results in what?
increased gastric secretions, GI motility, and urinary frequency
72
how do cholinergic drugs affect the eyes?
- stimulate constriction of the pupil (miosis) - help decrease intraocular pressure
73
how do cholinergic drugs affect other body systems?
increase salivation and sweating, reduce heart rate and vasodilation, constrict bronchi of the lungs and the airways to narrow
74
what are the indications for use of cholinergic drugs?
direct-acting drugs: reduce intraocular pressure in patients with glaucoma or in those undergoing ocular surgery - causes increased bladder and GI tract tone and motility
75
what are the contraindications for cholinergics?
known drug allergy, GI, GU obstruction, bradycadia, defects in cardiac impulse conduction, hyperthyroidism, epilepsy, hypotension, COPD
76
what are the adverse effects of cholinergics?
consequence of overstimulation of the parasympathetic nervous system. - ar extensions of the cholinergic reactions that affect many body functions
77
overdose of cholinergic drug effects are
circulatory collapse, hypotension, bloody diarrhea, shock, cardiac arrest, bradycardia
78
what nursing indications and patient teaching are important for cholinergic drugs?
blood pressure, pulse rate, end electrocardiogram need to be carefully monitored throughout therapy
79
what therapeutic goals should the nurse be monitoring for cholinergic therapy?
- myasthenia gravis, a decrease in signs and symptoms - GI peristalsis postoperatively, increase in bowel sounds, the passage of flatus, the occurrence of bowel movements - hypotonic bladder with urinary retention, micturition (voiding) within about 60 minutes of the administration of bethanechol
80
what drugs are given to alzheimers disease?
cholinergic drugs
81
what patient teaching is important for Alzheimer's disease?
monitor the patient's family and other support personnel closely, and be sure that their questions are answered fully and completely and their needs are met
82
the nurse caring for a patient who is receiving beta1-agonist drug therapy needs to be aware that these drugs cause which effect? (SABA) a. increase cardiac contractility b. mydriasis c. increased heart rate d. vasoconstriction
increased cardiac contractility increased heart rate
83
during a trahcing sesison for a patient who is receiving inhale dsalmetreol, the nurse emphasizes that the drug is indicated for which condition? a. rescue treatment of acute bronchospasm b. prevention of bronchospasm c. reduction of airway inflammation
prevention of bronchospasms
84
for a patient receiving a vaosactive drug such as intravenous dopamine, which action by the nurse is most appropriate? a. monitor the gravity drip infusion closely and adjusts as needed b. assess the pateint's cardiac function by checking the radial pulse c. assess the IV site hourly for possible infiltration
assess the IV site hourly for possible infiltration
85
a patient is receiving dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. what will the nurse do next? a. titrate the drug to a higher dose to reduce the palpitation b. assess the pateint's vital signs and cardiac rhythm c. discontinue the dobutamine immediately
assess the patient's vital signs and cardiac rhythm
86
when a drug is characterized as having negative chronotropic effect, the nurse knows to expect which effect? a. reduced Bp b. decreased heart rate c. decreased ectopic rate
decreased heart rate
87
the nurse is monitoring a patient who is receiving an infusion of a beta-adrenergic agonist. which adverse effects may occur with this infusion?(SABA) a. mild tremors b. bradycardia c. tachycardia d. palpitations e. drowsiness f. nervousness
mild tremors tachycardia palpitations nervousness
88
the nurse is reviewing the home medications for a newly admitted patient and notes that the patient takes mirabegron. the nurse will conclude that the patient has which condition? a. asthma b. overactive bladder c. urinary retention
overactive bladder
89
the nurse is reviewing the use of bethanechol in a patient who is experiencing postoperative urinary retention. which statement best describes the mechanism of action of bethanechol? a. it causes decreased bladder tone and motility b. it causes increased bladder tone and motility
it causes increased bladder tone and motility
90
the family of a patient who has recently been diagnosed with Alzheimer's disease is asking about a new drug prescribed to treat this disease. the patients' wife says, I'm so excited that there are drugs that can cure this disease! i cant wait for him to start treatment. which reply from the nurse is appropriate? a. the sooner he starts the medicine, the sooner it can have this effect b. these effects won't be seen for a few months c. these drugs do not cure alzheimer's disease. let's talk about what the physician said to expect with this drug therapy
these drugs do not cure alzheimer's disease. let's talk about what the physician said to expect with this drug therapy
91
the nurse is giving a dose of bethannechol to a postoperative patient. the nurse is aware that contraindications to bethanechol include which of these? (SABA) .a badder atony b. urinary retention c. peptic ulcer d. hyperthyroidism e. cardiac disease
peptic ulcer hyperthyroidism cardiac arrest
92
while at home, a patient took an accidental overdose of a cholinergic drug. he comes to the emergency department with severe abdominal crmapin and blood diarrhea. which drug would the nurse expect to use to treat this patient? a. atropine b. bethanechol
atropine
93
the nurse is reviewing the orders for a newly admitted patient and sees an order for endrophonium. the nurse expects that this drug was ordered for which reason? a. to reduce symptoms and delay the onset of alzheimer's disease b. to treat the symptoms of myasthenia gravis c. to aid in the diagnosis of myasthenia gravis
to aid in the diagnosis of myasthenia gravis
94
the nurse must watch for symptoms of a cholinergic crisis when giving IV cholinergic drugs. which of these symptoms of a cholinergic crisis? (SABA) a. hypotension b. syncope c. dyspnea d. abdominal crmaping
syncope dyspnea abdominal cramping
95
the nurs eis teaching a pateint about the possible adverse effects of donepezil for alzheimer;s disease. which of these are possible adverse effects? (SABA). a. constipation b. Gi upset c. drowsiness d. blurred vision
GI upset drowsiness dizziness
96
the nurse is providing education about cholinergic-blocking drug therapy to an older adultbpatient. which is an important point to emphasize for this patient? a. avoid exposure to high temperatures b. limit liquid intake to avoid fluid overload c. begin an exercise program to avoid adverse effect
avoid exposure to high temperatures
97
the nurse is giving a cholinergic-blocking drug and will assess the patient for which contraindication to these drugs? a. chronic bornchities b. peptic ulcer disease c. BPH
BPH
98
when assessing for adverse effects of a cholinergic-blocking drug therapy, the nurse knows that the patients may experience which drug effect? (SABA) a. diaphoresis b. dry mouth c. dilated pupils d. urinary frequency e. constipation
dry mouth dilated pupils constipation
99
the nurse admidnestering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect? a. decreased muscle rigidity and tremors b. increased HR c. decreased bronchial secretionsn
decreased muscle rigidity and tremors
100
during the assessment of a pateint about to receive a cholinergic-blocking drug, the nurse will determine where the patient is taking any drugs that may potentially interact with the anticholinergic, including which of these? a. opioids, such as morphine sulfate b. antibiotics, such as penicillin tricyclic antidepressants, such as amitriptyline
tricyclic antidepressants, such as amitriptyline
101
a patient has been given a prescription for transdermal scopolamine patches for motion sickness for use during a vacation cruise. the nurse will include which instructions? (SABA) a. apply the patch 4-5 hours before boarding the ship b. the patch needs to be placed on a nonhairy area just behind your ear c. change the patch every 3 days d. rotate the application sites
- apply the patch 4-5 hours before boarding the ship - the patch needs to be placed on a nonhairy area just behind your ear - change the patch every 3 days - rotate the application sites
102
the nurse is assess a patient who has a prescription for dicyclomine. which condition is considered a contraindication to this medication? a. GI atony b. IBS c. overactive bladder
GI atony

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