Beginning
The patient receives methyldopa (Aldomet), an adrenergic drug. The nurse determines that the patient is having side effects when the patient makes which statement?
1. "Will you check my pupils? I can't see very well at all."
2. "I am so thirsty; will you please bring me another pitcher of water?"
3. "I am so anxious; I really need to walk around the room."
4. "I feel so sleepy that I don't think I can eat my dinner."
Correct: 3
Rationale 1: Adrenergic drugs dilate the pupils, so vision should not be affected.
Rationale 2: Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be thirsty.
Rationale 3: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness.
Rationale 4: Adrenergic drugs increase alertness, so the patient would not be sleepy.
The nurse has been doing medication education for the patient receiving atenolol (Tenormin), a beta blocker. The nurse determines that learning has occurred when the patient makes which statement?
1. "I need to take my pulse every day."
2. "If I have any side effects, I will stop the medication."
3. "I cannot take this drug if I develop glaucoma."
4. "I cannot continue to have my morning cup of coffee."
Correct: 1
Rationale 1: Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every day.
Rationale 2: Beta blockers should not be stopped suddenly.
Rationale 3: Adrenergic blockers, not beta blockers, are used to treat glaucoma.
Rationale 4: Caffeine is not prohibited with beta blockers.
The patient receives metaproterenol (Alupent), an adrenergic drug. A consulting physician orders carteolol (Cartrol), a beta blocker. What best describes the nurse's assessment?
1. The patient is at risk for a hypertensive crisis.
2. The effects of metaproterenol (Alupent) will be decreased.
3. The drugs are compatible; there will not be any adverse effects.
4. The effects of metaproterenol (Alupent) will be increased.
Correct: 2
Rationale 1: A hypertensive crisis is unlikely.
Rationale 2: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased.
Rationale 3: The drugs are not compatible.
Rationale 4: The effects of metaproterenol (Alupent) would not be increased.
The physician ordered prazosin (Minipress), an alpha-adrenergic blocker, for the patient. The nurse plans to do medication education. What will the best plan of the nurse include?
1. Instruct the patient to not take OTC herbal preparations containing saw palmetto.
2. Instruct the patient to not take tub baths.
3. Instruct the patient to decrease his intake of sodium.
4. Instruct the patient to wear sunglasses when outdoors.
Correct: 1
Rationale 1: A hypotensive response may occur when saw palmetto is taken concurrently.
Rationale 2: Patients should be careful when taking tub baths, especially if the drug causes dizziness, but such baths are not prohibited.
Rationale 3: There is no relationship between alpha blockers and sodium intake.
Rationale 4: Alpha blockers do not cause photophobia; sunglasses are not required with this drug.
A patient has been prescribed an alpha1 adrenergic agonist drug. The nurse would plan to monitor for effects from which organs? (select all that apply)
1. Kidneys
2. Eyes
3. Heart
4. Bowels
5. Lungs
Correct: 1, 2, 4, 5
Rationale 1: Alpha1 receptors have potential to affect the renal system.
Rationale 2: Alpha1 receptors result in dilation of the pupils.
Rationale 3: Alpha1 receptors do not affect receptors in the heart.
Rationale 4: Alpha1 receptors have potential to affect receptors in the gastrointestinal tract.
Rationale 5: Alpha1 receptors have potential to affect receptors in the respiratory system.
A patient is prescribed a drug that activates alpha2 receptors. The nurse would plan care based on which physiological response?
1. Inhibition of norepinephrine release
2. Absence of monoamine oxidase
3. Increased lipolysis
4. Destruction of presynaptic nerve terminals
Correct: 1
Rationale 1: The action of alpha2 receptors is to inhibit release of norepinephrine.
Rationale 2: Alpha2 receptors do not destroy monoamine oxidase.
Rationale 3: Alpha2 receptors do not increase lipolysis.
Rationale 4: Alpha2 receptors do not destroy presynaptic nerve terminals.
The nurse is providing discharge medication instruction to the family of a child who is severely allergic to peanuts. Mark the spot where the family or patient should inject epinephrine from an EpiPen should an allergic response occur?
1. Stomach
2. Bicep
3. Hip/Glute
4. Theigh
Correct: 4
Rationale: This drug should be injected into the thigh only.
A patient has been prescribed isoproterenol (Isuprel). The nurse plans care based on the drug’s stimulation of which receptors? (select all that apply)
1. Alpha1
2. Alpha2
3. Beta1
4. Beta2
5. Beta3
Correct: 3, 4
Rationale 1: This drug does not affect alpha1 receptors.
Rationale 2: This drug does not affect alpha2 receptors.
Rationale 3: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 receptors.
Rationale 4: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta2 receptors.
Rationale 5: This drug does not affect beta3 receptors.
Place these substances in the correct order of synthesis of catecholamines.
1. Norepinephrine
2. Tyrosine
3. Dopamine
4. Epinephrine
5. L-dopa
Correct: 2, 5, 3, 1, 4
Rational: The synthesis begins with tyrosine then moves to L-dopa, dopamine, norepinephrine, and ends with the synthesis of epinephrine.
A nurse is reviewing medical records for usage of drugs that are beta2 agonists. The nurse should start with the medical records of patients with which conditions? (select all that apply)
1. Heart failure
2. Asthma
3. COPD
4. Overactive bladder
5. Nasal congestion
Correct: 2, 3
Rationale 1: Beta1 agonists are most likely to be given to patients with heart failure.
Rationale 2: Beta2 agonists are useful in the treatment of asthma.
Rationale 3: Beta2 agonists are useful in the treatment of COPD.
Rationale 4: Beta3 agonists are most likely to be given to patients with overactive bladder.
Rationale 5: Alpha1 agonists are most likely to be given to patients with nasal congestion.
A patient who has used an adrenergic nasal spray for 2 weeks complains that, “I am more stuffed up now than I was when I was sick.” What advise should the nurse provide? (select all that apply)
1. “You are having an allergic reaction to the nasal spray. Stop using it immediately.”
2. “You probably have developed a secondary infection.”
3. “Try increasing the amount of fluids you are drinking.”
4. “Switch to a saline-based nasal spray.”
5. “Continue to use your current nasal spray until the congestion goes away.”C
Correct: 3, 4
Rationale 1: There is no evidence that an allergic reaction has occurred.
Rationale 2: There is no evidence that a secondary infection has occurred.
Rationale 3: Increased oral fluids may help to thin secretions, making them easier to remove.
Rationale 4: The patient is probably experiencing rebound congestion. Switching from the adrenergic spray to a saline spray will keep the mucosa moist and more comfortable until the effects of the adrenergic spray abate.
Rationale 5: The patient is probably experience rebound congestion. Continuing to use this spray is contraindicated.
The nurse is preparing to administer an adrenergic drug intravenously. What nursing actions should be planned? (select all that apply)
1. Give the drug as rapidly as possible by intravenous push.
2. Dilute the drug before administration.
3. Use an infusion pump to control rate of administration.
4. Monitor for blanching at the infusion site.
5. Advise the patient that a sweet taste may occur as the drug is being given.
Correct: 2, 3, 4
Rationale 1: These drugs should be administered slowly.
Rationale 2: These drugs should be diluted prior to administration.
Rationale 3: Infusion of these drugs should be controlled via an infusion pump.
Rationale 4: Blanching at the infusion site indicates probable extravasation. The drip should be stopped.
Rationale 5: There is no evidence that a sweet taste will occur.
A patient has been prescribed phenylephrine (Neo-Synephrine) spray for nasal congestion. What information about adverse effects should the nurse provide in discharge teaching? (select all that apply)
1. “This drug may cause some stinging or burning in your nose.”
2. “You may notice that your nasal secretions take on a slightly orange tint.”
3. “You may feel like your blood pressure is low for the first few times you use this spray.”
4. “One of the major adverse effects of this drug is rebound congestion if it is used more than a few days.”
5. “Do not drink herbal teas while taking this medication.”
Correct: 1, 4
Rationale 1: Intranasal use of this drug can cause burning of the mucosa.
Rationale 2: There is no indication that orange-tinted nasal secretions should be expected.
Rationale 3: Intranasal medications, if used properly, should have little or no effect on blood pressure.
Rationale 4: Rebound congestion is likely to occur if the drug is used for over 3–5 days.
Rationale 5: There are no known drug–herbal interactions with this drug.
A nurse is providing discharge medication instruction regarding use of injectable epinephrine (EpiPen). What information should the nurse include? (select all that apply)
1. If you need to use this pen, seek medical advice as follow-up.
2. You can dispose of a used EpiPen in your regular trash.
3. Keep an extra EpiPen on hand.
4. Store this device in your refrigerator.
5. Carry an EpiPen in your car’s glovebox.
Correct: 1, 3
Rationale 1: If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling 911 or the provider.
Rationale 2: The used EpiPen should be taken to an emergency department or the provider’s office for disposal.
Rationale 3: It is recommended that the patient have an extra EpiPen on hand in case of emergency or failure of the original unit.
Rationale 4: It is not necessary to refrigerate the EpiPen.
Rationale 5: The EpiPen should be kept in a cool, dark place. The glovebox of a car becomes too hot.
A patient who is in heart failure is administered a beta1 agonist. The nurse would evaluate that the drug is effective if which changes occur? (select all that apply)
1. Heart rate increases
2. Pulse becomes stronger
3. Pupils dilate
4. Dysrhythmias dissipate
5. Blood pressure drops
Correct: 1, 2
Rationale 1: One of the effects of beta1 agonists is to increase the heart rate.
Rationale 2: One of the effects of beta1 agonists is to increase force of cardiac contraction, which would be felt as a stronger pulse.
Rationale 3: Pupil dilation is an effect of alpha1 drugs.
Rationale 4: Beta1 antagonists are given to control dysrhythmias.
Rationale 5: Beta1 antagonists are given to control hypertension.
A patient has been prescribed an adrenergic nasal spray. What medication instruction should the nurse provide? (select all that apply)
1. “Do not share this spray with anyone.”
2. “Sit upright while using this spray.”
3. “Only use this spray for 3–5 days.”
4. “Do not shake the bottle before using this spray.”
5. “Keep this spray refrigerated.”
Correct: 1, 2, 3
Rationale 1: Sharing nasal sprays may spread infection.
Rationale 2: The patient should sit upright to use this medication so that it is delivered appropriately, avoiding overdosage.
Rationale 3: Adrenergic nasal sprays may cause rebound congestion if used more that 3–5 days.
Rationale 4: There is no indication that the bottle should not be shaken.
Rationale 5: There is no indication that the medication should be refrigerated.
Which statement is accurate concerning drugs classified as adrenergic antagonists?
1. They are also known as anticholinergics.
2. Their actions will block the neurotransmitter acetylcholine.
3. Their actions are the opposite of those of sympathomimetics.
4. They will stimulate the sympathetic nervous system.
Correct:3
Rationale 1: They are also known as sympatholytics.
Rationale 2: They block adrenergic receptors, not cholinergic receptors.
Rationale 3: Adrenergic antagonists inhibit the actions of the sympathetic nervous system.
Rationale 4: Adrenergic antagonists inhibit the actions of the sympathetic nervous system.
An older adult patient received an adrenergic eye drop to dilate the pupils for a retinal exam. What information should the nurse provide when discharging this patient? (select all that apply)
1. “Do not drive until the effects of the eye drops have worn off.”
2. “Wear sunglasses when in bright light.”
3. “You may be more comfortable in a darkened room.”
4. “You may experience burning in your eyes for a couple of days.”
5. “Do not eat or drink anything for at least an hour after discharge.”
Correct: 1, 2, 3
Rationale 1: Older adults may notice blurring of vision after receiving drops to dilate the eyes. The patient should not drive until vision is clear.
Rationale 2: Photosensitivity is a common effect, and protective eyewear should be worn.
Rationale 3: Photosensitivity is a common effect, and the patient may be more comfortable in a darkened room or with a soft cloth covering the eyes.
Rationale 4: The burning associated with these drops should be transient. It should not last for “a couple of days.”
Rationale 5: There is no reason for the patient to be NPO.
A patient has been prescribed phenylephrine (Neo-Synephrine). Prior to administering this drug the nurse would review the patient’s medication history for presence of which drugs? (select all that apply)
1. MAO inhibitors
2. Tricyclic antidepressants
3. Iron supplements
4. Digoxin
5. Aspirin
Correct: 1, 2, 3, 4
Rationale 1: Concurrent use with MAO inhibitors may result in hypertensive crisis.
Rationale 2: Tricyclic antidepressants can potentiate the effects of phenylephrine (Neo-Synephrine).
Rationale 3: Iron supplements are incompatible with phenylephrine (Neo-Synephrine).
Rationale 4: Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used concurrently.
Rationale 5: There is no incompatibility with aspirin.
A patient who was recently prescribed an adrenergic drug says, “I am so nervous and I cannot sleep.” The nurse would ask which questions? (select all that apply)
1. “How much coffee do you drink?”
2. “Have you recently increased your intake of dairy products?”
3. “Do you eat chocolate?”
4. “When was the last time you ate pickled foods or aged cheese?”
5. “How much wine or other alcoholic beverages do you drink?”
Correct: 1, 3
Rationale 1: The caffeine in coffee may cause excessive nervousness, insomnia, and tremors.
Rationale 2: There should be no drug-food interaction with dairy products.
Rationale 3: The caffeine in chocolate may cause excessive nervousness, insomnia, and tremors.
Rationale 4: There should be no drug-food interaction with pickled foods or aged cheese.
Rationale 5: There should be no drug-food interaction with beverages that contain alcohol.
A patient who was administered prazosin (Minipress) became unconscious 30 minutes after the first dose. What medications should the nurse prepare for resuscitation? (select all that apply)
1. Normal saline
2. Dobutamine
3. Atenolol (Tenormin)
4. Carvedilol (Coreg)
5. Propranolol (Inderal)
Correct: 1, 2
Rationale 1: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Normal saline can be used as a volume expander.
Rationale 2: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Treatment with a vasopressor such as dobutamine may be indicated.
Rationale 3: Atenolol (Tenormin) is an adrenergic blocker and would exacerbate the problem.
Rationale 4: Carvedilol (Coreg) is an adrenergic blocker and would exacerbate the problem.
Rationale 5: Propranolol (Inderal) is an adrenergic blocker and would exacerbate the problem.
A patient has been prescribed prazosin (Minipress). What information should the nurse provide? (select all that apply)
1. “Stay out of the sun until you determine if you become sun-sensitive.”
2. “Take this medication just before you go to bed.”
3. “This medication may make you dizzy.”
4. “This medication may slow your heart rate noticeably.”
5. “Do not take this medication with milk.”
Correct: 2, 3
Rationale 1: There is no indication that this medication will make the patient sensitive to the sun.
Rationale 2: This medication should be taken just before bedtime as it may cause drowsiness or light-headedness.
Rationale 3: Dizziness is a common adverse effect of this drug.
Rationale 4: Tachycardia is the expected adverse effect.
Rationale 5: There is no reason to avoid milk when taking this drug.
A patient states, “I stopped taking that beta blocker last week. It made me so tired, I just couldn’t go on taking it.” What are the priority nursing assessments? (select all that apply)
1. Blood pressure
2. Heart rhythm
3. Urinary output
4. Presence of chest pain
5. Presence of respiratory crackles
Correct: 1, 2, 4
Rationale 1: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as hypertension.
Rationale 2: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as dysrhythmia.
Rationale 3: Abruptly discontinuing beta blockers should not have an immediate effect on urinary output.
Rationale 4: Abruptly discontinuing beta blockers may result in chest pain.
Rationale 5: Abruptly discontinuing beta blockers should not result in pulmonary complications.
During assessment a patient says, “I took my blood pressure at home and it was high. I have been taking my husband’s propranolol (Inderal) for the last week.” The nurse is especially concerned about this action when it is noted that the patient has which preexisting conditions? (select all that apply)
1. Obesity
2. Diabetes mellitus
3. COPD
4. Asthma
5. Rheumatoid arthritis
Correct: 2, 3, 4
Rationale 1: While obesity may be contributing to the patient’s hypertension, use of propranolol (Inderal) is not contraindicated.
Rationale 2: Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms of hypoglycemia in patients with diabetes.
Rationale 3: Beta blockers may cause significant bronchial constriction.
Rationale 4: Beta blockers may cause significant bronchial constriction.
Rationale 5: Beta blockers are not contraindicated for use in patients with rheumatoid arthritis.
A patient has been prescribed an adrenergic-blocker for treatment of hypertension. What information should the nurse provide? (select all that apply)
1. “Rise from a sitting position slowly.”
2. “Sit on the side of the bed a few moments before you stand.”
3. “If you feel dizzy, add more salt to your diet.”
4. “If you feel dizzy, sit or lie down until the dizziness passes.”
5. “Try to continue daily activities even if dizziness occurs.”
Correct: 1, 2, 4
Rationale 1: Patients who are starting on adrenergic-blocking drugs should move slowly from the sitting position.
Rationale 2: Sitting on the side of the bed will help blood pressure normalize before standing.
Rationale 3: Additional salt is not indicated for people who have hypertension.
Rationale 4: If the patient feels dizzy, sitting down or lying down will help to prevent falls.
Rationale 5: The patient should monitor dizziness and should take safety precautions until acclimated to the medication.