Epinephrine
A Nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects?
A. Hypotension
B. Hyperthermia
C. Hypoglycemia
D. Tachycardia
D. Tachycardia
Rationale: Adverse effects of epinephrine, an adrenergic agonist, can include tachycardia and dysrhythmias due to cardiac due to cardiac stimulation.
A client is receiving dopamine for treatment of shock. Which finding indicates the medication is improving the client’s condition?
A. Urine output increases to 35mL/hr
B. Heart rate rises to 140/min
C. Peripheral pulses become weak
D. Blood pressure decreases to 78/40
A. Urine output increases to 35mL/hr
Rationale: Dopamine improves renal perfusion at low to moderate doses. Increased urine output indicates improved perfusion and cardiac output.
A nurse is preparing to administer adenosine to a client with supraventricular tachycardia (SVT). Which of the following should the nurse anticipate after giving the medication?
A. Brief periods of asystole
B. Profound hypotension
C. Worsening tachycardia
D. Ventricular fibrillation
A: Brief periods of asystole
Rationale: Adenosine often causes a brief period of asystole or pauses before conversion to normal rhythm. It is expected.
What condition is atropine commonly used to treat?
True or False
You can use sodium bicarbonate in a patient who is overdosing on Tricyclic Antidepressants
True
A nurse is teaching the parents of a toddler who had an anaphylactic reaction to peanut butter about administering injectable epinephrine. Which of the following instructions should the nurse include?
A. Common sites for an injection of epinephrine are the fatty tissue found in the upper arm and in the lower abdomen.
B. Administer epinephrine prior to giving your child peanut products in the future.
C. No further treatment is needed after injecting the epinephrine.
D. You will need to increase the dosage as your child gains weight.
D. You will need to increase the dosage as your child gains weight.
Epinephrine is a weight-based medication that is available in dosages of 0.15mg and 0.3 mg. As the child grows, it will be necessary to change the epinephrine dosage that is administered.
The nurse notes that the dopamine infusion has infiltrated. What is the priority nursing action?
A. Apply a warm compress
B. Increase the infusion rate
C. Stop the infusion immediately
D. Flush the IV line with saline
C. Stop the infusion immediately
Rationale: Dopamine is a vesicant. The infusion must be stopped immediately to prevent tissue necrosis. Then treat with phentolamine.
The nurse is administering adenosine to a client with SVT. Which nursing action is appropriate?
A. Administer slowly over 1-2 minutes
B. Use a large-bore IV line close to the heart
C. Mix the dose in 50mL of normal saline
D. Give the drug IM if IV access is unavailable
B. Use a large-bore IV line close to the heart
Rational: Adenosine must be given through a large, proximal IV (AC or central line) because it has an extremely short half-life.
What is one common side effect of atropine?
Dry mouth
A nurse is caring for a client receiving IV sodium bicarbonate for severe metabolic acidosis. Which of the following findings should the nurse recognize as a common side effect of sodium bicarbonate therapy?
A. Hyperkalemia
B. Metabolic alkalosis
C. Hyponatremia
D. Increased ionized calcium levels
B. Metabolic alkalosis
Sodium bicarbonate increases serum bicarbonate levels. Too much can overcorrect the acidosis, causing metabolic alkalosis, a well-known side effect.
NCLEX QUESTION
A nurse is preparing to administer an epinephrine IV bolus to a client. Which of the following should the nurse verify before initiating the IV medication?
A. Concentration of the formulation
B. Reversibility of the medication
C. Potential barriers to absorption
D. Gastric emptying time
A. Concentration of the formulation
Rationale: Epinephrine can be injected through several routes, and a solution prepared for use by a certain route can differ in concentration from others. Solutions intended for subcutaneous administration are generally concentrated, whereas solutions intended for intravenous use are dilute. If a solution prepared for subcutaneous administration is administered intravenously, the result could be fatal because intravenous administration of concentrated epinephrine can overstimulate the heart and blood vessels, causing severe hypertension, cerebral hemorrhage, stroke, and death.
NCLEX QUESTION
A client receiving dopamine begins experiencing a heart rate of 128/min and reports palpitations. What should the nurse do?
A. Continue to monitor; this is an expected effect
B. Reduce the infusion rate per protocol
C. Discontinue dopamine and notify the provider
D. Give a beta blocker to decrease the heart rate
B. Reduce the infusion rate per protocol
Rationale: Tachycardia can indicate dopamine overdose or excessive dosing. The nurse should reduce the infusion rate according to protocol.
NCLEX QUESTION
A nurse gives adenosine to convert SVT. Which finding indicates the drug is effective?
A. Heart rate decreases from 180/min to 70/min
B. Blood pressure rises by 30 mmHg
C. Patient reports chest pain
D. Premature Ventricular Contractions appear on the monitor
A. Heart rate decreases from 180/min to 70/min
Rationale: The expected therapeutic effect is conversion to normal sinus rhythm and normalization of the heart rate
NCLEX QUESTION
A patient is receiving atropine for symptomatic bradycardia. Which finding indicates the medication is effective?
A. Heart rate increases from 42bpm to 68bpm
B. Blood pressure decreases from 130/82 to 104/60
C. Patient reports dry mouth
D. Respiratory rate increases from 16 to 22
A. Heart rate increases from 42bpm to 68bpm
Rationale: Atropine is given to increase heart rate; an improvement from 42 to 68 bpm shows it is working.
NCLEX QUESTION
A nurse in the emergency department is caring for a client receiving IV sodium bicarbonate for severe metabolic acidosis. Which of the following findings should the nurse immediately report to the provider?
A. Serum potassium level of 3.1 mEq/L
B. pH of 7.34
C. Mild swelling at the IV site
D. Serum sodium level of 142 mEq/L
A. Serum potassium level of 3.1 mEq/L — CORRECT
Sodium bicarbonate can cause hypokalemia by shifting potassium into the cells.
A value of 3.1 mEq/L is low and can lead to life-threatening dysrhythmias, so this finding must be reported immediately.
References
50 drugs every emergency physician should know. AAEM/RSA. (2023, May 25). https://www.aaemrsa.org/education/50-drugs/
Emergency medicines. HPRA. https://www.hpra.ie/regulation/human-medicine/patients-and-healthcare-professionals/emergency-medicines
Pharmacology Made Easy 5.0. The Cardiovascular System. ATI.
Thank You!