Chapter 30, 33
Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response?
a. Decrease in pulse
b. Increase in urine output
c. Weight gain
d. Improved gastric motility
ANS: B
Rationale: Dopamine would cause an increase in urine output, because cardiac output is increased as a result of the increase in blood pressure. The effectiveness of dopamine would not be measured by a decrease in pulse, because dopamine’s primary effect is to increase blood pressure. Dopamine’s effectiveness would not be evaluated by a weight gain. Dopamine’s effectiveness would not be evaluated by improved gastric motility.
A patient on metoprolol asks why the medication lowers heart rate. Which explanation is correct?
a. “It blocks alpha receptors that slow the heart.”
b. “It enhances vagal tone, which increases parasympathetic activity.”
c. “It blocks sympathetic stimulation of beta-1 receptors in your heart.”
d. “It increases the effects of adrenaline.”
ANS: C
Rationale: Metoprolol is beta-1 selective, working directly on the sympathetic nervous system to reduce HR and contractility, making it a front-line ANS medication for cardiac conditions.
A patient newly diagnosed with PUD reports taking low- dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The most realistic counsel the nurse should provide is to :
a. Change the meal pattern to five or six smaller meals per day.
b. Discontinue taking aspirin, because it can irritate the stomach.
c. Stop drinking wine or any other alcoholic beverage.
d. Switch to a decaffeinated coffee and reduce the number of servings
ANS: A
Rationale: Consumption of five or six smaller meals a day can reduce fluctuations in the intragastric pH, which may facilitate recovery. ASA should be avoided, along with other NSAIDs except for low-dose ASA used for the prevention of cardiovascular disease. No hard data implicate alcohol as a contributor to PUD (smoking is correlated). No data indicate that caffeine contributes to PUD.
Which antiemetic would most likely be prescribed for motion sickness before a long sea voyage?
a. Ondansetron
b. Scopolamine
c. Metoclopramide
d. Dexamethasone
ANS: B
Rationale: Scopolamine is an anticholinergic drug that blocks acetylcholine in the inner ear and the vomiting center, making it highly effective for motion sickness.
The nurse knows which of the following are appropriate uses for laxative drugs? Select all that apply
a. Preparation for colonoscopy
b. Hepatic encephalopathy
c. Following myocardial infarction
d. Weight management
e. With opioid analgesics
ANS: A, B, C, E
Laxatives are used to evacuate the large intestine before colonoscopy, to remove intestinal ammonia in clients with hepatic encephalopathy, and to decrease straining to defecate in clients after a myocardial infarction. Opioid analgesics cause constipation, which can be alleviated with laxatives. Weight management is not an appropriate use for laxatives.
A nurse is administering intravenous dopamine (Intropin) to a patient in the intensive care unit. Which assessment finding would cause the most concern?
a. Blood pressure of 100/70 mm Hg
b. Increased urine output
c. Edema at the IV insertion site
d. Headache
ANS: C
Rationale: The nurse would be concerned if the patient’s peripheral IV were edematous, because this could signal infiltration of the solution into the tissues. Dopamine can cause necrosis if it extravasates. Dopamine is indicated to increase the patient’s blood pressure; this blood pressure reading is acceptable. When dopamine is effective at increasing cardiac output, it also causes an increase in urine output. Headache is not a contraindication to the use of dopamine.
A nurse is monitoring a patient receiving propranolol. Which symptom indicates sympathetic nervous system suppression?
a. Increased alertness
b. Pupillary dilation
c. Decreased heart rate and blood pressure
d. Bronchodilation
ANS: C
Rationale: Propranolol is a nonselective beta blocker that inhibits beta-1 (heart) and beta-2 (lungs/vasculature). Blocking sympathetic stimulation of beta-1 causes bradycardia and hypotension, hallmark signs of ANS suppression.
A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct?
a. “After 3 months, if the drug is not effective, you may need to increase the dose.”
b. “Metoclopramide may cause hiccups, especially after meals.”
c. “Serious side effects will occur but will stop when the drug is discontinued.”
d. “You should take the drug 30 minutes before each meal and at bedtime.”
ANS: D
Rationale: Metoclopramide should be given 30 minutes before meals and at bedtime. Metoclopramide should not be used long term and increasing the dose after 3 months of therapy is not recommended. Metoclopramide is used to treat hiccups; it does not cause hiccups. Tardive dyskinesia is a serious and irreversible side effect
A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest?
a. Avoiding fatty and spicy foods
b. Consuming extra clear fluids
c. Eating three meals daily
d. Taking foods later in the day
ANS: A
Rationale: Nausea and vomiting of pregnancy (NVP) can be treated with nondrug measures, including avoiding fatty and spicy foods. Consuming extra fluids does not help with nausea and vomiting (N/V) but may be needed to prevent dehydration. Patients should be advised to eat small portions of food throughout the day rather than three complete meals. "Morning sickness " may actually occur all day, so delaying intake is not recommended.
A client who experiences frequent constipation is using psyllium (Metamucil). The nurse knows what contraindications to using psyllium? Select all that apply
a. Difficulty swallowing
b. GI obstruction
c. Fecal impaction
d. Undiagnosed abdominal pain
e. Use of herbal preparations
ANS: A, B, C, D
Rationale: Difficulty swallowing and gastrointestinal obstruction contraindicates psyllium. Fecal impaction and undiagnosed abdominal pain are contraindications to all orally administered laxatives. Use of herbal preparations is not a contraindication. There are no interactions reported with psyllium.
A patient receiving glycopyrrolate complains of difficulty urinating. The nurse understands this is due to the drug’s effect on which part of the autonomic nervous system?
a. Activation of sympathetic nerves
b. Blockade of parasympathetic receptors causing urinary retention
c. Stimulation of cholinergic receptors increasing bladder contraction
d. Increased adrenergic stimulation of the detrusor muscle
ANS: B
Rationale: Glycopyrrolate is an anticholinergic that blocks parasympathetic muscarinic receptors, leading to relaxation of smooth muscle including in the bladder detrusor muscle, causing urinary retention. This is a common autonomic side effect. It does not stimulate sympathetic nerves directly or cholinergic receptors.
A patient on propranolol for migraine prevention reports cold hands and feet. What is the best explanation to provide?
a. "The drug increases metabolism, which can cause heat loss."
b. "This happens because the drug improves blood flow to your brain."
c. "Propranolol blocks beta-2 receptors, reducing peripheral blood flow."
d. "It means the drug isn’t working and may need to be increased."
ANS: C
Rationale: Beta-2 blockade leads to vasoconstriction in peripheral vessels, which can cause cold extremities — a common ANS-related side effect of non-selective beta blockers like propranolol.
When educating a client prescribed histamine-2 antagonists, which of the following should be avoided? Select all that apply
a. Cigarettes
b. Caffeine
c. Fibrous foods
d. Acid stimulating foods
ANS: A, B, D
The instruction should include ways to decrease acid production (such as avoiding cigarettes, acid stimulating foods, alcohol, and caffeine). Fibrous foods are not considered acid stimulating.
Which antiemetic is often combined with other medications to enhance its anti-nausea effect, especially in chemotherapy?
a. Meclizine
b. Dexamethasone
c. Prochlorperazine
d. Scopolamine
ANS: B
Rationale: Dexamethasone, a corticosteroid, is commonly used off-label as an adjunct for chemotherapy-induced nausea and vomiting. It enhances the effect of other antiemetics.
A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient’s abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will:
a. order a bulk-forming laxative.
b. order extra fluids and fiber.
c. perform diagnostic tests.
d. prescribe a cathartic laxative.
ANS: C
Rationale: Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis. A bulk-forming laxative is contraindicated. Patients with acute abdomens should be kept NPO pending diagnosis. A cathartic laxative is contraindicated.
A patient with orthostatic hypotension is prescribed midodrine. Which assessment finding indicates the medication is effective?
a. Supine blood pressure is 150/90 mmHg
b. Patient reports dizziness upon standing
c. Standing blood pressure is 120/80 mmHg without dizziness
d. Pulse rate is 110 bpm
ANS: C
Rationale: Midodrine is an alpha-1 adrenergic agonist that causes vasoconstriction, thereby increasing vascular tone and blood pressure—especially when upright. It is used to treat symptomatic orthostatic hypotension, so the absence of dizziness and a stable BP upon standing indicates therapeutic effectiveness.
A patient with hypertension is prescribed doxazosin. The nurse explains that this medication works by blocking alpha-1 receptors. Which autonomic nervous system effect should the nurse include in the teaching?
a. "It increases heart rate and cardiac output by stimulating beta-1 receptors."
b. "It lowers blood pressure by dilating blood vessels through alpha-1 receptor blockade."
c. "It decreases the release of norepinephrine from sympathetic nerve terminals."
d. "It stimulates parasympathetic activity to improve baroreceptor sensitivity."
ANS: B
Rationale: Doxazosin is a selective alpha-1 adrenergic receptor antagonist. Alpha-1 receptors are part of the sympathetic nervous system, and their activation normally causes vasoconstriction. By blocking these receptors, doxazosin leads to vasodilation, which reduces vascular resistance and lowers blood pressure — a direct autonomic effect.
When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to do what?
a. Avoid any alcoholic beverages
b. Avoid foods containing tyramine
c. Take the drug on an empty stomach
d. Take the drug with food
ANS: A
Rationale: The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol. Nothing indicates that the patient should avoid foods containing tyramine. Metronidazole may be taken with or without food.
Which of the following patients would most likely benefit from meclizine?
a. A patient undergoing chemotherapy
b. A patient with inner ear vertigo
c. A patient with a bowel obstruction
d. A patient with severe constipation
ANS: B
Rationale: Meclizine is an antihistamine effective for motion sickness and vertigo by acting on the vestibular system and vomiting center.
A patient has been taking psyllium (Metamucil) 2 to 3 times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do?
a. Ask the patient to drink a full glass of water.
b. Give another dose of the psyllium.
c. Request an order for a bisacodyl (Dulcolax) suppository.
d. Palpate the patient’s abdomen and auscultate for bowel sounds.
ANS: D
Rationale:
Psyllium is a bulk-forming laxative and can cause a fecal impaction or obstruction. Abdominal pain can be a sign of impaction or obstruction, so the nurse should assess the patient for this complication. Giving fluids by mouth, administering more laxative, or giving a suppository are all contraindicated if an obstruction has developed and should not be done until this condition is ruled out.
A patient receiving epinephrine for anaphylaxis is being monitored. Which clinical finding requires immediate intervention?
a. Increased blood pressure to 130/85 mmHg
b. Heart rate of 160 bpm with palpitations
c. Respiratory rate of 24 breaths per minute
d. Pink, warm skin
ANS: B
Rationale: Epinephrine stimulates alpha-1, beta-1, and beta-2 receptors, causing vasoconstriction, increased cardiac output, and bronchodilation—making it life-saving in anaphylaxis. However, excessive beta-1 stimulation can cause dangerous tachycardia, arrhythmias, or increased myocardial oxygen demand, especially in patients with underlying cardiac conditions. A heart rate of 160 bpm is concerning and may indicate the need to reassess the dose or patient's response to the drug.
A patient receiving labetalol complains of feeling fatigued and having low energy. The nurse recognizes this as a potential result of which autonomic nervous system effect of the drug?
a. Increased sympathetic stimulation
b. Blockade of cholinergic receptors
c. Reduced sympathetic output
d. Activation of muscarinic receptors
ANS: C
Rationale: Fatigue is a common side effect of beta blockers like labetalol due to decreased sympathetic nervous system stimulation. Blocking beta-1 receptors reduces cardiac output, and blocking alpha-1 causes vasodilation—together they reduce systemic stimulation, which can make the patient feel tired. This is a classic autonomic nervous system effect. The other choices are not correct mechanisms for labetalol.
Which behavior can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.)
a. Avoiding late-night meals
b. Consuming a glass of wine with meals
c. Drinking soft drinks
d. Stopping smoking
ANS: A, D
Rationale: Avoiding late-night meals and stopping smoking may help with symptoms of GERD. Alcohol (including wine) relaxes the lower esophageal sphincter (LES), which can allow stomach acid to backflow into the esophagus — making GERD worse, not better. Carbonated beverages increase gastric pressure and can also relax the LES, both of which can exacerbate GERD. Also, many sodas contain caffeine, another potential trigger.
A patient is being discharged with a prescription for scopolamine patches to prevent motion sickness during a cruise. Which discharge instruction should the nurse emphasize?
a. "Apply the patch to your lower back 2 hours before travel."
b. "Use a second patch if the first doesn’t work within 4 hours."
c. "Avoid driving or operating machinery while using this patch."
d. "Keep the patch on for 12 hours and then replace it."
ANS: C
Rationale: Scopolamine causes sedation and dizziness, so patients should avoid hazardous activities. It’s applied behind the ear, lasts up to 72 hours, and should never be doubled or applied incorrectly.
Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide?
a. Chronic renal failure
b. Cirrhosis
c. Hemorrhoids
d. Prostatitis
ANS: A
Rationale:
Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication. Magnesium hydroxide is not contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.