Pharm questions 91-135

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91. A patient in the postanesthesia recovery unit received ketamine (Ketalar) for right open reduction internal fixation surgery. What drug would be beneficial as a premedication to help minimize adverse reactions?

a. Thiopental sodium (Pentothal)
b. Sevoflurane (Ultane)
c. Atropine (Sal-Tropine)
d. Diazepam (Valium)

d. Diazepam (Valium)

To minimize the effects of ketamine, the patient should be premedicated with diazepam or midazolam to reduce the risk of an adverse reaction. Thiopental sodium would further sedate the patient. Sevoflurane would further complicate sedation and would not be indicated. Atropine would not reduce the risk of an adverse reaction.

92. A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent:

a. anxiety.
b. bradycardia.
c. dry mouth.
d. hypertension.

b. bradycardia.

Atropine, an anticholinergic drug, is used as an adjunct to anesthesia to counter the effects of vagal stimulation, which is caused by surgical manipulations that trigger parasympathetic reflexes, resulting in bradycardia. Atropine is not an anxiolytic. Atropine causes dry mouth and sometimes is used to minimize bronchial secretions

93. A patient will receive intravenous midazolam (Versed) combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching?

a. "The patient may appear anxious and restless during the procedure."
b. "The patient will be unconscious during the procedure."
c. "The patient will not need cardiorespiratory support during the procedure."
d. "The patient will not remember the procedure."

d. "The patient will not remember the procedure."

Midazolam, combined with an opioid analgesic, is used for conscious sedation for minor surgeries and endoscopic procedures. It does not cause anesthesia during this state, which is characterized by sedation, analgesia, amnesia, and lack of anxiety. The patient will not remember the events even though the person will be able to respond to commands during the procedure. The patient will appear unperturbed and passive and not anxious or restless. The patient is sedated, not unconscious. Midazolam can cause dangerous cardiorespiratory effects, including respiratory depression and respiratory and cardiac arrest

94. A patient receives a neuromuscular blocking agent as an adjunct to inhalation anesthesia. When caring for this patient, it is important for the nurse to remember that neuromuscular blocking agents:

a. cause vagal slowing of the heart.
b. increase the required dose of inhalation anesthetics.
c. increase the depth of unconsciousness.
d. prevent contraction of the diaphragm.

d. prevent contraction of the diaphragm.

Neuromuscular blocking agents enhance skeletal muscle relaxation so that the dose of inhalation anesthetics can be reduced to a safer amount. Because these drugs prevent contraction of all skeletal muscles, including the diaphragm, mechanical ventilation is required to support respiration. These agents do not cause vagal slowing of the heart. They reduce the required dose of inhalation agents. They do not affect the level of consciousness

95. A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication?

a. Bethanechol
b. Droperidol
c. Promethazine
d. Ondansetron

a. Bethanechol

Bethanechol is a muscarinic agonist that is used to treat abdominal distention and urinary retention. The other three agents are antiemetics and would not be useful in this situation.

96. A patient will receive isoflurane (Forane) as an anesthetic for a surgical procedure. The nurse caring for this patient during the perioperative period knows that, unlike halothane, this agent will not cause:

a. myocardial depression.
b. muscle relaxation.
c. rapid induction.
d. respiratory depression.

a. myocardial depression.

Isoflurane does not cause myocardial depression and does not reduce cardiac output. Isoflurane actually produces more muscle relaxation than halothane. Induction with isoflurane is rapid. Isoflurane causes respiratory depression, as do all inhalation anesthetics.

97. A patient is given nitrous oxide, along with another inhalation anesthetic. The nurse knows that the benefits of nitrous oxide include what? (Select all that apply.)

a. It is a potent analgesic.
b. It has high anesthetic potency.
c. It is less likely to cause nausea and vomiting.
d. It is less likely to precipitate malignant hyperthermia.
e. It can significantly reduce the dose of inhalation anesthetic.

a. It is a potent analgesic.
d. It is less likely to precipitate malignant hyperthermia.
e. It can significantly reduce the dose of inhalation anesthetic.

Nitrous oxide is an inhalation agent with high analgesic potency. It is not likely to precipitate malignant hyperthermia. It can significantly reduce the dose of the primary anesthetic by as much as 50% or more. It does not have high anesthetic potency, so it cannot be used alone to induce anesthesia. It is more likely to cause postoperative nausea and vomiting.

98. A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?

a. "I will apply a thin layer of the medication to a small area of skin."
b. "I will cover the burn with a dressing after applying the medication."
c. "I will make sure to apply the medication to the entire burn area."
d. "I will use the medication only on the most painful, blistered areas."

a. "I will apply a thin layer of the medication to a small area of skin."

Topical anesthetics can be absorbed in sufficient amounts to cause serious and even life-threatening systemic toxicity, so they should be applied in the smallest amount needed to as small an area as possible. Covering the site increases the skin's temperature, which increases absorption, so this should be avoided. Applying the medication to a large area increases systemic absorption. Applying the medication to broken skin increases systemic absorption.

99. A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?

a. "Anesthetic effects develop slowly and persist for several hours."
b. "Cocaine is a local anesthetic administered by injection."
c. "Vasoconstrictors should not be used as adjunct agents with this drug."
d. "When abused, cocaine causes physical dependence."

c. "Vasoconstrictors should not be used as adjunct agents with this drug."

Cocaine should not be combined with epinephrine or other vasoconstrictors, because it causes vasoconstriction itself, and the combination could precipitate severe hypertension. Cocaine has a rapid onset of effects, which last about 1 hour. It is used only topically for anesthesia. Although subject to widespread abuse with profound psychologic dependence, it does not cause substantial physical dependence

100. A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:

a. allow more systemic absorption to speed up metabolism of the lidocaine.
b. increase the rate of absorption of the lidocaine.
c. improve perfusion by increasing blood flow to the area.
d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

Epinephrine causes vasoconstriction, which reduces local blood flow and delays systemic absorption of lidocaine, which prolongs local anesthetic effects and reduces the risk of systemic toxicity. Epinephrine slows the rate of absorption. Epinephrine delays systemic absorption of lidocaine, so metabolism is slowed and the effects are prolonged in the periphery. Epinephrine does not increase local blood flow.

101. A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic, the patient has a pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of:

a. heart block.
b. anaphylaxis.
c. central nervous system excitation.
d. respiratory depression.

a. heart block.

When absorbed in a sufficient amount, local anesthetics can affect the heart and blood vessels. These drugs suppress excitability in the myocardium and conduction system and can cause hypotension, bradycardia, heart block, and potentially cardiac arrest. Anaphylaxis would be manifested by hypotension, bronchoconstriction, and edema of the glottis. Central nervous system excitation would be manifested by hyperactivity, restlessness, and anxiety and may be followed by convulsions. No evidence indicates respiratory depression; this patient's respirations are within normal limits.

102. A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?

a. Contact the anesthetist to request an order for ephedrine.
b. Have the patient sit up to relieve the headache pain.
c. Lower the head of the bed to a 10- to 15-degree head-down position.
d. Obtain an order for a urinary catheter for urinary retention.

c. Lower the head of the bed to a 10- to 15-degree head-down position.

Spinal anesthetics have several adverse effects, but the most significant is hypotension caused by the venous dilation that occurs from blockade of sympathetic nerves. The result is decreased blood return to the heart, which causes reduced cardiac output and a drop in blood pressure. The first step in treating this is to put the patient in a 10- to 15-degree head-down position to promote venous return to the heart. Ephedrine or phenylephrine is used if the first measure fails. Spinal headaches are common; the intervention for this is to have the patient assume a supine position. Urinary retention can occur secondary to autonomic blockade; it is a concern if the patient has not voided for 8 hours after the procedure, but not in the immediate postoperative period.

103. A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for:

a. bradycardia.
b. hypoglycemia.
c. jitteriness.
d. tachypnea.

a. bradycardia.

Local anesthetics can cross the placenta, causing bradycardia and central nervous system (CNS) depression in the infant. They do not affect blood glucose. Jitteriness is a sign of CNS excitation. Increased respirations are not an adverse effect in the newborn.

104. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?

a. Difficulty moving the fingers of the affected hand
b. Inability to feel pressure at the suture site
c. Nervousness and tachycardia
d. Sensation of pain returning to the wound

c. Nervousness and tachycardia

Absorption of the vasoconstrictor can cause systemic effects, including nervousness and tachycardia. If severe, alpha- and beta-adrenergic antagonists can be given. Local anesthetics are nonselective modifiers of neuronal function and also can block motor neurons, so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is an expected effect. As the local anesthetic wears off, the sensation of pain will return.

105. A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?

a. Ask the provider why an injectable anesthetic is being used for this procedure.
b. Draw up the medication as ordered and prepare the infant for the procedure.
c. Make sure that seizure precautions are in place.
d. Question the use of the epinephrine for this procedure.

d. Question the use of the epinephrine for this procedure.

The physician is preparing to use infiltration anesthesia by injecting the local anesthetic directly into the immediate area of surgery. Epinephrine can be used in some cases but should never be used in areas supplied by end arteries, such as the penis, toes, fingers, nose, or ears, because restriction of blood flow in these areas can result in gangrene. Injectable agents are appropriate for this procedure. The nurse should not draw up the medication as requested, because the combination of agents can harm the patient. Seizure precautions are not necessary.

106. A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?

a. "Local anesthetics affect large myelinated neurons first."
b. "Local anesthetics affect motor and sensory nerves."
c. "Local anesthetics do not block temperature perception."
d. "Local anesthetics do not cause systemic effects."

b. "Local anesthetics affect motor and sensory nerves."

Local anesthetics are nonselective modifiers of neuronal function. They block actions in both motor and sensory nerves. They affect small myelinated neurons first. They block temperature, pressure, and pain sensation. When absorbed into the systemic circulation, they can cause systemic effects.

107. Vasoconstrictors are combined with local anesthetics for which reasons? (Select all that apply.)

a. To enhance absorption
b. To reduce the risk of toxicity
c. To prevent bradycardia
d. To shorten the duration of action
e. To prolong anesthesia

b. To reduce the risk of toxicity
e. To prolong anesthesia

Vasoconstrictors, when combined with local anesthetics, reduce the risk of toxicity and prolong the anesthetic effects. Vasoconstrictors, when combined with local anesthetics, do not speed up the absorption process, prevent bradycardia, or shorten the duration of action.

108. A prescriber has ordered clonidine (Catapres) for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching?

a. "I should chew sugar-free gum or drink water to reduce dry mouth."
b. "I should not drive as long as I am taking this drug."
c. "I should stand up slowly when taking this medication."
d. "I should stop taking this drug if I feel anxious or depressed."

a. "I should chew sugar-free gum or drink water to reduce dry mouth."

Xerostomia is a common side effect of clonidine and is often uncomfortable enough that patients stop using the drug. Counseling patients to chew sugar-free gum and take frequent sips of liquid can help alleviate this discomfort. Drowsiness is common, but this side effect becomes less intense over time. Patients should be counseled to avoid hazardous activities in the first weeks of therapy if they feel this effect. The hypertensive effects of clonidine are not posture dependent, as they are with the peripheral alpha-adrenergic blockers, so orthostatic hypotension is minimal with this drug. Clonidine causes euphoria, hallucinations, and sedation in high doses and can cause anxiety or depression, although the last two effects are less common. The drug should not be stopped abruptly because of the risk of rebound hypertension, so patients experiencing unpleasant central nervous system (CNS) effects should consult their provider about withdrawing the medication slowly.

109. A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what?

a. "If you have a positive Coombs' test result, you will need to discontinue the medication, because this means you have hemolytic anemia."
b. "Methyldopa can be used for its analgesic effects and for its hypertensive effects."
c. "Xerostomia and orthostatic hypotension are serious side effects and indications for withdrawing the medication."
d. "You will need to contact the provider and stop taking the medication if your eyes look yellow."

d. "You will need to contact the provider and stop taking the medication if your eyes look yellow."

Hepatotoxicity is a serious adverse effect of methyldopa and is an indication for withdrawal of the drug to prevent fatal hepatic necrosis. Jaundice is a sign of liver toxicity. Patients should undergo periodic liver function tests while taking the drug. Liver function usually improves when the drug is withdrawn. A positive Coombs' test result is not an indication for withdrawal of the drug in itself. About 5% of patients with a positive Coombs' test result develop hemolytic anemia; withdrawal of the drug is indicated for those patients. Methyldopa does not have analgesic effects. Xerostomia and orthostatic hypotension are known side effects of methyldopa but usually are not serious.

110. A patient complains to the nurse that the clonidine (Catapres) recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate?

a. "Drowsiness is a common side effect initially, but it will lessen with time."
b. "You may also experience orthostatic hypotension along with the drowsiness."
c. "You may be at risk for addiction if you have central nervous system side effects."
d. "You should discontinue the medication and contact your prescriber."

a. "Drowsiness is a common side effect initially, but it will lessen with time."

CNS depression, evidenced in this patient by drowsiness, is common in about 35% of the population. These responses become less intense with continued drug use. Orthostatic hypotension is less likely with clonidine, because its antihypertensive effects are not posture dependent. The experience of drowsiness does not indicate abuse potential. The patient should not discontinue the medication abruptly because of the potential for rebound hypertension; the patient should contact the prescriber before stopping the medication.

111. A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching?

a. "Methyldopa results in alpha2 agonist activation, but it is not itself an alpha2 agonist."
b. "Methyldopa is not effective until it is converted to an active compound."
c. "Methyldopa reduces blood pressure by reducing cardiac output."
d. "Methyldopa's principal mechanism is vasodilation, not cardiosuppression."

c. "Methyldopa reduces blood pressure by reducing cardiac output."

Methyldopa does not reduce the heart rate or cardiac output, so its hypotensive actions are not the result of cardiac depression. The drug is not, in itself, an alpha2 agonist. When taken up into brainstem neurons, it is converted into methylnorephinephrine, which is an alpha2 agonist; it is not effective until converted to this active compound. Its hypotensive effects are the result of vasodilation, not cardiosuppression.

112. A nurse is teaching a patient about a new prescription for reserpine (Serpasil) for hypertension. Which statement by the patient indicates the need for further teaching?

a. "Depressive side effects are common and will improve over time."
b. "I should report gastrointestinal side effects to the provider."
c. "I should stand up slowly when getting up and lie down if I feel dizzy."
d. "Therapeutic effects may not be optimal for a couple of weeks."

a. "Depressive side effects are common and will improve over time."

Reserpine can produce severe depression, which may persist for months during drug therapy and after the drug is withdrawn. Reserpine can stimulate the secretion of gastric acid, which can cause ulcers; it also can increase the tone and motility of intestinal smooth muscle, which can cause cramps and diarrhea. Reserpine can cause orthostatic hypotension, so patients should be counseled to rise slowly when standing up and to sit or lie down if they feel dizzy. Reserpine works by depleting norepinephrine, and the processes necessary for this may take 1 to 2 weeks.

113. A patient who has been taking clonidine (Catapres) for several weeks complains of drowsiness and constipation. What will the nurse do?

a. Recommend that the patient take most of the daily dose at bedtime.
b. Suggest asking the provider for a transdermal preparation of the drug.
c. Suspect that the patient is overusing the medication.
d. Tell the patient to stop taking the drug and call the provider.

a. Recommend that the patient take most of the daily dose at bedtime.

CNS depression is common with clonidine, but this effect lessens over time. Constipation is also a common side effect. Patients who take most of the daily amount at bedtime can minimize daytime sedation. Transdermal forms of clonidine do not alter adverse effects. Patients who are abusing clonidine often experience euphoria and hallucinations along with sedation, but they generally find these effects desirable and would not complain about them to a healthcare provider. Clonidine should not be withdrawn abruptly, because serious rebound hypertension can occur.

114. A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question?

a. Clonidine (Catapres)
b. Guanabenz (Wytensin)
c. Methyldopa
d. Reserpine (Serpasil)

a. Clonidine (Catapres)

Patients who abuse cocaine, opioids, and other such drugs also frequently abuse clonidine, so this agent would not be the best choice for this patient. The other drugs do no share this abuse potential.

115. A prescriber orders transdermal clonidine (Catapres TTS) for a patient with hypertension. What will the nurse teach this patient?

a. That medication given by transdermal patch has fewer systemic side effects
b. That localized skin reactions are uncommon
c. To apply the patch to intact skin on the forearm or leg
d. To change the patch every week

d. To change the patch every week

Transdermal patches are to be changed every 7 days. Medication administered by patch has the same therapeutic effect and adverse effects as that given by other routes, except that localized skin reactions may occur and are common with clonidine patches. The patch should be applied to intact, hairless skin on the upper arm or torso.

116. A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are important before beginning therapy with this drug? (Select all that apply.)

a. Coombs' test
b. Hemoglobin and hematocrit (H&H)
c. Liver function tests
d. Pregnancy test
e. Urinalysis

a. Coombs' test
b. Hemoglobin and hematocrit (H&H)
c. Liver function tests

A positive Coombs' test result occurs in 10% to 20% of patients who take methyldopa chronically. A few of these patients (5%) develop hemolytic anemia. Blood should be drawn for a Coombs' test and an H&H before treatment is started and at intervals during treatment. Because methyldopa is associated with liver disorders, liver function tests should be performed before therapy is started and periodically during treatment. Clonidine, not methyldopa, is contraindicated during pregnancy. A urinalysis is not indicated.

117. A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by the student indicates the need for further teaching?

a. "Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins."
b. "Dilation of arterioles has a direct effect on arterial pressure."
c. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output."
d. "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure."

c. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output."

Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha1 receptors on both arterioles and veins. When alpha1 receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct effect on arterial pressure occurs. When alpha1 receptors on veins are blocked by alpha-adrenergic antagonists, an indirect effect on arterial pressure occurs.

118. A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?

a. It is ordered to prevent perioperative hypertensive crisis.
b. It prevents secretion of catecholamines by the adrenal tumor.
c. It reduces contraction of smooth muscles in the adrenal medulla.
d. It is given chronically after the surgery to prevent hypertension.

a. It is ordered to prevent perioperative hypertensive crisis.

Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute hypertension during surgery. These agents do not prevent secretion of catecholamines; they block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They are given chronically in patients who have inoperable tumors.

119. A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient?

a. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements."
b. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose."
c. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."
d. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."

c. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.

120. The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?

a. "I need to stop the medication if my heart rate increases."
b. "I should not drive while taking this medication."
c. "I should take the first dose at bedtime."
d. "I will stop taking the medication if I feel dizzy."

c. "I should take the first dose at bedtime."

Orthostatic hypotension is a common side effect of this class of drugs and is most severe with the first dose. Administering the first dose at bedtime eliminates the risk associated with this first-dose effect. Tachycardia is an expected side effect; if severe, it can be treated with other medications. Patients should not drive during the first 12 to 24 hours after taking these agents, because fainting and dizziness may occur, but they may drive after that. Dizziness is not an indication for stopping the drug; patients who experience dizziness are instructed to sit or lie down until symptoms pass.

121. A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next?

a. Administer the drug as prescribed.
b. Request an order for atropine.
c. Withhold the dose and document the pulse rate.
d. Withhold the dose and notify the prescriber.

d. Withhold the dose and notify the prescriber.

A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats per minute; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient's heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication.

122. A patient has benign prostatic hyperplasia (BPH) and will receive alfuzosin (Uroxatral). What is an important nursing action when administering this drug?

a. Administer the first dose at bedtime to minimize the first-dose effect.
b. Prepare the patient for potential ejaculatory dysfunction.
c. Request an order for a diuretic to counter the effects of sodium retention.
d. Review the patient's chart for liver function tests (LFTs).

d. Review the patient's chart for liver function tests (LFTs).

Alfuzosin is indicated for BPH only and is contraindicated in patients with moderate to severe hepatic impairment; therefore, LFTs would be an important assessment. It does not interfere with ejaculation. It does not reduce blood pressure and does not cause sodium retention or increased blood volume, so diuretics are not necessary. It does not cause orthostatic hypotension, so first-dose effect precautions are not necessary

123. A nurse is discussing phentolamine (OraVerse) with a nursing student. Which statement by the student indicates the need for further teaching?

a. "Phentolamine can be used to block both epinephrine- and norepinephrine-mediated vasoconstriction."
b. "Phentolamine can be used to treat pheochromocytoma."
c. "Phentolamine is a competitive adrenergic agonist that acts selectively on alpha1 receptors."
d. "Side effects of phentolamine may include tachycardia and hypotension."

c. "Phentolamine is a competitive adrenergic agonist that acts selectively on alpha1 receptors."

Phentolamine has actions on both alpha1 and alpha2 receptors; it is not selective for alpha1 receptors only. It blocks both epinephrine- and norepinephrine-mediated vasoconstriction. It is used to treat pheochromocytoma. Side effects include tachycardia and hypotension.

124. A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with:

a. bronchoconstriction.
b. left-sided heart failure.
c. rebound cardiac excitation.
d. sinus bradycardia.

b. left-sided heart failure

The signs and symptoms describe left-sided heart failure, in which the blood normally handled by the left ventricle and forced out through the aorta into the body backs up into the lungs, producing respiratory signs and symptoms. The patient's signs and symptoms are not indicative of bronchoconstriction, which would cause wheezing and diminished breath sounds. Rebound cardiac excitation occurs when the beta blocker is withdrawn, not during administration of the drug. The patient's heart rate is elevated, so sinus bradycardia is not present.

125. A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe?

a. Alfuzosin (Uroxatral)
b. Prazosin (Minipress)
c. Silodosin (Rapaflo)
d. Tamsulosin (Flomax)

a. Alfuzosin (Uroxatral)


Alfuzosin is used for BPH and does not interfere with ejaculation. All of the other drugs have ejaculatory side effects. Prazosin may be useful for BPH, but it is not approved for this use.

126. A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding of the drug's effects?

a. "It causes bronchodilation, which increases oxygen flow."
b. "It helps reduce the heart's oxygen needs."
c. "It improves blood flow to the heart."
d. "It increases cardiac output."

b. "It helps reduce the heart's oxygen needs."

Blockade of beta1 receptors in the heart reduces cardiac work by reducing the heart rate, the force of contraction, and the velocity of impulse conduction through the AV node. Beta blockers result in bronchoconstriction, not bronchodilation. They do not increase blood flow to the heart. Cardiac output is decreased, not increased.

127. A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition?

a. Hyperglycemia
b. Hyperthyroidism
c. Respiratory distress
d. Tachycardia

c. Respiratory distress

Use of beta blockers during pregnancy can affect a newborn for several days after birth. Newborns are at risk for bradycardia, respiratory distress, and hypoglycemia. Hyperglycemia, hyperthyroidism, and tachycardia are not expected residual effects.

128. A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication?

a. "Check your hands and feet for swelling and report that to your provider."
b. "It is safe to take this medication with a calcium channel blocker."
c. "Stop taking the drug if you become short of breath."
d. "Take your pulse and do not take the medication if your heart rate is fast."

a. "Check your hands and feet for swelling and report that to your provider."

Patients taking propranolol can develop heart failure because of the suppression in myocardial contractility. Patients should be taught to watch for signs, which include shortness of breath, night coughs, and swelling of the extremities. Use of these agents with calcium channel blockers is contraindicated, because the effects are identical and excessive cardiosuppression can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not be given if the pulse is less than 60 beats per minute.

129. A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects?

a. "I need to take it every day to reduce the frequency of migraines."
b. "I will take it as needed to get relief from migraines."
c. "I will take it to shorten the duration of my migraines."
d. "I will take this drug when a migraine starts."

a. "I need to take it every day to reduce the frequency of migraines."

When taken prophylactically, beta blockers can reduce the frequency of migraine attacks. Beta blockers do not provide complete relief from migraines. They do not reduce the duration of migraines. They are not effective for treating migraines once the migraine has begun.

130. Which are adverse effects of alpha blockade? (Select all that apply.)

a. Hypertension
b. Reflex tachycardia
c. Nasal congestion
d. Ejaculation
e. Hypernatremia

b. Reflex tachycardia
c. Nasal congestion
e. Hypernatremia

Adverse effects of alpha blockade include reflex tachycardia, nasal congestion, and hypernatremia. Other adverse effects include orthostatic hypotension and inhibition of ejaculation. Hypertension and ejaculation are not adverse effects of alpha blockade.

131. A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching?

a. "Catecholamines may be given orally."
b. "Catecholamines often require continuous infusion to be effective."
c. "Noncatecholamines do not cross the blood-brain barrier."
d. "Noncatecholamines undergo rapid degradation

b. "Catecholamines often require continuous infusion to be effective."

Catecholamines undergo rapid degradation by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). Consequently, they have a brief duration of action, and continuous infusion often is required to maintain the drug's effects. Catecholamines cannot be used orally. Catecholamines do not cross the blood-brain barrier; noncatecholamines do. Noncatecholamines are not degraded by MAO.

132. 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

b. Increase in urine output

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.

133. A nursing student asks the nurse about receptor specificity of adrenergic agonist medications. What will the nurse say?

a. "As the dosage of these medications increases, drugs in this class are more selective."
b. "Dopamine is selective for dopamine receptors and has no effects on alpha or beta receptors."
c. "Epinephrine is the most selective alpha-adrenergic agonist medication."
d. "Specificity is relative and is dose dependent."

d. "Specificity is relative and is dose dependent."

Receptor specificity is relative, not absolute, and is dose dependent. At low doses, selectivity is maximal, and selectivity declines as the dose increases. Dopamine is the only drug in this class that acts on dopamine receptors, but it also has effects on alpha and beta receptors. Epinephrine is the least selective of this class.

134. A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to:

a. prevent hypertension induced by the anesthetic.
b. prolong absorption of the anesthetic.
c. reduce anesthetic-induced nausea.
d. reduce the pain of an injection.

b. prolong absorption of the anesthetic.

Epinephrine prolongs absorption of the anesthetic, because it is an alpha1 agonist. It is frequently combined with a local anesthetic for this purpose. Local anesthetics do not induce hypertension; therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as an antiemetic and would not reduce anesthetic-induced nausea. Epinephrine is not used to reduce the pain of an injection.

135. 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

c. Edema at the IV insertion site

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.

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