pharm evolve questions for test 2!

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When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.)
A) Decreased peristalsis
B) Diarrhea
C) Delayed gastric emptying
D) Urinary retention

A) Decreased peristalsis
C) Delayed gastric emptying
D) Urinary retention

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses with that of
A) meperidine.
B) fentanyl.
C) codeine.
D) morphine.

D)
The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine.

A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication?
A) Morphine
B) Methadone
C) Meperidine
D) Naloxone

B) Methadone
Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?
A) Renal failure
B) Kidney stones
C) Acute hepatic necrosis
D) Metabolic alkalosi

C) Acute hepatic necrosis

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which of the following medications to prevent toxicity?
A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) vitamin K

B) acetylcysteine (Mucomyst)

Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that
A) massaging muscles decreases the inflammatory response that initiates the painful stimuli.
B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.
C) massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.
D) massaging muscles helps relax the contracted fibers and decrease painful stimuli.

B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.

When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient's
A) respiratory rate.
B) heart rate.
C) blood pressure.
D) mental status.

A) respiratory rate.

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?
A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) protamine sulfate

A) naloxone (Narcan)

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect?
A) Stimulation of the immune system
B) Cough suppressant
C) Expectorant
D) Bronchodilation

B) Cough suppressant

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of
A) autonomic control over circulation.
B) cough reflex center.
C) chemoreceptor trigger zone.
D) respiratory rate and depth.

C) chemoreceptor trigger zone.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?
A) Administer a smaller dose and record the findings
B) Notify the physician and delay drug administration
C) Administer the prescribed dose and notify the physician
D) Hold the drug, record the assessment, and recheck in 1 hour

B) Notify the physician and delay drug administration

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by
A) taking Lomotil with each dose.
B) eating foods high in lactobacilli.
C) taking the medication on an empty stomach.
D) increasing fluid and fiber in the diet

D) increasing fluid and fiber in the diet.

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
A) When pain recurs
B) Every 24 hours
C) Every 72 hours
D) Once a week

C) Every 72 hours

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that
A) narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction.
B) analgesics should be administered as needed (prn) to minimize side effects.
C) pain relief is best obtained by administering analgesics around the clock.
D) patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.

C) pain relief is best obtained by administering analgesics around the clock.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?
A) Acute pain
B) Risk for injury related to central nervous system side effects
C) Impaired gas exchange related to respiratory depression
D) Constipation related to gastrointestinal side effects

C) Impaired gas exchange related to respiratory depression

A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?
A) naloxone (Narcan)
B) naltrexone (ReVia)
C) nalmefene (Revex)
D) flumazenil (Romazicon)

D) flumazenil (Romazicon)

Older adults who are prescribed a benzodiazepine for treatment of insomnia need to be monitored for
A) hallucinations.
B) ataxia.
C) alertness.
D) dyspnea.

B) ataxia.

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?
A) Ineffective peripheral tissue perfusion
B) Fluid volume excess
C) Risk for injury
D) Risk for infection

C) Risk for injury

A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
A) Naloxone HCl (Narcan)
B) Activated charcoal
C) Flumazenil (Romazicon)
D) Ipecac syrup

B) Activated charcoal

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?
A) "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time."
B) "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis."
C) "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses."
D) "There really is no difference; the terms are used interchangeably."

C) "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses."

The patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced
A) delirium tremens.
B) malignant hyperthermia.
C) a tonic-clonic seizure.
D) respiratory arrest.

B) malignant hyperthermia.

A 25-year-old female patient asks the nurse about a new drug advertised on television. The patient wants to know if Ambien would be better for her to use than her current medication, Restoril, for periodic insomnia. The nurse's response is based on knowledge that zolpidem (Ambien) (Select all that apply.)
A) is less likely to cause grogginess in the morning.
B) is a pregnancy category B medication.
C) is contraindicated with depression.
D) should be limited to 7 to 10 days of treatment.

A) is less likely to cause grogginess in the morning.
B) is a pregnancy category B medication.
D) should be limited to 7 to 10 days of treatment.

Midazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect?
A) Decreased heart rate
B) Amnesia
C) Constipation
D) Dry mouth

B) Amnesia

The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system stimulants?
A) atomoxetine (Strattera)
B) dextroamphetamine sulfate (Dexedrine)
C) methylphenidate (Concerta)
D) amphetamine aspartate (Adderall)

A) atomoxetine (Strattera)

Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants?
A) CNS stimulants decrease the production of excitatory neurotransmitters
B) CNS stimulants increase release of and block reuptake of neurotransmitters
C) CNS stimulants block the activity of inhibitory neurons
D) CNS stimulants enhance the effects of phosphodiesterase and subsequent breakdown of cyclic adenosine monophosphate (cAMP)

B) CNS stimulants increase release of and block reuptake of neurotransmitters

When assessing for side effects expected in a patient taking analeptics, the nurse would monitor for which effect?
A) Insomnia
B) Bradycardia
C) Hypotension
D) Decreased mental alertness

A) Insomnia

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug?
A) Myelin degeneration
B) Cardiac dysrhythmias
C) Constipation
D) Heart block

B) Cardiac dysrhythmia

To reduce the gastrointestinal side effects of orlistat (Xenical), what will the nurse encourage the patient to do?
A) Take the medication with an antacid
B) Limit dietary intake of fat to <30% of total calories
C) Supplement diet with fat-soluble vitamins
D) Increase fluid and fiber in the diet

B) Limit dietary intake of fat to <30% of total calories

The nurse should advise a patient prescribed sumatriptan (Imitrex) to avoid which food?
A) Licorice
B) Carrots
C) Broccoli
D) Chocolate

D) Chocolate

Ergot alkaloids such as ergotamine tartrate (Ergostat) exert a therapeutic effect by causing
A) vasoconstriction.
B) vasodilation.
C) blockade of the beta-2 receptors.
D) simulation of the alpha receptors.

A) vasoconstriction.

The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene based on the knowledge that a common side effect of this drug is:
A) Gingival hyperplasia.
B) Oral candidiasis.
C) Increased risk of dental abscesses.
D) Increased incidence of dental caries.

A) Gingival hyperplasia.

The patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic?
A) 8 mcg/mL
B) 30 mcg/mL
C) 12 mcg/mL
D) 6 mcg/mL

C) 12 mcg/mL

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). Which condition will the nurse suspect that the patient experiences?
A) Absence seizures
B) Tonic-clonic seizures
C) Panic attacks
D) Partial seizures

A) Absence seizures

While teaching a patient newly diagnosed with a seizure disorder, the nurse correctly states the goal of pharmacologic therapy as:
A) Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months.
B) Reducing seizure occurrence to one per week.
C) Maximally reducing seizure activity while minimizing side effects of medication therapy.
D) Maximizing drug dosages to control seizure activity.

C) Maximally reducing seizure activity while minimizing side effects of medication therapy.

Antiepileptic drugs work by:
A) Decreasing seizure threshold.
B) Enhancing transmission of impulses from one nerve to another.
C) Decreasing nerve conduction.
D) Correcting electrolyte imbalances.

C) Decreasing nerve conduction.

While teaching a patient newly diagnosed with a seizure disorder, the nurse correctly states the goal of pharmacologic therapy as:
A) Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months.
B) Reducing seizure occurrence to one per week.
C) Maximally reducing seizure activity while minimizing side effects of medication therapy.
D) Maximizing drug dosages to control seizure activity.

C) Maximally reducing seizure activity while minimizing side effects of medication therapy.

Antiepileptic drugs work by:
A) Decreasing seizure threshold.
B) Enhancing transmission of impulses from one nerve to another.
C) Decreasing nerve conduction.
D) Correcting electrolyte imbalances.

C) Decreasing nerve conduction.

While completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that abruptly stopping this drug could cause:
A) Rebound seizure activity.
B) Acute withdrawal syndrome.
C) Hypotension.
D) Confusion and delirium

A) Rebound seizure activity.

A postoperative craniotomy patient is received in the intensive care unit. The nurse makes sure which of the following drugs is readily available to treat acute seizure activity?
A) gabapentin (Neurontin)
B) diazepam (Valium)
C) ethosuximide (Zarontin)
D) flumazenil (Romazicon)

B) diazepam (Valium)

The nurse administers phenytoin (Dilantin) intravenously at a rate no greater than:
A) 10 mg/min.
B) 25 mg/min.
C) 50 mg/min.
D) 100 mg/min.

C) 50 mg/min.
Infusing phenytoin at rates >50 mg/min can cause severe hypotension.

When administering intravenous phenytoin (Dilantin), which action will the nurse perform?
A) Always use an infusion pump.
B) Flush the line with 10 mL normal saline to prevent precipitation.
C) Administer through peripheral intravenous sites only.
D) Monitor for hypertension.

B) Flush the line with 10 mL normal saline to prevent precipitation.

The patient asks the nurse why she is receiving a different drug than her usual phenytoin (Dilantin). The patient is NPO (nothing by mouth) secondary to illness and is receiving intravenous fosphenytoin (Cerebyx). Which is the nurse's most accurate response?
A) "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug."
B) "Phenytoin is not effective while you are NPO, so your health care provider has changed your medication to a more effective drug."
C) "Fosphenytoin is a prodrug of phenytoin—it is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin."
D) "Since you are NPO, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will be transferred back to phenytoin after you recover from this illness."

C) "Fosphenytoin is a prodrug of phenytoin—it is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin."

A patient receiving valproic acid (Depakote) should be monitored for which side effects? (Select all that apply.)
A) Tremors
B) Weight gain
C) Hepatoxicity
D) Hypoglycemia
E) Insomnia

A) Tremors
B) Weight gain
C) Hepatoxicity

The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
A) "You have obviously developed resistance to your current medication and will have to be switched to another drug."
B) "This is an atypical response. Unfortunately, there are no other options of drug therapy to give you."
C) "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
D) "You just need to keep taking your medication and these effects will go away."

C) "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."

When teaching a patient about carbidopa-levodopa (Sinemet), the nurse responds based on knowledge that
A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.
B) carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain.
C) giving both drugs together minimizes side effects.
D) carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.

Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications?
A) levodopa
B) carbidopa
C) selegiline
D) diphenhydramine

C) selegiline

What is the goal of pharmacologic therapy in treating Parkinson's disease?
A) Increase the amount of acetylcholine at the presynaptic neurons.
B) Decrease the amount of dopamine available in the substantia nigra.
C) Balance cholinergic and dopaminergic activity in the brain.
D) Block dopamine receptors in both presynaptic and postsynaptic neurons.

C) Balance cholinergic and dopaminergic activity in the brain.

The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's response is based on knowledge that
A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa.
B) carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease.
C) both drugs have the same pharmacodynamic and side effect profiles.
D) carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.

A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa.

The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brownish-orange urine. The nurse's response is based on the knowledge that
A) the patient may be developing renal failure.
B) the patient may be developing hepatic failure.
C) brownish-orange urine signifies a lack of fluid intake.
D) this is a normal occurrence related to entacapone (Comtan).

D) this is a normal occurrence related to entacapone (Comtan).

The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient suffers from?
A) Obsessive-compulsive disorder
B) Absence seizures
C) Bipolar disorder
D) Paranoid schizophrenia

C) Bipolar disorder

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?
A) Blocking the reuptake of neurotransmitters at nerve endings
B) Increasing alertness levels in the brain
C) Decreasing levels of epinephrine and serotonin at nerve endings
D) Increasing the placebo effect

A) Blocking the reuptake of neurotransmitters at nerve endings

A patient diagnosed with depression is started on a tricyclic antidepressant after failure to improve symptoms on a selective serotonin reuptake inhibitor. The nurse should include which teaching point when educating the patient on the new medication?
A) There are no contraindications to this medication
B) The medication is safe; it has been used longer than many others
C) This class of medications has no other use and is only for depression
D) There is a risk of toxicity when this medication is taken with alcohol

D) There is a risk of toxicity when this medication is taken with alcohol

A patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance?
A) ibuprofen
B) St. John's wort
C) vitamin E supplements
D) glucosamine condroitin

B) St. John's wort

A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education?
A) "I can just stop taking my Elavil and start taking the Celexa as ordered."
B) "I can expect fewer cardiovascular side effects such as orthostatic hypotension with the Celexa."
C) "The doctor is switching me to this medication because it is less expensive but just as effective."
D) "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."

B) "I can expect fewer cardiovascular side effects such as orthostatic hypotension with the Celexa."

Which activity should the patient be cautioned against while taking an MAO inhibitor?
A) Participating in a bowling league
B) Sunbathing at the pool
C) Eating aged cheese
D) Smoking a low-nicotine cigarette

C) Eating aged cheese

Bupropion (Zyban), a second-generation antidepressant, is unique in that it is also used to
A) treat orthostatic hypotension.
B) aid in smoking cessation.
C) increase appetite in patients undergoing chemotherapy.
D) treat nocturnal enuresis in children.

B) aid in smoking cessation.

A patient diagnosed with an anxiety disorder has been utilizing lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient?
A) alprazolam (Xanax)
B) buspirone (BuSpar)
C) chlordiazepoxide (Librium)
D) hydroxyzine hydrochloride salt (Atarax)

B) buspirone (BuSpar)

Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy?
A) "I need to change positions slowly to prevent dizziness."
B) "I will need to wear sunscreen and protective clothing when outdoors."
C) "It is okay to take this drug with a small glass of wine to help relax me."
D) "I should call my doctor if I notice any uncontrollable movements of my tongue."

C) "It is okay to take this drug with a small glass of wine to help relax me."

Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)?
A) Renal panel
B) Complete blood count
C) Liver function tests
D) Immunoglobulin levels

B) Complete blood count

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects, including
A) dystonia
B) orthostatic hypotension
C) dry mouth and constipation
D) neuroleptic malignant syndrome

A) dystonia

An atypical antipsychotic medication useful for treatment of refractory schizophrenia is
A) trazodone (Desyrel).
B) phenelzine (Nardil).
C) amoxapine (Asendin).
D) risperidone (Risperdal)

D) risperidone (Risperdal).

The patient asks the nurse if switching from citalopram (Celexa) to escitalopram (Lexapro) would be beneficial. The nurse responds based on knowledge that
A) citalopram (Celexa) is more expensive than excitalopram (Lexapro).
B) both medications have similar therapeutic and side effect profiles.
C) escitalopram (Lexapro) has a decreased risk of side effects compared to citalopram (Celexa).
D) escitalopram (Lexapro) has a better therapeutic effect if used in combination therapy.

C) escitalopram (Lexapro) has a decreased risk of side effects compared to citalopram (Celexa).

Epinephrine, as an adrenergic (sympathomimetic) drug, produces which of the following therapeutic effects?
A) Urinary retention
B) Bronchial constriction
C) Increased heart rate and contractility
D) Decreased intestinal motility

C) Increased heart rate and contractility

The doctor has ordered dopamine to treat your patient's hypovolemic shock due to severe blood loss. For the medication to be effective, the physician must also order
A) fluid replacement.
B) beta-stimulating drugs.
C) antibodies.
D) fluid restriction.

A) fluid replacement.

Your patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.)
A) Heart rate
B) Blood pressure
C) Urine output
D) Liver enzymes

A) Heart rate
B) Blood pressure
C) Urine output

Your patient is to receive dopamine 5 mcg/kg/min. He weighs 176 lb. You have dopamine 400 mg in 500 mL D5W. You will infuse this at
A) 20 mL/hr.
B) 30 mL/hr.
C) 35 mL/hr.
D) 50 mL/hr.

B) 30 mL/hr.

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce
A) a positive inotropic, positive chronotropic, and positive dromotropic effect.
B) a positive inotropic, negative chronotropic, and negative dromotropic effect.
C) a negative inotropic, positive chronotropic, and positive dromotropic effect.
D) a negative inotropic, negative chronotropic, and negative dromotropic effect.

A) a positive inotropic, positive chronotropic, and positive dromotropic effect.

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with
A) beta-blockers.
B) diuretics.
C) alpha1-blockers.
D) MAO inhibitors.

D) MAO inhibitors.

The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which of the following medications to treat this infiltration?
A) lidocaine (Xylocaine)
B) phentolamine (Regitine)
C) nitroprusside (Nipride)
D) naloxone (Narcan)

B) phentolamine (Regitine)

A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that
A) Afrin nasal spray is not an effective nasal decongestant.
B) the medication needs to be used every 30 minutes for maximum effectiveness.
C) the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.
D) adrenergic decongestants should only be used prophylactically, not to treat acute congestion.

C) the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.

Nonselective beta-blockers may be used to treat hypertension and
A) chronic obstructive pulmonary disease (COPD).
B) heart failure.
C) heart block.
D) supraventricular arrhythmias.

D) supraventricular arrhythmias.

Feedback: CORRECT
Nonselective beta-blockers are used to treat supraventricular arrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure, COPD, and heart block secondary to their negative inotropic effect (heart failure), blocking of bronchodilation (COPD), and negative chronotropic effects (heart block).

An example of a cardioselective beta-blocker includes
A) propranolol (Inderal).
B) labetalol (Normodyne).
C) atenolol (Tenormin).
D) sotalol (Betapace).

C) atenolol (Tenormin).
Feedback: CORRECT
At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.

When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that
A) these medications may be taken with antacids to minimize gastrointestinal distress.
B) hot baths and showers will help enhance the therapeutic effects and are encouraged.
C) alcohol intake is encouraged for its vasodilating effects.
D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

Feedback: CORRECT
Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.

Propranolol (Inderal) is an effective
A) selective alpha-adrenergic antagonist.
B) nonselective beta-adrenergic antagonist.
C) beta1-adrenergic antagonist.
D) beta2-adrenergic antagonist.

B) nonselective beta-adrenergic antagonist.

Feedback: CORRECT
Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses.

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) nadolol (Corgard)
B) phentolamine (Regitine)
C) dobutamine (Dobutrex)
D) verapamil (Calan)

B) phentolamine (Regitine)
Feedback: CORRECT
Phentolamine is a potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma.

When assessing for cardiovascular effects of a beta-blocker, the nurse understands that these drugs produce
A) a positive inotropic, positive chronotropic, and positive dromotropic effect.
B) a positive inotropic, negative chronotropic, and negative dromotropic effect.
C) a negative inotropic, positive chronotropic, and positive dromotropic effect.
D) a negative inotropic, negative chronotropic, and negative dromotropic effect.

D) a negative inotropic, negative chronotropic, and negative dromotropic effect.

Beta-blockers exert a sympatholytic effect, blocking the effects of sympathetic nervous system stimulation, causing a decrease in heart rate (negative chronotropic), conductivity (negative dromotropic), and contractility (negative inotropic).

Beta-blockers are used to treat which disorders? (Select all that apply.)
A) Hypertension
B) COPD
C) Angina pectoris
D) Cardiac dysrhythmias

A) Hypertension
C) Angina pectoris
D) Cardiac dysrhythmias
Feedback: CORRECT
Beta-blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta-blockers can exacerbate COPD as they block beta2 receptors and subsequent bronchodilation.

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be
A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication.
B) Disturbed sensory perception related to adverse central nervous system effects of the drug.
C) Deficient knowledge related to therapeutic regimen.
D) Risk for injury related to possible side effects of the adrenergic blockers.

A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication.
Feedback:
Using the ABCs of prioritization, Ineffective tissue perfusion (cerebral and cardiovascular) puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Patient teaching for a patient being discharged on a beta-blocker includes which statement?
A) "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
B) "If you become dizzy, do not take your medication for 2 days and then restart on the third day."
C) "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem."
D) "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

A) "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
Feedback: CORRECT
Beta-blockers have a negative chronotropic effect and could cause symptomatic bradycardia and/or heart block. The physician should be consulted before administering to a patient with bradycardia (heart rate <60 beats/min).

The nurse is admitting a patient with a history of angina and hypertension who is currently experiencing moderate heart failure. The patient's current medication regimen includes digoxin, furosemide, and accupril. Which medication would be most beneficial to add to this patient's treatment plan?
A) carvedilol (Coreg)
B) propranolol (Inderal)
C) esmolol (Brevibloc)
D) sotalol (Betapace)

A) carvedilol (Coreg)
Feedback:
Carvedilol (Coreg), a combined alpha1- and beta-blocker, has been shown to slow the progression of heart failure and decrease the frequency of hospitalization in patients with mild to moderate (Class II or III) heart failure. Carvedilol is most commonly added to digoxin, furosemide, and angiotensin-converting enzyme (ACE) inhibitors when used to treat heart failure.

Cholinergic (parasympathomimetic) drugs have which therapeutic effect?
A) Urinary retention
B) Increased gastrointestinal motility
C) Mydriasis
D) Vasoconstriction

B) Increased gastrointestinal motility

Feedback: CORRECT
Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing gastrointestinal motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.

Cholinergic (parasympathomimetic) drugs are indicated for which situation?
A) Treating a postoperative patient who has bradycardia
B) Lowering intraocular pressure in patients with glaucoma
C) Inhibiting muscular activity in the bladder
D) Preventing salivation and sweating

B) Lowering intraocular pressure in patients with glaucoma

Feedback: CORRECT
Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.

During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat
A) postoperative hypotension.
B) urinary atony.
C) respiratory atelectasis.
D) postoperative ischemic colitis.

B) urinary atony.
Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.

Adverse reactions to bethanechol include
A) constipation.
B) hypertension.
C) tachycardia.
D) headache.

D) headache.
Feedback: CORRECT
Side effects of bethanechol include abdominal cramps, diarrhea, hypotension, bradycardia, and headache.

The nurse would question an order for cevimeline (Evoxac) in a patient with a history of
A) leg cramps.
B) hemorrhoids.
C) tachycardia.
D) narrow-angle glaucoma.

D) narrow-angle glaucoma.

The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to
A) relieve anxiety and restless behavior of the patient.
B) increase levels of acetylcholine in the brain by blocking its breakdown.
C) block the effects of acetylcholine at the presynaptic neurons.
D) help control associated urinary incontinence.

B) increase levels of acetylcholine in the brain by blocking its breakdown.

When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate?
A) Increase fluid and fiber in the diet to prevent constipation.
B) Take the medication 30 minutes before meals.
C) If a dose is missed, double the next dose to prevent withdrawal.
D) Common side effects include tachycardia and hypertension.

B) Take the medication 30 minutes before meals.

Side effects to expect from anticholinergic (parasympatholytic) drugs, such as atropine, include which effects? (Select all that apply.)
A) Dilated pupils (mydriasis)
B) Urinary retention
C) Dry mouth
D) Diarrhea
E) Increased sweating

A) Dilated pupils (mydriasis)
B) Urinary retention
C) Dry mouth

A patient presents with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously?
A) 0.3 mg
B) 0.5 mg
C) 1.25 mg
D) 2 mg

B) 0.5 mg
The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

A patient presents to the emergency room with insecticide poisoning. The nurse prepares to administer which dose of atropine intravenously?
A) 0.3 mg
B) 0.5 mg
C) 2 mg
D) 4 mg

C) 2 mg
Higher doses of atropine (1 to 3 mg) are needed to treat cholinergic overdoses such as insecticide poisoning.

The nurse monitors a patient taking tolterodine (Detrol) for which therapeutic effect?
A) Decrease in gastrointestinal motility
B) Decrease in urinary frequency
C) Increase in heart rate
D) Increase in blood pressure

B) Decrease in urinary frequency

The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect?
A) Decrease in gastrointestinal motility
B) Decrease in urinary frequency
C) Increase in heart rate
D) Increase in blood pressure

A) Decrease in gastrointestinal motility

A priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs would be
A) Risk for injury related to excessive central nervous system stimulation.
B) Impaired gas exchange related to thickened respiratory secretions.
C) Urinary retention related to loss of bladder tone.
D) Deficient knowledge related to pharmacologic regimen.

B) Impaired gas exchange related to thickened respiratory secretions.

Which would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness?
A) At bedtime
B) Every 4 hours as needed
C) 4 to 5 hours before travel
D) At the first sign of motion sickness

C) 4 to 5 hours before travel

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