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Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz
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Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz
Description
WITH ANSWERS
Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz
Chapter 02: Basic Principles of Drug Action and Drug Interactions
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition
MULTIPLE CHOICE
- The nurse assesses hives in a patient started on a new medication. What is the nurses priority action?
| a. | Notify physician of allergic reaction. |
| b. | Notify physician of idiosyncratic reaction. |
| c. | Notify physician of potential teratogenicity. |
| d. | Notify physician of potential tolerance. |
ANS: A
An allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria, which are easily identified. An idiosyncratic reaction occurs when something unusual or abnormal happens when a drug is first administered. A teratogenic reaction refers to the occurrence of birth defects related to administration of the drug. Tolerance refers to the bodys requirement for increasing dosages to achieve the same effects that a lower dose once did.
DIF: Cognitive Level: Application REF: Page 17 OBJ: 4
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
- The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after administration, the nurse finds the patient agitated and stating that everyone is out to get me. What is the term for this unusual reaction?
| a. | Desired action |
| b. | Adverse effect |
| c. | Idiosyncratic reaction |
| d. | Allergic reaction |
ANS: C
Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first administered. Patients typically exhibit an overresponsiveness to a medication related to diminished metabolism. These reactions are believed to be related to genetic enzyme deficiencies. Desired actions are expected responses to a medication. Adverse effects are reactions that occur in another system of the body; they are usually predictable. Allergic reactions appear after repeated medication dosages.
DIF: Cognitive Level: Knowledge REF: Page 18 OBJ: 4
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Caregiving; Safety; Sensory Perception
- Which is the best description of when drug interactions occur?
| a. | On administration of toxic dosages of a drug |
| b. | On an increase in the pharmacodynamics of bound drugs |
| c. | On the alteration of the effect of one drug by another drug |
| d. | On increase of drug excretion |
ANS: C
Drug interactions may be characterized by an increase or decrease in the effectiveness of one or both of the drugs. Toxicity of one drug may or may not affect the metabolism of another one. Drug interactions may result from either increased or decreased pharmacodynamics. Drug interactions may result from either increased or decreased excretion.
DIF: Cognitive Level: Comprehension REF: Page 18 OBJ: 5
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Safety; Patient Education; Clinical Judgment
- What occurs when two drugs compete for the same receptor site, resulting in increased activity of the first drug?
| a. | Desired action |
| b. | Synergistic effect |
| c. | Carcinogenicity |
| d. | Displacement |
ANS: D
The displacement of the first drug from receptor sites by a second drug increases the amount of the first drug because more unbound drug is available. An expected response of a drug is the desired action. A synergistic effect is the effect of two drugs being greater than the effect of each chemical individually or the sum of the individual effects. Carcinogenicity is the ability of a drug to cause cells to mutate and become cancerous.
DIF: Cognitive Level: Comprehension REF: Page 19 OBJ: 6
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Safety; Patient Education
- What do drug blood levels indicate?
| a. | They confirm if the patient is taking a generic form of a drug. |
| b. | They determine if the patient has sufficient body fat to metabolize the drug. |
| c. | They verify if the patient is taking someone elses medications. |
| d. | They determine if the amount of drug in the body is in a therapeutic range. |
ANS: D
The amount of drug present may vary over time and the blood level must remain in a therapeutic range in order to obtain the desired result. Generic drugs do not necessarily produce a different drug blood level than proprietary medications. Body fat is not measured by drug blood levels. Drug blood levels only measure the amount of drug in the body; they do not determine the source of the medication.
DIF: Cognitive Level: Comprehension REF: Page 17 OBJ: 4
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
- What is the process by which a drug is transported by circulating body fluids to receptor sites?
| a. | Osmosis |
| b. | Distribution |
| c. | Absorption |
| d. | Biotransformation |
ANS: B
Distribution refers to the ways in which drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, and excretion. Osmosis is the process of moving solution across a semipermeable membrane to equalize the dilution on each side. Absorption is the process by which a drug is transferred from its site of entry into the body to the circulating fluids for distribution. Biotransformation, also called metabolism, is the process by which the body inactivates drugs.
DIF: Cognitive Level: Comprehension REF: Page 15 OBJ: 3
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- The nurse assesses which blood level to determine the amount of circulating medication in a patient?
| a. | Peak |
| b. | Trough |
| c. | Drug |
| d. | Therapeutic |
ANS: C
When a drug is circulating in the blood, a blood sample may be drawn and assayed to determine the amount of drug present; this is known as the drug blood level. Peak levels are only those drug blood levels that are at their maximum before metabolism starts to decrease the amount of circulating drug. Trough levels are only those drug blood levels that are at their minimum when metabolism has decreased the amount of circulating drug and before an increase caused by a subsequent dose of the medication. Therapeutic levels are only those within a prescribed range of blood levels determined to bring about effective action of the medication.
DIF: Cognitive Level: Comprehension REF: Page 17 OBJ: 3
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body?
| a. | 8:00 AM |
| b. | 11:00 AM |
| c. | 2:00 PM |
| d. | 6:00 PM |
ANS: C
Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00 AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life is 8 hours.
DIF: Cognitive Level: Analysis REF: Page 15 OBJ: 2
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Elimination; Health Promotion
- What will the nurse need to determine first in order to mix two drugs in the same syringe?
| a. | Absorption rate of the drugs |
| b. | Compatibility of the drugs |
| c. | Drug blood level of each drug |
| d. | Medication adverse effects |
ANS: B
Knowledge of absorption is important but not in order to mix drugs. In order to mix two drugs, compatibility is determined so there is no deterioration when the drugs are mixed in the same syringe. Drug level does not indicate if it is acceptable to mix medications in the same syringe. Adverse effects are important for the nurse to know, but not in order to mix drugs.
DIF: Cognitive Level: Application REF: Page 19 OBJ: 6
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
- A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate?
| a. | Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy. |
| b. | Explain to the patient that these are signs and symptoms of an anaphylactic reaction. |
| c. | Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary. |
| d. | Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction. |
ANS: A
This initial allergic reaction is mild, and the patient is more likely to have an anaphylactic reaction at the next exposure; a medical alert bracelet is necessary to explain the reaction. Signs and symptoms of an anaphylactic reaction are respiratory distress and cardiovascular collapse. A more severe reaction will occur at the next exposure, and the patient should not receive the drug again.
DIF: Cognitive Level: Application REF: Page 18 OBJ: 4
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- When obtaining a patients health history, which assessment data would the nurse identify as having the most effect on drug metabolism?
| a. | History of liver disease |
| b. | Intake of a vegetarian diet |
| c. | Sedentary lifestyle |
| d. | Teacher as an occupation |
ANS: A
Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian diet may affect absorption but not metabolism. Sedentary lifestyle and occupations could affect metabolism (exposure to environmental pollutants), but these do not have the most significant effect on metabolism.
DIF: Cognitive Level: Application REF: Page 16 OBJ: 3
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- A physicians order indicates to administer a medication to the patient via the percutaneous route. The nurse can anticipate that the patient will receive this medication
| a. | intramuscularly. |
| b. | subcutaneously. |
| c. | topically. |
| d. | rectally. |
ANS: C
The percutaneous route refers to drugs that are absorbed through the skin and mucous membranes. Methods of the percutaneous route include inhalation, sublingual (under the tongue), or topical (on the skin) administration. The parenteral route bypasses the gastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or intravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut, IM, or IV injection. In the enteral route, the drug is administered directly into the GI tract by the oral, rectal, or nasogastric route.
DIF: Cognitive Level: Application REF: Page 14 OBJ: 1
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- A nurse is preparing to administer tetracycline to a patient diagnosed with an infection. Which medication should not be administered with tetracycline?
| a. | Ativan |
| b. | Tylenol |
| c. | Colace |
| d. | Mylanta |
ANS: D
Administering tetracycline with Mylanta can provide an antagonistic effect that will result in decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not contraindicated to administer with tetracycline.
DIF: Cognitive Level: Application REF: Page 18 OBJ: 5 | 6
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
MULTIPLE RESPONSE
- Which statement(s) about liberation of drugs is/are true? (Select all that apply.)
| a. | A drug must be dissolved in body fluids before it can be absorbed into body tissues. |
| b. | A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action. |
| c. | The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form. |
| d. | Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patients stomach. |
| e. | Elixirs take longer to be liberated from the dosage form. |
ANS: A, B, C, D
Regardless of the route of administration, a drug must be dissolved in body fluids before it can be absorbed into body tissues. Before a solid drug taken orally can be absorbed into the bloodstream for transport to the site of action, it must disintegrate and dissolve in the GI fluids and be transported across the stomach or intestinal lining into the blood. The process of converting a drug into a soluble form can be partially controlled by the pharmaceutical dosage form used (e.g., solution, suspension, capsules, and tablets with various coatings). The conversion process can also be influenced by administering the drug with or without food in the patients stomach. Elixirs are already drugs dissolved in a liquid and do not need to be liberated from the dosage form.
DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- Which are routes of drug excretion? (Select all that apply.)
| a. | GI tract; feces |
| b. | Genitourinary (GU) tract; urine |
| c. | Lymphatic system |
| d. | Circulatory system; blood/plasma |
| e. | Respiratory system; exhalation |
ANS: A, B, E
The GI system is a primary route for drug excretion. The GU and the respiratory systems do function in the excretion of drugs. The lymphatic and circulatory systems are involved with drug distribution, not drug excretion.
DIF: Cognitive Level: Knowledge REF: Page 15 OBJ: 3
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety; Elimination
- Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all that apply.)
| a. | IV route |
| b. | IM route |
| c. | Inhalation/sublingual |
| d. | Intradermal route |
| e. | Enteral route |
ANS: A, B, C
IV route of administration enables drug absorption more rapidly than the subcut route. IM route of administration enables drug absorption more rapidly because of greater blood flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug absorption more rapidly than the subcut route. Intradermally administered drugs are absorbed more slowly because of the limited available blood supply in the dermis. Enterally administered drugs are absorbed more slowly because of the biotransformation process.
DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 1 | 3
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- The nurse recognizes that which factor(s) would contribute to digoxin toxicity in a 92-year-old patient? (Select all that apply.)
| a. | Taking the medication with meals |
| b. | Prolonged half-life of the drug digoxin |
| c. | Impaired renal function |
| d. | Diminished mental capacity |
ANS: B, C
Impaired renal and hepatic function in older adults impairs metabolism and excretion of drugs, thus prolonging the half-life of a medication. Food would decrease the absorption of the drug. Diminished mental capacity does not contribute to drug toxicity unless it is due to administration errors.
DIF: Cognitive Level: Application REF: Page 15 OBJ: 2 | 3 | 7
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- Which statement(s) about variables that influence drug action is/are true? (Select all that apply.)
| a. | An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person. |
| b. | Body weight can affect the therapeutic response of a medication. |
| c. | Chronic smokers may metabolize drugs more rapidly than nonsmokers. |
| d. | A patients attitude and expectations affect the response to medication. |
| e. | Reduced circulation causes drugs to absorb more rapidly. |
ANS: B, C, D
Body weight can affect response to medications; typically, obese patients require an increase in dosage and underweight patients a decrease in dosage. Chronic smoking enhances metabolism of drugs. Attitudes and expectations play a major role in an individuals response to drugs. Older adults require decreased dosages of drugs to achieve a therapeutic effect. Decreased circulation causes drugs to absorb more slowly.
DIF: Cognitive Level: Comprehension REF: Page 16 | Page 17
OBJ: 5 | 6 | 7 TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
- Which factor(s) affect(s) drug actions? (Select all that apply.)
| a. | Teratogenicity |
| b. | Age |
| c. | Body weight |
| d. | Metabolic rate |
| e. | Illness |
ANS: B, C, D, E
Age, body weight, metabolic rate, and illness may contribute to a variable response to a medication. Teratogenicity does not contribute to a variable response to a medication.
DIF: Cognitive Level: Comprehension REF: Page 16 | Page 17
OBJ: 7 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
COMPLETION
- A patient receives 200 mg of a medication that has a half-life of 12 hours. How many mg of the drug would remain in the patients body after 24 hours?
ANS:
50
The half-life is defined as the amount of time required for 50% of the drug to be eliminated from the body. If a patient is given 200 mg of a drug that has a half-life of 12 hours, then 50 mg of the drug would remain in the body after 24 hours.
DIF: Cognitive Level: Analysis REF: Page 15 OBJ: 2 | 3
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
Chapter 12: Drugs That Affect the Autonomic Nervous System
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition
MULTIPLE CHOICE
- Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously?
| a. | Hypertension |
| b. | Raynauds phenomenon |
| c. | Emphysema |
| d. | Cardiac dysrhythmias |
ANS: C
Beta-adrenergic blockers can produce severe bronchoconstriction. Selective beta-1 antagonists are used to treat hypertension. Alpha-adrenergic blocking agents are used to treat patients with Raynauds disease. Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.
DIF: Cognitive Level: Application REF: Page 180 OBJ: 8
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Care Coordination
- A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate?
| a. | The symptoms are typical and indicate that the medication is at a therapeutic level. |
| b. | The symptoms will tend to resolve with continued therapy. |
| c. | The symptoms are unusual and need to be reported to the health care provider immediately. |
| d. | The symptoms are indicative of toxicity. |
ANS: B
Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive central nervous system (CNS) stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy. The therapeutic level can only be determined by analyzing a blood sample. These are common symptoms and should only be reported if they persist. Symptoms of toxicity are chest pain, persistent palpitations, and tachycardia.
DIF: Cognitive Level: Application REF: Page 178 OBJ: 4 | 5
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Gas Exchange; Patient Education
- What is the primary response to alpha-1 receptor stimulation?
| a. | Bronchodilation |
| b. | Tachycardia |
| c. | Vasoconstriction |
| d. | Uterine relaxation |
ANS: C
Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha-1 receptor stimulation causes bronchoconstriction. Alpha-1 receptor stimulation does not cause tachycardia. Beta-2 receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.
DIF: Cognitive Level: Knowledge REF: Page 180 OBJ: 4 | 5
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Perfusion
- Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynauds disease?
| a. | Adrenergic agents |
| b. | Alpha-adrenergic blocking agents |
| c. | Beta-adrenergic blocking agents |
| d. | Cholinergic agents |
ANS: B
Alpha-adrenergic blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta-adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.
DIF: Cognitive Level: Comprehension REF: Page 180 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Perfusion
- Why are beta blockers used cautiously in patients with respiratory conditions?
| a. | They mask the signs and symptoms of acute hypoglycemia. |
| b. | They cause extensive vasodilation and cardiac overload. |
| c. | They may produce severe bronchoconstriction. |
| d. | They increase hypertensive episodes. |
ANS: C
Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.
DIF: Cognitive Level: Comprehension REF: Page 180 OBJ: 6
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Gas Exchange
- A patient with Parkinsons disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate?
| a. | These drugs help you urinate. |
| b. | These drugs will decrease your eye pressure. |
| c. | These drugs inhibit the action of acetylcholine. |
| d. | These drugs will assist in lowering your heart rate. |
ANS: C
Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinsons disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate.
DIF: Cognitive Level: Application REF: Page 183 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Patient Education
- Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition?
| a. | Hypertension |
| b. | Infectious diseases |
| c. | Diabetes |
| d. | Closed-angle glaucoma |
ANS: D
The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.
DIF: Cognitive Level: Comprehension REF: Page 184 OBJ: 8
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Health Promotion
- Which nerve endings liberate norepinephrine?
| a. | Cholinergic |
| b. | Adrenergic |
| c. | Anticholinergic |
| d. | Muscarinic |
ANS: B
Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.
DIF: Cognitive Level: Knowledge REF: Page 176 OBJ: 5 | 6
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- The autonomic nervous system can be subdivided into which types of adrenergic receptors?
| a. | Nicotinic and muscarinic |
| b. | Afferent and efferent |
| c. | Alpha and beta |
| d. | Agonists and antagonists |
ANS: C
The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors. Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function.
DIF: Cognitive Level: Knowledge REF: Page 176 OBJ: 1 | 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess?
| a. | Blood pressure |
| b. | Lung sounds |
| c. | Mental status |
| d. | Urine output |
ANS: A
Beta-adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect but is not the most important assessment prior to the administration of a beta-adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta-adrenergic blocking agent.
DIF: Cognitive Level: Application REF: Page 180 OBJ: 7
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion
- A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching?
| a. | This medication should not be discontinued suddenly. |
| b. | This medication lowers my blood pressure by helping me get rid of fluid. |
| c. | I may not have my usual symptoms of a hypoglycemic reaction while on this drug. |
| d. | This medication may take a few weeks to work. |
ANS: B
Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta-adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta-adrenergic blocking agents may mask symptoms of hypoglycemia. Beta-adrenergic blocking agents may take several days to weeks to show optimal improvement.
DIF: Cognitive Level: Application REF: Page 180 OBJ: 6
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Patient Education; Perfusion
- An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first?
| a. | Determine the therapeutic blood level. |
| b. | Encourage the patient to decrease water intake. |
| c. | Elevate the patients legs. |
| d. | Withhold the medication. |
ANS: D
These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a health care provider. Determining the therapeutic blood level, encouraging the patient to decrease water intake, and elevating the patients legs are not the first actions that should be taken.
DIF: Cognitive Level: Application REF: Page 178 OBJ: 7
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Cellular Regulation; Perfusion
- A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling dizzy and weak. The most appropriate action for the nurse is to
| a. | immediately notify the physician. |
| b. | teach the patient to move slowly from standing to sitting. |
| c. | discontinue the adrenergic blocker. |
| d. | monitor the blood pressure in both the supine and standing positions. |
ANS: D
Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.
DIF: Cognitive Level: Analysis REF: Page 178 OBJ: 5
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion
- A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to
| a. | report development of alterations to the charge nurse. |
| b. | assess blood glucose. |
| c. | provide for residents safety. |
| d. | medicate with antianxiety medication. |
ANS: C
Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.
DIF: Cognitive Level: Analysis REF: Page 184 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Mood and Affect; Sensory Perception
- The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to
| a. | provide the next dose of the cholinergic agent immediately. |
| b. | assess heart rate and blood pressure. |
| c. | reposition the patient. |
| d. | withhold the next dose and notify the physician. |
ANS: D
Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a health care provider.
DIF: Cognitive Level: Analysis REF: Page 183 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Gas Exchange
MULTIPLE RESPONSE
- Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.)
| a. | Nausea |
| b. | Hypertension |
| c. | Dizziness |
| d. | Bradycardia |
| e. | Constipation |
ANS: A, C, D
Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping.
DIF: Cognitive Level: Knowledge REF: Page 183 OBJ: 8
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
- Which statement(s) is/are true about efferent nerves? (Select all that apply.)
| a. | They transmit signals to the spinal cord and brain. |
| b. | They leave the CNS to carry impulses to other body parts. |
| c. | They are part of the peripheral nervous system. |
| d. | They transmit signals that control contractions of smooth and skeletal muscle. |
| e. | They transmit signals that control contractions of some glandular secretions. |
ANS: B, C, D, E
Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.
DIF: Cognitive Level: Comprehension REF: Page 175 OBJ: 1 | 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.)
| a. | Take the medication with meals. |
| b. | Increase fluids daily. |
| c. | Decrease fiber in the diet. |
| d. | Suck on candy or ice chips. |
| e. | Monitor blood glucose. |
ANS: B, D
Anticholinergic medications cause dryness of mucous membranes. Increasing fluids, sucking on candy or ice chips, or chewing gum helps alleviate the dryness of the mouth, nose, and throat. Taking the medication with meals and decreasing fiber in the diet will not help patients cope with the adverse effects. Anticholinergics do not affect blood glucose levels.
DIF: Cognitive Level: Application REF: Page 184 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Patient Education
- Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.)
| a. | Blood pressure |
| b. | Skeletal muscle contraction |
| c. | GI secretion |
| d. | Body temperature |
| e. | Urination |
ANS: A, C, D, E
Blood pressure, GI secretion, body temperature, and urinary bladder function are body functions controlled by the autonomic nervous system. The autonomic nervous system maintains control over most tissue function, with the exception of skeletal muscle.
DIF: Cognitive Level: Knowledge REF: Page 175 | Page 176
OBJ: 1 | 2 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.)
| a. | Palpitations |
| b. | Dizziness |
| c. | Orthostatic hypotension |
| d. | Hypoglycemia |
| e. | Tremors |
| f. | Bradycardia |
ANS: A, B, C, E
Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient.
DIF: Cognitive Level: Application REF: Page 182 OBJ: 5
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Patient Education
- Neurotransmitter(s) include: (Select all that apply.)
| a. | gamma aminobutyric acid. |
| b. | acetylcholine. |
| c. | serotonin. |
| d. | glucose. |
| e. | histamine. |
| f. | epinephrine. |
ANS: A, B, C, E, F
The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the bodys main source of energy.
DIF: Cognitive Level: Comprehension REF: Page 176 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.)
| a. | Glaucoma |
| b. | Benign prostatic hypertrophy |
| c. | Bradycardia |
| d. | Parkinsons disease |
| e. | Preparation for surgery |
| f. | Stimulation of the vagus nerve |
ANS: C, D, E
Anticholinergic drugs are used to treat bradycardia and Parkinsons disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.
DIF: Cognitive Level: Comprehension REF: Page 184 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Health Promotion
Chapter 24: Drugs Used to Treat Angina Pectoris
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition
MULTIPLE CHOICE
- Which medication combinations may be beneficial in treating angina pectoris?
| a. | Antidysrhythmics and platelet active agents |
| b. | ACE inhibitors and statins |
| c. | Vasoconstrictors and diuretics |
| d. | Analgesics and thrombolytics |
ANS: B
ACE inhibitors and statins are often combined to treat angina pectoris. Antidysrhythmics and platelet active agents are not used in combination to treat angina because angina does not typically result in rhythm disturbances. Vasoconstrictors would exacerbate angina and are not used with diuretics. Analgesics and thrombolytics are not used in combination to treat angina because angina is not caused by a clot, so thrombolytics are not necessary.
DIF: Cognitive Level: Knowledge REF: Page 380 OBJ: 2 | 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG CoA reductase inhibitor. What is the primary indication in using this medication?
| a. | Reduce coronary vessel spasm. |
| b. | Simplify oxygen requirements of the cardiac cells. |
| c. | Lower cholesterol levels. |
| d. | Dilate the coronary arteries. |
ANS: C
HMG CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels. This medication prevents added atherosclerotic vessel buildup and further narrowing of the coronary arteries. Statins do not affect vascular spasms or oxygen requirements of cells. Statins do not dilate coronary arteries.
DIF: Cognitive Level: Comprehension REF: Page 380 OBJ: 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
- What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?
| a. | Use the sublingual form only. |
| b. | Administer subsequent doses parenterally. |
| c. | Allow for a daily 8- to 12-hour nitrate free period. |
| d. | Store the drug in a dark container, free from light and moisture. |
ANS: C
An 8- to 12-hour nitrate free period will eliminate the development of tolerance to nitroglycerin. Route of administration and medication storage methods do not affect tolerance.
DIF: Cognitive Level: Comprehension REF: Page 386 OBJ: 2 | 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Patient Education; Safety; Health Promotion
- Which instruction will the nurse include for a patient prescribed
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