Pharmacology Nursing|Test Bank Lehnes Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants 1st Edition

Pharmacology Nursing| Test Bank Lehnes Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants 1st Edition. A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drugdrug interaction? A) Antibiotics B) Oral contraceptives Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material C) Nonsteroidal anti-inflammatory drugs (NSAIDs) Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material D) Antifungal agents Ans: C Feedback: A decreased hypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs. If this combination is used, the patient should be monitored closely and dosage adjustments made. Antibiotics, oral contraceptives, and antifungal agents are not known to have a drugdrug interaction. 9. A busy patient with many responsibilities is to have a medication ordered to treat her hypertension. To increase compliance with drug therapy, what drug would be a good choice for this patient? A) Acebutolol (Sectral) B) Atenolol (Tenormin) C) Bisoprolol (Zebeta) D) Metoprolol (Lopressor) Ans: D Feedback: Metoprolol would be the best choice because it has an extended release form that only needs to be taken once a day, which should increase patient compliance. Acebutolol, atenolol, and bisoprolol do not come in extended release forms. 10. The nurse provides patient teaching for a patient who has a new order for nadolol (Corgard) to treat hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that the teaching has been effective? A) I should cover my head at all times while I am outdoors. B) Since I am taking this drug, I no longer need to worry about diet and exercise. C) I will not stop taking this drug abruptly and will talk to my doctor before discontinuing. D) I may have a very dry mouth while taking this drug. Ans: C Feedback: Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material A patient receiving an adrenergic blocker must be aware that abruptly stopping the medication may result in a serious reaction. When changing medications or discontinuing their use, these drugs need to be tapered off gradually. This drug is not associated with photophobia or the anticholinergic effect of dry mouth. If the teaching were effective, the patient would be aware that he would need to continue lifestyle modifications, including diet and exercise. Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 2nd Ed. Chapter 15: Adrenergic Agonists Test Bank Multiple Choice 50. 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.” Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material 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.” ANS: D Receptor specificity is relative, is 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.DIF: Cognitive Level: AnalysisREF: pp. 110TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 51. A nurse is teaching parents how to use an Epi-Pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding of the teaching? a. “After using the Epi-Pen, we must go to the emergency department.” b. “The Epi-Pen should be stored inthe refrigerator, because epinephrine issensitive to heat.” c. “The teacher should call us when symptoms start so that we can bring the Epi-Pen to school.” d. “We should jab the device into the thigh until it is empty of solution.” ANS: A After using the Epi-Pen, it is important that the individual get medical attention as quickly as possible. The effects of epinephrine fade in 10 to 20 minutes, and the anaphylactic reaction can be biphasic and prolonged. Epinephrine is sensitive to heat, but storing the device in the refrigerator can compromise the injection mechanism; the device should be stored at room temperature in a dark place. Individuals who need an Epi-Pen must have the device with them at all times; any delay in treatment can be fatal, because anaphylaxis can occur within minutes after exposure. The EpiPen contains 2 mL of epinephrine, but only 0.3 mL is injected; the device will not be empty with a successful injection.DIF: Cognitive Level: ApplicationREF: pp. 116TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 52. A nursing student asks the nurse why epinephrine, and not other adrenergic agonists, isused to treat anaphylactic shock. What will the nurse tell the student? a. “Epinephrine is the only adrenergic agonist that may be given parenterally.” b. “Epinephrine has the ability to activate multiple types of adrenergic receptors.” c. “Other adrenergic agonists have more severe adverse effects and are not safe in the doses needed to treat anaphylaxis.” d. “Other adrenergic agonists have little or no effects on beta2-adrenergic receptors.” ANS: B Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material Epinephrine is used to treat anaphylactic shock because of its ability to activate multiple adrenergic receptor types. Activation of beta1 receptors helps to increase cardiac output and improve blood pressure as well as suppress glottal edema. Activation of beta2 receptors helps to counteract bronchoconstriction. Activation of alpha1 receptors also causes vasoconstriction, which improves blood pressure. Isoproterenol may also be given parenterally but does not activate multiple receptor types. Other adrenergic agonists, such as albuterol, are more specific to beta2 receptors and have fewer side effects.DIF: Cognitive Level: ApplicationREF: pp. 114TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 53. Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? a. Decrease in pulse b. Increase in urine output c. Weight gain d. Improved gastric motility ANS: B 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.DIF: Cognitive Level: ApplicationREF: pp. 119TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 54. A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should the nurse respond? a. “Adrenergic agonists can lose their selectivity when given at higher doses.” b. “Bronchodilation lowers blood pressure, which causes a reflex tachycardia.” c. “Some patients metabolize the drug differently and have unusual side effects.” d. “Systemic effects are intensified with inhaled doses.” ANS: A Although albuterol affectsthe beta2 receptors, at higher doses it may also activate beta1 receptors, causing an increase in the heart rate. Bronchodilation does not lower the blood pressure, and activation of beta1 receptors actually may increase it. Tachycardia is a common side effect. The inhaled route reduces the likelihood of systemic side effects.DIF: Cognitive Level: ApplicationREF: pp. 118TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Downloaded by: chelle | Distribution of this document is illegal Downloaded by: Studypool | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material S - The Marketplace to Buy and Sell your Study Material 55. Because they cause vasoconstriction, alpha1-adrenergic agonists are especially usefulfor: a. causing hemostasis in skin and mucous membranes. b. producing mydriasis to facilitate ophthalmic examinations. c. slowing the heart rate in tachycardic patients. d. treating hypotension. ANS: A The vasoconstrictive effects of alpha1-adrenergic agonists, such as epinephrine, help produce hemostasis in skin and mucous membranes. These agents can increase blood pressure but are not the primary drugs used except in emergency situations. Alpha1 receptors in the radial muscles of the iris, not vasoconstriction, cause mydriasis. Reflex bradycardia is a side effect and not a clinical use of these agents.DIF: Cognitive Level: ApplicationREF: pp. 112TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 56. A nurse isteaching 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 by monoamine oxidase.” ANS: B Catecholamines undergo rapid degradation by monoamine oxidase (MAO) and catechol-Omethyltransferase (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.DIF: Cognitive Level: AnalysisREF: pp. 110TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies.