Questions and Answers
Which drug complication is the nurse trying to prevent when the nurse advises a patient who is taking cholinergic drugs to avoid changing to an upright position rapidly?
Which outcome would be appropriate to establish for patients taking beta1 agonists?
Which question would the nurse ask if a patient recently diagnosed with hypertension reports dizziness when standing?
Which assessment finding would prompt the nurse to hold the medication and contact the health care provider if the nurse is preparing to administer an indirect-acting cholinergic agonist?
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Which assessment is important for the nurse to complete before administering an adrenergic agonist?
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Which parameter would be a priority for the nurse to monitor in a patient taking more than one cholinergic agonist that stimulates muscarinic receptors?
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Which condition in a patient’s history would put the patient at an increased risk for adverse effects after the administration of a beta blocker?
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Which intervention would the nurse add to the plan of care for a patient who has been prescribed bethanechol?
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Which condition in a patient’s medical history would make the use of a direct-acting cholinergic agonist contraindicated?
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Which term is the name for drugs that stimulate the parasympathetic nervous system (PNS)?
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Which patient assessment data indicates a contraindication to the use of bethanechol?
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Which assessment finding would indicate that propranolol is having a therapeutic effect?
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Which action would the nurse take if a patient who was started on a beta-adrenergic agonist reports experiencing heart palpitations after being on the drug for several days?
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Which occurrence is an effect of beta1-adrenergic receptor stimulation?
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Which statement describes the rationale behind administering atropine to a patient before the patient undergoes a scheduled endoscopy?
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Which outcome criteria would the nurse use when determining whether a patient is responding appropriately to the use of an adrenergic drug?
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Which response is a result of sympathetic nervous system stimulation?
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Which side effect will the nurse include in an education session about bethanechol for the treatment of urinary retention? Select all that apply.
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Which finding after 45 minutes indicates that the administration of bethanechol to a patient with neurogenic bladder has been effective?
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Which statement by the patient indicates that the nurse’s teaching is effective if the nurse is teaching the patient about the administration of an adrenergic agonist medication?
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Which conclusion would the nurse draw if the patient, who is being treated with bethanechol for urinary retention, is sweaty and flushed and reports nausea, muscle weakness, and increased salivation?
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Which assessment finding would the nurse expect in a patient taking a selective beta1-receptor blocker?
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Which finding is a therapeutic effect of atropine?
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Which drug classification stimulates the sympathetic nervous system?
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Which action would the nurse take if an asthmatic patient who has completed an albuterol nebulizer treatment tells the nurse, 'I feel like my heart is fluttering, and my hands are very shaky'?
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Which finding is a contraindication for the safe administration of bethanechol?
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Which injectable, fast-acting medication would the nurse expect to administer during a cardiopulmonary resuscitation emergency?
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Which assessment finding would indicate that a patient receiving intravenous epinephrine is experiencing the expected therapeutic effect?
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Which description of anticholinergic medications is accurate?
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Which condition in a patient would make the patient an unsuitable candidate for a sympathomimetic agent?
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Which finding would be of concern to the nurse when assessing a patient receiving an adrenergic agent?
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Which action would the nurse take first if a diabetic patient who is on beta blockers exhibits tremors, irritability, diaphoresis, a blood pressure reading of 130/75 mm Hg, a pulse rate of 80 beats per minute, and a respiration rate of 18 breaths per minute?
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Which action would the nurse take before administering the first dose of atenolol to a patient with hypertension?
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Which cholinergic drug would the nurse anticipate incorporating into the plan of care for a patient with neurogenic bladder?
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Which physiologic effect would be unexpected with the administration of cholinergic agonists?
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Which occurrence would the nurse infer from the assessment findings if a patient receiving anticholinergic drug therapy develops dry skin, dry oral mucous membranes, and mydriasis?
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Which assessment datum indicates that the desired outcome for direct-acting cholinergic agonist agents has been achieved?
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Which clinical presentation is suggestive of complications of anticholinergic drugs? Select all that apply.
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Which clinical indicator would the nurse monitor as a means of observing the activation of muscarinic receptors?
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Which assessment finding would be expected following the administration of an anticholinergic drug?
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Which statement by the nurse explains the differences between cholinergic agonists and cholinergic antagonists?
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Which statement best describes the rationale behind the nurse instructing a patient who has received atropine eye drops for an eye examination to remain in a darkened room or wear sunglasses until the medication wears off?
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Which action would the nurse take if the nurse obtains a blood pressure reading of 160/90 mm Hg when assessing a patient before administering the first dose of an adrenergic drug to treat asthma?
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Which body part is controlled and regulated by the autonomic nervous system? Select all that apply.
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Which adverse reaction would the nurse monitor for in a patient taking bethanechol for the treatment of urinary retention?
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Which assessment finding is a clinical indicator of parasympathetic nervous system stimulation?
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Which medication would the nurse prepare to administer if a patient who received bethanechol for urinary retention develops flushing, increased salivation, sweating, nausea, and abdominal cramping?
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Which information would the nurse include when teaching a patient about the administration of anticholinergic drug therapy?
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Which information would the nurse include when teaching a patient with a new prescription for atenolol about self-administration and monitoring for adverse effects of the drug? Select all that apply.
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Which statement(s) describes how the therapeutic effect of atenolol differs from the therapeutic action of prazosin in decreasing blood pressure? Select all that apply.
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Study Notes
Autonomic Nervous System Overview
- The autonomic nervous system controls involuntary body functions such as heart rate, digestion, and respiratory rate.
- It regulates smooth muscles and glands, playing a crucial role in maintaining homeostasis.
Atenolol Administration
- Before giving atenolol for hypertension, educate patients on medication use and potential side effects.
- Atenolol selectively blocks beta1 receptors, mainly affecting the heart, making respiratory disease history less relevant.
Cholinergic Drugs
- Bethanechol is a direct-acting cholinergic drug specifically indicated for treating neurogenic bladder.
- Early symptoms of cholinergic agonist overdose include flushing, salivation, and abdominal cramping, which necessitate administering atropine as an antidote.
Effects of Cholinergic Agonists
- Cholinergic agonists lower blood pressure through vasodilation and increase gastrointestinal activity, leading to enhanced peristalsis.
- Unexpected cholinergic agonist effects include increased secretions and decreased blood pressure, making increased BP an unusual finding.
Anticholinergic Drugs
- Anticholinergic drug therapy can lead to dry mouth, tachycardia, and blurred vision as side effects by blocking cholinergic receptors.
- The patient should be advised to avoid hot and humid environments due to risks of heat stroke.
Monitoring and Assessment
- For patients taking bethanechol, monitoring for bronchospasms is essential due to potential adverse effects.
- Signs of parasympathetic nervous system stimulation include decreased heart rate.
Atenolol vs. Prazosin
- Atenolol, a beta1 antagonist, reduces blood pressure by decreasing heart rate and cardiac output, while prazosin (an alpha1 antagonist) causes blood vessel vasodilation.
Patient Education
- Instruct patients taking atenolol to monitor for hypotension and advise against abrupt discontinuation of the medication.
- Weight gain of more than 2 lbs in one day should be reported as it may indicate heart failure.
Assessing Drug Effects
- Symptoms like heart palpitations in patients on beta-adrenergic agonists require notifying the healthcare provider due to possible significant cardiovascular effects.
- Understanding the different receptor effects is key in managing medications — beta1 stimulation increases renin secretion, while alpha1 leads to mydriasis and vasoconstriction.
Teaching Tips
- Create a checklist to improve organization and retention of critical information about autonomic medications.
- Engagement in self-monitoring for side effects can empower patients in managing their health effectively.### Atropine Administration
- Atropine decreases apical heart rate and increases intraocular pressure.
- Reduces salivation, assisting in endoscopic procedures to ease the insertion of an endoscope.
- Used to treat bradycardia and ventricular systole by increasing heart rate.
- In glaucoma patients, increased intraocular pressure can result in vision loss.
- Overdose of atropine can lead to increased frequency of urination.
Adrenergic Drug Response Criteria
- Effective response includes alertness, coherent conversation, and vital signs within normal ranges such as a respiratory rate of 16 breaths per minute and blood pressure of 130/72 mm Hg.
- Awakening easily or stating side effects does not indicate appropriate drug response.
Sympathetic Nervous System Effects
- Sympathetic stimulation leads to pupillary dilation.
- Parasympathetic stimulation results in bronchial constriction, increased peristalsis, and decreased heart rate.
Bethanechol Side Effects and Efficacy
- Common side effects of bethanechol include nausea, abdominal cramps, and urinary urgency.
- Constipation is not a side effect; instead, diarrhea may occur.
- Effectiveness is indicated by the occurrence of micturition within 60 minutes of administration.
Adrenergic Agonist Education
- Patients should be instructed to avoid caffeine (in coffee and chocolate) while on adrenergic agonists due to potential cardiac system irritability.
- Increasing fluid intake is essential to prevent constipation.
Cholinergic Crisis Symptoms
- Symptoms such as sweating, flushed skin, nausea, muscle weakness, and increased salivation indicate a cholinergic crisis, not mere side effects.
- Immediate treatment includes intravenous atropine to reverse the crisis.
Selective Beta1-Receptor Blockers
- Expected findings include a decreased heart rate, around 62 beats per minute, consistent with the effects of beta1 blockers.
- Wheezing and irregular pulse are not expected; a bounding radial pulse would also be unusual.
Contraindications and Therapeutic Effects
- Atropine's therapeutic effect includes increased heart rate, particularly in treating bradycardia.
- The drug classification that stimulates the sympathetic nervous system is adrenergic agonists, while antagonists block these effects.
Albuterol and Side Effects
- Albuterol, a beta2 agonist, can cause tachycardia and tremors due to its not entirely selective action on beta2 receptors.
- Patient-reported sensations (heart fluttering, shaky hands) are typical side effects that should be explained rather than necessitating treatment changes.
Assessment of Patients on Cholinergic Drugs
- Assess for postural hypotension, a significant side effect of cholinergic drugs, by advising patients to change positions slowly to avoid dizziness and fainting.
Managing Patients with Beta1 Agonists
- The expected therapeutic effect of beta1 agonists includes increased contractility of the myocardium, enhancing heart function.
Patient Assessment for Dizziness
- In cases of dizziness after hypertension diagnosis, inquire about current medications to rule out potential adrenergic blockers affecting the patient's status.
Indirect-Cholinergic Agonists Monitoring
- When administering an indirect-acting cholinergic agonist, a pulse rate below 60 beats per minute requires holding the medication and contacting a healthcare provider.### Adrenergic Agonists
- Blood pressure assessment is critical before administering adrenergic agonists due to their vasoconstrictive effects, which can lead to life-threatening high blood pressure and stroke.
- Other parameters like temperature, skin integrity, and respiratory rate are not significantly impacted by adrenergic agonists.
Cholinergic Agonists
- Monitoring blood pressure is essential for patients on multiple cholinergic agonists that stimulate muscarinic receptors to detect early hypotension.
- Cholinergic side effects may include diarrhea, urinary frequency, and increased lacrimation, but hemodynamic changes take precedence in monitoring.
Beta Blockers
- Patients with diabetes mellitus using insulin are at a heightened risk for adverse effects when given beta blockers, as these drugs may mask hypoglycemia symptoms.
- A history of myocardial infarction benefits from beta blocker administration, while minor injuries or disorders like hyperactivity are not contraindications.
Bethanechol Administration
- An accurate record of fluid intake and output is necessary to determine the effectiveness of bethanechol in treating urinary retention.
- Common side effects include excessive salivation; thus, oral moisturizers are unnecessary.
- Bethanechol is typically taken 1 hour before or 2 hours after meals to reduce nausea.
Contraindications for Direct-Acting Cholinergic Agonists
- Direct-acting cholinergic agonists are contraindicated in patients with asthma due to the risk of bronchial constriction.
- They are not contraindicated in hypertension, gastroparesis, or neurogenic bladder.
Cholinergic Agents
- Cholinergic agonists stimulate the parasympathetic nervous system (PNS) by mimicking acetylcholine.
- Acetylcholinesterase refers to an enzyme that prolongs the action of acetylcholine, while cholinergic inhibitors block its breakdown and cholinergic blocking agents counteract its effects.
Bethanechol Contraindications
- Bethanechol is contraindicated in patients with asthma as it may cause bronchoconstriction.
- A pulse rate of 60, blood pressure of 140/83 mm Hg, and use of antihypertensive drugs do not contraindicate its use.
Propranolol Therapeutic Effects
- A therapeutic effect of propranolol is indicated by a normal blood pressure reading of 130/75 mm Hg.
- Clear lung fields suggest that the patient is not experiencing respiratory side effects, though strong peripheral pulses are not directly relevant to the drug's action.
- Propranolol serves as a nonselective beta blocker, impacting both beta1 and beta2 receptors for treating hypertension.
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Test your knowledge on the Autonomic Nervous System with this quiz. Covering key concepts and actions related to nursing practices, this quiz aims to assess your understanding of the material. Perfect for students and professionals looking to reinforce their learning.
