Topic 4 Autonomic Nervous System PDF

Performance Exit Topic 4 Autonomic Nervous System Due Jun 2, 2024 by 11:59 pm Final Score 42% 21 out of 50 questions answered correctly Completed o...

Performance Exit Topic 4 Autonomic Nervous System Due Jun 2, 2024 by 11:59 pm Final Score 42% 21 out of 50 questions answered correctly Completed on Jun 2, 2024 11:43 pm Incorrect (29) Report content error Which action would the nurse take before administering the first dose of atenolol to a patient with hypertension?  Assess the patient’s lungs. Teach the patient about beta blockers. Assess the patient’s oxygenation status. Ask the patient if the patient has a history of any respiratory disease. Rationale The nurse would teach the patient about the new medication, including safe administration and side effects. Although the nurse should assess the patient overall on a regular basis, the assessment should include all body systems, not just the lungs and oxygenation status. At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors in the lungs; thus it is not necessary to obtain a specific history of respiratory disease. Study Tip: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as by using index cards with essential data, which are easy to carry and review whenever you have a spare moment. p. 183 Report content error Which cholinergic drug would the nurse anticipate incorporating into the plan of care for a patient with incorporating into the plan of care for a patient with neurogenic bladder? Donepezil hydrochloride Cevimeline Bethanechol Succinylcholine Rationale Bethanechol is a direct-acting cholinergic drug that is used to treat neurogenic bladder. It is the only direct-acting cholinergic drug that is administered orally. Thus the nurse would anticipate incorporating bethanechol into the plan of care for this patient. Donepezil, cevimeline, and succinylcholine are not useful for treating neurogenic bladder. Donepezil is an indirect-acting cholinergic drug that is used to treat Alzheimer disease. Cevimeline is a direct-acting cholinergic drug used in the treatment of xerostomia (dry mouth) due to Sjögren syndrome. Succinylcholine is used in general anesthesia as a neuromuscular blocker. p. 188 Report content error Which physiologic effect would be unexpected with the administration of cholinergic agonists? Increased peristalsis Increased blood pressure Increased bronchial secretions Increased pupillary constriction Rationale Cholinergic agonists stimulate the parasympathetic nervous system, resulting in decreased, not increased, blood pressure due to vasodilation. Thus increased blood pressure would be unexpected. Other effects of cholinergic agonists include increased tone and motility of the gastrointestinal system, resulting in increased peristalsis; stimulation of bronchial smooth muscle contraction and increased bronchial secretions; and increased pupillary constriction. p. 189 Report content error 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? A drug interaction An allergic reaction An overdose of the drug Alcohol use with the drug Rationale An overdose of an anticholinergic drug acts directly on the parasympathetic nervous system and activates the nicotinic receptors. This decreases the oral secretions, causing dry skin and mucous membranes. Stimulation of nicotinic receptors also causes contraction of the sphincter muscle of the iris, thereby causing mydriasis. Based on the assessment findings, the nurse would infer that an anticholinergic overdose has occurred. The patient has not reported any other drug consumption, so a major drug interaction would not be possible. An allergic reaction to this drug causes sedation and constipation, not dry skin and mydriasis. Alcohol does not interact with anticholinergic drugs. p. 189 Report content error Which assessment datum indicates that the desired outcome for direct-acting cholinergic agonist agents has been achieved? Hourly urine output of 70 mL Blood pressure of 130/89 mm Hg Pulse rate of 70 beats per minute Bilateral mydriasis with accommodation Rationale Direct-acting cholinergic agonist agents are used to manage urinary retention. Therefore an hourly urine output of 70 mL is the desired outcome. Blood pressure, heart rate, and pupillary dilation are not desired outcomes for direct-acting cholinergic agonist agents. Test-Taking Tip: Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement. p. 188 Report content error Which clinical presentation is suggestive of complications of anticholinergic drugs? Select all that apply. One, some, or all responses may be correct. or all responses may be correct. Some correct answers were not selected Diarrhea Dry mouth Tachycardia Blurred vision Bronchospasm Rationale Clinical manifestations of complications associated with the use of anticholinergic drugs include dry mouth, tachycardia, and blurred vision. These complications occur due to blockage of cholinergic receptors. Diarrhea and bronchospasm are not complications of anticholinergic drugs. Report content error Which clinical indicator would the nurse monitor as a means of observing the activation of muscarinic receptors? Urinary retention Increased heart rate Decreased gastric secretions Increased bronchial secretions Rationale Muscarinic receptor activation causes an increase in secretions from the pulmonary system. Thus the nurse would monitor the patient for increased bronchial secretions as a means of observing the activation of muscarinic receptors. Muscarinic stimulation causes contraction of smooth muscle in the bronchi, increases bladder tone (but relaxes urinary sphincters), and slows the heart rate. p. 190 Report content error Which assessment finding would be expected following the administration of an anticholinergic drug? Miosis Vasodilation Urinary frequency Decreased gastrointestinal (GI) motility Rationale Anticholinergics act by blocking the parasympathetic nerves, allowing the sympathetic nervous system to dominate. Anticholinergics have the opposite effect of cholinergics. The major response to anticholinergic drug therapy is a decrease in GI motility, along with dilation of the pupils, a decrease in salivation, and an increase in pulse rate. Miosis, vasodilation, and urinary frequency are all assessment findings consistent with the use of cholinergic agonist drugs. p. 192 Report content error Which statement by the nurse explains the differences between cholinergic agonists and cholinergic antagonists? “Cholinergic agonists result in ‘fight or flight’ responses, whereas cholinergic antagonists result in ‘rest and digest’ responses.” “Cholinergic agonists stimulate acetylcholine, and cholinergic antagonists block acetylcholine by occupying its receptors.” “Cholinergic agonists mimic epinephrine to increase heart rate, whereas cholinergic antagonists mimic acetylcholine to decrease heart rate.” “Cholinergic agonists are used to stimulate epinephrine to improve perfusion, whereas cholinergic antagonists mimic acetylcholine to decrease perfusion.” Rationale Cholinergic agonists stimulate acetylcholine, and cholinergic antagonists block acetylcholine by occupying its receptors. Cholinergic agonists do not result in “fight or flight” responses because these are sympathetic nervous system actions. Cholinergic agonists mimic the action of acetylcholine, not epinephrine. Epinephrine is a neurotransmitter of the sympathetic nervous system, and cholinergic agents affect the parasympathetic responses. Cholinergic agonists do not stimulate epinephrine to improve perfusion. pp. 187,191 Report content error 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 for several hours until the medication wears off? “Atropine causes miosis.” “Atropine causes paralysis of the iris sphincter.” “Atropine causes relaxation of ciliary muscles.” “Atropine causes elevation of intraocular pressure.” Rationale Atropine causes paralysis of the iris sphincter by blocking muscarinic receptors in the eye. This leads to dilation of the pupils. Consequently, the eye cannot adapt to bright light. Muscarinic agonists cause miosis; atropine causes mydriasis. Atropine relaxes the ciliary muscles and thus causes blurred vision. This also causes an elevation in intraocular pressure, which increases the risk for glaucoma. Nevertheless, it is not an indication for remaining in a darkened room or wearing sunglasses. p. 195 Report content error 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? Notify the health care provider of the patient’s elevated blood pressure reading. Administer the medication but monitor the blood pressure closely for the first hour. Administer the medication as usual because the patient’s hypertension is not new onset. Hold the initial dose of the medication until the patient’s blood pressure decreases. Rationale Adrenergic drugs are contraindicated in the case of severe hypertension, so the nurse would notify the health care provider of the finding. The medication should not be administered, and the nurse should notify the health care provider rather than simply wait for the patient’s blood pressure to go down before administering the medication. pp. 177,180 Report content error Which body part is controlled and regulated by the autonomic nervous system? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Eyes Heart Urinary bladder Skeletal system Respiratory system Gastrointestinal (GI) tract Rationale The autonomic nervous system acts on smooth muscles and glands. Its functions include control and regulation of the eyes, heart, urinary bladder, respiratory system, and GI tract. It is an involuntary system over which humans have little or no control; humans breathe, their hearts beat, and peristalsis continues without them realizing it. Humans have voluntary control over the skeletal system; it is not controlled by the autonomic nervous system. Report content error Which adverse reaction would the nurse monitor for in a patient taking bethanechol for the treatment of urinary retention? Mydriasis Constipation Hypertension Bronchospasms Rationale Adverse effects of taking bethanechol include bronchospasms, hypotension, tachycardia, headaches, seizures, and gastrointestinal upset. Thus the nurse would monitor for bronchospasms in a patient taking bethanechol for the treatment of urinary retention. Miosis, not mydriasis, may result from the use of bethanechol. Mydriasis, constipation, and hypertension are not expected adverse reactions from the use of bethanechol. p. 188  Report content error Which assessment finding is a clinical indicator of parasympathetic nervous system stimulation? Retention of urine Dilation of the pupils Dilation of the bronchi Slowing of the heart rate Rationale The parasympathetic nervous system performs seven regulatory functions: slowing the heart rate, increasing gastric secretions, emptying the bladder, emptying the bowel, focusing the eye for near vision, constricting the pupil, and contracting bronchial smooth muscle. Thus slowing of the heart rate is one clinical indicator of parasympathetic nervous system stimulation. Parasympathetic nervous system stimulation relaxes the bladder, allowing the release, not the retention, of urine. Alpha stimulation leads to dilation of the pupils. Cholinergic drugs help the bronchi to contract rather than dilate. p. 189  Report content error 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? Atropine Naloxone Flumazenil Methylprednisolone Rationale Bethanechol is a cholinergic agonist. Early signs of overdose include flushing, salivation, sweating, nausea, and abdominal cramping. Intravenous atropine is the antidote for cholinergic agonist overdose. Thus the nurse would prepare to administer intravenous atropine in this case. Naloxone is the reversal agent for treating opioid overdose. Flumazenil is the antidote for treating benzodiazepine overdose. Methylprednisolone is a corticosteroid agent that is used to treat respiratory distress and decrease the immune response. p. 191 Report content error Which information would the nurse include when teaching a patient about the administration of anticholinergic drug therapy? “Limit fluid intake.” “Avoid yogurt consumption.” “Take medication at bedtime.” “Avoid hot and humid weather.” Rationale Thermoregulation can be impaired when taking anticholinergic medications. Thus the nurse would instruct the patient to stay out of hot and humid weather due to a high risk for developing heat stroke. Patients should not be instructed to limit fluid intake. Drinking six to eight glasses of water daily helps in minimizing effects such as dry mouth. Patients do not need to avoid yogurt, as the tyramine in yogurt does not diminish the effect of the drug. The medication should be taken before bedtime if the anticholinergics produce sedation. p. 195 Report content error 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. One, some, or all responses may be correct. Some correct answers were not selected Watch for first-dose hypotension. Never stop taking this medication abruptly. Gradually stop the medication once symptoms subside. Report weight gain of more than 2 lb in 1 day. Notify the health care provider of dizziness or fainting during exercise. Rationale The nurse would be aware of the drug’s therapeutic action and the crucial components of patient education. The nurse would advise the patient to watch for first-dose hypotension, so the patient would be instructed to change positions slowly in order to prevent or minimize postural hypotension. The nurse would tell the patient to never stop taking the medication abruptly, as doing so could cause a significant rise in the patient’s blood pressure or symptoms of anxiety, such as heart palpitations, tremors, or sweating. The nurse would also inform the patient to report weight gain of more than 2 lb in a day, as this could indicate that the patient is experiencing heart failure. Additionally, the patient would be instructed to notify the health care provider of dizziness or fainting during exercise, as this could mean that the patient’s medication dosage needs to be adjusted or decreased. The nurse would not instruct the patient to stop taking the beta blocker once the symptoms subside, because a significant rise in blood pressure could occur. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. pp. 183,185 Report content error Which statement(s) describes (describe) how the therapeutic effect of atenolol differs from the therapeutic action of prazosin in decreasing blood pressure? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected The beta1 antagonist causes vasodilation. The alpha1 antagonist causes vasodilation. The beta1 antagonist decreases heart rate and cardiac output. The alpha1 antagonist decreases heart rate and cardiac output. The beta1 antagonist decreases cardiac contractility and conduction velocity. The alpha1 antagonist decreases cardiac contractility and conduction velocity. Rationale The beta1 antagonist atenolol decreases blood pressure by decreasing heart rate, cardiac output, cardiac contractility, and conduction velocity. The alpha1 antagonist prazosin decreases blood pressure by causing vasodilation. The beta1 antagonist atenolol does not cause vasodilation, and the alpha1 antagonist prazosin does not decrease heart rate, cardiac output, cardiac contractility, or conduction velocity. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger the answer in your mind or provide an important clue to an earlier question. pp. 184-185 Report content error 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? Reassure the patient that this is an expected side effect of the medication. Question the patient about what over-the-counter medications the patient uses to treat pain. Notify the prescribing health care provider about the information provided by the patient. Instruct the patient to maintain a symptom diary documenting the incidence of the palpitations. Rationale Although it is important to gain as much information as possible from the patient, such as use of over-the-counter medications and details recorded in a symptom diary, because of the likelihood that beta- adrenergic agonists will affect blood pressure and pulse rate, the prescribing health care provider should be notified of any chest pain, palpitations, headaches, or seizures. Thus the nurse would notify the prescribing health care provider about the information provided by the patient. p. 182 Report content error Which occurrence is an effect of beta1-adrenergic receptor stimulation? Mydriasis Ejaculation Vasoconstriction Increased renin secretion Rationale Beta1-adrenergic receptor stimulation causes increased renin secretion. Mydriasis, ejaculation, and vasoconstriction are the result of alpha1-adrenergic receptor stimulation. p. 178 Report content error Which statement describes the rationale behind administering atropine to a patient before the patient undergoes a scheduled endoscopy? Atropine decreases the apical heart rate. Atropine increases intraocular pressure. Atropine reduces salivation in the mouth. Atropine increases the frequency of urination. Rationale Atropine is administered before endoscopy to reduce salivation; this may aid in inserting the endoscope. Atropine is used in the treatment of bradycardia and ventricular systole because it increases the heart rate. Atropine increases intraocular pressure in glaucoma patients, which may result in loss of vision. An atropine overdose increases the frequency of urination. p. 193  Report content error Which outcome criteria would the nurse use when determining whether a patient is responding appropriately to use of an adrenergic drug? The patient awakens easily and states, “I feel fine.” The patient is able to correctly state three side effects of the medication. The patient is alert to time, person, and place and makes coherent conversation. The patient’s respiratory rate is 16 breaths per minute, and the patient’s blood pressure is 130/72 mm Hg. Rationale The nurse would use the blood pressure and respiratory readings to determine whether a patient is responding appropriately to use of an adrenergic drug. The patient awakening easily or being able to state three side effects of the medication does not demonstrate the patient’s response to the medication. The patient’s orientation status does not demonstrate the patient’s response to the medication either. p. 182  Report content error Which response is a result of sympathetic nervous system stimulation? Pupillary dilation Bronchial constriction Increased peristalsis Decreased heart rate Rationale Stimulation of the sympathetic nervous system results in pupillary dilation. Stimulation of the parasympathetic nervous system results in bronchial constriction, increased peristalsis, and decreased heart rate. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 176 Report content error Which side effect will the nurse include in an education Which side effect will the nurse include in an education session about bethanechol for the treatment of urinary retention? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Nausea Constipation Abdominal cramps Dysuria Urinary urgency Rationale Bethanechol chloride has side effects of nausea, abdominal cramps, and urinary urgency. Constipation is not a side effect, but diarrhea is. Dysuria is not a side effect because the medication instead causes urinary frequency and urgency. p. 188 Report content error Which finding after 45 minutes indicates that the administration of bethanechol to a patient with neurogenic bladder has been effective? bladder has been effective? A reduction in blood pressure The occurrence of micturition Hypoactive bowel sounds Decreased respiratory rate Rationale Patients with neurogenic bladder have urinary retention. Thus to determine the efficiency of the drug, the nurse would reassess the patient after administering the medication. If the patient has micturition within 60 minutes of administration, this indicates that the patient is effectively responding to the drug. Hypotension is an adverse effect of cholinergic medications, such as bethanechol. Therefore a reduction in blood pressure would indicate that the patient is having adverse effects from the drug. Cholinergic medications prevent constipation by increasing gastric motility; these drugs may cause an increase in the bowel sounds. Bronchoconstriction is an adverse effect of the drug; when this occurs, the patient will have a reduced rate of respiration. Therefore a reduced respiratory rate does not indicate effectiveness of the therapy. p. 188 Report content error 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? “I should limit my fluid intake while taking this medication.” “I should avoid drinking my morning coffee while taking this drug.” “There’s no need to stop eating chocolate while I’m on this medication.” “One glass of red wine with meals will not interfere with the medication.” Rationale Caffeine, such as that found in coffee and chocolate, should be avoided while on the medication because it can further irritate the cardiac and central nervous systems. Thus the patient’s statement about avoiding coffee while taking the drug indicates that the nurse’s teaching is effective. The patient should increase fluid intake, not limit fluid intake, to prevent constipation. Alcohol ingestion should be avoided because it causes vasodilation, increasing the risk for hypotension. Study Tip: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test, and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question. p. 182  Report content error 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? Adverse effects of the medication are occurring. Symptoms are consistent with common medication side effects. Urinary obstruction is occurring, and the Foley catheter needs to be irrigated. A cause unrelated to the urinary retention or the medication is the source of the symptoms. Rationale Sweating, flushing, nausea, muscle weakness, and increased salivation are indications of a cholinergic crisis. Thus the nurse would conclude that the patient is experiencing a cholinergic crisis. The patient should be treated immediately with intravenous atropine to reverse the crisis. These signs and symptoms are not indicative of medication side effects. There is no information in the question stem supporting a conclusion of urinary obstruction. As long as the Foley catheter is draining, it should not be irrigated. Given the signs and symptoms and the fact that the patient is receiving a direct-acting cholinergic medication, another cause is unlikely. p. 191  Report content error Which assessment finding would the nurse expect in a patient taking a selective beta1-receptor blocker? Pulse of 62 beats per minute Wheezing bilaterally Irregular apical pulse Bounding radial pulse Rationale Blocking of selective beta1 receptors results in a decrease in heart rate, conduction, and contractility, with no bronchoconstriction. This results in a lowered pulse, so the nurse would expect to find a pulse rate of 62 beats per minute. Wheezing would not be expected, as this would indicate bronchoconstriction. The nurse would expect the apical pulse to be regular, and a bounding radial pulse would not be expected if contractility is decreased. p. 183 Report content error  Which finding is a therapeutic effect of atropine? Miosis Lethargy Hypertension Increased heart rate Rationale Atropine, a muscarinic antagonist, works primarily on the heart, exocrine glands, smooth muscle, and eyes. It produces an increased heart rate and thus has a therapeutic effect in the treatment of bradycardia. Atropine is likely to cause mydriasis, not miosis. Lethargy is not a therapeutic effect of atropine. Because there is no parasympathetic innervation to muscarinic receptors in blood vessels, atropine has no effect on vascular smooth muscle tone and therefore no effect on blood pressure. p. 193 Correct (21) Report content error Which drug classification stimulates the sympathetic nervous system? Adrenergic agonists Adrenergic antagonists Adrenergic blockers Sympatholytics Rationale Adrenergic agonists are drugs that stimulate the sympathetic nervous system because they mimic sympathetic neurotransmitters. Adrenergic antagonists, adrenergic blockers, and sympatholytics are all the same type of drugs that block the effect of adrenergic agonists. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option. pp. 175,182,177 Report content error 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”? Notify the health care provider. Hold the next albuterol treatment. Explain that these sensations are side effects. Request a decreased dose of albuterol. Rationale Albuterol is a beta2 agonist that predominantly acts on beta2 receptors in the lungs to cause bronchodilation. Side effects include tachycardia and jitteriness, as the medication is not 100% selective on beta2 receptors. Thus the nurse would explain to the patient that the sensations of a fluttering heart and shaky hands are side effects. It would not be necessary to notify the health care provider because the patient is describing common side effects of the medication. The next treatment should not be held because the patient’s breathing takes priority over harmless side effects. A decreased dose of albuterol would not be necessary. p. 178 Report content error Which finding is a contraindication for the safe administration of bethanechol? Bradycardia Gastroparesis Urinary retention Gastroesophageal reflux Rationale Bradycardia is a contraindication for the safe administration of bethanechol, a parasympathomimetic. This drug stimulates the parasympathetic nervous system, decreasing the heart rate. The drug is safely and effectively used for gastroparesis, urinary retention, and gastroesophageal reflux. p. 188 Report content error Which injectable, fast-acting medication would the nurse expect to administer during a cardiopulmonary resuscitation emergency? Salmeterol Epinephrine Naphazoline  Oxymetazoline Rationale Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Thus the nurse would expect to administer epinephrine during a cardiopulmonary resuscitation emergency. Salmeterol is given via the respiratory tract because of its affinity for beta2 receptors that act on the lungs. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. p. 180 Report content error Which assessment finding would indicate that a patient receiving intravenous epinephrine is experiencing the expected therapeutic effect? Increased heart rate Bronchial constriction Increased bowel sounds Decreased blood pressure Rationale Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. Thus an increased heart rate would indicate that a patient receiving intravenous epinephrine is experiencing the expected therapeutic effect. Epinephrine causes bronchial dilation, not constriction. Epinephrine does not have an impact on bowel sounds. Epinephrine does not decrease blood pressure; at high doses, intravenous epinephrine increases blood pressure. p. 180 Report content error Which description of anticholinergic medications is accurate? “Anticholinergics increase saliva production.” “Anticholinergics cause problems with urinary retention.” “In small doses, anticholinergics increase the heart rate.” “In large doses, anticholinergics decrease muscle rigidity.” Rationale Anticholinergic drugs relax the bladder detrusor muscle and increase constriction of the internal sphincter; these two effects may result in urinary retention. Thus the nursing student’s statement about anticholinergics causing problems with urinary retention indicates that the nurse’s teaching was effective. Anticholinergic drugs inhibit the parasympathetic nervous system and thereby decrease salivation. These drugs in high doses inhibit the vagus nerve and thereby increase the heart rate. When given in small doses, anticholinergics decrease muscle rigidity and tremors, so they are prescribed for patients with Parkinson disease. p. 191 Report content error Which condition in a patient would make the patient an unsuitable candidate for a sympathomimetic agent? Asthma Insomnia Hypertension Common cold Rationale Hypertension would make a patient an unsuitable candidate for the administration of a sympathomimetic agent. Administration of a sympathomimetic agent in a hypertensive patient may cause a further increase in blood pressure or increase the risk for heart failure. A patient with insomnia, asthma, or a common cold is not precluded from being a suitable candidate for the administration of a sympathomimetic agent. p. 177 Report content error Which finding would be of concern to the nurse when assessing a patient receiving an adrenergic agent? Weak peripheral pulses Increased cardiac output Increased peripheral pulses Heart rate of 95 beats per minute Rationale Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the peripheral pulses remain weak, as this indicates that the therapeutic effect of the drug is not being achieved. Increased cardiac output, increased peripheral pulses, and a heart rate of 95 beats per minute would not be of concern to the nurse, as these would be indicative of the medication having a therapeutic effect. p. 177  Report content error 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? Offer a cup of orange juice. Obtain a blood glucose level. Check apical pulse for 1 minute. Assess blood pressures sitting and lying down. Rationale Beta blockers can mask signs of hypoglycemia, such as tachycardia. Other signs of hypoglycemia include tremors, irritability, and diaphoresis. Thus the nurse would first check the patient’s blood glucose level before offering orange juice. The nurse would assess before intervening, as per the nursing process. Checking the blood glucose level would take priority over obtaining the apical pulse rate and blood pressures in this case. p. 183  Report content error 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? Nausea Dyspnea Muscle cramps Postural hypotension Rationale The nurse is trying to prevent postural hypotension, the main adverse effect of cholinergic drugs. Postural hypotension results in dizziness and fainting. This effect can be decreased by changing positions slowly when taking an upright position. These drugs do not affect gastrointestinal function, respiratory function, or muscular function. Therefore nausea, dyspnea, and muscle cramps are not adverse effects related to cholinergic drugs. p. 191 Report content error Which outcome would be appropriate to establish for patients taking beta1 agonists? Relaxation of uterine smooth muscle Increased contractility of the myocardium Relaxation of bronchial smooth muscle Increased resistance of peripheral vessels Rationale Stimulation of beta1 receptors in the fight-or-flight response results in stronger ventricular contraction owing to increased contractility of the myocardium. Beta1 agonists act most specifically on the heart. Relaxation of uterine smooth muscle is a result of taking alpha1 antagonists. Bronchial smooth muscle is affected by beta2 agonists. Beta2 agonist stimulation results in vasodilation and decreased resistance of peripheral vessels. p. 177 Report content error Which question would the nurse ask if a patient recently diagnosed with hypertension reports dizziness when standing? “How much alcohol have you had to drink today?”  “Do you have air conditioning in your home?” “Which medications are you currently taking?” “Have you been to a sauna in the past 24 hours?” Rationale Adrenergic blockers can be prescribed for hypertension and have side effects such as dizziness and syncope. Because the patient was recently diagnosed with hypertension, the patient has most likely been prescribed new medication, such as an adrenergic blocker. Asking if the patient has been drinking alcohol would not be the most important or relevant question at this point. If the patient has been prescribed an adrenergic blocker, a sauna or any other excessive heat could exacerbate the symptoms of vasodilation. The nurse would first determine exactly what medications the patient is currently taking. p. 183 Report content error 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? Temperature of 98.6ºF Pulse of 50 beats per minute  Blood pressure of 150/88 mm Hg Respiratory rate of 18 breaths per minute Rationale Indirect-acting cholinergic agonists act by inhibiting or inactivating cholinesterase, permitting acetylcholine to accumulate at the receptor sites. When acetylcholine is increased, the parasympathetic system is stimulated, which can result in a decreased heart rate. Therefore an assessment finding of a pulse rate less than 60 beats per minute would prompt the nurse to hold the medication and contact the health care provider. Body temperature is regulated by the hypothalamus gland. The blood pressure is elevated at 150/88 mm Hg, but an indirect-acting cholinergic agonist would lower it slightly. Respiration is controlled by the medulla oblongata. p. 190 Report content error Which assessment is important for the nurse to complete before administering an adrenergic agonist? Temperature Skin integrity Blood pressure  Respiratory rate Rationale An adrenergic agonist causes vasoconstriction, leading to high blood pressure.Blood pressure is the most important assessment because of the detrimental effects of high blood pressure, such as stroke, which can be life-threatening. Temperature, skin integrity, and respiratory rate are not directly affected by adrenergic agonists. p. 177 Report content error Which parameter would be a priority for the nurse to monitor in a patient taking more than one cholinergic agonist that stimulates muscarinic receptors? Bowel pattern Blood pressure Urinary pattern Lacrimal secretion Rationale The adverse effects of cholinergic therapy that stimulates muscarinic receptors include orthostatic hypotension. Thus the nurse would monitor the patient’s blood pressure for early detection of hypotension. Although muscarinic poisoning is likely to cause diarrhea, urinary frequency, and increased lacrimal secretion, these problems are less important than hemodynamic changes. p. 190 Report content error 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? Wrist injury Diabetes mellitus on insulin Hyperactivity disorder Myocardial infarction Rationale A history of diabetes and insulin usewould put the patient at an increased risk for adverse effects after the administration of a beta blocker.In diabetic patients on insulin, beta blockers lead to an increased risk of hypoglycemia. Diabetic patients may be unable to tell when their blood glucose levels fall too low. Therefore beta blockers are contraindicated in patients with diabetes mellitus. A patient with a wrist injury would not be at risk, because it is a minor injury. A patient with hyperactivity disorder may sometimes be prescribed a beta blocker as a treatment therapy. A patient with a history of myocardial infarction would benefit from a beta blocker, as beta blockers block the harmful effects of the catecholamines that increase the heart rate after myocardial infarction. p. 183 Report content error Which intervention would the nurse add to the plan of care for a patient who has been prescribed bethanechol? Record fluid intake and output. Use oral moisturizer at bedtime. Administer with milk or crackers. Schedule medication to be taken at bedtime. Rationale Bethanechol is a cholinergic agonist used to treat urinary retention. Keeping an accurate record of fluid intake and output is important to determine drug effectiveness. Thus the nurse would add the intervention of recording fluid intake and output to the plan of care for this patient. Salivation, not dry mouth, is a common side effect of this medication, so oral moisturizers would not be necessary. Cholinergic agonists are usually administered 1 hour before meals or 2 hours after meals to prevent or minimize nausea and vomiting. Bethanechol results in more frequent urination, so it should be taken during the day, not at bedtime. p. 191 Report content error Which condition in a patient’s medical history would make the use of a direct-acting cholinergic agonist contraindicated? Asthma Hypertension Gastroparesis Neurogenic bladder Rationale Direct-acting cholinergic agonists are contraindicated for a patient with asthma because they cause bronchial constriction, which could exacerbate lung conditions, such as asthma, emphysema, and chronic obstructive pulmonary disorders. Direct-acting cholinergic agonists cause vasodilation and lower blood pressure, so hypertension is not a contraindication. Patients with gastroparesis and neurogenic bladder are often prescribed direct-acting cholinergic agonists. p. 190 Report content error Which term is the name for drugs that stimulate the parasympathetic nervous system (PNS)? Cholinergic agonists Acetylcholinesterase Cholinergic inhibitors Cholinergic blocking agents Rationale Drugs that stimulate the PNS are called cholinergic agonists. Cholinergic agonists stimulate the PNS by mimicking the parasympathetic neurotransmitter acetylcholine. Acetylcholinesterase is an enzyme that inhibits the enzyme cholinesterase (ChE) by forming a chemical complex that allows acetylcholine to persist and attach to a receptor. Cholinergic inhibitors are a group of medications that block the normal breakdown of acetylcholine. Cholinergic blocking agents halt the action of acetylcholine and substances similar to it. p. 187  Report content error Which patient assessment data indicates a contraindication to the use of bethanechol? Pulse rate of 60 History of asthma Blood pressure of 140/83 mm Hg Use of an antihypertensive drug Rationale Bethanechol is contraindicated in patients with active or latent asthma because it activates muscarinic receptors in the lungs, causing bronchoconstriction. A pulse rate of 60 is a normal reading and is not contraindicated with the use of bethanechol. Bethanechol can cause hypotension as a result of vasodilation, so hypertension is not a contraindication to its use, nor is the use of an antihypertensive drug. p. 188 Report content error Which assessment finding would indicate that propranolol is having a therapeutic effect? Lung fields clear Normal sinus rhythm Strong peripheral pulses Blood pressure of 130/75 mm Hg Rationale Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The patient’s blood pressure is within normal limits, which indicates a therapeutic effect. Clear lung sounds indicate that the patient is not having respiratory side effects. Nonselective beta blockers are not typically given for cardiac dysrhythmias. Strong peripheral pulses are an indication that circulation and cardiac output may be strong; however, these are not related to the drug action. p. 183