Question 1

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

Accepted Answer

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.

Question 2

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?

Accepted Answer

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 patient's legs are not the first actions that should be taken.

Question 3

Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously?

Accepted Answer

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 Raynaud's disease.Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.

Question 4

Which statement(s)is/are true about efferent nerves?(Select all that apply.)

Accepted Answer

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.

Question 5

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

Accepted Answer

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.

Question 6

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.)

Accepted Answer

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.

Question 7

What is the primary response to alpha-1 receptor stimulation?

Accepted Answer

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.

Question 8

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction,such as Raynaud's disease?

Accepted Answer

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.

Question 9

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?

Accepted Answer

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.

Question 10

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.)

Accepted Answer

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.

Question 11

Why are beta blockers used cautiously in patients with respiratory conditions?

Accepted Answer

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.

Question 12

Which nerve endings liberate norepinephrine?

Accepted Answer

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.

Question 13

Which body function(s)is/are controlled by the autonomic nervous system?(Select all that apply.)

Accepted Answer

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.

Question 14

Which adverse effect(s)is/are common when a patient is receiving a cholinergic agent?(Select all that apply.)

Accepted Answer

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.

Question 15

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

Accepted Answer

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.

Question 16

The autonomic nervous system can be subdivided into which types of adrenergic receptors?

Accepted Answer

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.

Question 17

Prior to the administration of metoprolol,a beta-adrenergic blocking agent,which is most important for the nurse to assess?

Accepted Answer

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.

Question 18

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?

Accepted Answer

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.

Question 19

Before the initiation of anticholinergic medications,it is important for the nurse to screen patients for which condition?

Accepted Answer

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.

Question 20

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment.Which response by the nurse is most accurate?

Accepted Answer

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 Parkinson's disease.Anticholinergic agents cause urinary retention,increase intraocular pressure,and increase the heart rate.

Quiz 12: Drugs That Affect the Autonomic Nervous System