Unit 5 Review

Unit 5 Review:

Drugs that affect the pNS​

Chapters 23, 24, 25, 26

Multiple Choice

An older client with acute sinusitis is administered epinephrine emergently. The nurse should prioritize reporting a change in which assessment finding to the health care provider?

• Blood Glucose

• Appetite

• Temperature

• Pulse Rate

​Rationale

• ​Epinephrine is an adrenergic drug (adrenaline, fight or flight)

• The nurse should report any changes observed in pulse rate or rhythm immediately.

• Epinephrine does not affect the glucose level, appetite, or temperature. These do not need to be reported immediately to the primary care provider unless they are severe.

• The nurse would need to perform further assessments to determine the cause of these findings.

Subject | Subject

Some text here about the topic of discussion

Multiple Choice

A nurse is teaching a client how to use an auto-injector as treatment for an allergic reaction. The nurse determines additional teaching is necessary when the client makes which statement?

• “I should not touch the orange or black tip on the small end.”

• “I should administer the dose and then call 9-1-1 if I'm alone.”

• “I should inject the black tip into my outer thigh.”

• “I need to massage the site for a couple seconds after removing the device.”

​Rationale

• The client should call the emergency number first and then administer the dose if they are alone.

• The client should not touch the orange or black tip on the end.

• The dose is administered into the outer thigh and the site is massaged for 10 seconds after removing the device.

Multiple Select

A nursing instructor has finished teaching a group of nursing students the basic functions of the autonomic nervous system (ANS). The instructor determines the teaching is successful when the students correctly choose which functions as controlled by the ANS? Select all that apply.

• Heart rate

• Muscle movement

• Blood pressure

• Glandular secretions

• GI activity

​Rationale

• The ANS division of the peripheral nervous system is concerned with functions essential to life and not consciously controlled, such as blood pressure, heart rate, GI activity, and glandular secretions.

• Muscle movement is controlled by conscious control. It is related to various substances in the central nervous system.

Multiple Select

A nurse working in the emergency department is prepared to provide care to clients with a variety of disorders. Which potential conditions should the nurse be prepared to administer a prescribed adrenergic drug?

Select all that apply.

• Hypovolemic shock

• Respiratory distress

• Severe hypertension

• Allergic reactions

• Cardiac arrest

​Rationale

• A nurse may be asked to administer adrenergic drugs to clients with hypovolemic shock, respiratory distress, severe hypotension, allergic reactions, and cardiac arrest.

• Severe hypertension could be treated with diuretics, beta-adrenergic blocking agents, antiadrenergic (both centrally acting and peripherally acting), calcium channel blocking, ACE inhibitors, angiotensin II receptor antagonists, and vasodilating drugs, depending on the client's situation and additional concerns.

Multiple Choice

A nurse is preparing to administer propranolol to a client for the treatment of cardiac arrhythmias. The nurse checks the client's apical pulse rate and blood pressure before administration and notes that the pulse rate is 58 bpm. Which action would the nurse prioritize?

• Provide proper ventilation to the client.

• Delay drug administration for some time.

• Withhold the drug and contact health care provider.

• Immediately give oxygen via face mask.

​Rationale

• The nurse should withhold the drug and contact the primary health care provider if the pulse rate of the client is below 60 bpm.

• Providing proper ventilation to the client, delaying drug administration for some time, or providing oxygen support to the client would be inappropriate for this client.

Multiple Select

A nurse prepares to administer atenolol to a client who has recently suffered an acute MI. The nurse anticipates the client will experience which changes related to this medication?

Select all that apply.

• Increase the heart's excitability

• Decrease the heart's workload

• Increase the heart's oxygen consumption

• Decrease heart rate

• Constrict blood vessels

​Rationale

• Atenolol is a beta-adrenergic blocking drug.

• Blockade of beta-adrenergic receptors results in decreased heart rate, dilation of blood vessels, a decrease in the heart's excitability, and a decrease in cardiac workload and oxygen consumption and provides membrane-stabilizing effects.

Multiple Select

A client taking prazosin is experiencing lightheadedness and dizziness when standing up. What are important to include in teaching the client about the medication?

Select all that apply.

• Call the prescriber.

• Avoid long hot showers.

• Change positions slowly

• Stop taking the medication.

• Take your blood pressure while sitting and then by standing.

​Rationale

• Prazosin is a peripherally acting andtiadrenergic

• Risk is the nursing diagnosis with a client taking prazosin.

• The client is experiencing postural hypotension and should be taught how to rise slowly from sitting or lying position.

• Teaching the client to avoid long hot showers to minimize the vasodilation from the shower.

• The prescriber does not need to be called.

• The client should be instructed to continue to take the medication as prescribed.

• A nurse would assess orthostatics by taking the client's blood pressure while sitting and then by standing. The client should not be instructed to perform this measurement.

Multiple Choice

A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department reporting abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which situation is occurring?

• Underdosage of the drug

• Tolerance to the drug

• Cholinergic crisis

• Underlying infection

​Rationale

• Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. (ATROPINE is the antidote)

• Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing.

• Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing.

• There is no information to suggest that the client has an underlying infection.

Multiple Select

The nurse is preparing to administer bethanechol (cholinergic drug) to an elderly client. Which assessment(s) should the nurse prioritize before administering this drug?

Select all that apply.

• Palpation of the bladder

• Palpation of the thyroid

• Blood glucose

• Blood pressure

• Pulse rate

​Rationale

• Bethanechol is used to treat urinary retentions.

• The nurse's preadministration assessment should include palpation of the bladder, blood pressure, and pulse rate.

• There is no need to palpate the thyroid before administration of the medication.

• The blood glucose should be checked before administering diabetic medication.

Multiple Select

When teaching the client about pyridostigmine (a cholinergic drug), which symptom(s) would the nurse include as a possible adverse reaction?

Select all that apply.

• Constipation

• Nausea

• Dry mouth

• Skin flushing

• Muscle rigidity

​Rationale

• Pyridostigmine is an oral cholinergic medication used in the treatment of myasthenia gravis.

• Specific adverse reactions include increased bronchial secretions, cardiac arrhythmias, and muscle weakness.

• General adverse reactions associated with oral administration of all cholinergic medications include nausea, diarrhea, abdominal cramping, salivation, skin flushing, cardiac arrhythmias, and muscle weakness.

Multiple Select

The nurse is teaching an elderly client and caregiver about the potential adverse reactions of the cholinergic blocking drug. The nurse determines the session is successful when they correctly indicate which action(s) they will apply once the client is home?

Select all that apply.

• Removing throw rugs

• Moving furniture against the wall

• Making sure floors are dry

• Attach handrails to the walls

• Ensure use of assistive devices

​Rationale

• The older client may experience visual and mental impairments (blurred vision, confusion, agitation) that can increase the risk of falls.

• Objects or situations that may cause falls, such as throw rugs, electrical cords, footstools, furniture, and wet or newly waxed floors, are removed or avoided whenever possible.

• Attaching handrails to the walls and ensuring the use of assistive devices are not necessarily required, depending on the individual situation.

Multiple Select

A nurse is administering glycopyrrolate (a cholinergic blocking drug) to a client with a peptic ulcer. Which assessment finding(s) should the nurse prioritize?

Select all that apply.

• Diarrhea

• Dry Mouth

• Constipation

• Nausea

• Dysphagia

​Rationale

A nurse administering glycopyrrolate to a client with a peptic ulcer should monitor the client for dry mouth, nausea, vomiting, constipation (not diarrhea), and dysphagia.