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NURS 488 WEEK 8 MIDTERM EXAM 1 LATEST 2025 EXAM
VERIFIED EXAM WITH ANSWERS
Adrenergic Drugs drugs that stimulate the sympathetic nervous system
- epinephrine
- norepinephirne
- dopamine
- α2-Receptor agonists (central) Clonidine and methyldopa
- α1-Receptor blockers (peripheral) doxazosin, prazosin, terazosin *osin or zosin
- β-Receptor blockers propranolol, metoprolol, atenolol, nebivolol *olol, ilol, alol
- Combination α1- and β-receptor blockers labetalol Agonist medications The group of medications that initiates or alters a cellular activity by attaching to receptor sites, prompting a cellular response. Adrenergic-Blocking Drugs
- Bind to adrenergic receptors to block or inhibit stimulation of the SNS
- Have the opposite effect of adrenergic drugs
- a blockers
- b blockers
- a and b blockers
Drug Effects and Indications: α-Blockers
- Cause both arterial and venous dilation, reducing peripheral vascular resistance and blood pressure (BP)
- Examples: phentolamine mesylate,
- Effect on receptors on prostate gland and bladder
- Examples: tamsulosin hydrochloride (Flomax) β-Blockers Block stimulation of β-receptors in the SNS
- Compete with norepinephrine and epinephrine
- Can be selective or nonselective
- Cardioselective β-blockers or β1-blocking drugs
- Nonselective β-blockers block both β1-receptors and β2-receptors. Cardioselective β-blockers (β1)
- Reduce SNS stimulation of the heart
- Decrease heart rate
- Prolong sinoatrial node recovery
- Slow conduction rate through the atrioventricular (AV) node
- Decrease myocardial contractility, thus reducing myocardial oxygen demand Nonselective β-blockers (β1 and β2)
- Cause same effects on heart as do cardioselective ß-blockers
- Constrict bronchioles, resulting in narrowing of airways and shortness of breath
- Produce vasoconstriction of blood vessels
blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication Cholinergic Toxicity or Crisis SLUDGE
- Salivation
- Lacrimation
- Urinary - Incontinence
- Diarrhea
- Gastrointestinal cramps
- Emesis Cholinergic-Blocking Drugs Drugs that block the action of acetylcholine and substances similar to acetylcholine at receptor in PSNS Anticholinergic Toxicity
- Hot as a hare
- Blind as a bat
- Dry as a bone
- Red as Beet
- Mad as a hatter captopril maximum dose 450mg a day
captopril (Capoten) class Angiotensin-converting enzyme inhibitor (ACEI) Why would a patient take captopril? Hypertension Heart Failure LVD after MI Diabetic Nephropathy Alpha 2 Agonists Stimulate α2-adrenergic receptors in the brain Decrease sympathetic outflow from the central nervous system Decrease norepinephrine production Stimulate α2-adrenergic receptors, thus reducing renin activity in the kidneys Result in decreased BP Angioedema swelling of the blood vessels Calcium Channel Blockers Blocks calcium channels so leads to vasodilation, which reduces BP, slows the heart beat, controls an irregular heart, reduces chest pain Cause coronary artery vasodilation
what class of medication for anaphylaxis Non-selective adrenergic example - epinephrine (epipen) Corticosteroids (Glucocorticoids) •Anti-inflammatory effects •Act synergistically with ß2 agonists •May be administered IV, PO or inhaled •Use regularly at the lowest effective dose to prevent adverse symptoms •Inhaled: (reduce systemic effects) •beclomethasone (Qvar) •budesonide (Pulmicort) •fluticasone (Flovent, Flonase) Inhaled Corticosteroids (ICS) •Adverse Effects •Thrush, hoarse voice, throat irritation, dry mouth •Adrenocortical insufficiency, increased infection susceptibility, osteoporosis •Contraindications •Systemic fungal infection •Drug Interactions •Hyperglycemia Leukotriene Receptor Antagonists •Nonbronchodilating •Newer class of asthma medications
•Currently available drugs •montelukast (Singulair®) •zafirlukast (Accolate®) Monoclonal anti-IgE antibody
- omalizumab (Xolair) •Controller medication for moderate to severe, persistent allergic asthma •Given SC every 2 - 4 weeks •Takes weeks to see effect •Most common adverse effect is injection site reactions Xanthine Derivatives •Bronchodilation by increasing cAMP •Aminophylline - theophylline-caffeine •3rd line due to systemic toxicity and mild bronchodilator activity •(theophylline po) add on therapy in patients receiving high dose ICS •Slow onset of action •Narrow therapeutic window Autonomic Dysreflexia
- Life-threatening condition caused by distention of the bladder or rectum or tight clothing
- Raise head of bed to 45o and notify physician
- Often resolved by urinary catheterization or digital rectal exam What does acetylcholine do?
They block SNS stimulation of beta 1. What is a contraindication that ALL drugs will have? Allergic What is Raynaud's disease? Occurs in the arterioles and nerve endings in the extremities and limits the blood flow to that portion of the extremity. Decreasing Ca, decreases: Contractility of the heart What do ACE inhibitors do? Block conversion of angiotensin I to angiotensin II, lowers BP What do ACE inhibitors end in?
- pril Who should never take an ACE inhibitor? Pregnant women because it will damage their fetus. To be used when there are no other options. What is a symptom that ACE inhibitors have that ARBs don't?
The dry cough what diuretic can be used to decrease ICP mannitol - osmotic diuretic Which finding would the nurse anticipate when assessing a patient with an atropine (anticholinergic) overdose? Urinary retention Atropine overdose is manifested by flushing, dry skin and mucous membranes, mydriasis, altered mental status, and fever. Other serious effects include sinus tachycardia, urinary retention, hypertension, hallucinations, and cardiovascular collapse. Activated charcoal is usually given along with supportive therapy. The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from IV to PO. The nurse expects the oral dose to be higher because of the first-pass effect. Rationale: The first-pass effect is the metabolism of a drug before it becomes systemically available, and it reduces the bioavailability of the drug. Therefore, oral doses need to be higher than IV doses because of the first-pass effect. The nurse is administering a drug that has been ordered as follows: "Give 10 mg on odd-numbered days and 5 mg on even-numbered days." When the date changes from May 31 to June 1, what should the nurse do? Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd or even numbered When a nurse administers an a-blocker for the first time, which of the following is the most important development for the nurse to assess?
The adverse effects of a nonselective β-blocker are likely to be the most immediately life threatening in which of the following patients? Patient with asthma A 58 - year old patient is recovering in the critical care unit after a myocardial infarction (MI). The nurse notes an order for the B-blocker metoprolol (Lopressor). The purpose of this drug is to inhibit stimulation of the myocardium by circulating catecholamines. A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of the greatest concern for the nurse initiating the nitroglycerin drip? Blood pressure is 88/46 mm Hg A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? captopril Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after the onset of a myocardial infarction (MI) to revascularize the blocked coronary arter After a teaching session about the Angiotensin-converting Enzyme Inhibitor (benazepril), which statement by the client indicates a need for further instructions? "It's okay to skip a few doses if I am feeling bad as long as it's just for a few days."
A client has chest pain rated 8 on a 10 point scale. the 12 - lead electrocardiogram reveals a ST elevation in the inferior leads, and tropin levels are elevated. What should the nurse do first? Reduce pain and myocardial oxygen demand A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should do initiate cardiopulmonary resuscitation A patient wants to take garlic tablets to improve cholesterol levels. Which condition would be a contraindication? scheduled surgery A 60-year old comes into the emergency department with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Admission orders include oxygen therapy by nasal prongs at 4 litres/minute, complete blood count (CBC), a chest x- ray, a 12-lead ECG, and 2 mg of morphine IV. The nurse should first: administer the morphine What instructions will the nurse include when teaching patients about taking ß2-blocking drugs for the treatment of angina? "Call your health care provider if you experience a weight gain of 1 kg or more in 24 hours or 2.3 kg or more in 1 week." A client experiencing a sever asthma attack has the following arterial blood gas results: pH 7.33; PC02 48 mm Hg; P02 58 mm Hg; HC03 26 mmol/L. which prescriptions should the nurse implement first? salbutamol (Ventolin)
A young adult is admitted to the emergency department after an automobile accident. The client has severe pain in the right chest form contact with the steering wheel. what should the nurse do first? Maintain adequate oxygenation Which medication will the nurse teach a patient with asthma to use when the patient is experiencing an acute asthma attack? salbutamol (Ventolin) The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. Which is the priority nursing intervention? Place the client in a high-fowler's position. a 72 - year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician had recommended that she start taking low dose aspirin as a part of her treatment of transient ischemic attacks the concern with taking these two drugs together is increased risk of bleeding because of ginkgo a 10 year old with severe head injury is unconscious and has coarse breath sounds, a temp of 39, a heart rate of 70 bpm a bp of 130/60 which action should the nurse preform first? administer prescribed IV manitol a patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before which statement is most correct the heparin provides anticoagulation until therapeutic levels of warfarin are reached
the nurse administers mannitol to the client with increased ICP which parameter requires close monitoring intake and output the nurse has established a goal to maintain ICP within the normal range for a client who has a craniotomy 12 hours ago, what should the nurse do?
- contact the health care provider is the intracranial pressure is greater than 15mmhg
- elevate the head of bed 15 - 20 degrees
- monitor neurological status using the glasgo coma scale effective management of conscious client who is being treated with recombinant tissue plasminogen therapy during a CVA
- responds to comfort measures
- no signs or symptoms of bleeding headache reduced when preparing to teach a client about phenytoin sodium therapy the nurse should urge the client not to stop taking the drug suddenly because status epilepticus may develop status epilepticus A condition in which seizures recur every few minutes or last more than 30 minutes.
found throughout nervous system, sends + received information between the motor neurons and voluntary muscles. every movement you make depends on the release of ach Dopamine used by neurons to make voluntary movements + movements in response to emotions, plays role in pleasure and reward system and is crucial in focus and memory Norepinephrine regulates mood and arousal ( stress hormone)
- increased O2 to brain
- Increases HR and BP
- shuts down metabolic processes in stressful events to preserve energy GABA + Glutamate
- 2 most plentiful neurotransmitter in brain
- GABA produces an inhibitory postsynaptic potential so it decreases the likelihood that a neuron will fire an action potential
- Glutamate produces an excitatory postsynaptic potential thus it increases the likelihood that a neuron will fir an action potential autonomic nervous system (ANS) regulates involuntary functions including heart rate, respiratory rate and digestion by balancing the SNS and PNS Cholinergic Drugs
promotes action of neurotransmitter acetylcholine = increase in ACH stimulates the PNS - rest and relaxation adrenergic receptors alpha 1, alpha 2, beta 1, beta 2 Alpha 1 receptors smooth muscle
- activation causes contraction Alpha 2 receptors fat and smooth muscle
- cause decreased SNS activity
- causes dilation Beta 1 receptors located in heart
- activation causes contraction
- increased HR and increased force of contraction Beta 2 receptors bronchioles and smooth muscle
- cause vasodilation and bronchodilation
- increased release of glucagon
