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A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 beats/min, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 beats/min and 120/80 mm Hg). What is the nurse's immediate concern for this patient?
- A. She is experiencing normal adverse effects of dobutamine therapy.
- B. She may be experiencing an allergic reaction to the dobutamine.
- C. The medication may be causing a worsening of a preexisting cardiac disorder.
- D. The dosage of the dobutamine needs to be increased to control the symptoms better.
Correct Answer: C
Rationale: Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a preexisting cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect.
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An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?
- A. Volume restoration
- B. Increased cardiac output
- C. Decreased urine output
- D. Reduced anxiety
Correct Answer: B
Rationale: For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase cardiac output. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety.
When a patient is taking an adrenergic agonist drug, the nurse expects to observe which effect?
- A. Decreased heart rate
- B. Bronchodilation
- C. Constricted pupils
- D. Increased intestinal peristalsis
Correct Answer: B
Rationale: Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal motility, depending upon which receptors are stimulated.
The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine?
- A. Orally
- B. Intravenous (IV) push injection
- C. Intermittent IV infusions (IV piggyback)
- D. Continuous IV infusion with an infusion pump
Correct Answer: D
Rationale: Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect.
A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?
- A. Ephedra
- B. Epinephrine
- C. Phenylephrine
- D. Pseudoephedrine
Correct Answer: B
Rationale: Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices.
The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?
- A. Dopaminergic
- B. Beta1 adrenergic
- C. Beta2 adrenergic
- D. Alpha1 adrenergic
Correct Answer: C
Rationale: Stimulation of beta2 adrenergic receptors results in bronchodilation. The other choices are incorrect.