Pharm II - Exam 1 Quizzes + PK/PD Review + NCLEX study guide questions from packets

Muscarinic acetylcholinergic stimulation might have this effect(s) on organs if activated [Select all that apply]

A. Sweating

B. Dilation of the eye

C. Slowed GI motility

D. Decreased heart rate

A, D

A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. The patient astutely replies? [SELECT ALL THAT APPLY]

A. "The cardiovascular system."

B. "The fight-or-flight response."

C. "Body temperature."

D. "The digestive functions of the body."

A, B, C

Which of the following neurotransmitters is not found in the peripheral nervous system?

A. Norepinephrine

B. Epinephrine

C. Serotonin

D. Acetylcholine

C

Which of the following physiologic changes would occur if a person is chased by a grizzly bear or a creepy clown? [SELECT ALL THAT APPLY]

A. Constriction of the pupils (miosis).

B. Increase in lacrimation (tears).

C. Increase in heart rate.

D. Sweating

E. Increase in gastric motility.

F. Increase in blood glucose

C, D, F

Which of the following statements concerning the sympathetic nervous system is correct?

A. The sympathetic system only uses norepinephrine as a neurotransmitter.

B. The sympathetic system often discharges as a single, functional system.

C. The sympathetic system is involved in accommodation of near vision, movement of food and urination.

D. The sympathetic system does not control the sweat glands.

B

A nurse is administering an adrenergic agonist drug that acts on the adrenergic receptors of the sympathetic nervous system. Which response will the nurse expect to see?

A. Decreased sweating

B. Pinpoint pupils

C. Bronchodilation

D. Decreased cardiac output

C

Arrange the following steps of synaptic transmission into the correct order:

1. transmitter storage

2. transmitter synthesis

3. termination of transmission

4. receptor binding

5. transmitter release

A. 2, 1, 4, 3, 5

B. 2, 1, 5, 4, 3

C. 1, 5, 2, 4, 3

D. 1, 2, 4, 5, 3

B

Identify a structure in the autonomic nervous system that is only innervated and regulated by the sympathetic innervation. ______________

sweat glands

True or False:

Most organs in the autonomic nervous system are innervated by both sympathetic and parasympathetic nerves

True

Reading Quiz 3: Cholinergic

A nurse is caring for a client who has a prescription for bethanechol to treat urinary retention. The nurse should recognize that which of the following findings is a manifestation of muscarinic stimulation:

A. Hypertension.

B. Excessive perspiration.

C. Fecal impaction.

D. Dry mouth.

B

The nurse should be prepared to administer which of the following drugs as an antidote to cholinergic drug overdose?

A. Neostigmine.

B. Atropine.

C. Propranolol.

D. Diphenhydramine.

B

The nurse is discussing the therapeutic effects of bethanechol (Urecholine) with a patient who is receiving this drug for urinary retention. The nurse understands that bethanechol:

A. Changes in diameter of the urethral opening.

B. Improves blood flow to the kidneys.

C. Increases the amount of urine made in the kidneys.

D. Increases the contractions of the bladder and structures that promote urination.

D

Who am I?

Drugs that competitively block the actions of ACh at the muscarinic receptor site

Muscarinic antagonist

Who am I?

Drugs that mimic acethylcholine and activate the muscarinic receptors

Muscarinic agonist

Who am I?

Prevent the breakdown of acetylcholine to increase activation of cholinergic receptors

Cholinesterase inhibitors

Bethanechol - match the category (M. agonist, M. antagonist, C. inhibitor)

Muscarinic agonist

Atropine - match the category (M. agonist, M. antagonist, C. inhibitor)

Muscarinic antagonist

Neostigmine - match the category (M. agonist, M. antagonist, C. inhibitor)

Cholinesterase inhibitor

True or False:

Atropine is naturally found in a number of plants and is also known as Datura stramonium (a.k.a. stinkweed).

True

Identify the effects of muscarinic antagonists on the body as a result of muscarinic receptor blockade. [Select All That Apply]

A. Increased heart rate

B. Mydriasis

C. Decreased heart rate

D. Diaphoresis

A, B

True or False:

The BEERS Criteria refers to anticholinergic drugs that have been designated as potentially inappropriate for use among geriatric patients due to the increased susceptibility of risks.

True

Identify the potential adverse affects associated with use of muscarinic antagonists: [Select All That Apply]

A. Tachycardia

B. Blurred vision

C. Diarrhea

D. Xerostomia

E. Urinary retention

A, B, D, E

Reading Quiz 4: Adrenergic Agonists

Reading Quiz 4: Adrenergic Agonists

Drugs can activate adrenergic receptors by multiple processes. Which of the following processes are considered indirect mechanisms of activation? [Select All That Apply]

A. Promotion of norepinephrine release

B. Blockade of norepinephrine reuptake

C. Direct receptor binding

D. Inhibition of norepinephrine inactivation

A, B, D

Adrenergic agonists are classified as catecholamines and noncatecholamines. What are the characteristics of catecholamines? [Select All That Apply]

A. Catecholamines can cross the blood-brain barrier.

B. Catecholamines cannot be given orally.

C. Chemical structure contains a catechol group.

D. Catecholamines have a longer half-life than noncatecholamines.

B, C

Adrenergic agonists are classified as catecholamines and noncatecholamines. What are the characteristics of noncatecholamines? [Select All That Apply]

A. Noncatecholamines can be given orally.

B. Noncatecholamines are not metabolized by COMT and MAO enzymes

C. Noncatecholamines can cross the blood-brain barrier.

D. Noncatecholamines have two catechol groups.

A, C

True or False:

Epinephrine is the only drug that can activate all 4 adrenergic receptor types.

False

Identify the vascular adverse effects associated with alpha1 receptor activation. [Select All That Apply]

A. Nasal Decongestion

B. Necrosis

C. Bradycardia

D. Hypertension

E. Hypotension

B, C, D

True or False:

Alpha2 receptor activation decreases norepinephrine release.

True

Which of the following are therapeutic applications of Beta1 activation? [Select All That Apply]

A. Cardiac Arrest

B. Heart Failure

C. Shock

D. Hemostasis

A, B, C

Which of the following are catecholamines produced by the body? [Select All That Apply]

A. Norepinephrine

B. Dobutamine

C. Epinephrine

D. Dopamine

A, C, D

Reading Quiz 5: Drugs Affecting PNS III

The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug?

A. It selectively activates alpha2 receptors in the central nervous system

B. It depletes sympathetic neurons of norepinephrine

C. It causes peripheral activation of alpha1 and alpha2 receptors

D. It directly blocks alpha and beta receptors in the periphery

A

Which of the following are adverse effects associated with Clonidine (Catapres) [SELECT ALL THAT APPLY]

A. Orthostatic hypotension

B. Xerostomia

C. Rebound hypertension

D. Increased salivation

E. Drowsiness

F. Abuse

B, C, E, F

True or False:

Methyldopa is an oral antihypertensive agent that lowers blood pressure by acting at sites within the CNS and can cause severe hemolytic anemia and hepatic necrosis.

True

Which of the following are principal indications for administering a beta blocker?

A. Hypertension

B. Heart failure

C. Cardiac dysrhythmias

D. Angina

E. Bradycardia

F. Hypotension

A, B, C, D

The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug?

A. Urinary urgency

B. A heart rate of 100 beats/min

C. A glucose level of 180 mg/dL

D. Wheezing

D

The nursing student should question the order for a beta2 blocker for which patient?

A. A 74 year-old male with asthma

B. A 44 year-old patient with hypertension

C. A 32 year-old with chest pain

D. A 69 year-old with atrial fibrillation

A

Which of the following are major adverse effects of alpha blockers? [SECLET ALL THAT APPLY]

A. Inhibition of ejaculation

B. Nasal congestion

C. Orthostatic hypotension

D. Reflex bradycardia

E. Hypertension

A, B, C

A nurse is reviewing a new order for oral morphine. Which factor most affects its absorption?

A. Presence of food in the stomach

B. Patient's heart rate

C. Albumin binding

D. CYP450 enzyme activity

A

Which factors influence drug distribution in the body? select all that apply

A. Capillary permeability

B. Protein binding

C. Renal clearance

D. Blood flow to tissues

E. Lipid solubility

A, B, D, E

A patient on phenytoin develops decreased effectiveness of oral contraceptives. Why?

A. Phenytoin is a CYP450 inhibitor

B. Phenytoin is a CYP450 inducer

C. Oral contraceptives reduce drug absorption

D. Oral contraceptives increase renal clearance

B

Which organ is primarily responsible for drug excretion?

A. Kidney

B. Liver

C. Lungs

D. GI tract

A

A patient receives oral nitroglycerin but reports no pain relief. The nurse explains this is due to:

A. Poor absorption

B. Distribution to fat stores

C. Rapid hepatic inactivation

D. Renal clearance

C

Patinet is prescribed warfarin and starts erythromycin. What must the nurse monitor closely?

A. Blood pressure

B. INR and bleeding

C. Heart rate

D. Blood glucose

B

What am I?

High affinity, high intrinsic activity

*intrinsic activity: ability of a drug to activate the receptor after binding

Agonist

What am I?

High affinity, no intrinsic activity

*intrinsic activity: ability of a drug to activate the receptor after binding

Antagonist

What am I?

Moderate intrinsic activity

*intrinsic activity: ability of a drug to activate the receptor after binding

Partial agonist

Drug A produces a greater maximum of pain relief than Drug B, though Drug B requires a smaller dose. Which statement is correct?

A. Drug A is more potent

B. Drug A is more efficacious

C. Drug B is more efficacious

D. Drug B is less potent

B

Which patients are at higher risk for altered pharmacokinetics. select all that apply:

A. 3-week old infant

B. 35 y/o with asthma

C. 70 y/o with cirrhosis

D. Patient with renal insufficiency

E. A healthy 28-year

A, C, D

The nurse notes a patient's plasma drug level is below the MEC. What is the implication?

A. Drug is toxic

B. Drug is subtherapeutic

C. Drug is at peak effect

D. Dose must be decreased

B

Which ADR should the nurse monitor for in a patient taking bethanechol?

A. Constipation

B. Urinary retention

C. Bradycardia

D. Mydriasis

C

A patient with asthma should NOT take bethanechol because:

A. It decreases HR

B. It causes bronchoconstriction

C. It increases urinary retention

D. It raises intraocular pressure

B

Which medication is used to treat bradycardia?

A. Oxybutynin

B. Bethanechol

C. Atropine

D. Acetylecholine

C

Which effect is expected after administration of atropine?

A. Increased alivation

B. Pupil constriction

C. Urinary urgency

D. Decreased GI motility

D

The nurse should question oxybutynin in a patient with:

A. OAB

B. Constipation

C. Urinary frequency

D. Excessive salivation

B

A patient develops dry mouth, blurred vision, and tachycardia after medication. The nurse suspects:

A. Muscarinic agonist toxicity

B. Muscarinic antagonist effects

C. Cholinesterase inhibitors

D. Adrenergic agonist reaction

B

Which receptor is selectively blocked by oxybutynin?

A. M1

B. M2

C. M3

D. Nicotinic

C

Which antidote is appropriate for cholinergic toxidrome?

A. Epinephrine

B. Naloxone

C. Atropine

D. Bethanechol

C

The nurse expects bethanechol to be prescribed for which patient?

A. Urinary retention

B. Bradycardia

C. Asthma

D. Constipation

A

The nurse identifies which as a contraindication for atropine use?

A. Bradycardia

B. Glaucoma

C. Pre-anesthesia prophylaxis

D. GI hypermobility

B

A patient receiving IV dopamine develops tachycardia. What is the nurse's priority action?

A. Document as expected

B. Slow the infusion rate

C. Increase the IV fluids

D. Stop the infusion ASAP

B

Which finding indicates ADRs of A1 agonist therapy?

A. Nasal congestion

B. Bradycardia

C. Increased urination

D. Miosis

B (reflex brady)

The nurse prepares to administer epinephrine to a patient in anaphylaxis. Which receptor effects are most therapeutic?

A. Alpha activation reducing NE release

B. Beta1 and beta2 activation, restoring cardiac output and bronchodilation

C. Dopamine activation, improving renal perfusion

D. Alpha activation only, increasing BP

B

A patient develops tissue necrosis at an IV site after norepinephrine extravasation. Which antidote should the nurse anticipate?

A. Epinephrine

B. Phentolamine

C. Atropine

D. Albuterol

B

Which patient would most benefit from a beta2 agonist?

A. Atrial fib.

B. Asthma

C. Shock

D. AV block

B

The nurse is giving albuterol for asthma. Which ADR is expected?

A. Hypoglycemia

B. Hyperglycemia

C. Bradycardia

D. Urinary retention

B

Why are catecholamines NOT given PO?

A. They cause GI irritation

B. Rapidly destroyed by MAO and COMT in the GI tract

C. Too toxic

D. Cross BBB too easily

B

Which adrenergic agonist would be chosen to delay preterm labor?

A. Dobutamine

B. Ephedrine

C. Terbutaline

D. Dopamine

C

What is the therapeutic rationale for dopamine at low doses?

A. Enhances renal perfusion

B. Causes bronchodilation

C. Increases insulin release

D. Blocks norepinephrine

A

A patient receiving isoproterenol should be monitored for which effects?

A. HTN and urinary retention

B. Tachydysrhythmias, angina, and hyperglycemia

C. Constipation and blurred vision

D. Depression and sedation

B

Adrenergic Agonist_Antagonists Study Chart and Sample NCLEX Questions.docx

Adrenergic Agonist_Antagonists Study Chart and Sample NCLEX Questions.docx

Which action results from clonidine administration?

A. Increased HR and BP

B. Decreased sympathetic outflow from the CNS

C. Stimulation of beta-1 receptors

D. Increased renin release

B

A nurse gives methyldopa to a pregnant client. Which adverse effect requires monitoring?

A. Hyperkalemia

B. Hemolytic anemia

C. Bronchospasm

D. Hyperglycemia

B

Which condition is an indication for alpha-1 blockers?

A. Asthma

B. Hypertension

C. Seizures

D. Glaucoma

B

Which teaching is correct for a patient starting prazosin?

A. Take your first dose in the morning

B. Rise slowly to avoid dizziness

C. Expect an increased heart rate

D. Increase sodium intake

B

Which adverse effect of alpha blockers occurs due to venous pooling?

A. Bradycardia

B. Orthostatic hypotension

C. Tachypnea

D. Hyperreflexia

B

Which beta blocker is nonselective?

A. Metoprolol

B. Propranolol

C. Atenolol

D. Bisoprolol

B

A patient with asthma should avoid which drug?

A. Metoprolol

B. Prazosin

C. Propranolol

D. Clonidine

C

A nurse should teach which concept to a patient on beta blockers?

A. Can stop abruptly

B. May cause bradycardia

C. Raises BP and HR

D. Used for acute asthma

B

A nurse monitors which adverse effect in a patient on clonidine?

A. Dry mouth

B. Polyuria

C. Hyperactivity

D. Sweating

A

Which best describes the effect of beta-1 blockade on the heart?

A. Increases contractility

B. Decreases heart rate and conduction

C. Causes bronchoconstriction

D. Raises BP

B