Adrenergic Agonists

Which medication is first-line for anaphylaxis? A. Norepinephrine B. Epinephrine C. Dopamine D. Dobutamine

B. Epinephrine

Epinephrine improves bronchospasm primarily through stimulation of: A. a1 receptors B. B1 receptors C. B2 receptors D. Dopamine receptors

C. B2 receptors

A patient receives epinephrine and develops tachycardia and tremor. The nurse explains: A. These are signs of hypoglycemia. B. These are common sympathetic effects of epinephrine. C. This means the drug is not working. D. This indicates an allergic reaction to epinephrine.

B. These are common sympathetic effects of epinephrine.

After giving epinephrine for anaphylaxis, what is the nurse’s priority reassessment? A. Bowel sounds B. Airway, breathing, and blood pressure C. Pupillary response D. Skin turgor

B. Airway, breathing, and blood pressure

Which finding after epinephrine administration is most concerning? A. Mild tremor B. HR 118 C. New chest pain D. Mild headache

C. New chest pain

Epinephrine supports blood pressure in shock through primarily: A. a1 vasoconstriction increasing SVR B. B2 vasodilation decreasing SVR C. Blocking calcium channels D. Increasing aldosterone production

A. a1 vasoconstriction increasing SVR

Which condition is a common indication for epinephrine in acute care? A. Chronic constipation B. Cardiac arrest C. Hyperlipidemia D. DVT prophylaxis

B. Cardiac arrest

A patient on an epinephrine infusion develops severe hypertension. The nurse should anticipate: A. Increasing the infusion rate B. Titrating down or holding per protocol and notifying provider C. Giving vitamin K D. Encouraging ambulation

B. Titrating down or holding per protocol and notifying provider

Which effect of epinephrine helps reduce airway swelling in anaphylaxis? A. B1 stimulation increases HR B. a1 vasoconstriction reduces capillary leak and edema C. B2 causes tachycardia D. Dopamine receptor stimulation increases renal blood flow

B. α1 vasoconstriction reduces capillary leak and edema

A nurse should monitor which complication most closely with epinephrine? A. Bradycardia B. Dysrhythmias C. Constipation D. Ototoxicity

B. Dysrhythmias

A patient treated with epinephrine for anaphylaxis is also given antihistamines. The nurse understands: A. Antihistamines replace epinephrine B. Antihistamines are adjuncts; epinephrine is first-line C. Antihistamines treat hypotension immediately D. Antihistamines prevent tachycardia

B. Antihistamines are adjuncts; epinephrine is first-line

Which assessment trend best indicates epinephrine is effective in anaphylaxis? A. Increased flushing B. Improved breath sounds, rising BP, decreased swelling C. Rising temperature D. Increased edema

B. Improved breath sounds, rising BP, decreased swelling

Epinephrine is most likely to increase which parameter? A. Heart rate B. INR C. Potassium D. Hearing acuity

A. Heart rate

A patient receiving epinephrine develops severe anxiety and palpitations. The nurse should first: A. Ignore it B. Assess vitals and rhythm to rule out dangerous tachyarrhythmia C. Give potassium D. Give warfarin

B. Assess vitals and rhythm to rule out dangerous tachyarrhythmia

Which receptor profile best describes epinephrine? A. a1 only B. B1 only C. a1 + B1 + B2 D. Dopamine only

C. a1 + B1 + B2

A patient on epinephrine infusion has cool extremities and diminished peripheral pulses. The nurse interprets this as: A. Improved perfusion B. Possible excessive vasoconstriction C. Hyperkalemia D. Normal GI side effect

B. Possible excessive vasoconstriction

Which symptom suggests epinephrine is causing excessive cardiac stimulation? A. HR 130 with new PVCs B. Mild headache C. Slight tremor D. Warm skin

A. HR 130 with new PVCs

Primary nursing goal with epinephrine in emergencies is to: A. Maximize HR B. Restore airway patency and perfusion while avoiding ischemia and arrhythmias C. Cure allergy permanently D. Avoid all monitoring

B. Restore airway patency and perfusion while avoiding ischemia and arrhythmias

Norepinephrine primarily causes: A. Bronchodilation B. Strong vasoconstriction increasing SVR and BP C. Diuresis D. Potassium wasting

B. Strong vasoconstriction increasing SVR and BP

Which clinical situation commonly requires norepinephrine? A. Hyperlipidemia B. Septic shock with hypotension despite fluids C. Mild asthma attack D. Constipation

B. Septic shock with hypotension despite fluids

What is the priority nursing monitoring for norepinephrine infusion? A. Daily weight only B. Continuous BP (MAP) and tissue perfusion C. Bowel sounds every hour D. Visual acuity

B. Continuous BP (MAP) and tissue perfusion

A major complication of norepinephrine is: A. Severe constipation B. Tissue ischemia or necrosis from extravasation C. Hearing loss D. Dry cough

B. Tissue ischemia or necrosis from extravasation

A patient receiving norepinephrine has blanching and swelling at the IV site. What should the nurse do first? A. Increase the infusion B. Stop infusion and manage extravasation per protocol C. Apply a heating pad and continue D. Massage the site vigorously

B. Stop infusion and manage extravasation per protocol

Which finding suggests norepinephrine may be causing excessive vasoconstriction? A. Improved urine output B. Mottled skin and decreasing urine output C. Warm extremities D. Increased appetite

B. Mottled skin and decreasing urine output

Norepinephrine’s primary receptor target is: A. B2 B. a1 C. Dopamine receptors only D. Muscarinic receptors

B. a1

Which patient parameter best indicates norepinephrine therapy is effective? A. BP or MAP improves and urine output increases B. Constipation resolves C. LDL decreases D. Skin becomes flushed

A. BP or MAP improves and urine output increases

Which adverse effect requires immediate provider notification during norepinephrine therapy? A. Mild headache B. Chest pain or new arrhythmias C. Mild nausea D. Slight tremor

B. Chest pain or new arrhythmias

A nurse understands that norepinephrine is typically used after: A. No fluids are given B. Adequate fluid resuscitation to support volume status C. Antibiotics are completed D. Lipids are normalized

B. Adequate fluid resuscitation to support volume status

Which statement best explains why norepinephrine may reduce peripheral pulses? A. It causes vasodilation B. It causes vasoconstriction, shunting blood to vital organs C. It increases platelet breakdown D. It increases kidney filtration directly

B. It causes vasoconstriction, shunting blood to vital organs

Which patient is at greatest risk for IV-site injury from norepinephrine? A. Patient with central line B. Patient with fragile peripheral IV access C. Patient drinking water D. Patient with mild headache

B. Patient with fragile peripheral IV access

If norepinephrine is titrated too high, the biggest danger is: A. Hyperkalemia B. Excessive vasoconstriction causing tissue ischemia and organ hypoperfusion C. Hearing loss D. Constipation

B. Excessive vasoconstriction causing tissue ischemia and organ hypoperfusion

A patient on norepinephrine has improved BP but worsened mottling and rising lactate. Best interpretation: A. BP is all that matters B. Perfusion may still be poor and provider should be notified C. This is expected and should be ignored D. Give vitamin K

B. Perfusion may still be poor and provider should be notified

Which outcome represents safe, effective norepinephrine use? A. MAP in goal range with improving mentation and urine output B. MAP high with chest pain C. Severe blanching at IV site D. New ventricular tachycardia

A. MAP in goal range with improving mentation and urine output

Norepinephrine most directly increases BP by: A. Increasing blood volume B. Increasing SVR via vasoconstriction C. Increasing potassium excretion D. Blocking beta receptors

B. Increasing SVR via vasoconstriction

Which nursing action is most appropriate for a patient on norepinephrine? A. Ambulate frequently B. Continuous BP monitoring and frequent IV site checks C. Encourage grapefruit juice D. Give NSAIDs routinely

B. Continuous BP monitoring and frequent IV site checks

Primary nursing goal with norepinephrine is to: A. Improve BP or MAP and perfusion while avoiding ischemia and extravasation injury B. Cure sepsis C. Reduce cholesterol D. Treat constipation

A. Improve BP or MAP and perfusion while avoiding ischemia and extravasation injury

Dopamine is used in shock because it can: A. Only bronchodilate B. Increase cardiac output and BP depending on dose and patient response C. Decrease HR D. Treat allergies

B. Increase cardiac output and BP depending on dose and patient response

Which adverse effect is most concerning with dopamine? A. Constipation B. Tachyarrhythmias C. Dry cough D. Hearing loss

B. Tachyarrhythmias

A patient on dopamine develops HR 140 with frequent PVCs. Priority nursing action? A. Increase infusion B. Assess rhythm/vitals and notify provider; anticipate dose reduction C. Give vitamin K D. Encourage walking

B. Assess rhythm/vitals and notify provider; anticipate dose reduction

Which parameter best indicates dopamine is improving perfusion? A. LDL decreases B. Urine output increases and mentation improves C. Constipation resolves D. Hearing improves

B. Urine output increases and mentation improves

Dopamine’s biggest nursing safety focus is monitoring for: A. Hyperkalemia B. Dysrhythmias and BP changes C. Dry cough D. GI bleeding only

B. Dysrhythmias and BP changes

Which patient is at higher risk for dopamine complications? A. Patient with history of ventricular dysrhythmias B. Patient with seasonal allergies C. Patient with constipation D. Patient with acne

A. Patient with history of ventricular dysrhythmias

Dopamine infusion requires which type of monitoring? A. Weekly BP checks B. Continuous cardiac monitoring and frequent BP checks C. Bowel sounds every 2 hours only D. Vision checks

B. Continuous cardiac monitoring and frequent BP checks

A patient’s BP rises significantly on dopamine but they become cool and mottled. Best interpretation: A. The drug is perfect—no changes needed B. BP improved but perfusion may be compromised; reassess end-organ perfusion and notify provider C. This means hyperkalemia D. This indicates infection resolved

B. BP improved but perfusion may be compromised; reassess end-organ perfusion and notify provider

A key goal of dopamine in shock is: A. Lower BP B. Support BP and cardiac output to improve perfusion C. Treat infection D. Treat asthma

B. Support BP and cardiac output to improve perfusion

Which adverse effect suggests too much dopamine beta-1 activity? A. Bradycardia B. Tachycardia C. Constipation D. Hypoglycemia

B. Tachycardia

A nurse notes a dopamine IV site is swollen and blanched. Priority action? A. Continue infusion B. Stop infusion and manage extravasation per protocol C. Massage the site D. Apply heat and continue

B. Stop infusion and manage extravasation per protocol

Which finding suggests dopamine is not well tolerated? A. HR increases mildly B. New chest pain and arrhythmia C. BP improves gradually D. Urine output increases

B. New chest pain and arrhythmia

Dopamine is an adrenergic agonist that can stimulate: A. Only a1 B. Only B2 C. Dopamine receptors and adrenergic receptors depending on dose D. Only muscarinic receptors

C. Dopamine receptors and adrenergic receptors depending on dose

Which nursing outcome best indicates dopamine is effective? A. BP/MAP improves and urine output improves without arrhythmias B. BP improves with ventricular tachycardia C. HR 160 with agitation D. IV site blanches

A. BP/MAP improves and urine output improves without arrhythmias

A dopamine infusion should be titrated based on: A. Patient’s appetite B. BP/MAP and perfusion parameters per protocol C. Stool frequency D. Skin tone only

B. BP/MAP and perfusion parameters per protocol

Which is a priority nursing action before starting dopamine? A. Ensure patient is on continuous ECG monitoring B. Encourage grapefruit juice C. Give vitamin K D. Apply a heating pad to IV site

A. Ensure patient is on continuous ECG monitoring

Dopamine is most likely to worsen which condition? A. Ventricular dysrhythmias B. Constipation C. Seasonal allergies D. Low LDL

A. Ventricular dysrhythmias

Primary nursing goal with dopamine is: A. Raise BP at all costs B. Improve perfusion while minimizing dysrhythmias and ischemia C. Cure shock permanently D. Prevent constipation

B. Improve perfusion while minimizing dysrhythmias and ischemia

Dobutamine primarily stimulates: A. a1 B. B1 C. B2 only D. Muscarinic receptors

B. B1

Dobutamine is most appropriate for: A. Septic shock with very low SVR as first-line vasopressor B. Cardiogenic shock or acute HF with low cardiac output C. Allergic rhinitis D. Hyperlipidemia

B. Cardiogenic shock or acute HF with low cardiac output

Which assessment finding best indicates dobutamine is effective? A. Improved cardiac output signs: better mentation, improved urine output, reduced pulmonary congestion B. Increased constipation C. Decreased LDL D. Increased bruising

A. Improved cardiac output signs: better mentation, improved urine output, reduced pulmonary congestion

A patient on dobutamine develops tachycardia. The nurse understands: A. This can occur due to B1 stimulation and may require dose adjustment B. This means the drug is ineffective C. This indicates hypokalemia only D. This is unrelated to dobutamine

A. This can occur due to β1 stimulation and may require dose adjustment

A patient’s BP is low and dobutamine is started. The nurse knows dobutamine may: A. Always raise BP strongly B. Sometimes lower BP due to vasodilation, despite increased contractility C. Cause severe constipation D. Cause dry cough

B. Sometimes lower BP due to vasodilation, despite increased contractility

Which adverse effect is most concerning with dobutamine? A. Mild headache B. New chest pain and dysrhythmias C. Mild nausea D. Mild flushing

B. New chest pain and dysrhythmias

Dobutamine requires which monitoring? A. Weekly BP only B. Continuous ECG and frequent BP, plus perfusion assessment C. Stool frequency monitoring only D. Vision exams

B. Continuous ECG and frequent BP, plus perfusion assessment

A patient on dobutamine has HR 150 and increasing chest pain. Priority nursing action? A. Increase infusion B. Assess vitals/rhythm and notify provider immediately; anticipate titration down C. Give warfarin D. Encourage exercise

B. Assess vitals/rhythm and notify provider immediately; anticipate titration down

Which patient would benefit most from dobutamine? A. Patient with low cardiac output and signs of poor perfusion B. Patient with nasal congestion C. Patient with DVT D. Patient with hyperkalemia

A. Patient with low cardiac output and signs of poor perfusion

Dobutamine increases myocardial oxygen demand primarily by: A. Decreasing HR B. Increasing contractility and often HR C. Decreasing preload D. Blocking alpha receptors

B. Increasing contractility and often HR

A patient with cardiogenic shock is on dobutamine but BP remains low. Best nursing interpretation? A. Dobutamine is guaranteed to raise BP B. Low BP may persist; provider may add a vasopressor for SVR support C. Give nitrates D. Give potassium

B. Low BP may persist; provider may add a vasopressor for SVR support

Which finding indicates dobutamine is not tolerated? A. Mild improvement in urine output B. New ventricular tachycardia C. Slightly warmer skin D. Reduced crackles

B. New ventricular tachycardia

Dobutamine extravasation risk is best addressed by: A. No special monitoring needed B. Frequent IV site checks and proper access per facility protocol C. Applying heat routinely D. Massaging the IV site

B. Frequent IV site checks and proper access per facility protocol

Which outcome best indicates safe, effective dobutamine therapy? A. HR 160 with anxiety B. Improved perfusion with stable rhythm and manageable HR C. Severe chest pain D. Mottled skin and low urine output

B. Improved perfusion with stable rhythm and manageable HR

Primary nursing goal with dobutamine is to: A. Increase BP at all costs B. Increase cardiac output and perfusion while minimizing ischemia and dysrhythmias C. Cure heart failure permanently D. Treat asthma

B. Increase cardiac output and perfusion while minimizing ischemia and dysrhythmias

Which paired “best use” match is correct? A. Epinephrine = septic shock first-line pressor B. Norepinephrine = anaphylaxis first-line C. Dopamine = can support BP/CO but higher arrhythmia risk D. Dobutamine = primary drug for nasal congestion

C. Dopamine = can support BP/CO but higher arrhythmia risk