Question

1. The nurse is evaluating the vital signs of an obstetric patient in preterm labor who has recently begun taking terbutaline (Brethine). The patient reports that her heart feels like it is racing and questions if this is a normal feeling. Provide a response for the patient to include drug education.

2. The nurse is preparing to administer pyridostigmine (Mestinon) to a patient with myasthenia gravis. Prior to administration, the patient assessment is completed and bilateral lung wheezes are auscultated. Identify the appropriate nursing intervention in this scenario.

3. Examine the drug actions listed for adrenergic blocking agents. Explain the mechanisms whereby these drugs are beneficial in treating angina pectoris, cardiac dysrhythmias, and hypertension.

4. Identify the correct procedure that the nurse will use when evaluating a patient for orthostatic hypotension.

5. Which type of autonomic system drugs should generally not be used for patients with pulmonary disorders?

Answer 1

1. Terbutaline is a bronchodilator and tocolytics . It is used in bronchospasm and preterm labour to delay pregnancy for upto 48hrs. The nurse should respond to the patient that increased heart rate is one of the side effects of terbutalin.In the mother, using terbutaline side effects include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia.

2. The appropriate nursing intervention in this scenario is to suction out the secretions by providing suctioning ,chest physiotherapy ,postural drainage and medications because in Myasthenia gravis there is paralysis of the vagal reflexes and will result in aspiration .

3.Mechanism of action of adrenergic blocking agents :-

- binds to the adrenergic receptors

- inhibit or block the stimulation of sympathetic nervous system

Mechanism of the cardioselective adrenergic blocking agents :-

- reduces the sympathetic nervous system stimulation of heart

- decreases heart rate

- decreases myocardial contractility and reduces the myocardial oxygen demand

4. The procedure used by the nurse to diagnose orthostatic hypotension is to check blood pressure ,if you have a drop of 20 millimeters of mercury (mm Hg) in your systolic blood pressure or a drop of 10 mm Hg in your diastolic blood pressure within two to five minutes of standing up.