Light Bulb Moment
Test your knowledge and application.
Practice applying your knowledge regarding ANS neuroreceptors to the following patient scenarios where a nurse must use clinical judgment for a solution:
1. A patient begins a nicotine patch in an attempt to stop smoking. The patient reports feelings of nausea, weakness, and a rapid heartbeat.
a) What is the likely cause of these symptoms?
b) What is the nurse’s best response?
2. A patient with benign prostatic hyperplasia (BPH) has a new order for tamsulosin. He asks, “How will tamsulosin help me? I already take so many pills.”
a) What is the nurse’s best response?
b) What does the nurse plan to monitor carefully, especially after administering the first dose of tamsulosin?
3. A patient with asthma is taking albuterol to help when she feels increased shortness of breath.
a) How will albuterol assist in her breathing?
The patient states, “After I take albuterol, it feels as if my heart is racing.”
b) What is the likely cause of this symptom?
c) What is the nurse’s best response to the patient’s concern?
4. A patient with high blood pressure is prescribed propranolol.
a) How will propranolol help to lower the blood pressure?
b) What will the nurse assess before administering the propranolol?
The nurse listens to the patient’s lungs a few hours after administering propranolol and notices new wheezing.
c) What could be a potential cause of this new finding?
d) What is the nurse’ s next best response?
5. A patient is prescribed metoprolol to help control his atrial fibrillation, an irregular heart rhythm.
a) What will the nurse assess before administering the metoprolol?
b) What findings would cause the nurse to call the provider before administering the metoprolol?
Upon reassessment the next day, the nurse notices a new finding of edema in the patient’s feet and lower legs.
c) What could be a potential cause of this new finding?
d) What is the nurse’s next best response?
6. A patient with an acute episode of heart failure is admitted and is prescribed dobutamine.
a) How will dobutamine improve the patient’s condition?
b) What will the nurse monitor carefully during administration?
Note: Answers to the Light Bulb Moment can be found in the “Answer Key” sections at the end of the book.
Case Study 1
Mr. Lao is a 42-year-old male who was referred to the outpatient clinic for treatment of hypertension and attention deficit hyperactivity disorder (ADHD). He has a history of uncontrolled hypertension despite lifestyle modifications and multiple medication trials and reports symptoms of inattention, impulsivity, and hyperactivity consistent with ADHD.
Assessment:
- Vital Signs: Blood Pressure: 150/100 mmHg; Heart Rate: 90 bpm; Respiratory Rate: 20 breaths/minute
- Physical Examination: Well-nourished and well-developed male in no acute distress. Lung exam reveals clear breath sounds.
- Patient Report: Mr. Lao reports difficulty with attention and organization and experiences high levels of stress and anxiety, particularly in high-pressure situations at work.
- Laboratory Results: Blood Urea Nitrogen (BUN): 14 mg/dL; Creatinine: 1.2 mg/dL
- What medication would you expect to be prescribed to treat Mr. Lao’s hypertension and ADHD?
- Prior to administering this medication, what assessments should be performed?
- It is early August and Mr. Lao wants to begin an exercise regimen to that includes running outdoors. What education should be provided to Mr. Lao?
Note: Answers to the Case Study can be found in the “Answer Key” sections at the end of the book.
Case Study 2
Mrs. Lenni Anton is a 57-year-old female who was referred to the outpatient clinic for treatment of essential tremor and hypertension. She has a history of uncontrolled hypertension and reports persistent tremors in her hands that interfere with her daily activities.
Assessment:
- Vital Signs: Blood Pressure: 145/90 mmHg; Heart Rate: 80 bpm; Respiratory Rate: 16 breaths/minute
- Physical Examination: Well-nourished and well-developed female in no acute distress. Lung exam reveals clear breath sounds.
- Patient Report: Mrs. Anton reports difficulty with fine motor tasks due to her tremors and experiences high levels of stress and anxiety, particularly in social situations.
- Laboratory Results: Blood Urea Nitrogen (BUN): 18 mg/dL; Creatinine: 0.9 mg/dL
- What medication do you expect to be prescribed to Mrs. Anton?
- Mrs. Anton is prescribed and extended-release form of the medication. What special instruction should be given related to this form of the medication?
- Mrs. Anton monitors her blood pressure and heart rate at home, noting a gradual decline over the past two weeks. This morning she notes that her blood pressure is 89/56 mmHg and her heart rate is 52 bpm. What action should Mrs. Anton take next?
Note: Answers to the Case Study can be found in the “Answer Key” sections at the end of the book.
