The nurse administers pseudoephedrine to a patient who is experiencing severe bronchospasm. Which of these is an adverse reaction from the pseudoephedrine?

Choice A rationale Pseudoephedrine is a sympathomimetic drug that acts primarily as an alpha and beta agonist, stimulating the central nervous system (CNS). This stimulation usually leads to wakefulness, nervousness, and insomnia, rather than excessive sleepiness, which is a CNS depressant effect. Drowsiness can occur but is less common than CNS stimulation effects, as the drug promotes adrenergic activity. Choice B rationale Pseudoephedrine stimulates beta-1 adrenergic receptors in the heart, leading to an increase in heart rate (tachycardia) and force of contraction. This enhanced cardiac activity can be perceived by the patient as palpitations (irregular or rapid heartbeat). The normal adult heart rate is 60 to 100 beats per minute, and this drug can push it toward the upper limit or beyond. Choice C rationale Pseudoephedrine acts as a vasoconstrictor by stimulating alpha-1 adrenergic receptors on blood vessels, leading to an increase in systemic vascular resistance. This increase in resistance and cardiac stimulation typically results in a rise in blood pressure (hypertension), not hypotension. The normal adult blood pressure is less than 120/80 mm Hg. Choice D rationale Pseudoephedrine is generally a bronchodilator due to its beta-2 adrenergic receptor stimulation, which relaxes bronchial smooth muscles and improves (not worsens) respiration. Shallow respirations are a sign of respiratory depression or distress, which is not a common adverse effect of this sympathomimetic, which tends to increase the respiratory drive.