Chapter 18 Adrenergic Antagonists

Chapter 18: Adrenergic Antagonists Test Bank MULTIPLE CHOICE 1. A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching? a. “Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins.” b. “Dilation of arterioles has a direct effect on arterial pressure.” c. “Dilation of veins by alpha-adrenergic antagonists improves cardiac output.” d. “Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure.” ANS: C Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins. When alpha1 receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct effect on arterial pressure occurs. When alpha1 receptors on veins are blocked by alpha-adrenergic antagonists, an indirect effect on arterial pressure occurs. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 156-157 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha- blocking agent to be given preoperatively. What does the nurse understand about this agent? a. It is ordered to prevent perioperative hypertensive crisis. b. It prevents secretion of catecholamines by the adrenal tumor. c. It reduces contraction of smooth muscles in the adrenal medulla. d. It is given chronically after the surgery to prevent hypertension. ANS: A Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute hypertension during surgery. These agents do not prevent secretion of catecholamines; they block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They are given chronically in patients who have inoperable tumors. PTS: 1 DIF: Cognitive Level: Application REF: pp. 156-157 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 3. A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient? a. “Metoprolol has no effect on diabetes mellitus or on your insulin requirements.” b. “Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose.” c. “Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely.” d. “Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.” ANS: C Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels. PTS: 1 DIF: Cognitive Level: Application REF: p. 164 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. The nurse is discussing home management with a patient who will begin taking an alpha- adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? a. “I need to stop the medication if my heart rate increases.” b. “I should not drive while taking this medication.” c. “I should take the first dose at bedtime.” d. “I will stop taking the medication if I feel dizzy.” ANS: C Orthostatic hypotension is a common side effect of this class of drugs and is most severe with the first dose. Administering the first dose at bedtime eliminates the risk associated with this firstdose effect. Tachycardia is an expected side effect; if severe, it can be treated with other medications. Patients should not drive during the first 12 to 24 hours after taking these agents, because fainting and dizziness may occur, but they may drive after that. Dizziness is not an indication for stopping the drug; patients who experience dizziness are instructed to sit or lie down until symptoms pass. PTS: 1 DIF: Cognitive Level: Application REF: pp. 156-157 | p. 166 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient’s heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next? a. Administer the drug as prescribed. b. Request an order for atropine. c. Withhold the dose and document the pulse rate. d. Withhold the dose and notify the prescriber. ANS: D A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats per minute; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient’s pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient’s heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication. PTS: 1 DIF: Cognitive Level: Application REF: pp. 161-162 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. The nurse assesses a patient who has been given phentolamine [OraVerse] to treat pheochromocytoma. The nurse notes a blood pressure of 76/52 mm Hg and a heart rate of 90 beats per minute. Which action by the nurse is correct? a. Contact the provider to request an order for epinephrine. b. Continue to monitor the patient’s vital signs and notify the provider if the heart rate increases. c. Notify the provider and request an order for a beta blocker. d. Notify the provider and request an order for norepinephrine. ANS: D Phentolamine can cause orthostatic hypotension, reflex tachycardia, nasal congestion, and inhibition of ejaculation. Overdose can produce profound hypotension. When this occurs, blood pressure can be elevated with norepinephrine. Epinephrine should not be used because, in the presence of alpha1 blockade, the ability of epinephrine to promote vasodilation by activation of beta2 receptors may outweigh its ability to cause vasoconstriction, causing further lowering of blood pressure. Norepinephrine does not activate beta2 receptors. Beta blockers may be used to treat severe reflex tachycardia. This patient has significant hypotension, so it is not correct to continue to monitor without notifying the provider. PTS: 1 DIF: Cognitive Level: Application REF: p. 159 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 7. A nurse is discussing phentolamine [OraVerse] with a nursing student. Which statement by the student indicates the need for further teaching? a. “Phentolamine can be used to block both epinephrine- and norepinephrine-mediated vasoconstriction.” b. “Phentolamine can be used to prevent tissue necrosis after extravasation of drugs such as norepinephrine.” c. “Phentolamine is a competitive adrenergic agonist that acts selectively on alpha1 receptors.” d. “Side effects of phentolamine may include tachycardia and hypotension.” ANS: C Phentolamine has actions on both alpha1 and alpha2 receptors; it is not selective for alpha1 receptors only. It blocks both epinephrine- and norepinephrine-mediated vasoconstriction. It is used to prevent tissue necrosis after extravasation of drugs such as norepinephrine and other drugs that produce alpha1-mediated vasoconstriction. Side effects include tachycardia and hypotension. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 159 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with: a. bronchoconstriction. b. left-sided heart failure. c. rebound cardiac excitation. d. sinus bradycardia. ANS: B The signs and symptoms describe left-sided heart failure, in which the blood normally handled by the left ventricle and forced out through the aorta into the body backs up into the lungs, producing respiratory signs and symptoms. The patient’s signs and symptoms are not indicative of bronchoconstriction, which would cause wheezing and diminished breath sounds. Rebound cardiac excitation occurs when the beta blocker is withdrawn, not during administration of the drug. The patient’s heart rate is elevated, so sinus bradycardia is not present. PTS: 1 DIF: Cognitive Level: Application REF: pp. 159-160 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 9. A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha- adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe? a. Alfuzosin [Uroxatral] b. Prazosin [Minipress] c. Silodosin [Rapaflo] d. Tamsulosin [Flomax] ANS: A Alfuzosin is used for BPH and does not interfere with ejaculation. All of the other drugs have ejaculatory side effects. Prazosin may be useful for BPH, but it is not approved for this use. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 159 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse’s teaching indicates understanding of the drug’s effects? a. “It causes bronchodilation, which increases oxygen flow.” b. “It helps reduce the heart’s oxygen needs.” c. “It improves blood flow to the heart.” d. “It increases cardiac output.” ANS: B Blockade of beta1 receptors in the heart reduces cardiac work by reducing the heart rate, the force of contraction, and the velocity of impulse conduction through the AV node. Beta blockers result in bronchoconstriction, not bronchodilation. They do not increase blood flow to the heart. Cardiac output is decreased, not increased. PTS: 1 DIF: Cognitive Level: Application REF: p. 159 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A nurse is caring for a newborn 1 day after delivery. The infant’s mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition? a. Hyperglycemia b. Hyperthyroidism c. Respiratory distress d. Tachycardia ANS: C Use of beta blockers during pregnancy can affect a newborn for several days after birth. Newborns are at risk for bradycardia, respiratory distress, and hypoglycemia. Hyperglycemia, hyperthyroidism, and tachycardia are not expected residual effects. PTS: 1 DIF: Cognitive Level: Application REF: p. 161 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 12. A patient will begin taking propranolol [Inderal] for hypertension. Which statement by the nurse is important when teaching this patient about the medication? a. “Check your hands and feet for swelling and report that to your provider.” b. “It is safe to take this medication with a calcium channel blocker.” c. “Stop taking the drug if you become short of breath.” d. “Take your pulse and do not take the medication if your heart rate is fast.” ANS: A Patients taking propranolol can develop heart failure because of the suppression in myocardial contractility. Patients should be taught to watch for signs, which include shortness of breath, night coughs, and swelling of the extremities. Use of these agents with calcium channel blockers is contraindicated, because the effects are identical and excessive cardiosuppression can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not be given if the pulse is less than 60 beats per minute. PTS: 1 DIF: Cognitive Level: Application REF: p. 163 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 13. A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication’s effects? a. “I need to take it every day to reduce the frequency of migraines.” b. “I will take it as needed to get relief from migraines.” c. “I will take it to shorten the duration of my migraines.” d. “I will take this drug when a migraine starts.” ANS: A When taken prophylactically, beta blockers can reduce the frequency of migraine attacks. Beta blockers do not provide complete relief from migraines. They do not reduce the duration of migraines. They are not effective for treating a migraine once the migraine has begun. PTS: 1 DIF: Cognitive Level: Application REF: p. 160 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. Which are adverse effects of alpha blockade? (Select all that apply.) a. Hypertension b. Reflex tachycardia c. Nasal congestion d. Ejaculation e. Hypernatremia ANS: B, C, E Adverse effects of alpha blockade include reflex tachycardia, nasal congestion, and hypernatremia. Other adverse effects include orthostatic hypotension and inhibition of ejaculation. Hypertension and ejaculation are not adverse effects of alpha blockade. PTS: 1 DIF: Cognitive Level: Application REF: pp. 156-157 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which are conditions that may be treated using beta blockers? (Select all that apply.) a. Cardiac dysrhythmias b. Heart failure c. Hypotension d. Hypothyroidism e. Stage fright ANS: A, B, E Beta blockers are used to treat cardiac dysrhythmias, heart failure, and stage fright. They are used to treat hypertension and hyperthyroidism. PTS: 1 DIF: Cognitive Level: Application REF: p. 159 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies