Chapter 19 Indirect-Acting Antiadrenergic Agents

Chapter 19: Indirect-Acting Antiadrenergic Agents Test Bank MULTIPLE CHOICE 1. A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching? a. “I should chew sugar-free gum or drink water to reduce dry mouth.” b. “I should not drive as long as I am taking this drug.” c. “I should stand up slowly when taking this medication.” d. “I should stop taking this drug if I feel anxious or depressed.” ANS: A Xerostomia is a common side effect of clonidine and is often uncomfortable enough that patients stop using the drug. Counseling patients to chew sugar-free gum and take frequent sips of liquid can help alleviate this discomfort. Drowsiness is common, but this side effect becomes less intense over time. Patients should be counseled to avoid hazardous activities in the first weeks of therapy if they feel this effect. The hypertensive effects of clonidine are not posture dependent, as they are with the peripheral alpha-adrenergic blockers, so orthostatic hypotension is minimal with this drug. Clonidine causes euphoria, hallucinations, and sedation in high doses and can cause anxiety or depression, although the last two effects are less common. The drug should not be stopped abruptly because of the risk of rebound hypertension, so patients experiencing unpleasant central nervous system (CNS) effects should consult their provider about withdrawing the medication slowly. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-169 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what? a. “If you have a positive Coombs’ test result, you will need to discontinue the medication, because this means you have hemolytic anemia.” b. “Methyldopa can be used for its analgesic effects and for its hypertensive effects.” c. “Xerostomia and orthostatic hypotension are serious side effects and indications for withdrawing the medication.” d. “You will need to contact the provider and stop taking the medication if your eyes look yellow.” ANS: D Hepatotoxicity is a serious adverse effect of methyldopa and is an indication for withdrawal of the drug to prevent fatal hepatic necrosis. Jaundice is a sign of liver toxicity. Patients should undergo periodic liver function tests while taking the drug. Liver function usually improves when the drug is withdrawn. A positive Coombs’ test result is not an indication for withdrawal of the drug in itself. About 5% of patients with a positive Coombs’ test result develop hemolytic anemia; withdrawal of the drug is indicated for those patients. Methyldopa does not have analgesic effects. Xerostomia and orthostatic hypotension are known side effects of methyldopa but usually are not serious. PTS: 1 DIF: Cognitive Level: Application REF: pp. 169-170 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? a. “Drowsiness is a common side effect initially, but it will lessen with time.” b. “You may also experience orthostatic hypotension along with the drowsiness.” c. “You may be at risk for addiction if you have central nervous system side effects.” d. “You should discontinue the medication and contact your prescriber.” ANS: A CNS depression, evidenced in this patient by drowsiness, is common in about 35% of the population. These responses become less intense with continued drug use. Orthostatic hypotension is less likely with clonidine, because its antihypertensive effects are not posture dependent. The experience of drowsiness does not indicate abuse potential. The patient should not discontinue the medication abruptly because of the potential for rebound hypertension; the patient should contact the prescriber before stopping the medication. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-169 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching? a. “Methyldopa results in alpha2 agonist activation, but it is not itself an alpha2 agonist.” b. “Methyldopa is not effective until it is converted to an active compound.” c. “Methyldopa reduces blood pressure by reducing cardiac output.” d. “Methyldopa’s principal mechanism is vasodilation, not cardiosuppression.” ANS: C Methyldopa does not reduce the heart rate or cardiac output, so its hypotensive actions are not the result of cardiac depression. The drug is not, in itself, an alpha2 agonist. When taken up into brainstem neurons, it is converted into methylnorepinephrine, which is an alpha2 agonist; it is not effective until converted to this active compound. Its hypotensive effects are the result of vasodilation, not cardiosuppression. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 169-170 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A nurse is teaching a patient about a new prescription for reserpine [Serpasil] for hypertension. Which statement by the patient indicates the need for further teaching? a. “Depressive side effects are common and will improve over time.” b. “I should report gastrointestinal side effects to the provider.” c. “I should stand up slowly when getting up and lie down if I feel dizzy.” d. “Therapeutic effects may not be optimal for a couple of weeks.” ANS: A Reserpine can produce severe depression, which may persist for months during drug therapy and after the drug is withdrawn. Reserpine can stimulate the secretion of gastric acid, which can cause ulcers; it also can increase the tone and motility of intestinal smooth muscle, which can cause cramps and diarrhea. Reserpine can cause orthostatic hypotension, so patients should be counseled to rise slowly when standing up and to sit or lie down if they feel dizzy. Reserpine works by depleting norepinephrine, and the processes necessary for this may take 1 to 2 weeks. PTS: 1 DIF: Cognitive Level: Application REF: pp. 170-171 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do? a. Recommend that the patient take most of the daily dose at bedtime. b. Suggest asking the provider for a transdermal preparation of the drug. c. Suspect that the patient is overusing the medication. d. Tell the patient to stop taking the drug and call the provider. ANS: A CNS depression is common with clonidine, but this effect lessens over time. Constipation is also a common side effect. Patients who take most of the daily amount at bedtime can minimize daytime sedation. Transdermal forms of clonidine do not alter adverse effects. Patients who are abusing clonidine often experience euphoria and hallucinations along with sedation, but they generally find these effects desirable and would not complain about them to a healthcare provider. Clonidine should not be withdrawn abruptly, because serious rebound hypertension can occur. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-169 | p. 171 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? a. Clonidine [Catapres] b. Guanabenz [Wytensin] c. Methyldopa d. Reserpine [Serpasil] ANS: A Patients who abuse cocaine, opioids, and other such drugs also frequently abuse clonidine, so this agent would not be the best choice for this patient. The other drugs do not share this abuse potential. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 168-171 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? a. That medication given by transdermal patch has fewer systemic side effects b. That localized skin reactions are uncommon c. To apply the patch to intact skin on the forearm or leg d. To change the patch every week ANS: D Transdermal patches are to be changed every 7 days. Medication administered by patch has the same therapeutic effect and adverse effects as that given by other routes, except that localized skin reactions may occur and are common with clonidine patches. The patch should be applied to intact, hairless skin on the upper arm or torso. PTS: 1 DIF: Cognitive Level: Application REF: p. 169 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that this drug is being given to treat which condition? a. ADHD b. Hypertension c. Severe pain d. Tourette’s syndrome ANS: A Kapvay ER is used to treat ADHD and is given as a single dose at bedtime. This form of clonidine is not used for hypertension, severe pain, or treatment of Tourette’s syndrome. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-169 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are important before beginning therapy with this drug? (Select all that apply.) a. Coombs’ test b. Hemoglobin and hematocrit (H&H) c. Liver function tests d. Pregnancy test e. Urinalysis ANS: A, B, C A positive Coombs’ test result occurs in 10% to 20% of patients who take methyldopa chronically. A few of these patients (5%) develop hemolytic anemia. Blood should be drawn for a Coombs’ test and an H&H before treatment is started and at intervals during treatment. Because methyldopa is associated with liver disorders, liver function tests should be performed before therapy is started and periodically during treatment. Clonidine, not methyldopa, is contraindicated during pregnancy. A urinalysis is not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-170 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Clonidine is approved for the treatment of which conditions? (Select all that apply.) a. ADHD b. Hypertension c. Opioid withdrawal d. Severe pain e. Smoking cessation ANS: A, B, D Clonidine has three approved uses: treatment of ADHD, hypertension, and severe pain. It has investigational uses for management of opioid withdrawal and for smoking cessation. PTS: 1 DIF: Cognitive Level: Application REF: pp. 168-169 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies