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Chapter 31- Adrenergic Blocking Antagonists, Exams of Nursing

Walden UniversityNursing

Chapter 31- Adrenergic Blocking Antagonists

Typology: Exams

2021/2022

Available from 03/14/2022

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1. The nurse administers an adrenergic blocking agent in order to prevent release of what
neurotransmitter?
A) Epinephrine
B) Norepinephrine
C) Serotonin
D) Gamma-aminobutyric acid (GABA)
Ans: B
Feedback:
Adrenergic blocking agents prevent norepinephrine from being released from the adrenal
medulla or from the nerve terminal from activating the receptor, which blocks
sympathetic nervous system effects. Epinephrine, serotonin, and GABA are not
associated with this process.
2. What medication, if ordered for an 8-year-old patient, should the nurse question? (Select
all that apply.)
A) Amiodarone (Cordarone) 400 mg orally per 24 hours
B) Labetalol (Normodyne) 100 mg orally b.i.d.
C) Phentolamine (Regitine) 1 mg intramuscularly 1 to 2 hours before surgery
D) Prazosin (Minipress) 3 mg orally t.i.d.
E) Carvedilol (Coreg) 6.25 mg orally b.i.d.
Ans: A, B, E
Feedback:
Amiodarone, labetalol, and carvedilol are not indicated for pediatric use and do not have
established pediatric dosages. Phentolamine and prazosin have established pediatric
dosages and would not need to be questioned.
3.A nurse is working with a patient who is taking an adrenergic blocking agent. While
assessing the patient's medication history, the nurse discovers that the patient takes
several alternative therapies. What herb is the nurse concerned may interact with the
adrenergic blocking agent and affect the patient's blood glucose level?
A) Ginseng
B) Nightshade
C) Di huang
D) Saw Palmetto
Ans: C
Feedback:
Di huang is an alternative therapy that can lower blood glucose when used in
combination with adrenergic blocking agents. Ginseng increases antihypertensive effects;
nightshade slows the heart rate; and saw palmetto increases the risk of urinary tract
complications when used in combination with adrenergic blocking agents.
4.A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic
blocking agent would be what?
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  1. The nurse administers an adrenergic blocking agent in order to prevent release of what neurotransmitter? A) Epinephrine B) Norepinephrine C) Serotonin D) Gamma-aminobutyric acid (GABA) Ans: B Feedback: Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks sympathetic nervous system effects. Epinephrine, serotonin, and GABA are not associated with this process.
  2. What medication, if ordered for an 8 - year-old patient, should the nurse question? (Select all that apply.) A) Amiodarone (Cordarone) 400 mg orally per 24 hours B) Labetalol (Normodyne) 100 mg orally b.i.d. C) Phentolamine (Regitine) 1 mg intramuscularly 1 to 2 hours before surgery D) Prazosin (Minipress) 3 mg orally t.i.d. E) Carvedilol (Coreg) 6.25 mg orally b.i.d. Ans: A, B, E Feedback: Amiodarone, labetalol, and carvedilol are not indicated for pediatric use and do not have established pediatric dosages. Phentolamine and prazosin have established pediatric dosages and would not need to be questioned. 3.A nurse is working with a patient who is taking an adrenergic blocking agent. While assessing the patient's medication history, the nurse discovers that the patient takes several alternative therapies. What herb is the nurse concerned may interact with the adrenergic blocking agent and affect the patient's blood glucose level? A) Ginseng B) Nightshade C) Di huang D) Saw Palmetto Ans: C Feedback: Di huang is an alternative therapy that can lower blood glucose when used in combination with adrenergic blocking agents. Ginseng increases antihypertensive effects; nightshade slows the heart rate; and saw palmetto increases the risk of urinary tract complications when used in combination with adrenergic blocking agents. 4.A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what?

A) Monitoring respiratory rate B) Checking blood glucose level C) Measuring urine output D) Assessing heart rate Ans: D Feedback: The most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessing the heart rate. If the patient were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the patient was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the patient's care, but it is not the priority assessment.

  1. Bisoprolol (Zebeta) would be the drug of choice for which patient with a diagnosis of hypertension? A) A 7 - year-old patient B) A 15 - year-old patient C) A 37 - year-old patient D) A 69 - year-old patient Ans: D Feedback: Bisoprolol is the drug of choice for older adults. It is not associated with as many adverse effects in the elderly and regular dosing profiles can be used. This drug does not have an established pediatric dosage. Although the 37-year-old patient is an adult, there are additional choices for this patient, with a more favorable adverse effect profile.
  2. What would be the teaching priority for a diabetic patient being treated with a nonselective beta-blocker? A) To take his own pulse B) To weigh himself once a week at the same time of day C) To avoid smoke-filled rooms D) To understand signs and symptoms of hypo- or hyperglycemic reaction Ans: D Feedback: Because the beta-blockers stop the signs and symptoms of a sympathetic stress reaction, the signs and symptoms associated with hypo- or hyperglycemia, the diabetic patient taking a beta-blocker will need to understand this and learn new indicators of these reactions. Taking his pulse, weekly weighing, and avoiding smoke-filled rooms are good health practices and should be done, but not specifically needed by a diabetic patient taking a beta-blocker.

(Corgard) would indicate that the teaching has been effective? A) “I should cover my head at all times while I am outdoors.” B) “Since I am taking this drug, I no longer need to worry about diet and exercise.” C) “I will not stop taking this drug abruptly and will talk to my doctor before discontinuing.” D) “I may have a very dry mouth while taking this drug.” Ans: C Feedback: A patient receiving an adrenergic blocker must be aware that abruptly stopping the medication may result in a serious reaction. When changing medications or discontinuing their use, these drugs need to be tapered off gradually. This drug is not associated with photophobia or the anticholinergic effect of dry mouth. If the teaching were effective, the patient would be aware that he would need to continue lifestyle modifications, including diet and exercise.

  1. The nurse frequently administers propranolol (Inderal) as treatment for what condition? A) Hypotension B) Angina C) Prevent first myocardial infarction (MI) D) Cluster headaches Ans: B Feedback: The beta-adrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after MI. The prototype drug, propranolol, was in fact the most prescribed drug in the country in the 1980s and is still considered a first-line drug. Propranolol does not prevent first MIs and it is not used for hypotension or cluster headaches. 12.A patient with benign prostatic hypertrophy (BPH) has been prescribed prazosin (Minipress) and asks the nurse what this is going to do for him. The nurse's response will include what action to explain the purpose of taking this medication? A) Decreasing vascular tone and vasodilation B) Reducing the size of the prostate to reduce pressure on the urethra C) Relaxing the bladder and prostate and improving urine flow D) Lowering blood pressure Ans: C Feedback: Alpha 1 - selective adrenergic blocking agents block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male patients. Although they also block the postsynaptic alpha 1 - receptor sites, causing a decrease in vascular tone and vasodilation that leads to a fall in blood pressure without the reflex tachycardia that occurs when the presynaptic alpha 2 - receptor sites are blocked, this is not the purpose for administering the drug to a patient with BPH. They do not reduce the size

of the prostate.

  1. The nurse is caring for a 55 - year-old patient receiving metoprolol (Lopressor). What statement by the patient would lead the nurse to believe that he needs additional instruction? A) “If I have side effects from the medication, I will contact my physician before I stop taking it.” B) “I can take over-the-counter (OTC) cold medication while on metoprolol.” C) “I will take the medication on an empty stomach.” D) “I will report a weight gain of 2 pounds or more in 1 week.” Ans: B Feedback: OTC medications can interact to increase or decrease the effects of antiadrenergic drugs. Antacids decrease the effects of beta-adrenergic blocking drugs. Decreased antihypertensive effects result when taken with ibuprofen. Other options reflect correct statements and would not indicate that the patient would need further instruction.
  2. Nonselective adrenergic blocking agents have a variety of therapeutic uses. Which agent is used for the treatment of heart failure? A) Carvedilol (Coreg) B) Sotalol (Betapace) C) Propranolol (Inderal) D) Tamsulosin (Flomax) Ans: A Feedback: available orally and is used to treat hypertension as well as congestive heart failure and left ventricular dysfunction after a myocardial infarction. Sotalol is a nonselective beta- adrenergic blocking agent used to treat potentially life-threatening ventricular arrhythmias and to maintain normal sinus rhythm in patients with atrial fibrillation or flutter. Propranolol is a nonselective beta-adrenergic blocking agent used for treatment of hypertension, angina, idiopathic hypertrophic subaortic stenosis (IHSS)–induced palpitations, angina and syncope, some cardiac arrhythmias induced by catecholamines or digoxin, pheochromocytoma; prevention of reinfarction after myocardial infarction; prophylaxis for migraine headache (which may be caused by vasodilation and is relieved by vasoconstriction, although the exact action is not clearly understood); prevention of stage fright (which is a sympathetic stress reaction to a particular situation); and treatment of essential tremors. Tamsulosin is used to treat benign prostatic hyperplasia and is an alpha 1 - selective adrenergic blocking agent.
  3. Before administering a nonselective adrenergic blocker, what should the nurse assess? A) Pulse and blood pressure B) Bowel sounds and appetite C) Serum albumin level

D) The patient's angina is reduced. Ans: B Feedback: Timolol and carteolol are available in an ophthalmic form of the drug for reduction of intraocular pressure in patients with open-angle glaucoma. A decrease in intraocular pressure would indicate it has been effective. Timolol can also be used to treat hypertension but an increase in blood pressure would indicate the drug was not effective. Reduced pulse rate and reduced angina would not be related to this drug, especially if it was given in ophthalmic form when very little of the drug is absorbed systemically.

  1. The student nurse is studying for a pharmacology exam and notices that many of the adrenergic blocking antagonists drugs studied in class have what suffix? A) - aine B) - lol C) - azole D) - triptan Ans: B Feedback: The suffix - lol is seen in many of the drug names for adrenergic blocking antagonists. The suffix - aine would indicate a topical anesthetic, whereas - azole indicates an antifungal, and the suffix - triptan relates to the triptans. 20.A 23-year-old female patient presents at the clinic with a migraine headache. What beta- adrenergic blocking agent might the physician prescribe for the prophylactic prevention of future migraine headaches? A) Propranolol (Inderal) B) Nadolol (Corgard) C) Timolol (Blocadren) D) Sotalol (Betapace) Ans: A Feedback: Propranolol is indicated for the treatment of hypertension, angina pectoris, idiopathic hypertrophic subaortic stenosis, supraventricular tachycardia, tremor; prevention of reinfarction after myocardial infarction; adjunctive therapy in pheochromocytoma; prophylaxis of migraine headache; and management of situational anxiety. The other options do not treat or prevent migraine headaches. 21.A 5-year-old African American patient has been admitted to the pediatric intensive care unit with pheochromocytoma. The physician has ordered phentolamine. The nurse knows that the other indication for phentolamine is what? A) Migraine headaches B) Extravasation of IV norepinephrine or dopamine C) Life-threatening arrhythmias

D) Heart failure Ans: B Feedback: Phentolamine (Regitine) is used for the prevention of cell death and tissue sloughing after extravasation of intravenous norepinephrine or dopamine, and severe hypertension reactions caused by manipulation of the pheochromocytoma before and during surgery; diagnosis of pheochromocytoma. Phentolamine would not be indicated for treatment of migraine headaches, life-threatening arrhythmias, or heart failure.

  1. The nurse is caring for a well-known stage actor who has suddenly developed severe stage fright that is preventing him from working. What drug does the nurse suspect will be prescribed for this patient? A) Carteolol (Cartrol) B) Nebivolol (Bystolic) C) Nadolol (Corgard) D) Propranolol (Inderal) Ans: D Feedback: One of the indications for use of propranolol is prevention of stage fright, which is a sympathetic stress reaction to a particular situation. None of the other options are indicated for this use.
  2. The nurse assesses the patient receiving phentolamine (Regitine) and suspects what finding is an adverse effect of the medication? A) Hypertension B) Wheezing C) Tachycardia D) Depressed respirations Ans: C Feedback: Patients receiving phentolamine often experience extensions of the therapeutic effects, including hypotension, orthostatic hypotension, angina, myocardial infarction, cerebrovascular accident, flushing, tachycardia, and arrhythmia—all of which are related to vasodilation and decreased blood pressure. Headache, weakness, and dizziness often occur in response to hypotension. Nausea, vomiting, and diarrhea may also occur. Hypertension, wheezing, and depressed respiration would not be associated with phentolamine.
  3. The home care nurse is caring for a patient newly prescribed a nonselective beta-blocking agent. What would the nurse include in the teaching plan related to this drug? (Select all that apply.) A) Take with meals. B) Change position slowly.

27.A 31-year-old male patient has been prescribed propranolol to reduce and prevent angina. What will the nurse assess this patient for related to the medication? (Select all that apply.) A) Sleep disturbance B) Impotence C) Bronchospasm D) Gastric pain E) Tachycardia Ans: B, C, D Feedback: Adverse effects of propranolol that the nurse would assess for include allergic reaction, bradycardia, heart failure, cardiac arrhythmias, cerebrovascular accident, pulmonary edema, gastric pain, flatulence, impotence, decreased exercise tolerance, and bronchospasm.

  1. Which nonselective alpha-adrenergic blocking agent is still used? A) Metoprolol B) Propranolol C) Timolol D) Phentolamine Ans: D Feedback: Of the nonselective alpha-adrenergic blocking agents, only phentolamine is still used today. Metoprolol is a beta 1 - selective adrenergic blocking agent. Timolol and propranolol are nonselective beta-adrenergic blocking agents.
  2. The labor and delivery nurse assists with the delivery of a newborn to a woman taking an adrenergic blocker for a congenital heart defect. What organ systems may be affected in the newborn by these drugs? (Select all that apply.) A) Cardiovascular B) Respiratory C) Central nervous system (CNS) D) Gastrointestinal (GI) E) Genitourinary (GU) Ans: A, B, C Feedback: Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse cardiovascular, respiratory, and CNS effects. Problems with the GI and GU systems have not been reported.
  3. Beta-adrenergic blocking drugs are used in children for disorders similar to those in adults. What adrenergic blocking agent is used during surgery for pheochromocytoma? A) Propranolol

B) Prazosin C) Phentolamine D) Guanethidine Ans: C Feedback: Phentolamine is used during surgery for pheochromocytoma in children. Prazosin is used to treat hypertension in children. Propranolol and guanethidine are not indicated for use in children with a pheochromocytoma.

  1. What are the therapeutic and adverse effects associated with the adrenergic blocking agents related to? A) Receptor-site specificity B) Sympathetic nervous system manifestations C) Norepinephrine release D) Function of the nerve terminal Ans: A Feedback: The therapeutic and adverse effects associated with these drugs are related to their adrenergic-receptor-site specificity; that is, the ability to react with specific adrenergic receptor sites without activating them, thus preventing the typical manifestations of sympathetic nervous system (SNS) activation. By occupying the adrenergic receptor site, they prevent norepinephrine released from the nerve terminal or from the adrenal medulla from activating the receptor, thus blocking the SNS effects.
  2. The specificity of the adrenergic blocking agents allows the clinician to select a drug to do what? A) Have the desired effect B) Multiply undesired effects C) Increase specificity with higher serum blood levels D) Improving concentration in the body Ans: A Feedback: This specificity allows the clinician to select a drug that will have the desired therapeutic effects without the undesired effects that occur when the entire sympathetic nervous system is blocked. In general, however, the specificity of adrenergic blocking agents depends on the concentration of drug in the body. Most specificity is lost with higher serum drug levels.
  3. What agents are used primarily to treat cardiac-related conditions? (Select all that apply.) A) Nonselective adrenergic blocking agents B) Nonselective alpha-adrenergic blocking agents C) Alpha 1 - selective adrenergic blocking agents D) Nonselective beta-adrenergic blocking agents

allergic rhinitis. Nonselective adrenergic blocking agents block both alpha- and beta- adrenergic receptors exacerbating respiratory conditions by the loss of norepinephrine's effect of bronchodilation. Nonselective alpha-adrenergic blocking agents are not used to treat angina. Alpha 1 - selective adrenergic blocking agents are not used to treat angina.