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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
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.
What medication, if ordered for an 8-year-old patient, should the nurse question?
2
(Select all that apply.)
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Phentolamine (Regitine) 1 mg
C) intramuscularly 1 to 2 hours before
surgery
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.
A nurse is working with a patient who is taking an adrenergic blocking agent. While
3
assessing the patients medication history, the nurse discovers that the patient takes
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several alternative therapies. What herb is the nurse concerned may interact with the
.
adrenergic blocking agent and affect the patients 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.
Ans: D
Feedback:
The most serious adverse effect would be severe bradycardia, so the nurses 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 patients care, but it is not the priority assessment.
5 Bisoprolol (Zebeta) would be the drug of choice for which patient with a diagnosis of
. hypertension?
A 7-year-old patient
A)
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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.
6 What would be the teaching priority for a diabetic patient being treated with a
. nonselective beta-blocker?
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.
The nurse is caring for a patient who is receiving an adrenergic blocking agent. While
7
writing the care plan for this patient what nursing diagnoses would be most
.
appropriate concerning comfort?
Ans: A
Feedback:
All four options would be appropriate nursing diagnoses for a patient receiving an
adrenergic blocking agent. However, acute pain would be the only nursing diagnosis
related to the patients comfort level.
A) Antibiotics
B) Oral contraceptives
D) Antifungal agents
Ans: C
Feedback:
A busy patient with many responsibilities is to have a medication ordered to treat her
9
hypertension. To increase compliance with drug therapy, what drug would be a good
.
choice for this patient?
A) Acebutolol (Sectral)
B) Atenolol (Tenormin)
C) Bisoprolol (Zebeta)
D) Metoprolol (Lopressor)
Ans: D
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Feedback:
Metoprolol would be the best choice because it has an extended release form that only
needs to be taken once a day, which should increase patient compliance. Acebutolol,
atenolol, and bisoprolol do not come in extended release forms.
1 The nurse provides patient teaching for a patient who has a new order for nadolol
0 (Corgard) to treat hypertension. What statement by the patient concerning nadolol
. (Corgard) would indicate that the teaching has been effective?
Ans: C
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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
1
condition?
.
A) Hypotension
B) Angina
D) Cluster headaches
Ans: B
Feedback:
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1 A patient with benign prostatic hypertrophy (BPH) has been prescribed prazosin
2 (Minipress) and asks the nurse what this is going to do for him. The nurses response
. will include what action to explain the purpose of taking this medication?
Ans: C
Feedback:
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1 The nurse is caring for a 55-year-old patient receiving metoprolol (Lopressor). What
3 statement by the patient would lead the nurse to believe that he needs additional
. instruction?
Ans: B
Feedback:
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1
Nonselective adrenergic blocking agents have a variety of therapeutic uses. Which
4
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
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1
5 Before administering a nonselective adrenergic blocker, what should the nurse assess?
.
Ans: A
Feedback:
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Monitor vital signs and assess cardiovascular status including pulse, blood pressure,
and cardiac output to evaluate for possible cardiac effects. Although assessment of
bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels
may be important to patient care, they are not related to administration of a
nonselective adrenergic blocking agent.
1 A 75-year-old male patient was admitted to the unit with angina. He was started on
6 nadolol (Corgard). The patient asks why he is taking this medication because he does
. not have high blood pressure. What is the nurses best response?
Ans: A
Feedback:
oxygen consumption. The juxtaglomerular cells are not stimulated to release renin,
which further decreases the blood pressure. These effects are useful in treating
hypertension and chronic angina and can help to prevent reinfarction after a
myocardial infarction by decreasing cardiac workload and oxygen consumption.
Corgard will not prevent blood pressure problems, arrhythmias, or glaucoma in the
future. Corgard is not used to treat BPH.
1
7 In what patient is propranolol (Inderal) contraindicated?
.
Ans: B
Feedback:
failure, and heart block. The drug would not be contraindicated in the other patients.
1
What assessment finding indicates to the nurse that timolol (Timoptic) has been
8
effective?
.
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
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systemically.
1
The student nurse is studying for a pharmacology exam and notices that many of the
9
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.
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2 A 23-year-old female patient presents at the clinic with a migraine headache. What
0 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:
A 5-year-old African American patient has been admitted to the pediatric intensive
2
care unit with pheochromocytoma. The physician has ordered phentolamine. The
1
nurse knows that the other indication for phentolamine is what?
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A) Migraine headaches
Extravasation of IV norepinephrine or
B)
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.
2 The nurse is caring for a well-known stage actor who has suddenly developed severe
2 stage fright that is preventing him from working. What drug does the nurse suspect
. will be prescribed for this patient?
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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
3
finding is an adverse effect of the medication?
.
A) Hypertension
Wheezing
B)
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C) Tachycardia
D) Depressed respirations
Ans: C
Feedback:
2 The home care nurse is caring for a patient newly prescribed a nonselective beta-
4 blocking agent. What would the nurse include in the teaching plan related to this drug?
. (Select all that apply.)
Ans: A, B, C
Feedback:
2 The nurse is discharging a 35-year-old patient with diabetes who has been prescribed
5 an adrenergic blocking agent. What is the priority teaching point for the nurse to
. discuss with this patient?
Ans: A
Feedback:
It is important for the patient to be instructed to monitor blood sugar levels more
frequently because adrenergic blocking agents mask the normal hypo- and
hyperglycemic manifestations that normally alert patients such as sweating, feeling
tense, increased heart rate, and rapid breathing. There is no need to change the diet or
the diabetic medications. There may be no signs and symptoms to record because they
are blocked by the adrenergic blocker.
2 The home care nurse is providing teaching for a 59-year-old patient taking a
6 nonselective beta-blocker. The nurse teaches the patient the importance of notifying
. the prescribing physician when what occurs related to this medication?
cough
Ans: B
Feedback:
2 A 31-year-old male patient has been prescribed propranolol to reduce and prevent
7 angina. What will the nurse assess this patient for related to the medication? (Select all
. that apply.)
A) Sleep disturbance
B) Impotence
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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.
2
8 Which nonselective alpha-adrenergic blocking agent is still used?
.
A) Metoprolol
B) Propranolol
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C) Timolol
D) Phentolamine
Ans: D
Feedback:
2 The labor and delivery nurse assists with the delivery of a newborn to a woman taking
9 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
Gastrointestinal (GI)
D)
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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
0
adults. What adrenergic blocking agent is used during surgery for pheochromocytoma?
.
A) Propranolol
B) Prazosin
C) Phentolamine
D) Guanethidine
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Ans: C
Feedback:
3
What are the therapeutic and adverse effects associated with the adrenergic blocking
1
agents related to?
.
A) Receptor-site specificity
C) Norepinephrine release
Ans: A
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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.
3
The specificity of the adrenergic blocking agents allows the clinician to select a drug
2
to do what?
.
Ans: A
Feedback:
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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
3
apply.)
.
Ans: A, D, E
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Feedback:
Drugs that block both alpha- and beta-adrenergic receptors are primarily used to treat
cardiac-related conditions. Phentolamine, a nonselective alpha-adrenergic blocking
agent, is used to treat extravasation of IV norepinephrine or dopamine and
hypertension related to a pheochromocytoma. Alpha1-selective adrenergic blocking
agents are used for treatment of hypertension and benign prostatic hyperplasia. The
beta-adrenergic blocking agents are used to treat cardiovascular problems
(hypertension, angina, migraine headaches) and to prevent reinfarction after
myocardial infarction. Beta1-selective adrenergic blocking agents are used for treating
hypertension, angina, and some cardiac arrhythmias.
The patient takes labetalol and is scheduled for surgery. The anesthesiologist plans to
3
use halothane as one of the anesthetic agents. The nurse consults with the
4
anesthesiologist to ensure awareness the patients medication history knowing that the
.
combination of labetalol and halothane will have what effect?
A) Excessive hypotension
B) Hypoglycemia
D) Vomiting
Ans: A
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Feedback:
3 The 64-year-old patient has smoked since age 15 and has been diagnosed with chronic
5 obstructive pulmonary disease. What classification of adrenergic blocking antagonist
. would be safest for this patient to treat angina?
Ans: D
Feedback:
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