Adrenergic Blocking Antagonists

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.

5.

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.

6.

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.

7.

The nurse is caring for a patient who is receiving an adrenergic blocking agent. While writing the care plan for this patient what nursing diagnoses would be most appropriate concerning comfort?
A)
Acute pain related to cardiovascular and systemic effects
B)
Decreased cardiac output related to cardiovascular effects
C)
Ineffective airway clearance related to lack of bronchodilating effects
D)
Deficient knowledge regarding drug therapy
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 patient’s comfort level.

8.

A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drug–drug interaction?
A)
Antibiotics
B)
Oral contraceptives
C)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
D)
Antifungal agents
Ans:
C

Feedback:

A decreased hypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs. If this combination is used, the patient should be monitored closely and dosage adjustments made. Antibiotics, oral contraceptives, and antifungal agents are not known to have a drug–drug interaction.

9.

A busy patient with many responsibilities is to have a medication ordered to treat her 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

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.

10.

The nurse provides patient teaching for a patient who has a new order for nadolol (Corgard) to treat hypertension. What statement by the patient concerning nadolol (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.

11.

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:

Alpha1-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 alpha1-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 alpha2-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.

13.

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.

14.

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 analpha1-selective adrenergic blocking agent.

15.

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)
Serum sodium and potassium levels
Ans:
A

Feedback:

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.

16.

A 75-year-old male patient was admitted to the unit with angina. He was started on nadolol (Corgard). The patient asks why he is taking this medication because he does not have high blood pressure. What is the nurse’s best response?
A)
“Some beta-blockers have been approved as antianginal agents.”
B)
“This medication will prevent blood pressure problems later on.”
C)
“This drug will prevent you from developing an arrhythmia.”
D)
“This medication will reduce benign prostatic hypertrophy (BPH) as well as treat heart failure.”
Ans:
A

Feedback:

Decreased heart rate, contractility, and excitability, as well as a membrane-stabilizing effect, lead to a decrease in arrhythmias, a decreased cardiac workload, and decreased 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.

17.

In what patient is propranolol (Inderal) contraindicated?
A)
26-year-old man with viral myocarditis
B)
45-year-old woman with heart failure who suffered a myocardial infarction
C)
42-year-old man with hypertension
D)
65-year-old woman with persistent migraines
Ans:
B

Feedback:

Beta-adrenergic blocking agents are contraindicated in patients with bradycardia, heart failure, and heart block. The drug would not be contraindicated in the other patients.

18.

What assessment finding indicates to the nurse that timolol (Timoptic) has been effective?
A)
The patient’s blood pressure increases.
B)
The patient’s intraocular pressure is reduced.
C)
The patient’s pulse is reduced.
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.

19.

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.

22.

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.

23.

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.

24.

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.
C)
Avoid driving or operating hazardous machinery.
D)
Warn of possible increase in libido.
E)
Increase activity levels as much as possible.
Ans:
A, B, C

Feedback:

Patients should be taught to change position slowly, avoid driving or operating hazardous machinery, and to pace activities as a result of potential dizziness from orthostatic hypotension in order to avoid injury. Patients should take medicine with meals when possible. Drug is more likely to decrease libido than increase it. Activity levels should be paced and care should be taken not to overdo.

25.

The nurse is discharging a 35-year-old patient with diabetes who has been prescribed an adrenergic blocking agent. What is the priority teaching point for the nurse to discuss with this patient?
A)
“Monitor blood glucose levels closely and report any instability”
B)
“Document signs and symptoms of hyperglycemia and hypoglycemia”
C)
“Reduce carbohydrate intake more than usual while taking the new drug”
D)
“Increase insulin dosage to compensate for the drug’s effect in increasing blood sugar”
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.

26.

The home care nurse is providing teaching for a 59-year-old patient taking a nonselective beta-blocker. The nurse teaches the patient the importance of notifying the prescribing physician when what occurs related to this medication?
A)
If the patient’s pulse stays above 100 bpm for 3 or more days
B)
If the patient has a sudden onset of a cough
C)
If the patient falls
D)
If the patient’s pulse falls below 60 bpm for 3 or more days
Ans:
B

Feedback:

Bronchospasm, cough, rhinitis, and bronchial obstruction are related to loss of bronchodilation of the respiratory tract and vasodilation of mucous membrane vessels so a sudden onset of a cough or difficulty breathing should be immediately reported to the health care provider. Other options may need to be reported but not in relation to the nonselective beta-blocking medication.

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.

28.

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 beta1-selective adrenergic blocking agent. Timolol and propranolol are nonselective beta-adrenergic blocking agents.

29.

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.

30.

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.

31.

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.

32.

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.

33.

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)
Alpha1-selective adrenergic blocking agents
D)
Nonselective beta-adrenergic blocking agents
E)
Beta1-selective adrenergic blocking agents
Ans:
A, D, E

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.

34.

The patient takes labetalol and is scheduled for surgery. The anesthesiologist plans to use halothane as one of the anesthetic agents. The nurse consults with the anesthesiologist to ensure awareness the patient’s medication history knowing that the combination of labetalol and halothane will have what effect?
A)
Excessive hypotension
B)
Hypoglycemia
C)
Conduction system disturbances
D)
Vomiting
Ans:
A

Feedback:

There is increased risk of excessive hypotension if any of these drugs is combined with volatile liquid general anesthetics such as enflurane, halothane, or isoflurane. The effectiveness of diabetic agents is increased, leading to hypoglycemia when such agents are used with these drugs. Carvedilol has been associated with potentially dangerous conduction system disturbances when combined with verapamil or diltiazem. Vomiting is not associated with this combination of drugs.

35.

The 64-year-old patient has smoked since age 15 and has been diagnosed with chronic obstructive pulmonary disease. What classification of adrenergic blocking antagonist would be safest for this patient to treat angina?
A)
Nonselective adrenergic blocking agents
B)
Nonselective alpha-adrenergic blocking agents
C)
Alpha1-selective adrenergic blocking agents
D)
Beta1-selective adrenergic blocking agents
Ans:
D

Feedback:

Beta1-selective adrenergic blocking agents have an advantage over the nonselective beta-blockers in some cases. Because they do not usually block beta2-receptor sites, they do not block the sympathetic bronchodilation that is so important for patients with lung diseases or allergic rhinitis. Consequently, these drugs are preferred for patients who smoke or who have asthma, any other obstructive pulmonary disease, or seasonal or 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. Alpha1-selective adrenergic blocking agents are not used to treat angina.