Chapter 18: Adrenergic Agonists and Adrenergic Blockers Nursing School Test Banks

Chapter 18: Adrenergic Agonists and Adrenergic Blockers
Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect?
a. Increased blood glucose
b. Increased blood pressure
c. Increased heart rate
d. Increased gastrointestinal (GI) motility
ANS: A
Drugs that act on beta2 receptors activate glyconeogenesis in the liver causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 256
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient?
a. Pindolol (Visken)
b. Metoprolol (Lopressor)
c. Nadolol (Corgard)
d. Propranolol (Inderal)
ANS: B
Metoprolol is a selective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction.

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TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse administers subcutaneous epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect to monitor the patient for which symptom?
a. Bradycardia
b. Decreased urine output
c. Hypotension
d. Nausea and vomiting
ANS: B
Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has
a. over-used the albuterol.
b. not been using albuterol.
c. taken a beta-adrenergic blocker.
d. taken a monoamine oxidase (MAO) inhibitor.
ANS: A
High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.

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TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurses initial action?
a. Apply warm soaks to the area.
b. Monitor the patient closely for hypertension.
c. Obtain an order for an electrocardiogram.
d. Notify the provider of a need for phentolamine mesylate (Regitine).
ANS: D
Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient?
a. Stop using the medication after 3 days.
b. Spray the medication into the nose while lying supine.
c. Use frequently since systemic side effects do not occur.
d. Use the medication with any other over-the-counter medications.
ANS: A
Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication?
a. The drug must be taken twice daily.
b. The patient must rise slowly from a chair or bed.
c. The medication is safe to take during pregnancy.
d. Use NSAIDs as needed for mild to moderate pain.
ANS: B
The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided.

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TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do?
a. Hold the next dose until the provider can be notified of these side effects.
b. Reassure the patient that these symptoms are common and not worrisome.
c. Recommend that the patient discuss these effects with the provider.
d. Suggest that the patient request a different beta-adrenergic blocker.
ANS: C
Beta-adrenergic blockers can cause these side effects, which are often dose-related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose-related, reassuring the patient is not correct. All beta blockers have similar side effects.

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TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation?
a. Report rapid or irregular heart rate.
b. Drink 8 to 16 extra ounces of fluid each day.
c. Monitor serum glucose daily.
d. Take a calcium supplement.
ANS: A
High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient is taking doxazosin mesylate (Cardura) 1 mg per day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen?
a. Changing to a beta-adrenergic blocker
b. Decreasing the drug dose
c. Increasing the drug dose
d. Adding a diuretic
ANS: A
Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well-controlled.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 262
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient who has Raynauds disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynauds disease by causing
a. decreased peripheral vascular resistance.
b. orthostatic hypotension.
c. reflex tachycardia.
d. vasodilation.
ANS: D
Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 263
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action?
a. Apply pressure to the nose after spraying.
b. Administer the spray while in the supine position.
c. Insert the spray while sitting up.
d. Exhale deeply while injecting the nasal spray.
ANS: C
The patient should insert the spray while sitting up to avoid it being absorbed systemically.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patients family?
a. How to prepare a low-sodium diet
b. Assessments to detect fluid retention
c. How to monitor heart rate and blood pressure
d. Early signs of changing level of consciousness
ANS: C
Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

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TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is caring for a patient whose provider has just ordered a switch from atenolol (Tenormin) to reserpine. When preparing the patient to take this medication, what will the nurse do?
a. Ask about herbal supplements.
b. Counsel that NSAIDs are safe to take with reserpine.
c. Teach about potential side effects of mood elevation and euphoria.
d. Tell the patient to expect immediate therapeutic effects.
ANS: A
St. Johns wort may antagonize hypotensive effects of reserpine. Reserpine should not be taken with NSAIDs. Side effects include depression, not mood elevation. Therapeutic effects may take 2 to 3 weeks.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak. Which is the best response from the nurse?
a. I will hold your next dose of the medication.
b. You may need an increase in your next dose of the medication.
c. This is an adverse reaction to the medication. I will stop the drug.
d. This is a side effect of the medication. I will notify your physician.
ANS: D
Weakness can be a side effect of atenolol. Beta blockers should not be stopped abruptly.

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TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. Johns wort. The nurse anticipates that the patient will have
a. hypotension.
b. hypertension.
c. bradycardia.
d. tachycardia.
ANS: B
St. Johns wort antagonizes the hypotensive effects of reserpine, causing hypertension.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 263
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The patient has been ordered to receive Sudafed to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for the nurse to take?
a. Administer the medication as ordered.
b. Contact the provider to discuss a lower dose.
c. Give the medication and monitor serum glucose closely.
d. Hold the medication and contact the provider.
ANS: D
Sympathetic drugs should not be taken by patients with diabetes. The medication should not be given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 261
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply.)
a. Dilated pupils
b. Increased heart rate
c. Increase gastrointestinal motility
d. Vasodilation
e. Bronchospasm
f. Relaxed uterine muscles
ANS: A, B, F
Adrenergic agents stimulate the sympathetic nervous system, evoking the fight or flight response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the reproductive tract and gastrointestinal organs as these functions are not needed during a fight or flight response.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 256
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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