Chapter 15 - Adrenergic Agonists and Antagonists - McCuistion

The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) as add-on therapy 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.

c. Recommend that the patient discuss these effects with the provider. 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 provider. 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.

A patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak and fatigued. Which is the best response from the nurse? a. "I will hold your next dose of themedication." b. "You may need an increase in your next dose of themedication." c. "This is an adverse reaction to themedication. I will stop thedrug." d. "This is a side effect of themedication. I will notify your physician."

d. "This is a side effect of themedication. I will notify your physician." Weakness and fatigue can be a side effect of atenolol. Beta blockers should not be stopped abruptly, thus it would be appropriate to notify thepatient that these symptoms could be due to themedication and that thephysician will be notified.

The patient has been ordered to receive pseudoephedrine (Sudafed) to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for thenurse to take? a. Administer themedication as ordered. b. Contact theprovider to discuss a lower dose. c. Give themedication and monitor serum glucose closely. d. Hold the medication and contact the provider.

d. Hold the medication and contact the provider. Sympathomimetic drugs should be used with caution in patients with diabetes. The nurse should verify the order with the provider before administration.

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 nurse's 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).

d. Notify the provider of a need for phentolamine mesylate (Regitine). Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

A patient who has Raynaud's 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 Raynaud's disease by causing a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation.

d. vasodilation. Peripheral alpha-adrenergic blockers can be used to treat peripheral vascular disorders like Raynaud's disease because they cause vasodilation.

Reserpine would be best categorized as which of the following? a. Adrenergic neuron antagonist b. Alpha blocker c. Beta blocker d. Alpha agonist

a. Adrenergic neuron antagonist Drugs that block therelease of norepinephrine from thesympathetic terminal neurons are often called adrenergic neuron antagonists (adrenergic neuron blockers). theclinical use is to decrease blood pressure. For example, reserpine is an antihypertensive agent that closely resembles alpha- and beta-adrenergic blockers; it also reduces theserotonin and catecholamine transmitters, depletion of which may lead to severe mental depression.

A patient is taking doxazosin mesylate (Cardura) 1 mg/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 an alternative medication class to treat hypertension b. Decreasing the doxazosin dose c. Increasing the doxazosin dose d. Adding a diuretic

a. Changing to an alternative medication class to treat hypertension Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Changing to an alternative medication class to treat hypertension would be appropriate to avoid hypotensive events. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well controlled.

The nurse caring for a patient who is taking a non-specific adrenergic agonist will expect which of the following side effects? (Select all that apply.) a. Dilated pupils b. Increased heart rate c. Increase gastrointestinal motility d. Vasodilation e. Bronchospasm

a. Dilated pupils b. Increased heart rate Adrenergic agonists stimulate thesympathetic 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 thegastrointestinal tract, as digestion is not critical during a fight or flight response.

A patient will begin taking an albuterol (Proventil) inhaler to treat asthma. The patient has no other chronic medical conditions. 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.

a. Report rapid or irregular heart rate. High dosages of albuterol may activate beta1 receptors, causing an increase in heart rate. 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 generally not a concern in patients without diabetes

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. Use this product for a maximum of 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 prophylactically to prevent future nasal congestion during cold season.

a. Use this product for a maximum of 3 days. 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. Because phenylephrine overuse can result in rebound nasal congestion, it should not be used prophylactically.

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. overused the albuterol. b. not been using albuterol. c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor

a. overused the albuterol. High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may overuse 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.

The nurse administers epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect which of the following? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting

b. Decreased urine output 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.

A patient who has asthma requires treatment with a beta blocker to manage his cardiovascular disease. The nurse understands that which drug will be the safest to give this patient? a. Pindolol (Visken) b. Metoprolol (Lopressor) c. Nadolol (Corgard) d. Propranolol (Inderal)

b. Metoprolol (Lopressor) Metoprolol is a cardioselective beta-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 beta-adrenergic blockers are not selective and have a greater risk for causing bronchoconstriction.

The nurse is caring for a patient who will begin taking atenolol (Tenormin) as add-on therapy for the treatment of hypertension. 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 should rise slowly from a chair or bed. c. The medication is safe to take during pregnancy. d. Use NSAIDs instead of acetaminophen for mild to moderate pain.

b. The patient should rise slowly from a chair or bed. 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 should be used with caution in the pregnant patient. NSAIDs can increase blood pressure and should be avoided if possible in patients with uncontrolled hypertension

A patient will be discharged home on a beta blocker. Which skill is essential for the nurse to teach the patient's family? a. How to prepare a high-potassium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness

c. How to monitor heart rate and blood pressure Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist (albuterol) to treat bronchospasm. The nurse knows this drug can potentially cause which side effect? a. Increased drowsiness b. Decrease blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility

c. Increased heart rate Selective beta2 agonists preferentially act on beta2 receptors, but can potentially contribute to side effects associated with beta1 receptor activation, including increased heart rate (tachycardia). Beta2 agonists can also be associated with side effects of hypertension and tachycardia. Adrenergic agonists cause decreased GI motility and are not generally associated with drowsiness.