Chapter 31

To record episodes of hypoglycemia for review by the home care nurse

A 35-year-old diabetic is being discharged home to recover after being hospitalized after an episode of diabetic ketoacidosis. The patient is being discharged home on a beta-adrenergic blocking agent and is to have home care follow-up. As the discharging nurse, what would be important to include in this patient's discharge teaching?

To decrease heart rate

A 35-year-old female has been diagnosed with hyperthyroidism. Her health care provider has prescribed propranolol to achieve which effect?

understand the signs and symptoms of hypoglycemia.

A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to:

Beta2 receptor blockade use results in less effective glucose metabolism, especially when accompanied with anti-diabetic medications.

A 71-year-old black woman with a history of diabetes for a follow-up appointment after visiting ED for increased angina. As a beta2 receptor blockade has been prescribed to better control the chest pain, what other teaching is very important about this pharmacological intervention?

"Some beta blockers are approved as anti-anginal agents."

A 75-year-old male client was admitted to the unit with angina. The client was started on nadolol . The client asks why this medication was prescribed since the client does not have high blood pressure. What is the nurse's best response?

angina

A 75-year-old male with no history of hypertension has been prescribed nadolol. The nurse knows that the client is likely taking the drug to treat:

Call the provider and advise them of the client's blood pressure prior to administering the medication.

A client has been admitted to the cardiac unit for heart failure and has been ordered carvedilol (Coreg). The client's blood pressure is 80/50. What should the nurse do?

Decrease the heart rate

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?

Demonstrate the technique of eye drop instillation

A client has been prescribed an adrenergic blocking drug for glaucoma. Which nursing interventions should the nurse include when teaching the client?

The proper method for instilling eye drops

A client has been prescribed the nonselective beta-adrenergic blocker, timolol for the treatment of open angle glaucoma. What instructions should the nurse provide to assure the effectiveness of the medication?

Carvedilol

A client has come to get lab results at the cardiology clinic. The nurse notes that the digoxin level is elevated. The nurse knows that what other medication may be responsible for the increase in digoxin level?

Phentolamine mesylate (Regitine)

A client has received a dose of dopamine intravenously. The client's IV was infiltrated, and the dopamine was injected into the subcutaneous tissues. Which medication will prevent the vasoconstriction and tissue necrosis based on this action?

an adrenergic antagonist.

A client has recently been prescribed a drug that treats hypertension by blocking the sympathetic receptors in the sympathetic nervous system. This action is characteristic of which?

Labetalol

A client presents to the emergency department reporting rapid heart rate, severe headache, and pounding in the chest. While obtaining the clients history, the nurse learns the client stopped taking medications because the prescriptions ran out and had no funds to refill them. The nurse knows that which medications being abruptly stopped could be causing these symptoms?

"Clonidine is sometimes prescribed for severe pain in cancer clients like this client."

A male client diagnosed with bone cancer has an order for clonidine on his chart. The nurse is concerned that this may be a mistake and asks another nurse why clonidine would be ordered for this client. What would be an appropriate response from the second nurse?

"Has your urine stream improved since beginning the medication?"

A male client has been prescribed an alpha1-selective adrenergic blocking agent to treat benign prostatic hyperplasia (BPH) 2 weeks ago. Which assessment question should the nurse ask to evaluate for the expected result of this medication therapy?

history of acute myocardial infarction.

A nurse is caring for a client in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the client's chart for indications of:

Active hepatic disease

A nurse is caring for a patient who has been administered a centrally acting anti-adrenergic drug. The nurse knows that under which condition is the use of a centrally acting anti-adrenergic drug contraindicated?

The pulse is less than 60 beats per minute. The systolic blood pressure is less than 90 mmHg. There is irregularity in the client's heart rate or rhythm.

A nurse is preparing to administer propranolol. Which are safety concerns that would alert the nurse to hold the medication? Select all that apply.

Propranolol (Inderal) Metoprolol (Lopressor) Atenolol (Tenormin)

A nurse must recognize which class of medication a drug is part of in order to help in planning ongoing assessment and patient education. Which is an example of a drug in the class of beta-adrenergic blockers? (Select all that apply.)

The medication inhibits urinary bladder contraction.

A patient has been diagnosed with benign prostatic hypertrophy and has been prescribed prazosin (Minipress) to assist in the treatment of the symptoms. How does this alpha1-blocking agent decrease urinary retention?

Nonselective alpha-blocking agents

A patient is diagnosed with a pheochromocytoma. Which medications provide adjunctive therapy in the treatment of hypertension and tachycardia?

liver function.

A patient is receiving carvedilol. The nurse emphasizes the need for follow-up testing to evaluate:

"Be sure to take the drug on an empty stomach."

A patient is receiving sotalol. Which instruction would be most important for the nurse to provide to the patient to ensure maximum effectiveness of the drug?

"Take this drug with food to help promote its absorption."

A patient is to receive metoprolol. What would the nurse include in the teaching plan for this patient?

hypoglycemia

A patient with diabetes who uses insulin is also receiving labetalol. The nurse would monitor the patient closely for:

Timoptic is given in the eye, not PO.

A provider orders timolol (Timoptic) for glaucoma. The order reads Timoptic 1 gtt PO bid. The nurse knows that something is wrong with this order. What is it?

level of consciousness respiratory distress cardiac arrhythmia seizure

Assessment has identified that a client with a history of monoamine oxidase inhibitor (MAO) therapy has also been taking an adrenergic drug for several days. What assessments should the nurse focus on to monitor the possible adverse reaction of the combination of medications? Select all that apply.

Administer the dose at bedtime

First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect?

Angina

Propranolol (Inderal) is used extensively as treatment for what condition?

False

The drug of choice for treating hypertension in an older adult is atenolol.

Propranolol

The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving:

sympathetic

The nurse is providing medication education to a client prescribed an adrenergic blocker. Which nervous system is the specific focus of this classification of medications?

Beta-adrenergic blocking drugs

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?

Pulse and blood pressure

What assessment should the nurse make before administering beta-adrenergic blocking agents?

beta-blockers

What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago?

Alfuzosin Terazosin

Which agent would be indicated for the treatment of benign prostatic hypertrophy? (Select all that apply.)

intraocular pressure decreases

Which observation might indicate that timolol is achieving the desired effect in a client?

"I can stop the drug once my blood pressure is controlled."

Which patient statement indicates the need for additional teaching about propranolol?

Sinus bradycardia

Which would a nurse identify as a contraindication for the use of a beta-1 selective blocker?