Chap.15 Adrenergic Agonist and Antagonist QUESTIONS
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?
c. Recommend that the patient discuss these effects with the provider. 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.)
A patient calls the home health agency to tell the nurse she is having a reaction to her albuterol (Proventil) inhaler. She tells the nurse she is shaking and trembling.
d. "How many puffs on the inhaler did you take?"
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?
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.
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?
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.
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 nurse's initial action?
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.
11. 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
d. vasodilation. ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation.
What is a catecholamine?
a. A substance that can produce a sympathomimetic response
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. ANS: A St. John's 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.
10. 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 a beta-adrenergic blocker 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.)
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 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.)
A patient presents to the clinic with a swollen face and tongue, difficulty breathing, and audible wheezes after eating a peanut butter sandwich for lunch. What is the first action the nurse should take?
a. Ensure a patent airway
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 ANS: A Drugs that act on beta2 receptors activate gluconeogenesis 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.) Beta 2 locations are: G.I, lungs, uterus and liver
When completing the patient health history, the nurse finds a history of narrow-angle glaucoma. When performing the medication reconciliation, which medication would concern the nurse? (Select all that apply.)
a. Pseudoephedrine b. Midodrine c. Albuterol
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. 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 nondiabetic patients.)
A patient tells the nurse during the admitting history that he utilizes alternative and complementary health care to help manage his medical conditions. Which medication would raise a concern in a patient taking St. John's wort?
a. Reserpine
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. 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.)
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. overused the albuterol. ANS: A 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.)
A patient with asthma asks the nurse how his albuterol inhaler will work to help him breathe better. What is the best response for the nurse to explain the action of the medication?
b. "Albuterol causes bronchodilation in the lungs, improving function."
Which medication(s) is/are classified as beta blockers? (Select all that apply.)
b. Atenolol (Tenormin) c. Propranolol (Inderal) e. Acebutolol (Sectral)
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?
b. Decreased urine output 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.)
Which adrenergic agent used in emergency settings does not decrease renal function?
b. Dopamine (Intropin)
The nurse has been floated to the cardiac telemetry unit and is preparing to give a new medication to the patient. The health care provider's order is for timolol (Blocadren) 100 mg b.i.d. Which is the nurse's best action?
b. Hold the medication and contact the health care provider regarding the dosage.
Some over-the-counter (OTC) medications for cold symptoms contain substances that have sympathetic properties. These medications are contraindicated in patients with which disease process?
b. Hypertension
2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient?
b. Metoprolol (Lopressor) 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.) MANBABE (cardioselective)= metoprolol, atenolol, nebivolol, betaxolol, acebutolol, bisoprolol and Esmolol
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?
b. The patient must rise slowly from a chair or bed. 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.)
16. The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. John's wort. The nurse anticipates that the patient will have
b. hypertension. ANS: B St. John's wort antagonizes the hypotensive effects of reserpine, causing hypertension.
13. A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patient's family?
c. How to monitor heart rate and blood pressure ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.
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?
c. Insert the spray while sitting up. ANS: C The patient should insert the spray while sitting up to avoid it being absorbed systemically.
Where are beta 1 receptors located? (Select all that apply.)
c. Kidneys e. Heart
