Chapter 31 PrepU Pharmacology (m)

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

intraocular pressure decreases Explanation: Timolol is a beta blocker used for treatment of glaucoma and hypertension. Depending on the intended use, a decrease in the client's intraocular pressure or blood pressure is an indication that the drug is achieving the desired effect.

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?

"Be sure to take the drug on an empty stomach." Explanation: Sotalol absorption is decreased by the presence of food; to ensure maximum effectiveness of the drug, the patient should take it on an empty stomach, not with an antacid or after a large meal. The dose is typically divided during the day and should not be taken all at once.

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:

understand the signs and symptoms of hypoglycemia. Explanation: Beta-adrenergic antagonists should be used cautiously in patients with diabetes mellitus because beta blockade can mask the signs of hypoglycemia, especially palpitations, tachycardia, and tremors. Taking his pulse, weekly weighing, and avoiding smoke-filled rooms are good health practices and should be done when taking these drugs, but they are not specifically necessary for a diabetic patient taking a beta-adrenergic antagonist.

The male client is prescribed prazosin (Minipress) for hypertension. He asks the nurse how the medication works. What is the nurse's best response?

"It works by making your blood vessels dilate." Explanation: Prazosin (Minipress) is a peripherally acting antiadrenergic drug that causes the blood vessels to expand. Calcium channel blockers inhibit the movement of calcium across the membrane and increase the supply of oxygen to the heart.

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

"Take this drug with food to help promote its absorption." Explanation: Food increases the bioavailability of the drug and facilitates its absorption. Metoprolol crosses the blood-brain barrier leading to a possible increase in CNS adverse effects. Metoprolol, like other beta-1 selective blockers, can lead to decreased exercise tolerance. Metoprolol, like other beta-1 selective blockers, can lead to decreased libido and impotence.

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?

Administer the dose at bedtime Explanation: The nurse can administer the dose at bedtime to decrease the risk of first-dose effect. The nurse should never administer half the prescribed dose, or at longer intervals than prescribed, any modifications must be ordered by the health care provider. Administering any drugs with food must be approved as food can delay absorption and may be contraindicated.

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?

Beta2 receptor blockade use results in less effective glucose metabolism, especially when accompanied with anti-diabetic medications. Explanation: Beta2 receptor blockade also results in less effective metabolism of glucose (decreased glycogenolysis) when needed by the body, especially in people taking beta-blocking agents along with anti-diabetic drugs.

A client calls the cardiology office and reports fatigue and drowsiness since starting a new medication. The nurse knows that which medications has these as common side effects?

Carvedilol Explanation: Cavedilol is an alpha/beta adrenergic blocking drug often used to treat heart failure. Common side effects include fatigue, dizziness, hypotension, drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain, bradycardia, and skin rashes. Norepinephrine and epinephrine side effects include increased heart rate and jitteriness. Lisinopril often causes lightheadedness due to a decrease in blood pressure and a nonproductive cough. Fatigue is not a common side effect from norepinephrine, epinephrine, or lisinopril.

Nonselective beta blockers are the drugs of choice for treating hypertension in patients who smoke.

False Explanation: Beta-1-selective blockers, because they do not block the sympathetic bronchodilation, are the preferred drugs for treating hypertension in patients who smoke.

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?v

Labetalol Explanation: Abruptly stopping an adrenergic blocking drug can cause increased heart rate, hypertension, headache, and pounding in the chest. Antidepressants have a long half-life, so side effects when they are discontinued take longer to develop. Stopping Tylenol PM may cause pain to resurface and an inability to sleep but not usually hypertension, rapid heart beat, and pounding in the chest. Stopping Reglan abruptly does not normally cause any sudden symptoms.

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?

Phentolamine mesylate (Regitine) Explanation: Phentolamine mesylate (Regitine) can be used to prevent tissue necrosis due to extravasation of potent vasoconstrictors, such as norepinephrine and dopamine, into subcutaneous tissues.

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.)

Propranolol (Inderal) Metoprolol (Lopressor) Atenolol (Tenormin) Explanation: Propranolol, metoprolol, and atenolol are beta-adrenergic blockers, but carvedilol and labetalol are alpha/beta-adrenergic blockers.

After teaching a group of students about beta-1 selective blockers, the instructor determines that the teaching was successful when the students identify what as a contraindication to using this group of drugs?

Sinus bradycardia Explanation: Beta-1 selective blockers are contraindicated in patients with sinus bradycardia. Thyroid disease is a condition that requires cautious use of beta-1 selective blockers. Diabetes is a condition that requires cautious use of beta-1 selective blockers. COPD is a condition that requires cautious use of beta-1 selective blockers.

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?

The medication inhibits urinary bladder contraction. Explanation: Prazosin (Minipress) can be administered in multiple doses to inhibit urinary bladder contraction to decrease urinary retention. The administration of prazosin (Minipress) is not used to increase gastric motility, increase muscle contraction, or decrease blood pressure when administered for benign prostatic hypertrophy.vv

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?

Timoptic is given in the eye, not PO. Explanation: Timoptic is an ophthalmic medication that treats glaucoma and is dosed in drops (gtt). It is given twice a day in the eye, not by mouth.

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

To decrease heart rate Explanation: Beta blockers, such as propranolol, are used to decrease heart rate, cardiac output, and tremors in hyperthyroidism.

Most nonselective adrenergic blockers are used to treat hypertension.

True

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

Decrease the heart rate Explanation: Beta blockers decrease (not increase) heart rate and dilate blood vessels (not the heart itself). Beta blockers do not prevent normal sinus rhythm.

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

Demonstrate the technique of eye drop instillation Explanation: The nurse should demonstrate the technique of eye drop installation while educating the client with glaucoma. Demonstrating the method of cleaning eyes, suggesting the client protect his eyes from exposure to sunlight, and informing the client about eye drop preservation are not related nursing interventions when teaching the client about the use of an adrenergic blocker for glaucoma.

A patient receives intravenous labetalol. The nurse would expect this drug to exert its maximum effectiveness within which time frame?

5 minutes Explanation: Labetalol, when given IV, peaks in 5 minutes.

The nurse is preparing medications for administration on the unit. In which client is metoprolol mostly likely contraindicated?

A 35-year-old post-MI female with a heart rate of 42 bpm Explanation: Contraindications for beta-adrenergic blocking agents such as metoprolol include sinus bradycardia and heart block. Clients with migraines, hypertension and myocarditis are not contraindicated.v

The client has been ordered a nonselective beta-blocking agent called propranolol, PO. Propranolol is used in the treatment of which disorders?

All the above Explanation: Propanolol is a nonselective beta-blocking agent with indications that include hypertension, angina, cardiac arrhythmias, hypertrophic subaortic stenosis, migraine prophylaxis, and myocardial infarction.

A client has been diagnosed with pheochromocytoma and has severe hypertension. The nurse knows that the client would be prescribed which type of medication?

An alpha-adrenergic blocker Explanation: In the case of hypertension associated with a pheochromocytoma (tumor of the adrenal gland), an alpha-adrenergic blocking medication would be prescribed. Beta blocker, adrenergic, and alpha-stimulating medications would not be appropriate.

A client is experiencing urinary retention. The client has been prescribed terazosin (Hytrin). What condition contributes to the urinary retention?

Benign prostatic hypertrophy Explanation: Terazosin (Hytrin) is administered for the treatment of benign prostatic hypertrophy. Terazosin (Hytrin) is not the primary drug used for bladder cancer, urinary tract infection, or kidney cancer.

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

The proper method for instilling eye drops Explanation: Timolol is available in an ophthalmic form of the drug for reduction of intraocular pressure in patients with open-angle glaucoma. The client should in instructed in the proper method of instilling eye drops. None of the other options present information that is relevant to the administration of timolol for open angle glaucoma.

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?

an adrenergic antagonist. Explanation: Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators), and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug.

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:

angina. Explanation: Nadolol is a beta blocker used in the treatment of hypertension and angina.

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

beta-blockers Explanation: Class II beta-adrenergic blockers are being used more often in clients following myocardial infarction and heart failure because of their effectiveness in improving symptoms, reducing hospitalization, and improving survival. A calcium channel blocker blocks the entry of calcium into the muscle cells of the heart and the arteries. By reducing the heart's need for oxygen, CCBs prevent or relieve angina. CCBs also are used for treating high blood pressure because of their blood pressure-lowering effects. Clinical trials support the use of digoxin (a cardiac glycoside) in heart failure in clients with left ventricular dysfunction, especially in those with advanced disease. Angiotensin II receptor blockers (ARBs) lower blood pressure and help prevent a heart attack or stroke.

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:

history of acute myocardial infarction. Explanation: The nurse will check the chart for any indication of a history of acute myocardial infarction. Phentolamine is contraindicated in clients with this history or any evidence of coronary artery disease because of its cardiac-stimulating effects and resultant increases in myocardial oxygen demand. This drug is used with caution in clients with gastric and duodenal ulcers because the drug has a histamine-like effect. Obesity and diabetes mellitus should not be a factor with the use of phentolamine.

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

hypoglycemia. Explanation: Labetalol, a nonselective adrenergic blocker, increases the effectiveness of antidiabetic agents leading to an increased risk for hypoglycemia. Hypotension would occur if the drug were combined with other drugs that are known to lower blood pressure. Arrhythmias and bronchospasm are adverse effects of nonselective adrenergic blockers and are unrelated to the combination of labetalol and insulin.