pharm chapter 16

25) The nurse is concerned that a client who received a dose of phentolamine (Regitine) is experiencing adverse effects. Which assessment findings support this?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypotension 2. Tachycardia 3. Nausea 4. Vomiting 5. Headache

Answer: 1, 2, 3, 4 Explanation: Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of hypotension. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of tachycardia. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of nausea. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of vomiting.

28) The nurse is preparing discharge instructions for a client who is prescribed an adrenergic antagonist. What should be included in this teaching?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weighing self daily, at the same time each day 2. How to measure blood pressure 3. How to measure pulse 4. Notifying the healthcare provider about a weight gain or loss of 2 lb in one day 5. Stopping taking the medication if dizziness occurs

Answer: 1, 2, 3, 4 Explanation: The nurse should instruct the client to perform a daily weight at the same time of day. The nurse should instruct the client on blood pressure monitoring since this measurement should be recorded every day. The nurse should instruct the client on measuring the pulse since this measurement should be recorded every day. The nurse should instruct the client on the importance of reporting a weight gain or loss of 2 lb in a 24-hour period.

3) A client is given tamsulosin (Flomax) for benign prostatic hyperplasia (BPH). The nurse knows that the action of this drug is due to selective blockade of which receptor? 1. Alpha 1 2. Alpha 2 3. Beta 2 4. Beta 1

Answer: 1 Explanation: Alpha1 receptors in the smooth muscle in the trigone and sphincter muscles at the base of the urinary bladder and in the prostate are blocked by this drug, causing relaxation of these muscles and an increase in the urine flow in clients who have difficulty voiding.

12) A client diagnosed with hypertension is prescribed atenolol (Tenormin). The nurse knows that this medication is a selective beta1 blocker and can be safely used for clients with which concurrent diagnosis? 1. Asthma 2. Diabetes 3. Heart failure 4. Hepatic disease

Answer: 1 Explanation: Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm.

13) Which medication should the nurse anticipate to be prescribed for a client with asthma and hypertension?1 . Metoprolol (Lopressor) 2. Propranolol (Inderal) 3. Sotalol (Betapace) 4. Nadolol (Corgard)

Answer: 1 Explanation: Metoprolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm.

18) A client is seen in the clinic for migraine headaches. The nurse anticipates that which medication might be prescribed as a prophylaxis for migraines? 1. Propranolol (Inderal) 2. Acebutolol 3. Carvedilol (Coreg) 4. Metoprolol (Lopressor)

Answer: 1 Explanation: Propranolol is a nonselective beta-adrenergic antagonist, blocking both beta1 and beta2 receptors all over the body, so it is used in the prophylaxis of migraine headache.

10) An older client who is prescribed terazosin (Hytrin) for treatment of benign prostatic hyperplasia (BPH) asks the nurse the reason why this drug should initially be taken at bedtime. On which rationale will the nurse base the response to the client? 1. It can cause a sudden fall in blood pressure. 2. It can depress the vasomotor center in the brain. 3. It can decrease the blood supply to the kidneys. 4. It can reduce the formation of urine at bedtime.

Answer: 1 Explanation: Terazosin (Hytrin) can cause a sudden fall in blood pressure. First-dose syncope generally occurs 30 to 90 minutes after an initial dose of 2 mg or more, which causes a sudden fall in blood pressure.

9) For which symptoms should the nurse teach the client to monitor when taking doxazosin (Cardura)? 1. Dizziness and headache 2. Difficulty in breathing 3. Decreased urinary frequency 4. Constipation

Answer: 1 Explanation: The most common side effects of doxazosin (Cardura) include dizziness, drowsiness, fatigue, and weakness. Also, first-dose syncope can occur 30 to 90 minutes following the initial dose, so the nurse should teach the client to be cautious.

PHARMACOLOGY CONNECTIONS TO NURSING PRACTICE 4TH EDITION ADAMS TEST BANK 21) A client is prescribed an alpha1 antagonist for blood pressure control. When instructing the client, the nurse will include that this medication performs which action?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blocks alpha1 receptors on arterial smooth muscle. 2. Dilates veins. 3. Blocks alpha2 receptors on arterial smooth muscle. 4. Reduces the heart rate. 5. Decrease the force of myocardial contraction.

Answer: 1, 2 Explanation: Alpha1 antagonists block alpha1 receptors on arterial smooth muscle, which directly lowers blood pressure. Alpha1 antagonists dilate veins, which indirectly lowers the blood pressure by decreasing venous return to the heart.

24) A client reports feeling lightheaded and dizzy with palpitations after being instructed to increase the dose of a prescribed beta-adrenergic antagonist. How should the nurse respond to this client's symptoms?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This is first-dose phenomenon." 2. "If the dose is increased again, take the medication at bedtime." 3. "This will go away in time." 4. "Maybe you have another health problem that needs to be examined." 5. "You may have taken too much medication."

Answer: 1, 2 Explanation: First-dose phenomenon is the onset of orthostatic hypotension when beginning or changing the dose of a beta-adrenergic antagonist. Taking the medication at bedtime will reduce the onset of first-dose phenomenon.

26) A client asks the nurse, "What would happen if I stop taking propranolol (Inderal)?" Which response by the nurse is the most appropriate?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You could start sweating and have palpitations." 2. "You could get a headache." 3. "You could develop nausea and vomiting." 4. "Nothing will occur." 5. "The medication will not work if prescribed again."

Answer: 1, 2 Explanation: If beta blockers are withdrawn abruptly, the client could develop sweating and palpitations because of the sensitivity of the heart to catecholamines. If beta blockers are withdrawn abruptly, the client could develop a headache because of the sensitivity of the heart to catecholamines.

23) The nurse learns that a client has been taking a beta-adrenergic antagonist but does not know why. For which disease processes should the nurse focus assessment with this client?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angina pectoris 2. Dysrhythmias 3. Glaucoma 4. Hypertension 5. Chronic obstructive pulmonary disease

Answer: 1, 2, 3, 4 Explanation: Beta-adrenergic antagonists decrease cardiac workload and oxygen demands and ease acute chest pain associated with angina pectoris. Beta-adrenergic antagonists slow cardiac conduction, which is helpful in the treatment of some dysrhythmias. Some beta-adrenergic antagonists reduce intraocular pressure, which is used in the treatment of glaucoma. Beta-adrenergic antagonists are used in the treatment of hypertension.

27) Prior to administering a newly prescribed order for metoprolol (Toprol), the nurse reviews the client's medications and decides to question the order for which reason?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is also prescribed a calcium channel blocker. 2. The client is already taking an antihypertensive medication. 3. The client is using cimetidine. 4. The client is taking oral contraceptives. 5. The client is taking aspirin.

Answer: 1, 2, 3, 4 Explanation: Concurrent use of a beta1 blocker with a calcium channel blocker can cause bradycardia or heart block.Concurrent use of a beta1 blocker with an antihypertensive can cause additive hypotension. Concurrent use of a beta1 blocker with cimetidine can cause additive hypotension. Concurrent use of a beta1 blocker with oral contraceptives can cause additive hypotension.

22) A client with hypertension is prescribed a beta blocker. The effects that this medication will have on the client's blood pressure are due to which factors?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reduced myocardial contractility 2. Reduced release of renin 3. Relaxed arteriole smooth muscle 4. Reduced sympathetic output from the brain 5. Reduced lipolysis

Answer: 1, 2, 3, 4 Explanation: Diminished myocardial contractility decreases cardiac output. The release of renin by the kidney, which is normally stimulated by catecholamines, is prevented. The nonselective adrenergic antagonists block alpha1-adrenergic receptors, relaxing arteriolar smooth muscle. Central actions reduce sympathetic output from the vasomotor center in the brain.

19) In preparing a teaching plan for a client who is on acebutolol (Sectral), the nurse should include which instructions?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take the radial pulse before each dose and report any irregular pulse. 2. Report cold, painful, or tender feet or hands to your healthcare provider. 3. If a dose is missed, take a double dose next time. 4. Stop the medication completely if dizziness or headache occurs. 5. This drug must not be stopped abruptly but must be taken regularly.

Answer: 1, 2, 5 Explanation: Acebutolol is an oral cardioselective beta1 antagonist similar to metoprolol that is used for HTN and recurrent ventricular dysrhythmias; high doses can produce hypotension and bradycardia. Take the radial pulse before each dose and report an irregular pulse or if pulse drops below the parameter recommended by the healthcare provider. Cold, painful, or tender feet or hands, or other symptoms of Raynaud's disease, such as cyanosis, intermittent pallor, redness, or paresthesias, can occur as a side effect of this drug and should be reported. The healthcare provider might prescribe a vasodilator. Acebutolol must be discontinued slowly over a period of 1 to 2 weeks. Sudden withdrawal can result in anginal attacks and MIs in clients diagnosed with angina pectoris, or in thyroid storm in clients diagnosed with hyperthyroidism.

20) The nurse is evaluating a client's response to a newly prescribed adrenergic agonist. Which assessment findings does the nurse anticipate this client will exhibit?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased peristalsis 2. Dilated pupils 3. Increased salivation 4. Deep respirations 5. Decreased heart rate

Answer: 1, 3, 5 Explanation: Increased peristalsis is a reaction consistent with the rest-and-digest response. Increased salivation is a reaction consistent with the rest-and-digest response. Decreased heart rate is a reaction consistent with the rest-and-digest response.

11) Prazosin (Minipress) is prescribed for a hypertensive client. Which measure should be used by the nurse to prevent the first-dose phenomenon? 1. Give the dosage early in the morning before breakfast. 2. Give initial low doses at bedtime. 3. Give the dosage with meals. 4. Give an initial high dosage and then lower gradually.

Answer: 2 Explanation: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime.

17) An older adult client who is taking doxazosin (Cardura) for hypertension is given a prescription of sildenafil (Viagra) for erectile dysfunction. The nurse should caution the client about which effect? 1. Sildenafil causes rapid elimination of doxazosin through the kidneys. 2. Sildenafil will potentiate the hypotensive effects of doxazosin. 3. Sildenafil blocks the absorption of doxazosin from the gastrointestinal tract. 4. Sildenafil causes hypertension, counteracting the effect.

Answer: 2 Explanation: Use of doxazosin (Cardura) with erectile dysfunction agents such as sildenafil (Viagra) can cause increased hypotension, since both these drugs relax the smooth muscles of the vessels. Using both together can cause added hypotension.

16) The nurse is preparing a care plan for an older adult client diagnosed with hypertension who is prescribed prazosin (Minipress) 1 mg 2 times a day. Which instructions should the nurse include in the care plan for this client?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. This drug decreases urinary output and causes urinary retention. 2. The first dose should be given at bedtime. 3. Monitor for drug-related side effects such as dizziness, fatigue, and weakness. 4. Client must be recumbent for 3 to 4 hours if the first dose is given during the daytime. 5. This drug can cause severe constipation, so a high-fiber diet is advisable.

Answer: 2, 3, 4 Explanation: Administer the initial dose of prazosin (Minipress) at bedtime to minimize adverse effects, such as postural hypotension and syncope. The most common side effects of prazosin include dizziness, drowsiness, fatigue, weakness, palpitations, orthostatic hypotension, and headache, since this drug is an alpha1-adrenergic blocker that causes a rapid decrease in peripheral resistance that reduces blood pressure. If the initial dose of prazosin (Minipress) must be taken during the day, advise the client to remain recumbent for at least 3 to 4 hours and not to perform hazardous activities during that time.

8) A client is to be treated for an overdose of propranolol (Inderal). Which medications should the nurse anticipate being used?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prazosin 2. Isoproterenol 3. Atropine 4. Metoprolol 5. Digoxin

Answer: 2, 3, 5 Explanation: Isoproterenol is an adrenergic agonist that is used to treat overdose of propranolol to reverse the bronchoconstriction. Atropine is an anticholinergic drug that is used to treat overdose of propranolol to reverse the severe bradycardia. Cardiac failure caused by beta-antagonist overdose can be treated by administering digoxin (Lanoxin) or diuretics.

15) A client prescribed propranolol (Inderal) for angina asks the nurse why this drug should not be abruptly discontinued. The nurse would be correct in telling the client that abrupt withdrawal could lead to which result?1. Extreme weight loss 2. Increase in blood glucose levels 3. Rebound chest pain or heart attack 4. Insomnia

Answer: 3 Explanation: Beta blockers should be withdrawn gradually over several weeks. If withdrawn abruptly, the heart displays hypersensitivity to catecholamines, and sweating, palpitations, headache, and tremulousness can occur. This phenomenon is called rebound cardiac excitation. Clients with coronary artery disease might experience a worsening of angina symptoms, and MIs have been recorded in some clients.

14) Which instruction should the nurse include in the discharge teaching plan of a client being treated with propranolol (Inderal) for angina? 1. "Salt and salt substitutes can be used with this medication." 2. "Take a double dose if you miss a dose." 3. "Do not stop taking this medication without talking to your healthcare provider." 4. "Use an OTC medication if you develop nasal allergies."

Answer: 3 Explanation: Propranolol (Inderal) must not be abruptly discontinued because abrupt discontinuation can cause tremors, sweating, palpitation, malaise, headache, rebound HTN, and life-threatening dysrhythmias (in patients with angina pectoris or MI).

6) A client is prescribed sotalol (Betapace) for a cardiac dysrhythmia. The nurse knows that sotalol (Betapace) is used in this client because it performs which action? 1. Increases secretion of renin from the kidneys. 2. Decreases sympathetic output from the vasomotor center in the brain. 3. Slows the travel of impulses across the myocardium. 4. Diminishes myocardial contractility.

Answer: 3 Explanation: Sotalol (Betapace) is a nonselective beta blocker used exclusively as an antidysrhythmic because it slows the action potential crossing the myocardium, allowing the heart to regain normal rhythm.

7) The nurse should question an order for propranolol (Inderal) in treatment of hypertension when the client has which associated disorders?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angina pectoris 2. Dysrhythmias 3. Hyperlipidemia 4. Asthma 5. Liver failure

Answer: 3, 4 Explanation: Propranolol increases serum triglycerides and decreases high-density lipoproteins. Patients with preexisting hyperlipidemia should have their lipid profiles monitored periodically to prevent hyperlipidemia.Propranolol is a nonselective beta blocker and can block the beta2 receptors in the lung, which can be dangerous in cases of asthma.

2) A client is prescribed alfuzosin (Uroxatral) for benign prostatic hyperplasia (BPH). The nurse should anticipate which intended effect of this drug? 1. Increased formation of residual urine in the bladder 2. Increased reabsorption of sodium in the kidney tubules 3. Excessive excretion of sodium in the urine 4. Increased frequency of urinary excretion

Answer: 4 Explanation: Alfuzosin (Uroxatral) is an alpha1-antagonist drug that causes increased urinary frequency due to more active smooth muscle contractions in the urinary tract.

5) A client diagnosed with hypertension is prescribed carvedilol (Coreg) and complains of dizziness and faintness immediately after taking this medication. The nurse knows that this effect is due to the action of which receptors? 1. Beta2 receptors only 2. Beta1 and beta2 receptors 3. Beta1 receptors only 4. Alpha1, beta1, and beta2 receptors

Answer: 4 Explanation: Carvedilol (Coreg) is classified as a nonselective beta blocker, blocking both the beta1 and beta2 receptors as well as the alpha1 receptors. The dizziness and faintness are due to its effect on all of these receptors.

4) Phentolamine is an antidote used for treating hypertensive emergencies caused by catecholamine overdose because it blocks which type of receptors? 1. Alpha 1 receptors 2. Alpha 2 receptors 3. Both beta 1 and beta 2 receptors 4. Both alpha 1 and alpha 2 receptors

Answer: 4 Explanation: Phentolamine is nonselective, blocks both alpha1 and alpha2 receptors, and can be used to treat or prevent hypertensive crises caused by catecholamine overdose.

1) Which symptom is the client who is prescribed alpha1-antagonist therapy likely to complain of within the first 24 hours? 1. Difficulty swallowing 2. Blurring of vision 3. Decreased urinary frequency 4. Attacks of dizziness and faintness

Answer: 4 Explanation: The first-dose phenomenon causes syncope due to reduced blood flow to the brain, and so attacks of dizziness and faintness can occur.