Chapter 18: Adrenergic Antagonists

Chapter 18: Adrenergic Antagonists

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching?

a.	“Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins.”
b.	“Dilation of arterioles has a direct effect on arterial pressure.”
c.	“Dilation of veins by alpha-adrenergic antagonists improves cardiac output.”
d.	“Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure.”

 

 

ANS:  C

Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha₁ receptors on arterioles and veins. When alpha₁ receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct effect on arterial pressure occurs. When alpha₁ receptors on veins are blocked by alpha-adrenergic antagonists, an indirect effect on arterial pressure occurs.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   pp. 156-157

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?

a.	It is ordered to prevent perioperative hypertensive crisis.
b.	It prevents secretion of catecholamines by the adrenal tumor.
c.	It reduces contraction of smooth muscles in the adrenal medulla.
d.	It is given chronically after the surgery to prevent hypertension.

 

 

ANS:  A

Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute hypertension during surgery. These agents do not prevent secretion of catecholamines; they block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They are given chronically in patients who have inoperable tumors.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 156-157

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

3. A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient?

a.	“Metoprolol has no effect on diabetes mellitus or on your insulin requirements.”
b.	“Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose.”
c.	“Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely.”
d.	“Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.”

 

 

ANS:  C

Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 164

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

4. The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?

a.	“I need to stop the medication if my heart rate increases.”
b.	“I should not drive while taking this medication.”
c.	“I should take the first dose at bedtime.”
d.	“I will stop taking the medication if I feel dizzy.”

 

 

ANS:  C

Orthostatic hypotension is a common side effect of this class of drugs and is most severe with the first dose. Administering the first dose at bedtime eliminates the risk associated with this first-dose effect. Tachycardia is an expected side effect; if severe, it can be treated with other medications. Patients should not drive during the first 12 to 24 hours after taking these agents, because fainting and dizziness may occur, but they may drive after that. Dizziness is not an indication for stopping the drug; patients who experience dizziness are instructed to sit or lie down until symptoms pass.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 156-157 | p. 166

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential