Lilley: Pharmacology and the Nursing Process, 7th Edition

Test Bank

Chapter 19: Adrenergic-Blocking Drugs

MULTIPLE CHOICE

1. During therapy with a beta-blocker, a patient notices that she has swollen feet,
has gained 3 pounds within 2 days, feels short of breath even when walking around the
house, and has been dizzy. The nurse suspects that which of the following is occurring?
A. The patient is experiencing expected adverse effects of the drug.
B. The patient is experiencing an allergic reaction.
C. More time is needed for the patient to see a therapeutic response to the drug.
D. The patient may be developing heart failure.
ANS: D
Even though some beta-blockers may be used for the treatment of some types of heart
failure, the patient should be assessed often for the development of heart failure, a potential
adverse effect of the drugs. These symptoms do not indicate expected adverse effects, an
allergic reaction, or a therapeutic response.

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TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. A patient is going home with a new prescription for the beta-blocker atenolol
(Tenormin). The nurse should include which content when teaching the patient about this
drug?
A. Never stop taking this medication abruptly.
B. The medication should be stopped once symptoms subside.
C. If adverse effects occur, skip a dose for a “drug holiday.”
D. Be watchful for first-dose hypotension.
ANS: A
Patients should be weaned off these medications slowly because rebound hypertension and
chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly
nor doses skipped. First-dose hypotension occurs with alpha-blockers.

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TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

3. During initial rounds, the nurse notes that a dopamine infusion has extravasat-
ed into the forearm of a patient. After stopping the infusion, the nurse follows standing orders
and immediately injects phentolamine subcutaneously in a circular fashion around the
extravasation site. What is the mechanism of action of the phentolamine in this situation?
A. It neutralizes the extravasated dopamine immediately.
B. It causes arterial vasoconstriction and reduced pain and swelling at the site.
C. It increases peripheral vascular resistance and reduces arterial pressure at the site.
D. It increases blood flow to the ischemic site by vasodilation to prevent tissue
damage.
ANS: D
Phentolamine is an alpha-blocker that reduces peripheral vascular resistance when given
systemically, but local subcutaneous injection around the site of extravasated vasoconstric-
tive drugs such as dopamine causes an alpha-adrenergic receptor blockade and vasodilation
and thus allows for increased blood flow to the ischemic tissue and, it is hoped, prevents
permanent tissue damage.

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TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. A 58-year-old man has had a myocardial infarction (MI), has begun rehabilita-
tion, and is ready for discharge. He is given a prescription for metoprolol (Lopressor), and he
becomes upset. “I don’t have high blood pressure—why did my doctor give me this
medicine?” The nurse explains to him that
A. this medication prevents emboli that may lead to another MI.
B. beta-blockers will improve blood flow to the kidneys.
C. it is being prescribed to prevent the hypertension that often occurs post-MI.
D. studies have shown that this medication has greatly increased survival rates in
patients after an MI.
ANS: D
Beta-blockers are frequently given to patients after they have suffered an MI because of their
cardioprotective properties; however, some contraindications may preclude the use of beta-
blockers for all post-MI patients.

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MSC: NCLEX: Psychosocial Integrity

5. The teaching for a patient who is taking tamsulosin (Flomax) to reduce

urinary obstruction due to benign prostatic hyperplasia should include which of the
following?
A. Fluids should be restricted while on this medication.
B. Take the medication with breakfast to promote the maximum effects of the drug.
 C. Lightheadedness may occur when standing up after sitting or lying down.
D. Blood pressure should be monitored because the medication may cause hyperten-
sion.
ANS: C
This medication is used to relieve impaired urinary flow in men with benign prostatic
hyperplasia but it also can cause orthostatic hypotension. Because of these effects, the blood
pressure may become dramatically lowered, and lightheadedness may occur.

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MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. When screening a patient who will be taking a nonspecific/nonselective beta-

blocker, the nurse knows that a patient with which condition may have serious problems
while on this medication?
A. Angina
B. Hypertension
C. Glaucoma
D. Asthma
ANS: D
Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension,
heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore,
any preexisting condition such as asthma might be worsened by the concurrent use of any of
these medications.

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MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. A patient is experiencing diastolic heart failure. The nurse expects which beta-
blocker to be ordered for this patient?
A. atenolol (Tenormin)
B. carvedilol (Coreg)
C. acebutolol (Sectral)
D. esmolol (Brevibloc)
ANS: B
Certain beta-blockers, such as carvedilol and metoprolol, are useful in the treatment of heart
failure.

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TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
 8. During a teaching session about self-monitoring while taking a beta-blocker at
home, the nurse has taught a patient to take his apical pulse daily for 1 minute. If the pulse
rate decreases to less than 60 per minute, he should be instructed to
A. contact his physician for instructions.
B. reduce the dose of his beta-blocker by half.
C. continue the medication because this is an expected effect.
D. skip the medication dose that day and check his pulse again the next day.
ANS: A
Cardiac depression can occur with beta-blockers; the patient should be told to contact his
physician if his pulse rate decreases to less than 60 per minute. The other options are not
correct.

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MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

9. A 49-year-old patient is in the clinic for a follow-up visit 6 months after

starting a beta-blocker for treatment of hypertension. During this visit, his blood pressure is
169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months
ago because of an “embarrassing problem.” What problem did he most likely experience
with this medication that caused him to stop taking it?
A. Urge incontinence
B. Dizziness when standing up
C. Excessive flatus
D. Impotence
ANS: D
Impotence is a potential adverse effect of beta-blockers and may cause patients to stop taking
the medication. The other options are not adverse effects of beta-blockers.

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TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

1. A beta-blocker is prescribed for a patient with angina. The nurse reviews the
orders for other drugs that may interact with the beta-blocker. Which drugs or drug classes
are known to have an interaction with a beta-blocker? Select all that apply.
A. Diuretics
B. Anticholinergics
C. Penicillins
 D. Oral hypoglycemics
E. Thyroid replacement hormones
F. Anticoagulants
ANS: A, B, D
When taken with beta-blockers, diuretics may cause additive hypotensive effects; oral
hypoglycemic medications may cause the blood glucose to decrease; and anticholinergics
may cause decreased beta-blocker effects. The other drugs are not known to interact with
beta-blockers.

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TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

OTHER

1. A patient has an order for carvedilol (Coreg) 6.25 mg twice a day PO. The
tablets are 3.125 mg. How many tablets will the nurse administer per dose?

ANS:
2 tablets
3.125 mg : 1 tablet :: 6.25 mg : x tablets
Solve for x:
(3.125 × x) = (1 × 6.25); 3.125x = 6.25; x = 2 tablets

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TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies