Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, prepU (GRADED A) Questions and Answers REF, Karch, A. M., Focus on Nursing Pharmacology, 8th ed | 100% VERIFIED.

Chp 31 Adrenergic Blocking Antagonists Question 1 See full question43s Report this Question The nurse frequently sees mature male clients with BPH seeking treatment for symptoms. After ensuring they do not test positive for prostate cancer, pharmacological intervention is one of a few treatment modalities available. Pharmacokinetics indicate alpha1-blocking agents as a treatment choice due to their: You Selected: prevention of smooth muscle contraction in nonvascular tissues. Correct response: prevention of smooth muscle contraction in nonvascular tissues. Explanation: Alpha1-adrenergic blocking drugs can prevent alpha-mediated contraction of smooth muscle in nonvascular tissues. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Therapeutic Actions and Indications, p. 526. Chapter 31: Adrenergic Blocking Antagonists - Page 526 Add a Note Question 2 See full question1m 55s Report this Question A nurse is caring for a patient with arrhythmia. What nursing interventions should the nurse perform when a patient with life-threatening arrhythmia receives an adrenergic-blocking drug through IV? You Selected: Monitor blood pressure and respiratory rate Correct response: Monitor blood pressure and respiratory rate Explanation: The nurse should monitor blood pressure and respiratory rate when the patient with life-threatening arrhythmia receives an adrenergic-blocking drug through IV. The nurse need not monitor rhythm at varying intervals, pulse rate, and body temperature. The nurse monitors rhythm at varying intervals and pulse rate when propranolol is administered orally for less serious cardiac arrhythmia. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Adverse Effects, p. 530. Chapter 31: Adrenergic Blocking Antagonists - Page 530 Add a Note Question 3 See full question1m 52s Report this Question 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: You Selected: understand the signs and symptoms of hypoglycemia. Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Box 31.2 Focus on Herbal and Alternative Therapies, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 4 See full question22s Report this Question A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessment findings? You Selected: Heart rate and blood pressure Correct response: Heart rate and blood pressure Explanation: Metoprolol has a profound effect on both blood pressure and heart rate. Consequently, the nurse should assess these parameters prior to administering the drug. Assessments related to pain, respiratory status, cognition, and temperature are not central to the administration of a beta blocker. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Table 31.5 Drugs in Focus: Beta1-Selective Adrenergic Blocking Agents, p. 530. Chapter 31: Adrenergic Blocking Antagonists - Page 530 Add a Note Question 5 See full question20s Report this Question A 35-year-old female has been diagnosed with hyperthyroidism. Her health care provider has prescribed propranolol to achieve which effect? You Selected: To decrease heart rate Correct response: To decrease heart rate Explanation: Beta blockers, such as propranolol, are used to decrease heart rate, cardiac output, and tremors in hyperthyroidism. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 6 See full question29s Report this Question 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? You Selected: Carvedilol Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Therapeutic Actions and Indications, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 7 See full question21s Report this Question After reviewing information about nonselective adrenergic blockers, a group of students demonstrate a need for additional teaching when they identify what as an effect of these agents? You Selected: Increased pulse rate Correct response: Increased pulse rate Explanation: Nonselective adrenergic blockers block the effects of norepinephrine at the alpha and beta receptors in the sympathetic nervous system, leading to a slower pulse rate, lowering of blood pressure, increased renal perfusion, and decreased renin levels. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, pulse rate, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 8 See full question2m 1s Report this Question After administering the oral form of labetalol to a patient, the nurse would monitor the patient for a peak drug effect at which time? You Selected: 2 to 3 hours Correct response: 1 to 2 hours Explanation: Oral labetalol peaks in 1 to 2 hours. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, labetalol, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 9 See full question1m 6s Report this Question Beta-1 selective blockers have what as an effect? You Selected: Reduction in arrhythmia Correct response: Reduction in arrhythmia Explanation: Beta-1 selective blockers decrease the release of renin to aid in decreasing blood pressure. Beta-1 selective blockers decrease heart rate. Beta-1 selective blockers decrease cardiac excitability and exert a membrane stabilizing effect leading to a decrease in arrhythmias. Beta-1 selective blockers decrease cardiac workload. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Box 31.2 Focus on Herbal and Alternative Therapies, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 10 See full question41s Report this Question A client has been prescribed labetalol IV for a pheochromocytoma. What is the expected effect of the medication? You Selected: Management of the resulting hypertension Correct response: Management of the resulting hypertension Explanation: Labetalol is used IV and orally to treat hypertension associated with pheochromocytoma (tumor of the chromaffin cells of the adrenal medulla, which periodically releases large amounts of norepinephrine and epinephrine into the system) and clonidine withdrawal. Labetalol is not prescribed to affect tumor shrinkage. The tumor is responsible for the increase in norepinephrine not of urine Question 1 See full question1m 55s Report this Question Understanding that beta-blockers are used mainly for cardiovascular disorders, which is not an indication for beta-blocker use? You Selected: Cardiac bradydysrhythmia Correct response: Cardiac bradydysrhythmia Explanation: Clinical indications for use of beta-blocking agents are mainly cardiovascular disorders (e.g., angina pectoris, cardiac tachydysrhythmia, hypertension, MI, HF) and glaucoma. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Adverse Effects, p. 529. Chapter 31: Adrenergic Blocking Antagonists - Page 529 Add a Note Question 2 See full question9s Report this Question A client is suspected of having pheochromocytoma. Which agent would the nurse identify as being used to help diagnose this disorder? You Selected: Carvedilol Correct response: Phentolamine Explanation: Phenotolamine is the drug used to diagnose pheochromocytoma. Labetalol is used to treat the hypertension that is associated with pheochromocytoma. Carvedilol is used to treat hypertension, but not that associated with pheochromocytoma. Atenolol is used to treat myocardial infarction, chronic angina, and hypertension; it is not used to diagnose pheochromcytoma. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Nonselective Alpha-Adrenergic Blocking Agents, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 3 See full question1m 7s Report this Question A female client has been diagnosed with hyperthyroidism. She asks the nurse why she is taking a medication that decreases her blood pressure like her grandmother takes. What is the nurse's best response when teaching her about the action and use of propranolol (Inderal) in the treatment of hyperthyroidism? You Selected: “The administration of propranolol will decrease your heart rate.” Correct response: “The administration of propranolol will decrease your heart rate.” Explanation: The administration of propranolol (Inderal) to a client who has been diagnosed with hyperthyroidism will allow for decreased heart rate. It is not administered to promote bronchodilation, prevent respiratory depression, or decrease systolic blood pressure. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Nonselective Beta-Adrenergic Blocking Agents, p. 530. Chapter 31: Adrenergic Blocking Antagonists - Page 530 Add a Note Question 4 See full question5s Report this Question 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: You Selected: benign prostatic hyperplasia. Correct response: angina. Explanation: Nadolol is a beta blocker used in the treatment of hypertension and angina. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Adverse Effects, p. 527. Chapter 31: Adrenergic Blocking Antagonists - Page 527 Add a Note Question 5 See full question9s Report this Question A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart? You Selected: Decrease the heart rate Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 6 See full question1m 35s Report this Question A client has come to get lab results at the cardiology clinic. The nurse notes that the digoxin level is elevated. The nurse knows that what other medication may be responsible for the increase in digoxin level? You Selected: Carvedilol Correct response: Carvedilol Explanation: When taking both carvedilol and digoxin, the client's digoxin level becomes higher and the client is at greater risk of digoxin toxicity. Prozac, Zantac, and ampicillin do not increase a client's digoxin level. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Therapeutic Actions and Indications, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 7 See full question26s Report this Question A patient has a history of smoking. Which agent would the nurse most likely expect to be ordered? You Selected: Atenolol Correct response: Atenolol Explanation: Atenolol is a beta-1 selective adrenergic blocker. This agent would be preferred for the patient who smokes because the drug does not usually block beta-1 receptor sites. Subsequently, it does not block the sympathetic bronchodilation that would be important for this patient. Timolol, pindolol, and nadolol are nonselective beta-adrenergic blockers that would block this sympathetic bronchodilation. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Atenolol, p. 536. Chapter 31: Adrenergic Blocking Antagonists - Page 536 Add a Note Question 8 See full question1m 15s Report this Question A client has been prescribed labetalol. What assessment evaluates the effectiveness of the medication? You Selected: A decrease from baseline blood pressure. Correct response: A decrease from baseline blood pressure. Explanation: Labetalol is an adrenergic blocking agent prescribed to lower blood pressure. Monitor patient response to the drug by documenting improvement (lowering) in blood pressure. Cardiac arrhythmias and orthostatic hypotension are side effectives of the medication. Abrupt withdrawal of the medication can induce an MI with the associated chest pain. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Implementation with Rationale, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 9 See full question21s Report this Question A male client has been prescribed an alpha1-selective adrenergic blocking agent to treat benign prostatic hyperplasia (BPH) 2 weeks ago. Which assessment question should the nurse ask to evaluate for the expected result of this medication therapy? You Selected: "Has your urine stream improved since beginning the medication?" Correct response: "Has your urine stream improved since beginning the medication?" Explanation: Alpha1-selective adrenergic blocking agents are used to treat hypertension and are often used to treat BPH because of their relaxing effects on the bladder and prostate. Reporting a better urine stream would indicate the medication therapy has achieved its therapeutic goal. None of the other options assess an expected outcome for alpha1-selective adrenergic blocking medication therapy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Alpha1-Selective Adrenergic Blocking Agents, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 10 See full question2m 27s Report this Question What information identified by the client’s history should the nurse consider to be a contraindication for the administration of a nonselective beta-adrenergic blocker? You Selected: implanted pacemaker Correct response: history of exercise-induced asthma Explanation: The nonselective beta-adrenergic blocker will block both beta1 and beta2 receptors. The medication will prevent the sympathetic nervous system to be activated. The beta1 blockade results in a decrease in heart rate and blood pressure. The beta2 blockade can result in bronchoconstriction, which is not acceptable with a client with a history of asthma. Having a pacemaker will not affect the medication adversely because it is preset to pace at a predetermined rate. The medication will not interfere with a client with gallbladder disease or urinary tract infection since the medication blocks beta receptors that control the heart and lungs. Question 1 See full question1m Report this Question 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? You Selected: Beta2 receptor blockade use results in less effective glucose metabolism, especially when accompanied with anti-diabetic medications. Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 2 See full question20s Report this Question A patient is receiving tamsulosin. The nurse understands that this drug is most likely being given for which reason? You Selected: To relax prostatic smooth muscles Correct response: To relax prostatic smooth muscles Explanation: Tamsulosin blocks smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in males. A decrease in vascular tone would lead to a lowering of blood pressure; tamsulosin is not used to treat hypertension. Vasodilation would lead to a lowering of blood pressure; tamsulosin is not used to treat hypertension. Tamsulosin, an alpha-1 selective blocker, does not cause the reflex tachycardia that can occur with a drop in blood pressure; tamsulosin is not indicated for the treatment of hypertension. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Drugs Acting on the Autonomic Nervous System, p. 528. Chapter 31: Adrenergic Blocking Antagonists - Page 528 Add a Note Question 3 See full question1m 1s Report this Question A patient is to receive metoprolol. What would the nurse include in the teaching plan for this patient? You Selected: "Take this drug with food to help promote its absorption." Correct response: "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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Pharmacokinetics, p. 531. Chapter 31: Adrenergic Blocking Antagonists - Page 531 Add a Note Question 4 See full question4m 37s Report this Question A nurse is caring for a patient who has been administered a centrally acting anti-adrenergic drug. The nurse knows that under which condition is the use of a centrally acting anti-adrenergic drug contraindicated? You Selected: Active hepatic disease Correct response: Active hepatic disease Explanation: The use of a centrally acting anti-adrenergic drug is contraindicated in patients with active hepatic disease. The use of a centrally acting anti-adrenergic drug is not contraindicated in patients with active peptic ulcer, ulcerative colitis, or mental depression. In patients with active peptic ulcer, ulcerative colitis, or mental depression, the use of peripherally acting anti-adrenergic drug is contraindicated. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Pharmacokinetics, p. 528. Chapter 31: Adrenergic Blocking Antagonists - Page 528 Add a Note Question 5 See full question3m 30s Report this Question The male client is prescribed prazosin (Minipress) for hypertension. He asks the nurse how the medication works. What is the nurse's best response? You Selected: "It works by making your blood vessels dilate." Correct 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Alpha1-Selective Adrenergic Blocking Agents, p. 528. Chapter 31: Adrenergic Blocking Antagonists - Page 528 Add a Note Question 6 See full question1m 18s Report this Question The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving: You Selected: Propranolol Correct response: Propranolol Explanation: Although safety measures are important part of the teaching plan for any nonselective beta blocker, they would be a priority for a patient receiving propranolol. The drug crosses the blood–brain barrier, leading to the development of CNS effects. Carteolol, nadolol, and sotalol do not cross the blood–brain barrier; thus, the risk for CNS effects would be less. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Box 31.1 Focus on Drug Therapy across the Lifespan, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 7 See full question30s Report this Question Which would a nurse identify as a contraindication for the use of a beta-1 selective blocker? You Selected: Sinus bradycardia Correct response: Sinus bradycardia Explanation: Beta-1 selective blockers are contraindicated in patients with sinus bradycardia. Diabetes, thyroid disease, and chronic obstructive pulmonary disease are conditions that require cautious use of beta-1 selective blockers. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, p. 536. Chapter 31: Adrenergic Blocking Antagonists - Page 536 Add a Note Question 8 See full question1m 31s Report this Question A hospitalized adolescent is prescribed an adrenergic blocking medication. Which nursing interventions will the nurse implement recognizing the unique risk such medications have for children? Select all that apply. You Selected: Assessing heart rate every 4 hours Monitoring blood pressure every 4 hours Keeping strict intake and output documentation Correct response: Assessing heart rate every 4 hours Having supplemental oxygen available at the bedside Explanation: Children are at greater risk for complications associated with the use of adrenergic blocking agents, including bradycardia, difficulty breathing, and changes in glucose metabolism. Children on this classification of medication are not uniquely at risk for extremes in BP or for dehydration or urinary production issues. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 9 See full question1m 11s Report this Question A client taking prazosin is experiencing lightheadedness and dizziness when standing up. What are important things to include in teaching the client about the medication? Select all that apply. You Selected: Avoid long hot showers. Change positions slowly. Correct response: Avoid long hot showers. Change positions slowly. Explanation: Risk for injury is the nursing diagnosis with a client taking prazosin. The client is experiencing postural hypotension and should be taught how to rise slowly from sitting or lying position. Teaching the client to avoid long, hot showers to minimize the vasodilation from the shower. The prescriber does not need to be called. The client should be instructed to continue to take the medication as prescribed. A nurse would assess orthostatics by taking the client’s blood pressure while sitting and then while standing. The client should not be instructed to perform this measurement. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Adverse Effects, p. 524. Chapter 31: Adrenergic Blocking Antagonists - Page 524 Add a Note Question 10 See full question23s Report this Question What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago? You Selected: beta-blockers Correct response: 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. Question 1 See full question13s Report this Question 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: You Selected: understand the signs and symptoms of hypoglycemia. Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Box 31.2 Focus on Herbal and Alternative Therapies, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 2 See full question18s Report this Question 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: You Selected: history of acute myocardial infarction. Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Therapeutic Actions and Indications, p. 522. Chapter 31: Adrenergic Blocking Antagonists - Page 522 Add a Note Question 3 See full question27s Report this Question Which observation might indicate that timolol is achieving the desired effect in a client? You Selected: intraocular pressure decreases Correct response: 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Beta1-Selective Adrenergic Blocking Agents, p. 535. Chapter 31: Adrenergic Blocking Antagonists - Page 535 Add a Note Question 4 See full question24s Report this Question A 35-year-old female has been diagnosed with hyperthyroidism. Her health care provider has prescribed propranolol to achieve which effect? You Selected: To decrease heart rate Correct response: To decrease heart rate Explanation: Beta blockers, such as propranolol, are used to decrease heart rate, cardiac output, and tremors in hyperthyroidism. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 31: Adrenergic Blocking Antagonists, Contraindications and Cautions, p. 523. Chapter 31: Adrenergic Blocking Antagonists - Page 523 Add a Note Question 5 See full question16s Report this Question A patient with diabetes who uses insulin is also receiving labetalol. The nurse would monitor the patient closely for: You Selected: hypoglycemia. Correct response: 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. Show Less