C HAPTER 12: D RUGS A FFECTING THE
A UTONOMIC N ERVOUS S YSTEM
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition
MULTIPLE CHOICE
1. Which t ypes of adrenergic receptors subdivide the autonomic nervous
s ystem?
a. Nicotinic and muscarinic
b. Afferent and efferent
c. Alpha and beta
d. Agonists and antagonis ts
ANS: C
The autonomic nervous system can be subdivided into alpha - and beta-
adrenergic receptors. Nicotine and muscarine are specific agonists of one
type of cholinergic receptor. Afferent and efferent are sensory and motor
nerves. An agonist is a mol ecule that activates a receptor by reproducing the
effect of the neurotransmitter. An antagonist acts against and blocks a
function.
DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 1
NAT: NCLEX Client Needs Category: Physiological Integrit y
TOP: Nursing Process Step: Assessment CON: Clinical Judgment
2. Which is most important for the nurse to assess prior to the administration
of metoprolol, a beta -adrenergic blocking agent?
a. Blood pressure
, b. Lung sounds
c. Mental status
d. Urine output
ANS: A
Beta-adrenergic blocking agents cause vasodilation and decreased heart rate,
resulting in lowering of the blood pressure. A premedication assessment is to
take baseline heart rate and blood pressure. Fluid retention may occur as a
serious adverse effect bu t is not the most important assessment prior to the
administration of a beta -adrenergic blocking agent. Mental status and urine
output are not the most important assessments prior to the administration of a
beta-adrenergic blocking agent.
DIF: Cognitive Level: Application REF: p. 185 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrit y
TOP: Nursing Process Step: Assessment
CON: Clinical Judgment | Safet y | Perfusion
3. Which statement by the patient indicates a need for further teachi ng when a
patient with a history of t ype 1 diabetes after m yocardial infarction has
been placed on a beta-adrenergic blocking agent?
a. “This medication should not be discontinued suddenl y. ”
b. “This medication lowers m y blood pressure by helping me get rid of
fluid.”
c. “I may not have m y usual symptoms of a hypogl ycemic reaction
while on this drug. ”
d. “This medication may take a few weeks to work. ”
ANS: B
Beta-adrenergic blocking agents decrease the heart rate and dilate blood
vessels to lower blood pressure. Sud den discontinuation of beta -adrenergic
, blocking agents may result in an exacerbation of angina symptoms. Beta -
adrenergic blocking agents may mask symptoms of hypogl ycemia. Beta -
adrenergic blocking agents may take several days to weeks to show optimal
improvement.
DIF: Cognitive Level: Application REF: p. 185 | p. 187
OBJ: 4 NAT: NCLEX Client Needs Category: Physiological
Integrit y
TOP: Nursing Process Step: Evaluation
CON: Clinical Judgment | Safet y | Patient Education | Perfusion
4. An older adult patient is to receive atenolol, a beta -adrenergic blocking
agent. Prior to administration of the drug, the nurse assesses an apical
pulse rate of 58 and notes ankle edema. Which action will the nurse take
first?
a. Determine the therapeutic blood level .
b. Encourage the patient to decrease water intake.
c. Elevate the patient ’s legs.
d. Withhold the medication.
ANS: D
These signs and sym ptoms are indicative of serious adverse effects, and the
medication should be held or discontinued until the patient is e valuated by a
healthcare provider. Determining the therapeutic blood level, encouraging the
patient to decrease water intake, and elevating the patient ’s legs are not the
first actions that should be taken.
DIF: Cognitive Level: Application REF: p. 185 | p. 187
OBJ: 4 NAT: NCLEX Client Needs Category: Physiological
Integrit y
TOP: Nursing Process Step: Assessment
A UTONOMIC N ERVOUS S YSTEM
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition
MULTIPLE CHOICE
1. Which t ypes of adrenergic receptors subdivide the autonomic nervous
s ystem?
a. Nicotinic and muscarinic
b. Afferent and efferent
c. Alpha and beta
d. Agonists and antagonis ts
ANS: C
The autonomic nervous system can be subdivided into alpha - and beta-
adrenergic receptors. Nicotine and muscarine are specific agonists of one
type of cholinergic receptor. Afferent and efferent are sensory and motor
nerves. An agonist is a mol ecule that activates a receptor by reproducing the
effect of the neurotransmitter. An antagonist acts against and blocks a
function.
DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 1
NAT: NCLEX Client Needs Category: Physiological Integrit y
TOP: Nursing Process Step: Assessment CON: Clinical Judgment
2. Which is most important for the nurse to assess prior to the administration
of metoprolol, a beta -adrenergic blocking agent?
a. Blood pressure
, b. Lung sounds
c. Mental status
d. Urine output
ANS: A
Beta-adrenergic blocking agents cause vasodilation and decreased heart rate,
resulting in lowering of the blood pressure. A premedication assessment is to
take baseline heart rate and blood pressure. Fluid retention may occur as a
serious adverse effect bu t is not the most important assessment prior to the
administration of a beta -adrenergic blocking agent. Mental status and urine
output are not the most important assessments prior to the administration of a
beta-adrenergic blocking agent.
DIF: Cognitive Level: Application REF: p. 185 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrit y
TOP: Nursing Process Step: Assessment
CON: Clinical Judgment | Safet y | Perfusion
3. Which statement by the patient indicates a need for further teachi ng when a
patient with a history of t ype 1 diabetes after m yocardial infarction has
been placed on a beta-adrenergic blocking agent?
a. “This medication should not be discontinued suddenl y. ”
b. “This medication lowers m y blood pressure by helping me get rid of
fluid.”
c. “I may not have m y usual symptoms of a hypogl ycemic reaction
while on this drug. ”
d. “This medication may take a few weeks to work. ”
ANS: B
Beta-adrenergic blocking agents decrease the heart rate and dilate blood
vessels to lower blood pressure. Sud den discontinuation of beta -adrenergic
, blocking agents may result in an exacerbation of angina symptoms. Beta -
adrenergic blocking agents may mask symptoms of hypogl ycemia. Beta -
adrenergic blocking agents may take several days to weeks to show optimal
improvement.
DIF: Cognitive Level: Application REF: p. 185 | p. 187
OBJ: 4 NAT: NCLEX Client Needs Category: Physiological
Integrit y
TOP: Nursing Process Step: Evaluation
CON: Clinical Judgment | Safet y | Patient Education | Perfusion
4. An older adult patient is to receive atenolol, a beta -adrenergic blocking
agent. Prior to administration of the drug, the nurse assesses an apical
pulse rate of 58 and notes ankle edema. Which action will the nurse take
first?
a. Determine the therapeutic blood level .
b. Encourage the patient to decrease water intake.
c. Elevate the patient ’s legs.
d. Withhold the medication.
ANS: D
These signs and sym ptoms are indicative of serious adverse effects, and the
medication should be held or discontinued until the patient is e valuated by a
healthcare provider. Determining the therapeutic blood level, encouraging the
patient to decrease water intake, and elevating the patient ’s legs are not the
first actions that should be taken.
DIF: Cognitive Level: Application REF: p. 185 | p. 187
OBJ: 4 NAT: NCLEX Client Needs Category: Physiological
Integrit y
TOP: Nursing Process Step: Assessment
