Chapter 19: Adrenergic-Blocking Drugs

Test Bank

MULTIPLE CHOICE

1. During therapy with a beta blocker, the 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 an allergic reaction.
b. The patient may be developing heart failure.
c. More time is needed for the patient to see a therapeutic response to the drug.
d. The patient is experiencing expected adverse effects of the drug.
ANS: B
Even though some beta blockers may be used for the treatment of some types of heart failure,
the patient needs to 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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2. A patient is going home with a new prescription for the beta blocker atenolol (Tenormin). The
nurse will include which content when teaching the patient about this drug?
a. Never stop taking this medication abruptly.
b. The medication will be stopped once symptoms subside.
c. If adverse effects occur, stop taking the drug for 24 hours, and then resume.
d. Be watchful for first-dose hypotension.
ANS: A
Patients need to 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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3. During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the
forearm of a patient. After stopping the infusion, the nurse follows standing orders and
immediately injects phentolamine (Regitine) 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 dobutamine 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 vasoconstrictive
drugs, such as dobutamine, causes an alpha-adrenergic receptor blockade and vasodilation.
This allows for increased blood flow to the ischemic tissue and may prevent permanent tissue
damage.

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4. A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is
ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset
after reading the patient education pamphlet. “I don’t have high blood pressure—why did my
doctor give me this medicine?” Which explanation by the nurse is correct?
a. “This medication will prevent blood clots that may lead to another heart attack.”
b. “Beta blockers will improve blood flow to the kidneys.”
c. “This drug is prescribed to prevent the high blood pressure that often occurs after
a heart attack.”
d. “Studies have shown that this medication has greatly increased survival rates in
patients who have had a heart attack.”
ANS: D
Beta blockers are frequently given to patients after they have suffered an MI because of their
cardioprotective properties. The other responses are incorrect.

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5. The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction
due to benign prostatic hyperplasia will include which of these?
a. Fluids need to be restricted while on this medication.
b. Take the medication with breakfast to promote the maximum effects of the drug.
c. Get up slowly from a sitting or lying position.
d. Blood pressure must be monitored because the medication may cause
hypertension.
ANS: C
This medication is used to relieve impaired urinary flow in men with benign prostatic
hyperplasia, but it also can cause orthostatic hypotension when changing positions from
sitting or lying positions. Because of these effects, the blood pressure may become
dramatically lowered, and lightheadedness may occur, increasing the risk of falling.

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6. The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker.
Which condition, if present, may cause serious problems if the patient takes 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 respiratory condition such as asthma might be worsened by the concurrent use of
any of these medications.

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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
Not all beta blockers are used for the treatment of heart failure. Carvedilol and metoprolol are
currently used in the treatment of heart failure. The other options are not indicated for the
treatment of heart failure.

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8. During a teaching session about self-monitoring while taking a beta blocker at home, the
nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate
decreases to less than 60 beats per minute, the nurse will instruct the patient to:
a. notify his prescriber.
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; instruct the patient to contact his prescriber
if his pulse rate decreases to less than 60 per minute. The medication dose may need to be
changed, but it is not appropriate for the nurse to change the dosage. The other options are
incorrect.

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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 the patient 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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 317

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

10. A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic
hyperplasia. The nurse is checking his current medication list and will contact the prescriber
regarding a potential interaction if the patient is also taking which drug?
a. levothyroxine (Synthroid) for hypothyroidism
b. sildenafil (Viagra), an erectile dysfunction medication
c. omeprazole (Prilosec), a proton pump inhibitor
d. low-dose aspirin for stroke prevention
ANS: B
Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs;
additive hypotensive effects may occur. The other drugs do not interact with tamsulosin.

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11. A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse
will monitor for which potential drug effect?
a. Orthostatic hypotension
b. Increased blood pressure
c. Decreased urine flow
d. Discolored urine
ANS: A
Orthostatic hypotension can occur with any dose of an alpha blocker, and patients must be
warned to get up slowly from a supine position. The other responses are not drug effects of
alpha blockers.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient who has had recent myocardial infarction has been placed on a beta blocker. The
nurse recognizes that the main purpose of the beta blocker for this patient is to:
a. cause vasodilation of the coronary arteries.
b. prevent hypertension.
c. increase conduction through the SA node.
d. protect the heart from circulating catecholamines.
 ANS: D
Beta blockers are also considered to be cardioprotective because they inhibit stimulation of
the myocardium by circulating catecholamines. Myocardial infarction causes catecholamines
to be released. Unopposed stimulation by catecholamines would further increase the heart rate
and the contractile force and thereby increase myocardial oxygen demand. When a beta
blocker occupies myocardial beta1 receptors, circulating catecholamine molecules are
prevented from binding to the receptors. Thus, the beta blockers protect the heart from being
stimulated by these catecholamines. The other responses are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 317

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral 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. Alcohol
f. Anticoagulants
ANS: A, B, D, E
When taken with beta blockers, diuretics and alcohol may cause additive hypotensive effects;
oral hypoglycemic medications may cause the blood glucose to decrease; and anticholinergics
may cause decreased beta blocker effects. Penicillins and anticoagulants are not known to
interact with beta blockers.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 318

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral 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 tab :: 6.25 mg : x tab
(3.125 ´ x) = (1 ´ 6.25); 3.125x = 6.25; x = 2

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