Question 1

A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe?

Accepted Answer

Alfuzosin is used for BPH and does not interfere with ejaculation. All of the other drugs have ejaculatory side effects. Prazosin may be useful for BPH, but it is not approved for this use.

Question 2

Which are adverse effects of alpha blockade? (Select all that apply.)

Accepted Answer

Adverse effects of alpha blockade include reflex tachycardia, nasal congestion, and hypernatremia. Other adverse effects include orthostatic hypotension and inhibition of ejaculation. Hypertension and ejaculation are not adverse effects of alpha blockade.

Question 3

A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication?

Accepted Answer

Patients taking propranolol can develop heart failure because of the suppression in myocardial contractility. Patients should be taught to watch for signs, which include shortness of breath, night coughs, and swelling of the extremities. Use of these agents with calcium channel blockers is contraindicated, because the effects are identical and excessive cardiosuppression can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not be given if the pulse is less than 60 beats per minute.

Question 4

A nurse is discussing phentolamine (OraVerse) with a nursing student. Which statement by the student indicates the need for further teaching?

Accepted Answer

Phentolamine has actions on both alpha₁ and alpha₂ receptors; it is not selective for alpha₁ receptors only. It blocks both epinephrine- and norepinephrine-mediated vasoconstriction. It is used to treat pheochromocytoma. Side effects include tachycardia and hypotension.

Question 5

A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects?

Accepted Answer

When taken prophylactically, beta blockers can reduce the frequency of migraine attacks. Beta blockers do not provide complete relief from migraines. They do not reduce the duration of migraines. They are not effective for treating migraines once the migraine has begun.

Question 6

A patient has benign prostatic hyperplasia (BPH) and will receive alfuzosin (Uroxatral). What is an important nursing action when administering this drug?

Accepted Answer

Alfuzosin is indicated for BPH only and is contraindicated in patients with moderate to severe hepatic impairment; therefore, LFTs would be an important assessment. It does not interfere with ejaculation. It does not reduce blood pressure and does not cause sodium retention or increased blood volume, so diuretics are not necessary. It does not cause orthostatic hypotension, so first-dose effect precautions are not necessary.

Question 7

A patient with type I 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?

Accepted Answer

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.

Question 8

A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition?

Accepted Answer

Use of beta blockers during pregnancy can affect a newborn for several days after birth. Newborns are at risk for bradycardia, respiratory distress, and hypoglycemia. Hyperglycemia, hyperthyroidism, and tachycardia are not expected residual effects.

Question 9

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?

Accepted Answer

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.

Question 10

A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next?

Accepted Answer

A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats per minute; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient's heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication.

Question 11

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

Accepted Answer

Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha₁ receptors on both 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.

Question 12

A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with:

Accepted Answer

The signs and symptoms describe left-sided heart failure, in which the blood normally handled by the left ventricle and forced out through the aorta into the body backs up into the lungs, producing respiratory signs and symptoms. The patient's signs and symptoms are not indicative of bronchoconstriction, which would cause wheezing and diminished breath sounds. Rebound cardiac excitation occurs when the beta blocker is withdrawn, not during administration of the drug. The patient's heart rate is elevated, so sinus bradycardia is not present.

Question 13

A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding of the drug's effects?

Accepted Answer

Blockade of beta₁ receptors in the heart reduces cardiac work by reducing the heart rate, the force of contraction, and the velocity of impulse conduction through the AV node. Beta blockers result in bronchoconstriction, not bronchodilation. They do not increase blood flow to the heart. Cardiac output is decreased, not increased.

Question 14

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?

Accepted Answer

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.

Quiz 18: Adrenergic Antagonists