Propranolol (Inderal) has been ordered for a client with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect?
Bronchodilation
Tachycardia
Edema
Bradycardia
The Correct Answer is D
Propranolol (Inderal) is a non-selective beta-adrenergic blocker used to manage hypertension, arrhythmias, and angina. It works by blocking beta-1 and beta-2 receptors, leading to slowed heart rate and decreased cardiac output. Nurses must monitor cardiovascular and respiratory systems closely due to potential serious adverse effects.
Rationale for correct answer:
4. Bradycardia
Bradycardia is a major adverse effect due to beta-1 receptor blockade in the heart. Propranolol slows the SA node and AV node conduction, making it essential to monitor pulse and withhold the drug if the heart rate falls below safe limits (usually <60 bpm).
Rationale for incorrect answer:
1. Bronchodilation
Propranolol blocks beta-2 receptors in bronchial smooth muscle, which can cause bronchoconstriction, not bronchodilation. This effect is especially dangerous in clients with asthma or COPD.
2. Tachycardia
Propranolol decreases sympathetic stimulation of the heart, leading to slower heart rate, not tachycardia. It is often prescribed to prevent tachycardic conditions like atrial fibrillation or performance anxiety.
3. Edema
Edema is more commonly associated with calcium channel blockers or heart failure. Although beta blockers can worsen heart failure, peripheral edema is not a primary expected adverse effect of propranolol.
Take-home points:
- Propranolol causes bradycardia by blocking beta-1 receptors, reducing heart rate and cardiac output.
- It can also cause bronchoconstriction due to beta-2 blockade, so it must be used cautiously in patients with respiratory disease.
- Always assess pulse before administration and hold the medication if bradycardia is present.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B"]
Explanation
Albuterol (Proventil) is a short-acting beta-2 adrenergic agonist commonly used to relieve bronchospasm in conditions like asthma and COPD. While effective in relaxing bronchial smooth muscle, its adrenergic effects can also stimulate beta-1 receptors at higher doses, leading to cardiovascular side effects that nurses must monitor carefully.
Rationale for correct answers:
1. Palpitations – Albuterol can cause cardiac stimulation by activating beta-1 receptors at higher or repeated doses, resulting in palpitations, tachycardia, or other dysrhythmias.
2. Hypertension – Beta-agonists may increase heart rate and contractility, potentially raising blood pressure in some patients, especially in those with underlying cardiovascular conditions.
Rationale for incorrect answers:
3. Hypoglycemia – Albuterol is more commonly associated with hyperglycemia, not hypoglycemia. It stimulates glycogenolysis, potentially increasing blood glucose levels.
4. Bronchospasm – Albuterol is used to relieve, not cause, bronchospasm. However, paradoxical bronchospasm is rare and would be an adverse reaction, not a typical side effect to monitor for routinely.
5. Uterine contractions – Albuterol is sometimes used off-label to inhibit uterine contractions due to its smooth muscle relaxing effects. It does not typically cause uterine contractions.
Take-home points:
- Albuterol may cause palpitations and increased blood pressure due to beta-1 receptor stimulation at higher doses.
- Nurses should monitor cardiovascular effects when administering adrenergic agonists like albuterol.
- Though primarily a bronchodilator, albuterol can have systemic effects, especially if overused.
Correct Answer is A
Explanation
Cholinergic overdose from medications like bethanechol results in excessive stimulation of the parasympathetic nervous system. Signs include bradycardia, hypotension, excessive salivation, and diarrhea. Atropine, a muscarinic antagonist, is the antidote used to reverse these effects.
Rationale for correct answer:
1. Atropine
Atropine is the first-line antidote for cholinergic toxicity. It competitively blocks muscarinic receptors, thereby reversing the muscarinic overstimulation seen in cholinergic overdose.
Rationale for incorrect answer:
2. Tolterodine
Although it is an anticholinergic used to treat overactive bladder, it is not typically used in emergencies or acute overdose situations.
3. Benztropine
Benztropine is an anticholinergic primarily used to treat extrapyramidal symptoms from antipsychotic drugs. It is not used as a cholinergic antidote.
4. Metoclopramide
This is a prokinetic and antiemetic drug with cholinergic activity, which could worsen symptoms of a cholinergic overdose.
Take-home points:
- Atropine is the antidote for cholinergic toxicity, such as from bethanechol overdose.
- Cholinergic overdose presents with symptoms like bradycardia, excessive salivation, and hypotension.
- Prompt recognition and reversal of parasympathetic overstimulation can prevent complications like respiratory distress or shock.
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