Review Practice Exercise 2

Drugs Affecting the Autonomic Nervous System > Pharmacology

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Practice Exercise 2

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Total Questions : 5

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Question 1:

Nadolol (Corgard) is prescribed for a patient. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for patients with which condition?

A. Hypothyroidism B. Angina pectoris C. Bronchial asthma D. Liver dysfunction

Answer and Explanation

Choice A:

Hypothyroidism – Nadolol does not directly worsen hypothyroidism; however, it may mask symptoms like bradycardia. It is not absolutely contraindicated.

Choice B:

Angina pectoris – Nadolol is commonly used to manage angina by reducing myocardial oxygen demand and controlling heart rate.

Choice C:

Bronchial asthma – Non-selective beta blockers can cause bronchospasm by blocking beta-2 receptors in the lungs, which may trigger life-threatening asthma exacerbations.

Choice D:

Liver dysfunction – Nadolol is excreted primarily through the kidneys, so liver dysfunction does not strongly affect its metabolism compared to other drugs.

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Question 2:

The nurse realizes that beta1 receptor stimulation is differentiated from beta2 stimulation in that stimulation of beta1 receptors leads to which condition?

A. Increased bronchodilation B. Decreased uterine contractility C. Increased myocardial contractility D. Decreased blood flow to skeletal muscles

Answer and Explanation

Choice A:

Increased bronchodilationThis effect is associated with beta2 receptor stimulation, primarily found in bronchial smooth muscle, leading to relaxation and airway dilation. It is not the action of beta1 stimulation.

Choice B:

Decreased uterine contractilityBeta2 receptors also mediate uterine relaxation, which can be beneficial in preterm labor. Beta1 receptors do not influence uterine activity.

Choice C:

Increased myocardial contractilityBeta1 receptors are located mainly in the heart, and their stimulation results in increased heart rate (positive chronotropic effect) and increased contractility (positive inotropic effect), enhancing cardiac output. This is a hallmark effect of beta1 receptor activation.

Choice D:

Decreased blood flow to skeletal muscles
Beta2 stimulation leads to vasodilation in skeletal muscles, enhancing blood flow. A decrease in blood flow would result from vasoconstriction, which is more related to alpha receptor activation, not beta1.

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Question 3:

A client is given epinephrine (Adrenalin), an adrenergic agonist (sympathomimetic). The nurse should monitor the client for which condition?

A. Decreased pulse B. Pupil constriction C. Bronchial constriction D. Increased blood pressure

Answer and Explanation

Choice A:

Decreased pulseEpinephrine typically increases the heart rate (positive chronotropic effect) through beta1 stimulation. A decreased pulse would be contrary to its expected action.

Choice B:

Pupil constrictionSympathomimetic drugs like epinephrine cause pupil dilation (mydriasis) via alpha1 stimulation, not constriction. Miosis is associated with parasympathetic stimulation.

Choice C:

Bronchial constrictionEpinephrine activates beta2 receptors, causing bronchodilation, which helps open the airways. Bronchial constriction would be a parasympathetic effect or due to allergic reactions, not epinephrine.

Choice D:

Increased blood pressureAlpha1 receptor stimulation by epinephrine leads to vasoconstriction, raising systemic vascular resistance and thereby increasing blood pressure. This is a primary therapeutic effect in shock or cardiac arrest situations.

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Question 4:

A client who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? Select all that apply.

A. albuterol (Proventil) B. metoprolol (Lopressor) C. propranolol (Inderal) D. digoxin (Lanoxin) E. methyldopa (Aldomet)

Answer and Explanation

Choice A:

Albuterol (Proventil)Albuterol is a beta2-adrenergic agonist like epinephrine. While this combination may increase the risk of side effects like tachycardia or tremors, a significant interaction is less likely unless used in high doses. They may actually be used together in acute asthma.

Choice B:

Metoprolol (Lopressor)Metoprolol is a selective beta1 blocker. It may antagonize epinephrine's beta1 effects on the heart, potentially reducing its efficacy or causing unpredictable cardiovascular responses, such as hypertension from unopposed alpha effects.

Choice C:

Propranolol (Inderal)Propranolol is a non-selective beta blocker, which can block both beta1 and beta2 receptors. This may lead to bronchospasm and hypertension when combined with epinephrine due to unopposed alpha-adrenergic vasoconstriction.

Choice D:

Digoxin (Lanoxin)Both digoxin and epinephrine affect cardiac rhythm. When combined, there is an increased risk of cardiac dysrhythmias, particularly in clients with preexisting cardiac conditions.

Choice E:

Methyldopa (Aldomet)Methyldopa is a centrally acting antihypertensive that reduces sympathetic outflow. Although it works on the same system, a direct interaction with epinephrine is not well-established and is generally less clinically significant than with beta blockers or digoxin.

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Question 5:

A client is prescribed metoprolol (Lopressor) to treat hypertension. It is important for the nurse to monitor the client for which condition? Select all that apply

A. Bradycardia B. Hypotension C. Ankle edema D. Decreased respirations E. Increased respirations

Answer and Explanation

Choice A:

BradycardiaMetoprolol slows heart rate by blocking beta1 receptors in the sinoatrial (SA) node. This can result in bradycardia, which requires close monitoring especially in patients also on other rate-lowering agents or with conduction abnormalities.

Choice B:

HypotensionAs an antihypertensive, metoprolol decreases blood pressure by reducing cardiac output. Hypotension is a common side effect and should be monitored, especially when therapy is initiated or doses are adjusted.

Choice C:

Ankle edemaWhile not typical of metoprolol alone, peripheral edema may occur due to reduced cardiac output or if combined with other agents like calcium channel blockers. However, it is more commonly associated with vasodilators.

Choice D:

Decreased respirationsMetoprolol is cardioselective and does not usually affect respiratory rate at therapeutic doses. Non-selective beta blockers would pose more risk for bronchospasm or respiratory suppression, especially in patients with respiratory disorders.

Choice E:

Increased respirationsThis is not a known adverse effect of metoprolol. The drug does not stimulate the respiratory center and typically would not result in increased respiratory rate unless hypotension causes a compensatory response.

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Practice Exercise 2

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