Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 64-year-old male with a history of
chronic heart failure is being initiated on metoprolol
succinate. The nurse reviews the patient's electronic
health record and notes a history of severe persistent
asthma requiring daily high-dose inhaled
fluticasone/salmeterol.
• Question Stem: Which action should the nurse take prior
to administering the initial dose of metoprolol succinate?
o A. Administer the medication as prescribed, as
metoprolol succinate is highly cardioselective and
carries no respiratory risk.
o B. Hold the medication and collaborate with the
healthcare provider to discuss an alternative agent,
such as a non-selective beta-blocker.
o C. Hold the medication, contact the prescribing
healthcare provider, and highlight the patient's history
of severe persistent asthma.
o D. Administer the medication alongside an extra
rescue dose of inhaled albuterol to proactively
counteract bronchoconstriction.
• Correct Answer: C
,• Comprehensive Rationale: Metoprolol succinate is a
beta1-selective (cardioselective) adrenoceptor antagonist.
At standard therapeutic doses, it preferentially blocks
beta1 receptors in the heart, minimizing beta2 receptor
blockade in the bronchial smooth muscle. However,
cardioselectivity is relative and dose-dependent. In a
patient with severe persistent asthma, even minor beta2
blockade can precipitate severe, potentially life-
threatening bronchospasm. The nurse must recognize this
high-risk scenario, withhold the drug, and clarify the
prescription with the healthcare provider.
• Distractor Analysis:
o Option A is incorrect. Cardioselectivity is never
absolute; high doses or individual variation can lead
to beta2 cross-reactivity and airway resistance.
Treating it as carrying "no respiratory risk" is a critical
safety misconception.
o Option B is incorrect. Switching to a non-selective
beta-blocker (like carvedilol or propranolol) would
profoundly worsen the risk by directly blocking lung
beta2 receptors, inducing severe airway constriction.
o Option D is incorrect. Proactively giving a short-acting
beta2 agonist (albuterol) alongside a beta-blocker
creates a direct pharmacodynamic antagonism. The
, beta-blocker will reduce albuterol's efficacy, failing to
ensure airway safety.
• Nursing Process Integration: Assessment (The primary
step here is identifying the active respiratory history before
administration). Remaining steps: Planning: Establishing
safe parameters for heart rate/blood pressure.
Implementation: Properly withholding the medication and
communicating with the provider. Evaluation: Monitoring
respiratory rate, effort, and breath sounds if any beta-
blocker is introduced.
• NCJMM Competency: Recognize Cues
• Difficulty Level: Moderate
• Bloom's Cognitive Level: Analyze
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Analyze the safety boundaries of
relative cardioselectivity in beta-adrenergic antagonists for
patients with severe respiratory comorbidities.
Question 2: Select-All-That-Apply (SATA)
• Clinical Scenario: A nurse is preparing discharge teaching
for a 52-year-old female patient newly prescribed
amiodarone oral therapy for the long-term management of
recurrent ventricular ectopy.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 64-year-old male with a history of
chronic heart failure is being initiated on metoprolol
succinate. The nurse reviews the patient's electronic
health record and notes a history of severe persistent
asthma requiring daily high-dose inhaled
fluticasone/salmeterol.
• Question Stem: Which action should the nurse take prior
to administering the initial dose of metoprolol succinate?
o A. Administer the medication as prescribed, as
metoprolol succinate is highly cardioselective and
carries no respiratory risk.
o B. Hold the medication and collaborate with the
healthcare provider to discuss an alternative agent,
such as a non-selective beta-blocker.
o C. Hold the medication, contact the prescribing
healthcare provider, and highlight the patient's history
of severe persistent asthma.
o D. Administer the medication alongside an extra
rescue dose of inhaled albuterol to proactively
counteract bronchoconstriction.
• Correct Answer: C
,• Comprehensive Rationale: Metoprolol succinate is a
beta1-selective (cardioselective) adrenoceptor antagonist.
At standard therapeutic doses, it preferentially blocks
beta1 receptors in the heart, minimizing beta2 receptor
blockade in the bronchial smooth muscle. However,
cardioselectivity is relative and dose-dependent. In a
patient with severe persistent asthma, even minor beta2
blockade can precipitate severe, potentially life-
threatening bronchospasm. The nurse must recognize this
high-risk scenario, withhold the drug, and clarify the
prescription with the healthcare provider.
• Distractor Analysis:
o Option A is incorrect. Cardioselectivity is never
absolute; high doses or individual variation can lead
to beta2 cross-reactivity and airway resistance.
Treating it as carrying "no respiratory risk" is a critical
safety misconception.
o Option B is incorrect. Switching to a non-selective
beta-blocker (like carvedilol or propranolol) would
profoundly worsen the risk by directly blocking lung
beta2 receptors, inducing severe airway constriction.
o Option D is incorrect. Proactively giving a short-acting
beta2 agonist (albuterol) alongside a beta-blocker
creates a direct pharmacodynamic antagonism. The
, beta-blocker will reduce albuterol's efficacy, failing to
ensure airway safety.
• Nursing Process Integration: Assessment (The primary
step here is identifying the active respiratory history before
administration). Remaining steps: Planning: Establishing
safe parameters for heart rate/blood pressure.
Implementation: Properly withholding the medication and
communicating with the provider. Evaluation: Monitoring
respiratory rate, effort, and breath sounds if any beta-
blocker is introduced.
• NCJMM Competency: Recognize Cues
• Difficulty Level: Moderate
• Bloom's Cognitive Level: Analyze
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Analyze the safety boundaries of
relative cardioselectivity in beta-adrenergic antagonists for
patients with severe respiratory comorbidities.
Question 2: Select-All-That-Apply (SATA)
• Clinical Scenario: A nurse is preparing discharge teaching
for a 52-year-old female patient newly prescribed
amiodarone oral therapy for the long-term management of
recurrent ventricular ectopy.
