Pharmacology Exam 2 UPDATED ACTUAL
Exam Questions and CORRECT Answers
A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which
statement by the student indicates the need for further teaching?
A. "Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins."
B. "Dilation of arterioles has a direct effect on arterial pressure."
C. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output."
D. "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure." -
CORRECT ANSWER - Correct: C
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.
Chapter 18
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?
A. It is ordered to prevent perioperative hypertensive crisis.
B. It prevents secretion of catecholamines by the adrenal tumor.
C. It reduces contraction of smooth muscles in the adrenal medulla.
D. It is given chronically after the surgery to prevent hypertension. - CORRECT
ANSWER - Correct: A
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.
Chapter 18
,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?
A. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements."
B. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin
dose."
C. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose
closely."
D. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." -
CORRECT ANSWER - Correct: C
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.
Chapter 18
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?
A. "I need to stop the medication if my heart rate increases."
B. "I should not drive as long as I'm taking this medication."
C. "I should take the first dose at bedtime."
D. "I will stop taking the medication if I feel dizzy." - CORRECT ANSWER - Correct: C
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.
Chapter 18
, 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?
A. Administer the drug as prescribed.
B. Request an order for atropine.
C. Withhold the dose and document the pulse rate.
D. Withhold the dose and notify the prescriber. - CORRECT ANSWER - Correct: D
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.
Chapter 18
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:
A. bronchoconstriction.
B. left-sided heart failure.
C. rebound cardiac excitation.
D. sinus bradycardia. - CORRECT ANSWER - Correct: B
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.
Chapter 18
Exam Questions and CORRECT Answers
A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which
statement by the student indicates the need for further teaching?
A. "Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins."
B. "Dilation of arterioles has a direct effect on arterial pressure."
C. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output."
D. "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure." -
CORRECT ANSWER - Correct: C
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.
Chapter 18
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?
A. It is ordered to prevent perioperative hypertensive crisis.
B. It prevents secretion of catecholamines by the adrenal tumor.
C. It reduces contraction of smooth muscles in the adrenal medulla.
D. It is given chronically after the surgery to prevent hypertension. - CORRECT
ANSWER - Correct: A
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.
Chapter 18
,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?
A. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements."
B. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin
dose."
C. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose
closely."
D. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." -
CORRECT ANSWER - Correct: C
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.
Chapter 18
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?
A. "I need to stop the medication if my heart rate increases."
B. "I should not drive as long as I'm taking this medication."
C. "I should take the first dose at bedtime."
D. "I will stop taking the medication if I feel dizzy." - CORRECT ANSWER - Correct: C
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.
Chapter 18
, 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?
A. Administer the drug as prescribed.
B. Request an order for atropine.
C. Withhold the dose and document the pulse rate.
D. Withhold the dose and notify the prescriber. - CORRECT ANSWER - Correct: D
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.
Chapter 18
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:
A. bronchoconstriction.
B. left-sided heart failure.
C. rebound cardiac excitation.
D. sinus bradycardia. - CORRECT ANSWER - Correct: B
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.
Chapter 18
