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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is providing care for a client who is two days postoperative following a bowel resection. The client has a prescription for oral metoprolol to manage a history of hypertension. During the morning assessment, the PN notes a blood pressure of 96/64 mm Hg, a heart rate of 118 beats/min, and moderate serosanguineous drainage on the abdominal dressing. The client states, "I feel very weak and dizzy today." Which action should the PN take regarding the scheduled metoprolol dose?

  1. Retain the dose and urgently report the client's vital signs and symptoms to the registered nurse.Answer
  2. B
    Administer the dose as prescribed to help decrease the client's elevated heart rate.
  3. C
    Reposition the client flat in bed and recheck the vital signs in one hour before giving the drug.
  4. D
    Start an intravenous fluid bolus to stabilize the blood pressure prior to administering the drug.

Answer

The practical nurse should withhold the metoprolol and immediately report the findings to the registered nurse.
The client is exhibiting early signs of hypovolemic shock (tachycardia, borderline hypotension, dizziness, weakness) likely related to postoperative fluid loss or bleeding. The tachycardia is a critical compensatory mechanism attempting to maintain cardiac output. Metoprolol, a beta-adrenergic blocker, works by decreasing both heart rate and blood pressure. Administering this medication would block the client's compensatory response, potentially leading to immediate cardiovascular collapse. The practical nurse must recognize this dangerous clinical trend, withhold the drug, and immediately notify the RN for further medical evaluation.

Step-by-Step Solution

1
Analyze the client's vital signs and physical assessment findings.
The blood pressure is borderline low, the heart rate is significantly elevated, and the client reports weakness and dizziness alongside abdominal drainage.
Identifying abnormal data is the first essential step in clinical decision-making.
2
Correlate the assessment findings with the client's physiological state.
These findings collectively indicate early compensatory signs of fluid volume deficit or potential hemorrhage (hypovolemic shock).
Understanding the underlying cause of vital sign changes determines the safety of nursing interventions.
3
Evaluate the effects of the prescribed medication on the current physiological state.
Metoprolol is a beta-adrenergic blocker that decreases heart rate and blood pressure; administering it would blunt the compensatory tachycardia that is currently keeping the client stable.
Administering a contraindicated medication during instability could precipitate severe cardiovascular collapse.
4
Determine the appropriate nursing action within the PN scope of practice.
The safest and most appropriate action is to hold the medication and escalate the critical findings to the RN.
Practical nurses must recognize clinical deterioration, withhold medications that could worsen the condition, and promptly report to the supervising RN.

Key Concept

Recognizing compensatory mechanisms of shock and identifying pharmacological contraindications within the practical nursing scope of practice.
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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