Examkin

Question

Difficulty: HardPharmacological Therapies

A client with a documented history of severe asthma is receiving care on a medical-surgical unit. The practical nurse is preparing to administer scheduled morning medications, which includes a new prescription for oral propranolol to manage a familial tremor. During the pre-administration assessment, the client's vital signs are: blood pressure 132/84 mm Hg, heart rate 86 beats/min, and respiratory rate 18 breaths/min. The nurse notes faint expiratory wheezes upon auscultation. What is the most appropriate action for the practical nurse to take?

  1. Withhold the propranolol and immediately notify the registered nurse of the assessment findings.Answer
  2. B
    Administer the medication after verifying the client's identification band and scanning the barcode.
  3. C
    Provide a prescribed as-needed albuterol treatment to clear the wheezes before giving the propranolol.
  4. D
    Request that the registered nurse administer the medication via intravenous push to avoid systemic respiratory absorption.

Answer

The correct action is to withhold the medication and immediately notify the registered nurse of the client's respiratory status.
Propranolol is a non-selective beta-blocker, meaning it blocks both beta-1 (cardiac) and beta-2 (pulmonary) receptors. The blockade of beta-2 receptors leads directly to bronchoconstriction. In a client with a history of severe asthma who is already exhibiting wheezes, administering this medication can precipitate a severe, potentially life-threatening asthma attack. Safe pharmacological practice requires the practical nurse to withhold the contraindicated medication and escalate the finding to the registered nurse for intervention.

Step-by-Step Solution

1
Identify the pharmacological classification of the prescribed medication.
Propranolol is recognized as a non-selective beta-adrenergic antagonist (beta-blocker).
Understanding the drug class is essential to anticipate its systemic physiological effects on both the heart and lungs.
2
Analyze the client's medical history and current physical assessment findings.
The client has a history of severe asthma and is currently exhibiting faint expiratory wheezes.
Identifying pre-existing respiratory compromise is a critical pre-administration safety check.
3
Correlate the medication's mechanism of action with the client's respiratory condition.
Non-selective beta-blockers cause bronchoconstriction by blocking beta-2 receptors in the lungs, which is contraindicated for asthmatic clients.
This synthesis determines if the medication is safe to administer or if it will cause an adverse event.
4
Determine the appropriate nursing intervention within the practical nurse scope of practice.
The medication must be withheld and the findings escalated to the RN and the prescribing provider.
Practical nurses are responsible for recognizing severe contraindications and withholding harmful medications to prevent client injury.

Key Concept

Non-selective beta-blockers (like propranolol) are strictly contraindicated in clients with asthma due to the high risk of severe bronchoconstriction; the practical nurse must recognize this, withhold the drug, and report it.
Rate this question

Topics

Pharmacological Therapies

More questions from this topic