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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is preparing to administer a scheduled dose of oral metoprolol to an adult client. Prior to administration, the PN assesses the following vital signs: blood pressure 92/58 mm Hg92/58\text{ mm Hg}, heart rate 54 beats/minute54\text{ beats/minute}, and respiratory rate 16 breaths/minute16\text{ breaths/minute}. Which action should the PN take?

  1. Withhold the medication and report the vital signs to the registered nurse.Answer
  2. B
    Document the vital signs and administer the medication, assuming these are expected resting values.
  3. C
    Independently administer half of the prescribed dose to prevent a further decrease in the heart rate.
  4. D
    Administer the medication and elevate the head of the bed to promote airway clearance.

Answer

The practical nurse should withhold the metoprolol and immediately report the bradycardia and hypotension to the registered nurse.
Metoprolol is a beta-adrenergic blocking agent that lowers heart rate and blood pressure. Standard safety parameters dictate that this medication should be withheld if the client's heart rate is below 60 beats/minute60\text{ beats/minute} or if the systolic blood pressure is below 100 mm Hg100\text{ mm Hg}. Because this client exhibits both bradycardia and hypotension, the safe and legally appropriate action for the practical nurse is to hold the dose and notify the registered nurse for further evaluation.

Step-by-Step Solution

1
Analyze the client's vital signs against the expected parameters for metoprolol administration.
The heart rate is 54 beats/minute54\text{ beats/minute} (bradycardia) and blood pressure is 92/58 mm Hg92/58\text{ mm Hg} (hypotension).
Metoprolol is a beta-blocker that decreases heart rate and blood pressure; administering it to a client with already low parameters is dangerous.
2
Determine the appropriate action within the practical nurse scope of practice.
The medication must be withheld.
Standard nursing safety parameters require withholding beta-blockers if the heart rate is less than 60 beats/minute60\text{ beats/minute} or systolic blood pressure is less than 100 mm Hg100\text{ mm Hg}.
3
Identify the required follow-up communication.
The findings must be reported to the registered nurse or healthcare provider.
The practical nurse must escalate abnormal assessment data that affects medication administration for further clinical judgment.

Key Concept

Safe Administration of Beta-Blockers and Scope of Practice
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Topics

Pharmacological Therapies

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