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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is reviewing the medication administration record (MAR) for a client admitted with a blood pressure of 158/92 mmHg158/92\text{ mmHg} and a documented medical history of severe asthma. The provider has prescribed propranolol 40 mg40\text{ mg} orally every 12 hours and an albuterol metered-dose inhaler (MDI) as needed. Which action should the PN take first?

  1. Withhold the propranolol and notify the registered nurse (RN) to clarify the prescription with the provider.Answer
  2. B
    Assess the client's apical pulse for one full minute and administer the propranolol if the rate is above 60 beats/min60\text{ beats/min}.
  3. C
    Administer the propranolol as prescribed and monitor the client's oxygen saturation closely.
  4. D
    Administer the albuterol MDI 15 minutes before the propranolol to prevent medication-induced bronchospasm.

Answer

The correct action is to withhold the propranolol and notify the registered nurse (RN) to clarify the prescription with the provider.
The correct answer addresses the critical contraindication of administering a non-selective beta-blocker (propranolol) to a client with severe asthma. Propranolol blocks beta-2 receptors in the lungs, which can trigger severe, potentially fatal bronchospasm. The practical nurse must recognize this risk, withhold the dose, and notify the RN or provider to advocate for a safer alternative, such as a cardioselective beta-blocker.

Step-by-Step Solution

1
Review the client's medical history and the newly prescribed medications.
The client has a history of severe asthma and is prescribed propranolol, a non-selective beta-blocker.
Identifying potential drug-disease interactions is a critical component of safe medication administration.
2
Analyze the pharmacological effects of the prescribed medication in relation to the client's underlying conditions.
Non-selective beta-blockers inhibit both beta-1 (cardiac) and beta-2 (pulmonary) receptors, which can induce dangerous bronchospasm in a client with asthma.
Understanding the mechanism of action helps predict severe adverse effects that compromise the airway.
3
Determine the appropriate nursing intervention within the practical nurse (PN) scope of practice.
The PN must withhold the unsafe medication and immediately escalate the concern to the RN or provider.
The PN is responsible for ensuring client safety by refusing to administer contraindicated medications and reporting to the supervising RN.

Key Concept

Medication Contraindications and Patient Safety
Estimated Time:1m 15s
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Topics

Pharmacological Therapies

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