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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is reviewing the medication administration records for four newly admitted clients. Which prescribed parenteral therapy should the nurse question immediately?

  1. A
    IV 0.9% sodium chloride bolus for a client with suspected sepsis, a blood pressure of 88/52 mmHg88/52 \text{ mmHg}, and a heart rate of 118 bpm118 \text{ bpm}
  2. B
    IV potassium chloride infused at 10 mEq/hr10 \text{ mEq/hr} through a peripheral catheter for a client with a serum potassium level of 2.9 mEq/L2.9 \text{ mEq/L}
  3. IV labetalol for a client with a hypertensive emergency and a medical history of severe asthmaAnswer
  4. D
    IV regular insulin continuous infusion for a client with diabetic ketoacidosis who has an arterial blood gas pH of 7.257.25

Answer

The prescription for IV labetalol in a client with a history of severe asthma.
Labetalol is a non-selective beta-blocker that antagonizes both beta-1 and beta-2 adrenergic receptors. While it effectively lowers blood pressure by blocking beta-1 receptors in the heart, its beta-2 blockade can trigger severe, potentially fatal bronchoconstriction in clients with a history of asthma. The nurse must question this order immediately and request a cardioselective antihypertensive agent.

Step-by-Step Solution

1
Evaluate the mechanism of action for the prescribed antihypertensive medication.
Labetalol is identified as a non-selective beta-blocker, meaning it antagonizes both beta-1 (cardiac) and beta-2 (pulmonary) receptors.
Understanding receptor affinity is essential to predict adverse pharmacological effects.
2
Cross-reference the drug's mechanism with the client's medical history.
The client has a history of severe asthma. Blockade of beta-2 receptors in the lungs prevents bronchodilation and can induce severe bronchospasm.
Identifying absolute contraindications prevents life-threatening iatrogenic complications.
3
Synthesize the findings to determine the required nursing intervention.
The therapy poses an immediate, severe risk to the client's airway. The nurse must withhold the medication and question the healthcare provider.
Patient advocacy requires intercepting harmful medication orders and requesting a safe alternative, such as a cardioselective agent.

Key Concept

Non-selective Beta-blocker Contraindications
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Topics

Pharmacological and Parenteral Therapies

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