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Zorluk: ZorPharmacological Therapies

A practical nurse is reviewing the medication administration record for a client who is 24 hours postoperative following a bowel resection. The client is scheduled to receive oral metoprolol. Current vital signs are: blood pressure 92/58 mm Hg, apical pulse 116 beats/min, and respirations 22 breaths/min. The client's urine output for the last 4 hours was 85 mL. Which action should the practical nurse take first?

  1. Withhold the metoprolol and immediately report the assessment findings to the registered nurse.Cevap
  2. B
    Administer the scheduled metoprolol because the client's heart rate is elevated.
  3. C
    Initiate a prescribed as-needed rapid intravenous fluid bolus of normal saline.
  4. D
    Delay the metoprolol and prioritize administering a prescribed oral opioid for incisional pain.

Cevap

The practical nurse should withhold the metoprolol and immediately report the assessment findings to the registered nurse.
The client is exhibiting signs of compensatory shock (hypotension, tachycardia, and oliguria) 24 hours after major abdominal surgery. Metoprolol, a beta-blocker, lowers both blood pressure and heart rate. Administering this medication would eliminate the client's compensatory tachycardia and exacerbate the hypotension. Within the scope of practice, the practical nurse must withhold the unsafe medication and immediately notify the registered nurse of the client's deteriorating condition.

Adım Adım Çözüm

1
Analyze the client's vital signs and clinical data.
Blood pressure is low (92/58 mm Hg), heart rate is high (116 beats/min), and urine output is low (85 mL over 4 hours, which is approximately 21 mL/hr).
To identify any physiological instability or contraindications to the scheduled medication.
2
Evaluate the scheduled medication against the clinical data.
Metoprolol is a beta-blocker that lowers both heart rate and blood pressure.
Administering a beta-blocker to a hypotensive, hypovolemic client will block their compensatory tachycardia and dangerously worsen the hypotension.
3
Determine the appropriate nursing action within the practical nurse scope of practice.
The medication must be withheld and the client's unstable condition must be reported to the registered nurse immediately.
Practical nurses must recognize deteriorating conditions, withhold unsafe medications, and escalate care to the registered nurse for advanced assessment.

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