A client diagnosed with hypertension is prescribed atenolol ...

[s.tung]

A client diagnosed with hypertension is prescribed atenolol (Tenormin). The nurse knows that this medication is a selective beta1 blocker and can be safely used for clients with which concurrent diagnosis?
 
  1. Asthma
  2. Diabetes
  3. Heart failure
  4. Hepatic disease

Question 2

Prazosin (Minipress) is prescribed for hypertensive client. Which measure should be used by the nurse to prevent the first-dose phenomenon?
 
  1. Give the dosage early in the morning before breakfast.
  2. Give initial low doses at bedtime.
  3. Give the dosage with meals.
  4. Give initial high dosage and then lower gradually.

[SAUXC]

Answer to Question 1

Correct Answer: 1
Rationale 1: Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm.
Rationale 2: Diabetic clients, when given atenolol, must monitor blood glucose frequently and report other possible signs of hypoglycemia, such as fatigue, hunger, or lack of concentration.
Rationale 3: Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. It depresses the myocardium, so these clients need regular assessments of cardiac function during therapy.
Rationale 4: Beta1 blockers should be used with caution in patients with severe hepatic disease, since its major route of excretion is the liver.
Global Rationale: Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm. Diabetic clients, when given atenolol, must monitor blood glucose frequently and report other possible signs of hypoglycemia, such as fatigue, hunger, or lack of concentration. Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. It depresses the myocardium, so these clients need regular assessments of cardiac function during therapy. Beta1 blockers should be used with caution in patients with severe hepatic disease, since its major route of excretion is the liver.

Answer to Question 2

Correct Answer: 2
Rationale 1: Prazosin (Minipress) should be given at bedtime, not early in the morning before breakfast, because dizziness and headaches can continue through the day.
Rationale 2: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime.
Rationale 3: The first-dose phenomenon occurs even when prazosin (Minipress) is given with meals.
Rationale 4: Giving initial high dosage and then lowering the dose gradually does not prevent the first-dose phenomenon.
Global Rationale: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime. Prazosin (Minipress) should be given at bedtime, not early in the morning before breakfast, because dizziness and headaches can continue through the day. The first-dose phenomenon occurs even when prazosin (Minipress) is given with meals. Giving initial high dosage and then lowering the dose gradually does not prevent the first-dose phenomenon.