A client reports feeling lightheaded and dizzy with palpitations ...

[maychende]

A client reports feeling lightheaded and dizzy with palpitations after being instructed to increase the dose of a prescribed beta-adrenergic antagonist. How should the nurse respond to this client's symptoms?
 
  Standard Text: Select all that apply.
  1. This is first-dose phenomenon.
  2. If the dose is increased again, take the medication at bedtime.
  3. This will go away in time.
  4. Maybe you have another health problem that needs to be examined.
  5. You may have taken too much medication.

Question 2

A client with hypertension is prescribed a beta blocker. The effects that this medication will have on the client's blood pressure are due to which factors?
 
  Standard Text: Select all that apply.
  1. Reduced myocardial contractility
  2. Reduced release of renin
  3. Relaxed arteriole smooth muscle
  4. Reduced sympathetic output from the brain
  5. Reduced lipolysis

[miss_1456@hotmail.com]

Answer to Question 1

Correct Answer: 1,2
Rationale 1: First-dose phenomenon is the onset of orthostatic hypotension when beginning or changing the dose of a beta-adrenergic antagonist.
Rationale 2: Taking the medication at bedtime will reduce the onset of first-dose phenomenon.
Rationale 3: Although this reaction may dissipate in time, this statement does not explain the cause of the client's symptoms.
Rationale 4: The client is experiencing first-dose phenomenon because of the increase in the dosage.
Rationale 5: The client was taking the prescribed increased dose of the medication.
Global Rationale: First-dose phenomenon is the onset of orthostatic hypotension when beginning or changing the dose of a beta-adrenergic antagonist. Taking the medication at bedtime will reduce the onset of first-dose phenomenon. Although this reaction may dissipate in time, this statement does not explain the cause of the client's symptoms. The symptoms the client is experiencing are consistent with the first-dose phenomenon of the prescribed medication dose.

Answer to Question 2

Correct Answer: 1,2,3,4
Rationale 1: Diminished myocardial contractility decreases cardiac output.
Rationale 2: The release of renin by the kidney, which is normally stimulated by catecholamines, is prevented.
Rationale 3: The nonselective adrenergic antagonists block alpha1-adrenergic receptors, relaxing arteriolar smooth muscle.
Rationale 4: Central actions reduce sympathetic output from the vasomotor center in the brain.
Rationale 5: Nonselective beta blockers may increase serum triglycerides and decrease high-density lipoproteins.
Global Rationale: Diminished myocardial contractility decreases cardiac output. The release of renin by the kidney, which is normally stimulated by catecholamines, is prevented. The nonselective adrenergic antagonists block alpha1-adrenergic receptors, relaxing arteriolar smooth muscle. Central actions reduce sympathetic output from the vasomotor center in the brain. Nonselective beta blockers may increase serum triglycerides and decrease high-density lipoproteins.

[maychende]

Excellent

[flexer1n1]

Gracias!