A nurse prepares to administer propranolol (Inderal) to a patient ...

[bobthebuilder]

A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next?
 
  a. Administer the drug as prescribed.
  b. Request an order for atropine.
  c. Withhold the dose and document the pulse rate.
  d. Withhold the dose and notify the prescriber.

Question 2

The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?
 
  a. I need to stop the medication if my heart rate increases.
  b. I should not drive while taking this medication.
  c. I should take the first dose at bedtime.
  d. I will stop taking the medication if I feel dizzy.

[katara]

Answer to Question 1

ANS: D
A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats per minute; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient's heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication.

Answer to Question 2

ANS: C
Orthostatic hypotension is a common side effect of this class of drugs and is most severe with the first dose. Administering the first dose at bedtime eliminates the risk associated with this first-dose effect. Tachycardia is an expected side effect; if severe, it can be treated with other medications. Patients should not drive during the first 12 to 24 hours after taking these agents, because fainting and dizziness may occur, but they may drive after that. Dizziness is not an indication for stopping the drug; patients who experience dizziness are instructed to sit or lie down until symptoms pass.

[bobthebuilder]

Thanks

[katara]

Welcome