Answer to Question 1
ANS: D
A beta blocker, such as propranolol, should not be given with a pulse less than 60/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.
It is not up to the nurse to redose the medication; that would be a violation of the Nurse Practice Act (nurses do not prescribe). Dosages can be changed only by a licensed prescriber and/or by an order left by a licensed prescriber that has sliding dosages and allows the nurse to determine the dosage within that prescribed range, depending on the patient's status.
Withholding the dose and documenting the pulse rate is appropriate but an incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication.
Answer to Question 2
ANS: A
Metoprolol is preferred to the nonselective beta blockers for patients with asthma or diabetes.
Propranolol can cause blockade of beta2 receptors in the lungs, causing bronchoconstriction; it therefore is not recommended for patients with asthma.
Pindolol can cause blockade of beta2 receptors in the lungs, causing bronchoconstriction; it therefore is not recommended for patients with asthma.
Carteolol can cause blockade of beta2 receptors in the lungs, causing bronchoconstriction; it therefore is not recommended for patients with asthma.
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