Author Question: An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the ... (Read 41 times)

newbem · **on:** Jul 24, 2018

An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP should:

a. tell the patient to stop taking the medication immediately.
b. recommend that the patient take the medication at bedtime.
c. tell the patient that tolerance to this side effect will occur over time.
d. contact the patient's cardiologist to discuss decreasing the dose of propranolol.

Question 2

The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement.

The child's weight is 80 of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child's parents do not want the procedure. The NP should: a. compromise with the parents and order a nasogastric tube for feedings.
b. initiate a discussion with the parents about the potential outcomes of each possible action.
c. refer the family to a case manager who can help guide the parents to the best decision.
d. understand that the child's parents have a right to make choices that override those of the medical team.

gabrielle_lawrence · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
Elderly patients have described sedation and sleep disturbances with B-blockers. Elderly patients often need lower doses of these drugs. Patients should not be advised to discontinue the medication abruptly.

Answer to Question 2

B
In general, the goal of a health care decision maker is to choose an action that is most likely to deliver the outcomes the patient wants. Initiating a discussion about outcomes helps parents decide based on end results. A nasogastric tube is not the best choice for the child, and compromising without first exploring options is incorrect. As part of the therapeutic relationship, the NP should be involved with patients' decisions. Although patients and families have the right to make decisions, the NP has an obligation to ensure that the decisions are informed decisions.