Nokea
A client is receiving nadolol as part of the treatment plan for hypertension. The client reports dizziness on standing. The nurse checks the client's blood pressure lying, sitting, and standing and notes a significant drop in the readings. When developing this client's plan of care, which nursing diagnosis would the nurse most likely identify?
- A. Risk for Injury
- B. Ineffective Tissue Perfusion
- C. Impaired Comfort
- D. Decreased Cardiac Output
Correct Answer: A
Rationale: The client is experiencing orthostatic hypotension, placing the client at risk for falls and injury. Ineffective Tissue Perfusion would be appropriate if the client was experiencing more rapid changes in blood pressure and/or changes in pulse and heart rate. Impaired Comfort would apply if the client was complaining of other adverse reactions such as dry mouth or constipation. There is no information provided that would suggest decreased cardiac output.
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A nurse would administer phentolamine cautiously to a client with which condition?
- A. Recent MI
- B. Type 1 diabetes
- C. Renal failure
- D. Hepatic failure
- E. Peripheral artery disease
Correct Answer: A,C
Rationale: Phentolamine is an a-adrenergic blocker that should be used cautiously in clients who are pregnant or lactating, had a recent MI, or have renal failure or Reynaud's disease.
A nurse is preparing to administer propranolol to a client for the treatment of cardiac arrhythmias. The nurse checks the client's apical pulse rate and blood pressure before administration and notes that the pulse rate is below 60 bpm. Which of the following would the nurse do next?
- A. Provide proper ventilation to the client
- B. Delay drug administration for some time
- C. Withhold the drug and contact the primary health care provider
- D. Immediately give oxygen via face mask
Correct Answer: C
Rationale: The nurse should withhold the drug and contact the primary health care provider if the pulse rate of the client is below 60 bpm. Providing proper ventilation to the client, delaying drug administration for some time, or providing oxygen support to the client would be inappropriate for this client.
A nurse is caring for a client with an arrhythmia. Which of the following would be most important for the nurse to do for a client with a life-threatening arrhythmia who is receiving an adrenergic blocking drug intravenously?
- A. Perform continuous cardiac monitoring
- B. Obtain pulse rate readings every 6 to 8 hours
- C. Assess respiratory rate every hour
- D. Obtain body temperature readings every 15 minutes
Correct Answer: A
Rationale: The patient with a life-threatening arrhythmia may receive an adrenergic blocking drug, such as propranolol, by the intravenous (IV) route. When these drugs are administered IV, cardiac monitoring is necessary. Patients not in a monitored unit are usually transferred to one as soon as possible. When these drugs are administered for a life-threatening arrhythmia, it is important to monitor the patient continuously with cardiac, blood pressure, and respiratory rate monitoring frequently.
A client with a cardiac problem is treated with b-adrenergic blocking drugs. Which of the following should the nurse identify as a cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client?
- A. Vomiting
- B. Hyperglycemia
- C. Nausea
- D. Vertigo
Correct Answer: D
Rationale: The nurse should identify vertigo as the cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client. Vomiting, nausea, and hyperglycemia are not cardiac reactions; they are gastrointestinal reactions that are observed when the client is administered b-adrenergic blocking drugs.
A nurse is caring for a client who has been prescribed propranolol for angina. After administering the drug, which of the following would the nurse do?
- A. Ask about relief of symptoms and record responses on the chart
- B. Determine signs of infection in the client
- C. Monitor for sudden decrease in urine output
- D. Monitor for sudden increase in intraocular pressure
Correct Answer: A
Rationale: The nurse should ask about the relief of symptoms and record the responses on the client's chart. Determining the signs of infection in the client is part of the nurse's preadministration assessment, not the ongoing assessment. The nurse need not monitor the client for a sudden decrease in urine output and a sudden increase in intraocular pressure for a client receiving propranolol therapy for angina.