A 46-year-old African American man is in an outpatient clinic for a physical examination. His blood pressure (BP) is 126 mm Hg, his body mass index (BMI) is 24, and he reports no previous medical problems. Which of the following actions should the nurse take?

Choice A reason : Recently treated bilateral pneumonia is not a contraindication to metoprolol. Metoprolol is a beta-blocker used primarily for the management of hypertension and is not affected by a history of pneumonia.

Choice B reason : While tadalafil is known to interact with medications that lower blood pressure, it is not a direct contraindication to metoprolol. However, caution is advised when they are used concurrently due to the potential for additive blood pressure-lowering effects.

Choice C reason : Diabetes mellitus Type 2, especially when diet-controlled, is not a contraindication to metoprolol. Beta-blockers like metoprolol can mask hypoglycemic symptoms, so patients with diabetes should be monitored closely, but it does not preclude the use of the medication.

Choice D reason : A history of sinus bradycardia is a contraindication to metoprolol. Metoprolol can exacerbate bradycardia, leading to hemodynamic instability and is therefore contraindicated in patients with a history of significant bradycardia.

Choice A reason : A fixed volume deficit, or hypovolemia, is not a direct finding associated with bradycardia. Bradycardia refers to a slower than normal heart rate, typically below 60 beats per minute in adults⁸. Hypovolemia can cause various compensatory mechanisms to activate, including an increase in heart rate to maintain cardiac output, which is the opposite of bradycardia. Therefore, a fixed volume deficit is not a typical finding in bradycardia unless it is part of a broader clinical picture⁹.

Choice B reason : Anxiety is a condition that can sometimes lead to an increased heart rate, known as tachycardia, rather than a decreased heart rate as seen in bradycardia. While anxiety can coexist with bradycardia, especially if the patient is anxious about their health, it is not a direct symptom or finding of bradycardia itself⁹.

Choice C reason : Lightheadedness is a common symptom of bradycardia. When the heart rate is too slow, it may lead to inadequate cerebral perfusion, which can cause a feeling of lightheadedness or dizziness. This symptom can be particularly evident when the patient changes positions, such as standing up quickly, which can exacerbate the effects of reduced cardiac output on cerebral blood flow⁸⁹.

Choice D reason : An elevated temperature is not typically associated with bradycardia. Fever can actually lead to an increased heart rate as the body attempts to manage the higher metabolic demands associated with a raised temperature. Bradycardia in the presence of fever might indicate a more complex clinical scenario, such as myocarditis or central nervous system infections, but it is not a direct finding of bradycardia⁹.