A client has hypocalcemia caused by a parathyroid hormone deficiency. Which medication should the nurse anticipate administering to this client?

Choice A rationale:

COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease that causes airflow obstruction. While labetalol can cause some bronchoconstriction, it is generally considered safe for use in patients with COPD. However, it's essential to monitor respiratory status closely, especially in those with severe COPD.

Choice B rationale:

Narrow-angle glaucoma is an eye condition characterized by increased intraocular pressure (IOP) due to impaired drainage of aqueous humor. Labetalol can exacerbate this condition by further increasing IOP through its beta-blocking effects. This can lead to acute angle-closure glaucoma, a medical emergency that can result in permanent vision loss.

Specific mechanisms by which labetalol can increase IOP:

Reduced aqueous humor production: Beta-blockers like labetalol can decrease the production of aqueous humor, the fluid that maintains eye pressure. While this might seem beneficial, a significant reduction can lead to anterior chamber shallowing, which can mechanically block the drainage angle and trigger angle closure.

Impaired uveoscleral outflow: Beta-blockers can also impair the uveoscleral outflow pathway, an alternative route for aqueous humor drainage that becomes more important in glaucoma patients. This can further contribute to IOP elevation.

Vasoconstriction of ciliary blood vessels: Labetalol's alpha-blocking effects can cause vasoconstriction of the ciliary blood vessels, which supply blood to the ciliary body responsible for aqueous humor production. This can reduce blood flow and indirectly hinder aqueous humor drainage.

Pupillary dilation: Beta-blockers can cause pupillary dilation, which can mechanically narrow the anterior chamber angle and obstruct aqueous humor outflow.

Therefore, labetalol is generally contraindicated in patients with known narrow-angle glaucoma.

Choice C rationale:

Hypertension (high blood pressure) is one of the primary indications for labetalol. It is an effective antihypertensive medication that works by blocking beta receptors, leading to decreased heart rate, contractility, and blood pressure.

Choice D rationale:

Tachycardia (fast heart rate) can also be treated with labetalol due to its beta-blocking effects. It helps to slow down the heart rate and restore a normal rhythm.

Choice A rationale:

Placing the tablet under the patient's nose is not an effective method of administering aspirin. Aspirin is not absorbed through the nasal mucosa.

This action would not provide any therapeutic benefit to the patient with a suspected myocardial infarction. It could potentially lead to aspiration of the tablet if the patient sneezes or coughs.

Choice B rationale:

Enteric-coated aspirin tablets are designed to dissolve in the intestines, not in the stomach. This delays the absorption of aspirin and its antiplatelet effects.

In a patient with a suspected myocardial infarction, it is crucial to achieve rapid absorption of aspirin to inhibit platelet aggregation and prevent further clot formation.

Therefore, enteric-coated aspirin is not appropriate in this situation.

Choice C rationale:

Chewing the aspirin tablet would indeed speed up its absorption. However, it also increases the risk of gastric irritation and bleeding.

Aspirin can be irritating to the stomach lining, and chewing it can exacerbate this effect.

This is particularly concerning in a patient with a suspected myocardial infarction, who may already be at risk for gastrointestinal bleeding due to decreased blood flow to the stomach.

Choice D rationale:

Giving the aspirin tablet with a small sip of water is the most appropriate action for the nurse to take in this situation. This allows for timely absorption of the aspirin while minimizing the risk of gastric irritation.

The water helps to dissolve the tablet and transport it to the stomach, where it can be absorbed into the bloodstream. It also helps to lubricate the esophagus and reduce the risk of the tablet becoming lodged in the throat.