A client is scheduled to receive atenolol 25 mg PO and diltiazem 60 mg PO at 0800. The nurse assesses the client's heart rate as 45 beats/minute and irregular. What is the best nursing action at this time?

Document the pulse rate and administer the medications as prescribed

Assess for chest pain and administer atenolol if pain free

Hold the atenolol and administer the diltiazem

Withhold the medications and reassess the heart rate in 30 minutes

Answer and Explanation

The Correct Answer is C

Choice A reason: This is not the best nursing action. Documenting the pulse rate and administering the medications as prescribed may be harmful to the client. Atenolol and diltiazem are both medications that lower the blood pressure and the heart rate. Atenolol is a beta blocker that blocks the effects of adrenaline on the heart and blood vessels. Diltiazem is a calcium channel blocker that relaxes the muscles of the heart and blood vessels. Giving both medications to a client who already has a low and irregular heart rate may cause further bradycardia, which is a heart rate below 60 beats/minute, or arrhythmia, which is an abnormal heart rhythm. The nurse should check the parameters and the contraindications for the medications before administering them.

Choice B reason: This is not the best nursing action. Assessing for chest pain and administering atenolol if pain free may not be appropriate for the client. Chest pain can be a sign of angina or myocardial infarction, which are conditions where the blood flow to the heart is reduced or blocked. Atenolol can help relieve chest pain by reducing the oxygen demand of the heart, but it can also lower the heart rate and the blood pressure. The client already has a low and irregular heart rate, which may indicate a problem with the electrical conduction of the heart. The nurse should not give atenolol without checking the pulse rate and the blood pressure, and consulting the health care provider.

Choice C reason: This is the best nursing action. Holding the atenolol and administering the diltiazem is the most appropriate for the client. Atenolol can lower the heart rate and the blood pressure, which may worsen the client's condition. The nurse should hold the atenolol and notify the health care provider of the client's pulse rate and rhythm. Diltiazem can also lower the heart rate and the blood pressure, but it can also help regulate the heart rhythm by slowing down the electrical impulses in the heart. The nurse should administer the diltiazem as prescribed, and monitor the client's vital signs and cardiac status.

Choice D reason: This is not the best nursing action. Withholding the medications and reassessing the heart rate in 30 minutes may delay the treatment and the care of the client. The client has a low and irregular heart rate, which may indicate a serious cardiac problem that needs immediate attention. The nurse should not wait for 30 minutes to reassess the heart rate, but rather act promptly and notify the health care provider. The nurse should also administer the diltiazem as prescribed, unless there is a specific reason to withhold it.

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Correct Answer is A

Explanation

Choice A reason: Exertional dyspnea is a common symptom of unstable angina, which is caused by reduced blood flow to the heart muscle. Carvedilol is a beta-blocker that reduces the workload of the heart and improves its oxygen supply. Therefore, resolving exertional dyspnea indicates that the medication has been effective.

Choice B reason: A heart rate of 50 beats/minute is not a desired outcome of carvedilol therapy. It may indicate that the dose is too high or that the client has a conduction problem. A normal resting heart rate for adults is between 60 and 100 beats/minute.

Choice C reason: A regular heart rhythm is not a specific indicator of carvedilol effectiveness. Carvedilol can prevent or treat some arrhythmias, but it is not the primary goal of therapy for unstable angina. A regular heart rhythm may also be influenced by other factors such as electrolytes, hydration, and stress.

Choice D reason: A blood pressure of 120/90 is not a sign of carvedilol effectiveness. Carvedilol can lower blood pressure, but it is not the main purpose of treatment for unstable angina. A blood pressure of 120/90 is considered prehypertension, which may increase the risk of cardiovascular complications.

A. Decrease the incidence of tachycardia B. Dilate the coronary arteries C. Decrease cardiac workload D. Increase the strength of myocardial contraction

Correct Answer is A

Explanation

Choice A reason: Decreasing the incidence of tachycardia is not the main therapeutic effect of atenolol for coronary artery disease. Atenolol is a beta-blocker that lowers the heart rate, but this is not the primary goal of therapy for coronary artery disease. Coronary artery disease is caused by atherosclerosis, which is the buildup of plaque in the arteries that supply the heart. This reduces the blood flow and oxygen to the heart muscle and causes angina, or chest pain.

Choice B reason: Dilating the coronary arteries is not the therapeutic effect of atenolol for coronary artery disease. Atenolol does not directly affect the diameter of the coronary arteries. It works by blocking the beta receptors in the heart and reducing the response to adrenaline and other stress hormones. This lowers the blood pressure and the oxygen demand of the heart.

Choice C reason: This is the correct answer. Decreasing cardiac workload is the therapeutic effect of atenolol for coronary artery disease. Atenolol reduces the contractility and the excitability of the heart muscle, which lowers the force and the frequency of the heartbeats. This decreases the amount of work that the heart has to do and the amount of oxygen that it needs. This helps prevent or relieve anginal attacks and improve the quality of life of the client.

Choice D reason: Increasing the strength of myocardial contraction is not the therapeutic effect of atenolol for coronary artery disease. Atenolol does not increase the strength of myocardial contraction, but rather decreases it. Increasing the strength of myocardial contraction would increase the oxygen demand of the heart and worsen the angina. Atenolol aims to reduce the oxygen demand of the heart and improve the blood supply to the heart.

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A client is scheduled to receive atenolol 25 mg PO and diltiazem 60 mg PO at 0800. The nurse assesses the client's heart rate as 45 beats/minute and irregular. What is the best nursing action at this time?

Nursing Test Bank

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The nurse is evaluating the effects of the prescribed carvedilol 6.25 mg PO daily for a client with a history of unstable angina. Which of the following reflects that the medication has been effective?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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