A nurse is assessing a client prior to administration of atenolol and finds that the client's apical heart rate is 61/min.
Which of the following actions should the nurse take?
Administer half the dose now and the other half in 30 min.
Withhold the medication and contact the provider for further instructions.
Administer the prescribed dose to the client.
Prepare to administer atropine to the client.
The Correct Answer is B
Choice A rationale
Administering half the dose now and the other half in 30 minutes is an inappropriate action for a beta-blocker like atenolol when the heart rate is already low. This approach would still lead to a further reduction in heart rate, potentially causing symptomatic bradycardia or other adverse cardiovascular events, and is not a standard medication administration protocol.
Choice B rationale
Atenolol is a beta-blocker that reduces heart rate and blood pressure. A normal apical heart rate typically ranges from 60 to 100 beats/min. A heart rate of 61/min, although within the normal range, is on the lower end, especially for a client receiving a beta-blocker. Administering atenolol could further decrease the heart rate, leading to symptomatic bradycardia or other adverse effects. Therefore, withholding the medication and contacting the provider is the safest action to assess the client's tolerance and determine if a dose adjustment is necessary.
Choice C rationale
Administering the prescribed dose when the client's apical heart rate is 61/min is generally contraindicated for a beta-blocker like atenolol. Beta-blockers work by decreasing heart rate. Giving the medication could cause the heart rate to fall below acceptable limits (e.g., less than 60 beats/min), potentially leading to dizziness, syncope, or cardiac arrest, necessitating careful clinical judgment.
Choice D rationale
Atropine is an anticholinergic medication used to treat bradycardia (heart rate less than 60 beats/min) by blocking the action of acetylcholine on muscarinic receptors, thereby increasing heart rate. While atropine can be used to treat symptomatic bradycardia, preparing to administer it *before* giving atenolol, especially when the heart rate is 61/min and the client is not yet bradycardic, is premature and not indicated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Acyclovir is primarily excreted renally, and its metabolism can lead to crystal formation in the renal tubules, particularly if the client is dehydrated or the infusion is too rapid. Monitoring for an increase in creatinine (normal range 0.6-1.2 mg/dL) is crucial as it indicates decreased glomerular filtration rate and potential nephrotoxicity or acute kidney injury, necessitating dose adjustment or hydration.
Choice B rationale
Administering oxygen prophylactically is not a standard or scientifically indicated action for acyclovir administration. Acyclovir does not inherently cause respiratory depression or compromise oxygenation. Its primary adverse effects are typically related to renal function, central nervous system, or gastrointestinal system, not respiratory compromise.
Choice C rationale
While some antiviral medications can affect hematopoiesis, acyclovir is not commonly associated with significant decreases in hemoglobin (normal range 12-18 g/dL) and hematocrit (normal range 37-52%). These parameters are generally monitored in clients with pre-existing hematological conditions or those on long-term, high-dose therapy, but it's not a primary immediate concern for IV administration.
Choice D rationale
Administering acyclovir IV over 30 minutes is the recommended infusion duration. Rapid intravenous infusion can increase the risk of renal tubular damage and crystal formation, leading to nephrotoxicity. A slower infusion rate allows for proper dilution and minimizes the concentration of the drug in the renal tubules, thus protecting kidney function and reducing adverse effects.
Correct Answer is B
Explanation
Choice A rationale
Jaundice is a serious indicator of hepatotoxicity, a known and potentially severe adverse effect of rifampin. It signifies liver dysfunction and requires immediate medical attention. Therefore, stating that jaundice is harmless demonstrates a critical misunderstanding of the medication's potential risks and the need for prompt reporting to the healthcare provider.
Choice B rationale
Rifampin is known to cause discoloration of body fluids, including urine, sweat, tears, and saliva, due to its reddish-orange pigment. This discoloration can permanently stain soft contact lenses. Therefore, a client's statement about not wearing soft contact lenses indicates an understanding of this specific and important adverse effect.
Choice C rationale
Rifampin absorption is reduced when taken with food. To maximize its bioavailability and effectiveness, rifampin should be taken on an empty stomach, typically one hour before or two hours after a meal. Taking it when the stomach is full would decrease its therapeutic efficacy, indicating a misunderstanding of the teaching.
Choice D rationale
Rifampin is metabolized by the liver, and alcohol consumption also places a significant metabolic burden on the liver. Concurrent use of rifampin and alcohol significantly increases the risk of hepatotoxicity, which can lead to severe liver damage. Therefore, drinking alcohol while on rifampin is strongly contraindicated and shows a lack of understanding. .
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