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
Laryngeal edema is a severe manifestation of an immediate hypersensitivity (Type I anaphylactic) reaction to penicillin. It involves swelling of the larynx, leading to airway obstruction, stridor, and difficulty breathing. This life-threatening condition requires immediate medical intervention, including epinephrine and airway management, making it the priority to monitor.
Choice B rationale
Urticaria, or hives, is a common cutaneous manifestation of a hypersensitivity reaction to penicillin. It involves transient, itchy wheals on the skin due to histamine release. While uncomfortable and requiring attention, it is typically not life-threatening unless accompanied by systemic symptoms like laryngeal edema or bronchospasm.
Choice C rationale
Epigastric distress, such as stomach upset or pain, is a common gastrointestinal adverse effect of oral penicillin V, often due to direct irritation of the gastric mucosa or altered gut flora. While it can cause discomfort, it is generally not a life-threatening condition and can often be managed with food or dose adjustment.
Choice D rationale
Maculopapular rash is a delayed hypersensitivity reaction to penicillin, usually appearing several days after initiation of therapy. It presents as flat, red areas with small raised bumps. While it indicates a drug allergy, it is generally not immediately life-threatening compared to acute airway compromise and resolves upon discontinuation of the medication.
Correct Answer is C
Explanation
Choice A rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can exacerbate gastric ulcers by inhibiting prostaglandin synthesis, which normally protects the gastric mucosa. Continuing ibuprofen would counteract the therapeutic effects of esomeprazole, a proton pump inhibitor, and increase the risk of gastrointestinal bleeding and ulcer perforation.
Choice B rationale
Esomeprazole delayed-release capsules contain enteric-coated pellets to protect the active ingredient from gastric acid degradation, allowing absorption in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach and reduced bioavailability, thereby diminishing its therapeutic efficacy.
Choice C rationale
Esomeprazole is a proton pump inhibitor that irreversibly binds to and inhibits the H+/K+-ATPase pump in gastric parietal cells, thereby reducing gastric acid secretion. Taking it 60 minutes before a meal ensures that peak plasma concentrations coincide with the maximal activity of these pumps, which are stimulated by food intake, optimizing its acid-suppressing effect.
Choice D rationale
While some medications can cause insomnia, it is not a commonly reported adverse effect of esomeprazole. Common adverse effects of proton pump inhibitors typically include headache, nausea, diarrhea, abdominal pain, and flatulence, reflecting their primary actions on the gastrointestinal system and potential systemic effects.
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