A nurse is caring for a 45-year-old male client in an acute care unit.

For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.

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.

Choice A rationale

Gingival hyperplasia is an overgrowth of gum tissue, often associated with certain medications like phenytoin or cyclosporine. It is caused by an increase in the number of fibroblasts and collagen deposition in the gingiva. Haloperidol, an antipsychotic, primarily affects dopamine receptors in the brain and does not cause gingival hyperplasia.

Choice B rationale

Haloperidol is a first-generation antipsychotic that blocks D2 dopamine receptors in the brain. This blockade, particularly in the nigrostriatal pathway, can lead to extrapyramidal symptoms (EPS) such as acute dystonia, parkinsonism (including muscle rigidity, bradykinesia, and tremor), and akathisia. Muscle rigidity is a common manifestation of drug-induced parkinsonism.

Choice C rationale

Polyuria is the excessive production of urine, often a symptom of diabetes mellitus or insipidus. It results from impaired water reabsorption in the kidneys. While some medications can affect fluid balance, haloperidol's primary pharmacological action on dopamine receptors does not directly induce polyuria as a typical adverse effect.

Choice D rationale

Bruising, or ecchymosis, results from bleeding under the skin, often due to trauma or coagulation disorders. It is caused by extravasation of blood from capillaries into surrounding tissues. Haloperidol does not affect coagulation factors or platelet function and is not associated with increased bruising as a direct adverse effect.