A nurse is collecting data from a client prior to administering metoprolol. For which of the following findings should the nurse withhold the medication?

Blood pressure 160/94 mm Hg

Oxygen saturation 95%

Heart rate 50/min

Respiratory rate 18/min

Answer and Explanation

The Correct Answer is C

(A) Blood pressure 160/94 mm Hg:
Metoprolol is a beta-blocker commonly used to treat hypertension. A blood pressure reading of 160/94 mm Hg indicates hypertension, which is an indication for administering metoprolol, not withholding it.

(B) Oxygen saturation 95%:
An oxygen saturation of 95% is within the normal range and does not provide a reason to withhold metoprolol. Oxygen saturation levels are not directly impacted by this medication in a way that would warrant withholding it.

(C) Heart rate 50/min:
A heart rate of 50/min is bradycardia (a slow heart rate). Metoprolol can further lower the heart rate, so it should be withheld if the client is already experiencing bradycardia. The nurse should notify the healthcare provider for further instructions.

(D) Respiratory rate 18/min:
A respiratory rate of 18/min is within the normal range (12-20 breaths per minute) and does not provide a reason to withhold metoprolol. Respiratory rate is not typically a contraindication for this medication unless there are specific respiratory conditions or other related symptoms present.

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Correct Answer is A

Explanation

A. The ST segment is elevated above the isoelectric line: This is correct. ST-segment elevation is a key ECG finding in acute myocardial infarction. It indicates that a portion of the heart muscle is not receiving enough blood (ischemia), which can lead to tissue damage or death (infarction).

B. The PR intervals are 0.15 second: While the PR interval is an important part of the ECG, a PR interval of 0.15 second is within the normal range and does not indicate an acute myocardial infarction.

C. The QT interval is equal to the R to R interval: The QT interval represents the time from the start of the Q wave to the end of the T wave, encompassing ventricular depolarization and repolarization. While prolonged or shortened QT intervals can be associated with certain cardiac conditions, they are not specific indicators of an acute myocardial infarction.

D. The QRS intervals are 0.08 second: The QRS interval represents ventricular depolarization1. A QRS interval of 0.08 second is within the normal range and does not indicate an acute myocardial infarction.

A. Metabolic acidosis B. Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis

Correct Answer is A

Explanation

A) Recent oral intake: This information is crucial because pyridostigmine is typically administered orally and can interact with food, affecting its absorption. Ensuring that the client has recently eaten or will eat soon is essential to minimize gastrointestinal side effects and optimize medication absorption.

B) Trouble sleeping: While sleep disturbances can be a concern, particularly if they worsen with medication use, they may not be the most critical information to obtain before administering pyridostigmine. However, if the client experiences worsening sleep disturbances after starting the medication, it should be reported to the healthcare provider.

C) Unexplained weight loss: While weight loss can be a symptom of myasthenia gravis, it may not be directly related to the administration of pyridostigmine. However, if the client experiences significant weight loss or other unexplained symptoms, further assessment and evaluation may be necessary.

D) Difficulty with urination: Pyridostigmine can affect bladder function and may exacerbate urinary retention, especially in clients with myasthenia gravis. However, obtaining information about the client's recent oral intake is more crucial to ensure optimal medication absorption and minimize gastrointestinal side effects. Difficulty with urination should still be monitored, but it may not be the most immediate concern before administering the medication.

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A nurse is collecting data from a client prior to administering metoprolol. For which of the following findings should the nurse withhold the medication?

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