A nurse is preparing to administer metoprolol 25 mg PO to a client with a history of hypertension and heart failure. The client’s vital signs are: BP 132/78 mm Hg, HR 86 beats per minute, and respiratory rate 18 breaths per minute. Which action should the nurse take?

Give half of the prescribed dose

Give the full dose as ordered

Delay the dose until the pulse is below 60

Omit the dose and record the pulse rate as the reason

Answer and Explanation

The Correct Answer is B

Choice A reason: Giving half the dose of metoprolol is inappropriate without a medical order, as it may reduce therapeutic efficacy. The client’s vital signs (BP 132/78, HR 86) are stable, indicating no need to alter the prescribed dose, which is intended to manage hypertension and heart failure.

Choice B reason: Metoprolol, a beta-blocker, reduces heart rate and blood pressure in hypertension and heart failure. The client’s vital signs (BP 132/78, HR 86) are within acceptable ranges, indicating the full 25 mg dose is safe and appropriate to maintain therapeutic control of their condition.

Choice C reason: Delaying the dose until the pulse is below 60 is unnecessary, as the client’s heart rate of 86 is not bradycardic. Metoprolol is indicated for heart rates above 60 in heart failure and hypertension, and withholding it could worsen blood pressure control.

Choice D reason: Omitting the dose due to a pulse of 86 is inappropriate, as this heart rate is not dangerously low. Metoprolol is prescribed to manage hypertension and heart failure, and withholding it without clinical justification could lead to uncontrolled symptoms or disease progression.

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Correct Answer is B

Explanation

Choice A reason: Increased sleep may occur with sertraline due to its sedative effects, but it is not the priority assessment. Early in treatment, SSRIs can increase energy before mood improvement, heightening suicide risk, making suicidal ideation a more urgent concern.

Choice B reason: Sertraline, an SSRI, can initially increase energy in severe depression before fully improving mood, potentially increasing suicide risk. Assessing suicidal ideation is the priority to ensure safety, as this risk is highest early in treatment, requiring immediate intervention if present.

Choice C reason: Emotional changes are expected with sertraline as it improves mood over weeks. However, this is less urgent than assessing suicidal ideation, which poses an immediate safety risk, especially in severe depression during the early phase of SSRI treatment.

Choice D reason: Increased socialization may indicate improved depressive symptoms but is a secondary outcome. The priority is assessing suicidal ideation, as SSRIs can paradoxically increase suicide risk early in treatment due to improved energy without full mood stabilization, requiring vigilant monitoring.

A. Selective Serotonin Reuptake Inhibitors (SSRIs) B. Tricyclics C. Benzodiazepines D. Monoamine Oxidase Inhibitors (MAOIs)

Correct Answer is A

Explanation

Choice A reason: SSRIs increase serotonin levels in the brain, effectively managing GAD with a low risk of dependence. Side effects like nausea or headache are generally mild and transient, making SSRIs safer compared to other classes, as they do not cause significant physiological dependence or severe adverse effects.

Choice B reason: Tricyclic antidepressants affect multiple neurotransmitters, effectively treating GAD but with significant side effects like anticholinergic effects (dry mouth, constipation) and potential cardiotoxicity. They carry a higher risk of overdose and side effects compared to SSRIs, making them less safe for long-term use in GAD.

Choice C reason: Benzodiazepines enhance GABA activity, providing rapid anxiety relief but with a high risk of physiological dependence and withdrawal. Side effects like sedation and cognitive impairment, along with abuse potential, make them less safe than SSRIs for long-term GAD management.

Choice D reason: MAOIs inhibit monoamine oxidase, increasing neurotransmitter levels for GAD treatment. However, they have significant side effects, including hypertensive crises from dietary tyramine, and require strict dietary restrictions. Their risk profile and potential for severe interactions make them less safe than SSRIs.

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A nurse is preparing to administer metoprolol 25 mg PO to a client with a history of hypertension and heart failure. The client’s vital signs are: BP 132/78 mm Hg, HR 86 beats per minute, and respiratory rate 18 breaths per minute. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The client has been diagnosed with severe depression and prescribed sertraline (Zoloft). Which assessment of the client by the nurse is a priority after initiation of the medication?

Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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