The health care provider prescription reads "Metoprolol (Lopressor) 50 mg PO daily. Do not give if bloc pressure is less than 100 mm Hg systolic." The patient's blood pressure is 92/66. The nurse does not give the medication. Which action should the nurse take?
Documents that the medication was not given because of low blood pressure.
Does not inform the health care provider that the medication was held.
Does not tell the patient what the blood pressure is.
Documents only what the blood pressure was.
The Correct Answer is A
A. Documents that the medication was not given because of low blood pressure:
This is the correct and required nursing action. It communicates the reason for withholding and ensures continuity of care.
B. Does not inform the health care provider that the medication was held:
The provider should be informed so they can reassess the treatment plan, especially if BP remains low.
C. Does not tell the patient what the blood pressure is:
Lack of communication with the patient is inappropriate. Patients have the right to know their vital signs and treatment decisions.
D. Documents only what the blood pressure was:
Incomplete documentation. It must also indicate that the medication was withheld and why.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
A. Betadine:
Betadine (povidone-iodine) is commonly used for cleansing the perineal area. Patients may have an allergy to iodine-based antiseptics.
B. Shellfish:
A shellfish allergy may indicate a sensitivity to iodine, which is found in Betadine. While this connection is debated, many protocols still recommend caution.
C. Latex:
Many catheters and gloves are made with latex, which can cause serious allergic reactions, including anaphylaxis.
D. Silicone:
Silicone is hypoallergenic and usually used for patients with latex allergies. True silicone allergies are rare.
E. Tape:
Tape is used to secure the catheter tubing. Some patients have adhesive allergies that can cause skin irritation or blisters.
Correct Answer is A
Explanation
A. Documents that the medication was not given because of low blood pressure:
This is the correct and required nursing action. It communicates the reason for withholding and ensures continuity of care.
B. Does not inform the health care provider that the medication was held:
The provider should be informed so they can reassess the treatment plan, especially if BP remains low.
C. Does not tell the patient what the blood pressure is:
Lack of communication with the patient is inappropriate. Patients have the right to know their vital signs and treatment decisions.
D. Documents only what the blood pressure was:
Incomplete documentation. It must also indicate that the medication was withheld and why.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.