The nurse is caring for a client who is 3 hours post-operative following a right lobectomy for lung cancer. The client has shallow respirations at a rate of 14/minute with guarding of the operative site. The breath sounds are diminished throughout the left lung field. The nurse assigns the highest priority to which intervention to prevent acute respiratory failure?

A. Recent intake of sildenafil:
While there is a potential drug interaction between atenolol (a beta-blocker) and sildenafil (a phosphodiesterase inhibitor used for erectile dysfunction), this alone would not necessarily be an indication to hold atenolol. Sildenafil can cause hypotension, which might be exacerbated by atenolol, especially in older adults or those with cardiovascular issues. However, this interaction usually requires monitoring rather than immediate discontinuation of atenolol, unless the client is symptomatic (e.g., feeling faint, dizziness). If symptoms of hypotension occur after taking both medications, the nurse would assess the client's condition but would not automatically hold atenolol based solely on this information.

B. Heart rate 52 and blood pressure 90/56: The most concerning finding in a client receiving atenolol (a beta-blocker) for angina is a heart rate of 52 beats per minute (bradycardia) and a blood pressure of 90/56 mmHg (hypotension). Beta-blockers, such as atenolol, work by reducing the heart rate and lowering blood pressure. A heart rate of 52 beats per minute is below the typical threshold of 60 beats per minute and indicates bradycardia, which could worsen due to the medication's effects. Additionally, hypotension (blood pressure 90/56) can be dangerous, especially when combined with bradycardia. Both of these findings suggest that the client may be experiencing excessive beta-blockade, which could lead to severe complications such as cardiogenic shock or arrhythmias. Therefore, the nurse should hold the medication and contact the provider for further assessment and possible adjustment of the treatment plan.

C. Restlessness and mild confusion:
Restlessness and mild confusion could indicate several possible issues, such as hypoxia, electrolyte imbalances, or medication side effects. While beta-blockers can cause side effects like fatigue or depression, restlessness and confusion are not common acute reactions to atenolol. However, if these symptoms are due to hypotension or bradycardia from the atenolol, then holding the medication and notifying the provider may be warranted. Nonetheless, these symptoms alone are not a clear cause to immediately hold atenolol without further assessment.

D. Positional vertigo and wheezing:
Positional vertigo can occur due to a variety of causes, including inner ear issues, hypotension, or even medication side effects. Wheezing, however, raises concerns about potential bronchospasm, which is a known side effect of non-cardioselective beta-blockers. Atenolol is a cardioselective beta-blocker, meaning it is less likely to cause bronchospasm compared to non-cardioselective agents like propranolol. While wheezing could indicate a reaction to the medication, it is not a primary concern with atenolol, unless the client has a history of asthma or chronic obstructive pulmonary disease (COPD). If wheezing occurs, the nurse should still monitor the client but would not necessarily hold atenolol immediately unless the symptoms are severe.

A) Assess for conjunctival bleeding
Conjunctival bleeding refers to blood in the white part of the eye (the conjunctiva), which is typically associated with trauma, infections, or certain blood disorders, but it is not a common cause of diplopia (double vision). Diplopia in multiple sclerosis (MS) is more often due to nerve damage affecting the eye muscles or the pathways controlling eye movement. Therefore, assessing for conjunctival bleeding is not a priority intervention for a client with diplopia related to MS.

B) Encourage the use of sunglasses when outside
While wearing sunglasses may help alleviate light sensitivity, which is a common symptom in individuals with MS, it is not the most appropriate intervention for treating diplopia itself. Diplopia is typically caused by issues with eye muscle control or coordination, often related to the central nervous system. Therefore, while sunglasses might provide comfort, they do not address the underlying cause of the double vision.

C) Alternate the use of an eye patch on each eye
Alternating the use of an eye patch on each eye is an effective intervention for managing diplopia, especially when the cause is related to misalignment or weakness of the eye muscles. The eye patch works by covering one eye at a time to prevent double vision. In MS, this technique can help reduce the visual disturbance and provide relief until further interventions (such as eye exercises or medications) can be considered. This approach is commonly used to manage diplopia caused by nerve involvement affecting ocular muscle function.

D) Apply cool compresses for pain relief
Cool compresses may provide relief for eye irritation or inflammation, but they are not typically used to treat diplopia. Diplopia in MS is more related to neuromuscular dysfunction or nerve damage, rather than acute inflammation or irritation of the eye. Therefore, while a cool compress may offer temporary relief for other symptoms, it is not a targeted solution for double vision in this context.