The nurse is caring for a patient who has had an anterior wall MI. Which of the following complications should the nurse assess for in this patient?
(Select All that Apply.)

A. Atenolol is a beta-blocker, which can lower heart rate and blood pressure. A heart rate of 52 and a blood pressure of 90/56 are both abnormally low. The nurse should hold the medication and contact the provider, as this could indicate bradycardia or hypotension, both of which can be dangerous.

B. Recent intake of sildenafil. Sildenafil (Viagra) can interact with beta-blockers and cause a further drop in blood pressure. However, the priority is addressing the abnormal heart rate and blood pressure from option A before focusing on this interaction. The nurse should still monitor the patient closely for any significant changes in blood pressure, but the primary concern is not the interaction here.

C. Positional vertigo and wheezing. While wheezing could be a concern (as beta-blockers can exacerbate bronchospasm in patients with asthma or chronic lung conditions), positional vertigo may be more related to hypotension from the atenolol. Nonetheless, the priority here remains the low heart rate and blood pressure in option A, which is a more immediate concern.

D. Restlessness and mild confusion. These could be side effects or signs of an adverse reaction to atenolol, but they are less urgent compared to the low heart rate and blood pressure found in option A. The nurse should still assess the patient's mental status but prioritize contacting the provider for the more critical findings.

A. Encourage the patient to write questions on a white erase board: While writing on a whiteboard can be a helpful method of communication for some patients with ALS, it may not be effective as the disease progresses. In the later stages of ALS, patients often lose the ability to use their hands or arms, making writing impossible.

B. Use pre-arranged eye signals because eye muscles remain intact: In the later stages of ALS, most voluntary muscle function is lost, except for eye muscles. Using eye movements or pre-arranged eye signals (e.g., blinking or moving eyes up or down) is an effective way to communicate with patients who can no longer speak or write. The nurse can establish a system of eye signals to communicate with the patient.

C. Speak slow and repeat phrases due to cognitive decline: ALS typically does not cause cognitive decline. It primarily affects motor function. Speaking slowly and repeating phrases may be helpful if the patient is struggling with speech, but cognitive impairment is not a common symptom in ALS.

D. Have the patient squeeze the nurse's hand when intubated and on the ventilator: When a patient is intubated and on a ventilator, they may not be able to effectively squeeze the nurse's hand due to the presence of a tube in their airway. Additionally, the ability to use hand movements may be lost in advanced ALS, making this method of communication unreliable.