The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient’s provider if the patient had a history of which condition?

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.

A) Increase in mental acuity: Beta-adrenergic blockers (beta-blockers) do not directly affect mental acuity. In fact, some beta-blockers may cause side effects like fatigue or drowsiness, which can affect mental sharpness. Beta-blockers primarily focus on cardiovascular effects, not cognitive function, making this an unlikely therapeutic goal for their use.
B) Slowing of gastrointestinal motility: Beta-blockers can reduce sympathetic nervous system activity, which may indirectly affect the gastrointestinal system. However, slowing gastrointestinal motility is not a primary therapeutic goal of beta-blocker therapy. The main action of beta-blockers is in the cardiovascular system, not in regulating GI function.
C) Decreased production in gastric acid: Beta-blockers do not significantly reduce gastric acid production. Medications such as proton pump inhibitors or H2 blockers are typically used for managing gastric acid production or reflux. Beta-blockers focus on reducing the workload of the heart and controlling blood pressure, not on acid secretion.
D) Reduction in the heart rate and blood pressure: The primary therapeutic effect of beta-blockers is the reduction of heart rate (negative chronotropic effect) and blood pressure (due to reduced cardiac output and inhibition of the sympathetic nervous system). This is especially beneficial for managing conditions like hypertension, heart failure, and arrhythmias. It is the most likely goal of beta-blocker therapy prescribed by the provider.