Which of the following assessment findings in a client who is receiving atenolol for angina would be a cause for the nurse to hold the medication and contact the provider?

Recent intake of sildenafil

Heart rate 52 and blood pressure 90/56

Restlessness and mild confusion

Positional vertigo and wheezing

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is A

Explanation

A. "Reports taking an extra dose each day of their anticholinesterase medication."
This client is at highest risk for developing a cholinergic crisis. A cholinergic crisis occurs when there is overdose or excessive stimulation of acetylcholine receptors due to too much anticholinesterase medication. Symptoms include muscle weakness, respiratory distress, salivation, sweating, and bradycardia. Taking an extra dose of the medication can result in an overdose of acetylcholine, triggering these symptoms. Therefore, this client is at the greatest risk for a cholinergic crisis.

B. "Is experiencing a respiratory infection and is short of breath."
While respiratory infections can worsen symptoms of myasthenia gravis due to increased muscle weakness, this client is not directly at risk for a cholinergic crisis. Respiratory infections can increase the risk of myasthenic crisis, which is a different complication where muscle weakness worsens to the point of respiratory failure. A myasthenic crisis is caused by insufficient anticholinesterase medication or a disease exacerbation, not an overdose.

C. "Has a family history of autoimmune disorders."
A family history of autoimmune disorders may suggest a genetic predisposition to autoimmune diseases, but it does not increase the risk of a cholinergic crisis specifically. The risk of a cholinergic crisis is more directly related to medication management, not family history.

D. "Has a past medical history of type 2 diabetes mellitus."
Type 2 diabetes mellitus does not directly increase the risk of a cholinergic crisis. While diabetes may influence overall health and immune function, it does not have a direct impact on anticholinesterase therapy or the risk of cholinergic crisis in myasthenia gravis.

A. Expect fluctuations of symptoms with temperature change B. New surgical techniques offer the best hope for a cure C. Information about genetic testing D. The disease process is intense but short in duration

Correct Answer is C

Explanation

A. Expect fluctuations of symptoms with temperature change: While symptom fluctuations may occur due to various factors, temperature changes are not a hallmark feature of Huntington's Disease (HD). HD is characterized by progressive motor, cognitive, and psychiatric symptoms, including involuntary movements (chorea), cognitive decline, and mood disturbances. Although other neurological conditions may show symptom fluctuations with temperature changes, this is not specific to HD.

B. New surgical techniques offer the best hope for a cure: There are currently no cures for Huntington's Disease, and while medical management can help manage symptoms (such as using medications for chorea or psychiatric symptoms), surgical techniques do not offer a cure for HD. The disease is progressive, and interventions typically focus on symptom management rather than cure. Families should be informed that while research is ongoing, a cure is not currently available.

C. Information about genetic testing: Huntington's Disease (HD) is a genetic disorder caused by a mutation in the HTT gene. It is inherited in an autosomal dominant pattern, meaning that a person with a parent who has HD has a 50% chance of inheriting the disease. Genetic testing is a critical part of the diagnosis process, and it can confirm the presence of the mutated gene before symptoms appear, which is important for family planning and early intervention. However, while genetic testing can provide information about whether an individual will develop the disease, it does not alter the course of the disease or provide a cure. It is essential to provide this information to clients and families, so they understand the role of genetic counseling and testing in managing the disease.

D. The disease process is intense but short in duration: Huntington's Disease is progressive and long-lasting. The disease usually begins in mid-adulthood (typically between ages 30-50), and the symptoms worsen over time. Individuals with HD may live for 15-20 years after symptom onset. The disease duration is long-term, not short, and it becomes increasingly debilitating as it progresses. The intensity of symptoms increases over time, and the disease is not characterized by a short duration.

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Which of the following assessment findings in a client who is receiving atenolol for angina would be a cause for the nurse to hold the medication and contact the provider?

Nursing Test Bank

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Explanation

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