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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Partially compensated metabolic alkalosis:
Metabolic alkalosis is characterized by elevated bicarbonate levels (HCO3), but in this case, the HCO3 is elevated (29 mEq/L), which suggests alkalosis. However, the PaCO2 is elevated at 47 mmHg, which is more consistent with a respiratory problem. A fully or partially compensated metabolic alkalosis would show a normal or low PaCO2 (due to respiratory compensation). Therefore, this option does not fit the ABG results.
B. Partially compensated respiratory acidosis: In this case, the pH is 7.17, which is low and indicates acidosis. The PaCO2 is 47 mmHg, which is elevated (normal range: 35-45 mmHg), indicating that the respiratory system is contributing to the acidosis. The HCO3 is 29 mEq/L, which is elevated (normal range: 22-26 mEq/L), suggesting a compensatory response from the kidneys to retain bicarbonate in an attempt to buffer the acidosis. Since the pH is still below normal and has not yet returned to the normal range (7.35-7.45), this suggests that the compensation is partial and the primary issue is respiratory acidosis.
C. Fully compensated metabolic alkalosis:
This answer is incorrect because metabolic alkalosis is not the primary disturbance here. Also, for a condition to be fully compensated, the pH would need to be within the normal range (7.35-7.45). Since the pH is 7.17, the condition is not fully compensated.
D. Fully compensated respiratory acidosis:
For fully compensated respiratory acidosis, the pH should be within the normal range, as the kidneys would have fully compensated for the elevated PaCO2. Since the pH is 7.17, this is a sign of partial compensation, not full compensation. Therefore, this option is incorrect.
Correct Answer is A
Explanation
A. Allowing undamaged areas in the lower part of the lungs to be ventilated: The prone position is commonly used in patients with acute respiratory distress syndrome (ARDS) to improve oxygenation and ventilation. In ARDS, the lung tissue is often damaged, particularly in the dorsal (back) regions of the lungs, due to gravity and ventilation-perfusion mismatch. By placing the patient in the prone position, gravity helps redistribute the blood flow and improve ventilation to the posterior (lower) parts of the lungs, which are typically under-ventilated in the supine position. This positioning allows healthier or less-damaged areas of the lungs to receive better airflow, improving overall oxygenation.
B. Relieving pressure on the diaphragm and allowing expansion: While the prone position does shift pressure away from certain areas, its primary benefit is not related to relieving pressure on the diaphragm. The diaphragm, while somewhat affected by body position, is not the key structure being targeted for ventilation improvement. The main goal of prone positioning is to improve lung aeration in areas affected by ARDS, not directly to relieve diaphragm pressure.
C. Decreasing pressure to the back of the rib cage: The prone position does not specifically target reducing pressure to the back of the rib cage. Although it changes how pressure is distributed across the body, the main goal is to facilitate better ventilation and perfusion to the posterior lung regions, not necessarily to reduce pressure on the rib cage itself.
D. Sniffing fluid into the back area of the lungs: This option is unclear and not accurate. The prone position does not "sniff" fluid into the lungs; rather, it helps to redistribute fluid and improve the ventilation of the lung areas that are less affected by edema or inflammation in ARDS. The goal is to improve the ventilation/perfusion ratio and prevent further collapse of lung tissue.
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