• A client with asthma receives a prescription for high
blood pressure duringa clinic visit. Which prescription
should the nurse anticipate the client to receive that is at
least likely to exacerbate asthma?
The best antihypertensive agent for clients with asthma is metoprolol
(Lopressor)(C), a beta2 blocking agent which is also cardioselective and
less likely to cause bronchoconstriction.
-Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and
increaseasthmatic symptoms.
,-Although carteolol (B) is a beta blocking agent and an effective
antihypertensive agent used in managing angina, it can increase a client's
risk for bronchoconstrictiondue to its nonselective beta blocker action.
-Propranolol (D) also blocks the beta2 receptors in the lungs, causing
bronchocon- striction, and is not indicated in clients with asthma and other
obstructive pulmonarydisorders.
• A male client who has been taking propranolol ( inderal)
for 18 months tellsthe nurse the healthcare provider
discontinued the medication because his blood pressure has
been normal for the past three months. Which instruction
should the use provide ANS Ask the health care provider about
tapering the drug dose over the next week.
Although the healthcare provider discontinued the propranolol, measures
to prevent rebound cardiac excitation, such as progressively reducing the
dose over one to two weeks (C), should be recommended to prevent
rebound tachycardia, hypertension, and ventricular dysrhythmias. Abrupt
cessation (A and B) of the beta-blocking agent may precipitate
tachycardia and rebound hypertension, so gradual weaning should be
recommended.
,• A client who is taking clonidine ( Catapres, Duraclon)
reports drowsiness. Which additional assessment should the
nurse make ANS How long has the clientbeen taking the medication
Drowsiness can occur in the early weeks of treatment with clonidine and
with continued use becomes less intense, so the length of time the client
has been on
the medication (A) provides information to direct additional instruction.
(B, C, and D)are not relevant.
• The nurse is preparing to admister atropine, an
anticholinergic, to a clientwho is scheduled for a
cholecystectomy. The client asks the nurse to explainth
reason for the prescribed medication. What response is best
for the nurseto provide ANS Decrease the risk of bradycardia
during surgery
Atropine may be prescribed preoperatively to increase the automaticity
of the sinoatrial node and prevent a dangerous reduction in heart rate (B)
during surgicalanesthesia. (A, C and D) do not address the therapeutic
action of atropine use perioperatively.
, • An 80 year old client is given morphine sulphate for
postoperative pain. Which concomitant medication should
the nurse question that poses a po-tential development of
urniary retention in this geriatric client. ANS Tricyclic
antidepressants
Drugs with anticholinergic properties, such as tricyclic antidepressants
(C), can exacerbate urinary retention associated with opioids in the older
client. Although tricyclic antidepressants and antihistamines with
opioids can exacerbate urinary retention, the concurrent use of (A and B)
with opioids do not. Nonsteroidal antiin- flammatory agents (D) can
increase the risk for bleeding, but do not increase urinaryretention with
opioids (D).
• The nurse obtains a heart rate of 92 and a blood
pressure of 110/76 prior to administering a scheduled dose
of verapamil (Calan) for a client with atrial flutter Which
action should the nurse implement ANS Admister the dose as
prescribed
Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular
(AV) nodal conduction, which slows the ventricular rate, and is used to
treat atrial flutter, so (A) should be implemented, based on the client's
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