A nurse is reinforcing discharge teaching with a client who will be starting a new prescription for digoxin. Which of the following instructions should the nurse include?

Advance directives are legal documents that allow clients to communicate their healthcare preferences in advance, in case they become unable to make decisions in the future. These may include a living will and designation of a healthcare proxy or durable power of attorney for healthcare. They ensure that the client’s autonomy and treatment wishes are respected during illness or surgical procedures. Nurses play an important role in educating clients about their purpose and encouraging informed decision-making.

Rationale:
A. Advance directives protect a client’s right to make their own healthcare decisions by clearly documenting their wishes regarding treatment and end-of-life care. They ensure that healthcare providers and family members follow the client’s preferences if the client becomes incapacitated. This statement accurately reflects the purpose of advance directives and supports client autonomy.

B. Advance directives do not require approval by a lawyer to be valid in most settings. While legal consultation may help with preparation, many advance directives can be completed using standardized forms and require only proper signing and witnessing. Therefore, this statement is incorrect and may create unnecessary barriers to completion.

C. Advance directives are not limited to clients with life-threatening conditions. Any competent adult can complete them at any time, regardless of current health status. They are intended for future planning, not only for those who are critically ill.

D. Advance directives are not the same as a consent form for healthcare treatment. Consent forms are used to authorize specific procedures at a given time, while advance directives outline broader preferences for future care decisions. They serve different legal and clinical purposes.

Metoprolol is a beta-adrenergic blocker commonly used to manage hypertension, angina, heart failure, and certain arrhythmias. It works by selectively blocking beta-1 receptors in the heart, leading to decreased heart rate, reduced myocardial contractility, and lowered cardiac output. While these effects are therapeutic, they can also produce predictable adverse effects that require close nursing monitoring. Understanding these effects helps prevent complications such as excessive cardiac suppression.

Rationale:
A. Hypertension is not an expected adverse effect of metoprolol; instead, the medication is prescribed to lower blood pressure. By blocking beta-1 receptors, it reduces cardiac output and inhibits renin release from the kidneys, both of which contribute to decreased blood pressure. An increase in blood pressure would indicate treatment failure or another underlying issue rather than a drug side effect.

B. Bradycardia is a common adverse effect of metoprolol due to its action on beta-1 receptors in the heart. By decreasing sympathetic stimulation, it slows the sinoatrial node firing rate and reduces heart rate. Excessive bradycardia can lead to dizziness, fatigue, hypotension, or syncope and requires careful monitoring and possible dose adjustment.

C. Urinary retention is not typically associated with metoprolol use. This adverse effect is more commonly linked to anticholinergic medications or drugs that affect bladder contractility. Metoprolol primarily acts on cardiac receptors and does not significantly interfere with urinary function.

D. Weight loss is not a characteristic adverse effect of metoprolol. Beta-blockers are more commonly associated with weight gain in some patients due to reduced metabolic rate and fatigue-related activity changes. Therefore, unexpected weight loss would suggest an unrelated condition rather than a direct medication effect.