An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

A) Increases contractility: Metoprolol, a beta-blocker, actually decreases contractility. It reduces the force of contraction of the heart muscle, which can help reduce myocardial oxygen demand and improve outcomes after ACS. Increasing contractility would counteract the therapeutic goals of metoprolol in managing ACS.
B) Increases preload: Preload refers to the volume of blood in the ventricles at the end of diastole. Metoprolol does not increase preload; rather, it reduces myocardial workload and oxygen demand, which does not directly affect preload but rather the heart's performance overall.
C) Decreases afterload: Metoprolol reduces afterload indirectly by lowering blood pressure and decreasing heart rate, which helps reduce the workload on the heart. This reduction in afterload supports the therapeutic goals of metoprolol in managing ACS by decreasing the heart's work and improving cardiac efficiency.
D) Decreases diastolic filling time: Metoprolol slows the heart rate, which can lead to increased diastolic filling time, not a decrease. Increased filling time can be beneficial as it allows the heart more time to fill with blood between beats, thereby improving cardiac output.

A) Determine if the client is taking the medication before meals: While the timing of medication relative to meals can affect absorption, this action assumes a specific problem without first clarifying the client's concerns. It's important to understand the nature of the client's issue before assessing medication administration.
B) Ask if his morning voiding is dark colored: Dark-colored urine may be a side effect of some medications, but this is a less direct approach to understanding why the client feels the medication is not working. It does not directly address the effectiveness of the medication.
C) Explore what the client means by the drug not working: This is the most appropriate initial intervention. Understanding the client's perception and specific concerns about the medication's effectiveness will guide further actions, such as assessing medication adherence, side effects, or the need for a medication adjustment.

D) Evaluate the client for signs of dyskinesia: While assessing for dyskinesia is important, it is more of a specific follow-up step. The priority is to understand the client's concerns about the medication's overall effectiveness before focusing on specific side effects.