An unresponsive male victim of a diving accident is brought to the emergency department where it is determined that immediate surgery is required to save his life.

The client is accompanied by a close friend, but no family members are available.

Which action should the nurse take first?

Choice A rationale:

The nurse should monitor the client for tachycardia as an adverse effect of beta blockers like metoprolol. Beta blockers work by reducing heart rate and blood pressure, so the presence of tachycardia would be unexpected and could indicate a potential adverse reaction to the medication.

Choice B rationale:

Hyperglycemia is not a common adverse effect of beta blockers like metoprolol. In fact, these medications can sometimes mask the symptoms of hypoglycemia, making it important for diabetic patients to closely monitor their blood glucose levels. However, hyperglycemia is not a typical side effect.

Choice C rationale:

Bronchospasm is not a common adverse effect of metoprolol. Beta blockers like metoprolol can cause bronchoconstriction in some individuals, but this effect is generally more prominent with non-selective beta blockers like propranolol. It is not a common adverse effect of metoprolol and would not be the primary concern when monitoring a patient on this medication.

Choice D rationale:

The nurse should monitor the client for hyperkalemia as an adverse effect of metoprolol. Beta blockers can inhibit the release of insulin from the pancreas, which can lead to elevated blood potassium levels (hyperkalemia). This is particularly important in patients with renal impairment, as they may have difficulty clearing excess potassium from the body.

When a preoperative client expresses fear and uncertainty about undergoing surgery, the priority action for the practical nurse (PN) is to notify the charge nurse of the client's concerns. This is important because the charge nurse can coordinate appropriate interventions and support for the client, ensuring their emotional well-being and addressing their fears.

Let's evaluate the other options:

a) Encourage the client to continue with the scheduled surgery.
While it is important to provide support and reassurance to the client, simply encouraging them to continue with the scheduled surgery may not adequately address their specific concerns and fears. The charge nurse and the healthcare team should be involved to provide the necessary support and information to help alleviate the client's anxiety.

b) Document that the client has expressed concerns about the surgery.
Documenting the client's concerns is important for accurate record-keeping and continuity of care. However, it should not be the only action taken. Notifying the charge nurse is crucial to ensure appropriate follow-up and support for the client.

d) Remind the client that the consent has already been obtained.
Reminding the client that they have already signed the informed consent may not effectively address their fears and concerns. Reassurance and support should be provided, and involving the charge nurse and healthcare team is essential to address the client's emotional well-being.

In summary, when a preoperative client confides in the practical nurse (PN) about being frightened and unsure about undergoing surgery, the priority action is to notify the charge nurse of the client's concerns. This allows for appropriate interventions, support, and coordination of care to address the client's fears, ensure their emotional well-being, and provide necessary information about the surgical procedure.