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

Answer and Explanation

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.

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Correct Answer is D

Explanation

A. Encourage the daily use of the incentive spirometer: While the use of an incentive spirometer is important for improving lung expansion and preventing atelectasis, it may not be effective unless the client’s pain is well-managed. If pain is not addressed first, the client may be unable or unwilling to use the incentive spirometer properly, thus delaying recovery and increasing the risk of respiratory complications.

B. Assisting the client with ambulation in the hallway: Ambulation is an important post-operative activity for improving circulation and preventing complications such as deep vein thrombosis (DVT) or pneumonia. However, the priority at this time should be addressing the client's pain and ensuring adequate breathing before attempting more strenuous activities like ambulation. If the client is in pain and not breathing effectively, ambulation could exacerbate respiratory difficulties..

C. Increasing the chest tube suction to 44 mmHg: Increasing chest tube suction is not indicated unless there is evidence of inadequate drainage or a specific complication, such as a pneumothorax or pleural effusion. In this case, the priority is to address the client’s respiratory function, which is more likely to improve with pain relief, deep breathing, and appropriate positioning. Suctioning should only be adjusted if there is a clinical reason such as signs of a pneumothorax or inadequate drainage, which is not indicated by the information provided.

D. Assessing for adequate pain relief: The most urgent intervention in this scenario is ensuring that the client has adequate pain relief. The client’s shallow respirations and guarding of the operative site suggest that pain is inhibiting effective breathing and deep inspiration, which is crucial for preventing atelectasis and improving ventilation. Pain control is essential in promoting optimal respiratory function, as uncontrolled pain can lead to shallow breathing, reduced lung expansion, and compromised gas exchange, all of which can increase the risk of acute respiratory failure. Once pain is managed, the client will be better able to engage in other respiratory interventions

A. I will report any unusual movements or behaviors to my healthcare provider." B. I may experience nausea while taking this medication." C. I will take this medication with a high-protein meal." D. I will avoid sudden changes in position to prevent dizziness or falls."

Correct Answer is C

Explanation

A. "I will report any unusual movements or behaviors to my healthcare provider."
This statement is correct and indicates that the client understands the potential side effects of levodopa/carbidopa. The medication can cause dyskinesia (uncontrolled movements) and other behavioral changes, so the client should report these symptoms to their healthcare provider for possible adjustment of the treatment plan.

B. "I may experience nausea while taking this medication."
This is also correct. Nausea is a common side effect of levodopa/carbidopa, especially when starting the medication. Taking it with food may help reduce this side effect, but some clients may still experience nausea.

C. "I will take this medication with a high-protein meal."
This statement is incorrect. Levodopa is absorbed best on an empty stomach or with a low-protein meal. Protein can interfere with the absorption of levodopa because amino acids (found in proteins) compete with levodopa for absorption across the blood-brain barrier. Therefore, it's recommended that levodopa/carbidopa be taken either 30 minutes before or 1 hour after meals, especially those high in protein.

D. "I will avoid sudden changes in position to prevent dizziness or falls."
This statement is correct. Levodopa/carbidopa can cause orthostatic hypotension (a sudden drop in blood pressure when standing up), which increases the risk of dizziness and falls. The client should be advised to change positions slowly and use support when rising from a sitting or lying position to avoid injury.

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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?

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