Metoprolol

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.

1. Decrease in heart rate. The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse (AP) immediately before administration. The client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based on this data, which of the following is the appropriate action? 1. Withhold the medication. 2. Notify the registered nurse immediately. 3. Administer the medication as prescribed. 4. Administer half of the prescribed medication.

1. Withhold the medication. Rationale: Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and AP immediately before administration. If the systolic BP is below 90 mm/Hg and the AP is below 60 beats/min, the nurse should withhold the medication and document this action. Although the registered nurse should be informed of the client's vital signs, it is not necessary to do so immediately. The medication should not be administered because the data is outside of the prescribed parameters for this medication. The nurse should not administer half of the medication, or alter any dosages at any point in time.

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication. B) Disturbed sensory perception related to adverse central nervous system effects of the drug. C) Deficient knowledge related to therapeutic regimen. D) Risk for injury related to possible side effects of the adrenergic blockers.

A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication. Feedback: Using the ABCs of prioritization, Ineffective tissue perfusion (cerebral and cardiovascular) puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

A client has been taking metoprolol (Lopressor) and states to the homecare nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's primary intervention?

Assess the client's blood pressure. Abrupt withdrawal of a beta-blocking agent can cause rebound hypertension. These drugs should be gradually decreased. The nurse should immediately check the client's blood pressure, and then proceed with teaching and calling the health care provider.

When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that A) these medications may be taken with antacids to minimize gastrointestinal distress. B) hot baths and showers will help enhance the therapeutic effects and are encouraged. C) alcohol intake is encouraged for its vasodilating effects. D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

D) abrupt medication withdrawal may lead to a rebound hypertensive crisis. Feedback: CORRECT Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.

Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?

Decreased cardiac output related to effects of medication Using the ABCs of prioritization, decreased cardiac output puts the client at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?

Decreased cardiac output related to effects of medication Rationale: Using the ABCs of prioritization, decreased cardiac output puts the client at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?

Decreased cardiac output related to effects of medication Using the ABCs of prioritization, decreased cardiac output puts the client at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be

Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be

Risk for decreased cardiac tissue perfusion related to effects of medication.

After suffering an acute myocardial infarction (MI), a client w/ a history of type 1 diabetes is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated w/ I.V. metoprolol administration? Select all that apply. a) Monitor glucose level closely b) Monitor the client for heart block & bradycardia c) Monitor bp closely d) Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 mins. e) Know that the drug isn't compatible w/ morphine

a) Monitor glucose level closely b) Monitor the client for heart block & bradycardia c) Monitor bp closely Metoprolol masks the common signs of hypoglycemia; therefore, glucose level should be monitored closely in diabetics. Monitor the client for the development of heart block or bradycardia. When used to treat an MI, metoprolol is contraindicated in clients w/ heart rates less than 45 beats/min & any degree of heart block. Monitor bp frequently; metoprolol masks common signs & symptoms of shock, such as decreased bp. Give the drug undiluted by direct injection. Although mixing w/ other drugs should be avoided, studies have shown metoprolol is compatible when mixed w/ meperidine hydrochloride or morphine sulfate, or when administered w/ alteplase influsion at a Y-site connection

A client is prescribed metoprolol (Lopressor) to treat hypertension. It is important for the nurse to monitor the client for which condition? a. Bradycardia b. Hypertension c. Ankle edema d. Decreased respirations

a. Bradycardia

When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that

abrupt medication withdrawal may lead to a rebound hypertensive crisis.

For the client taking epinephrine, the nurse realizes there is a possible drug interaction with which drug? a. albuterol (Proventil) b. metoprolol (Lopressor) c. bethanechol (Urecholine) d. tolterodine tartrate (Detrol)

b. metoprolol (Lopressor)