Beta-Adrenergic Blockers

Every question here, with the answer

1. A client with heart failure is due for carvedilol. The nurse finds a blood pressure of 84/50 mm Hg and a heart rate of 58 beats per minute. What should the nurse do?

   1. Give the dose and have the client lie flat.
   2. Give the dose with a full glass of water.
   3. Withhold the dose and contact the health care provider.
   4. Give the dose and recheck vital signs in two hours.

   Answer: Withhold the dose and contact the health care provider.

   Blood pressure and pulse are checked before a beta blocker, and it should not be given to a hypotensive client or one with a heart rate under 50–60 beats per minute. This client is hypotensive with a borderline rate, so the dose is held and the provider contacted. The other options still give a drug that lowers blood pressure and heart rate further.

2. A client with heart failure also has moderate asthma and uses an albuterol inhaler as needed. The provider's order lists carvedilol. What is the nurse's priority concern?

   1. Carvedilol will raise the client's blood glucose.
   2. The client will need a higher dose of carvedilol because of asthma.
   3. A nonselective beta blocker may cause worsening bronchospasm in this client.
   4. Carvedilol will make the albuterol work faster.

   Answer: A nonselective beta blocker may cause worsening bronchospasm in this client.

   Carvedilol is nonselective, and nonselective beta blockers should not be used in clients with asthma taking a short-acting beta agonist because they may worsen bronchospasm. The other statements are not supported by the section.

3. A nurse is teaching a client with heart failure who is starting metoprolol succinate. Which instructions should the nurse include? Select all that apply.

   1. Check your blood glucose closely if you have diabetes.
   2. Take it only with a meal.
   3. Take your pulse before each dose as directed.
   4. Report weight gain and swelling in the feet or ankles.
   5. Stop the medication if you feel tired.

   Answer: Check your blood glucose closely if you have diabetes., Take your pulse before each dose as directed., Report weight gain and swelling in the feet or ankles.

   Clients take their pulse before the dose, watch for worsening heart failure such as weight gain and peripheral edema, and monitor glucose because beta blockers mask hypoglycemia. The drug must not be stopped abruptly, and it can be taken without regard to meals.

4. A client taking a beta blocker for heart failure says, "I feel better, so I'm going to stop these pills tomorrow." What is the nurse's best response?

   1. "That is fine once your symptoms are gone."
   2. "Skip every other day until you run out."
   3. "Cut the dose in half on your own for a week, then stop."
   4. "Stopping suddenly can worsen angina or cause a heart attack; talk to your provider, who can taper it."

   Answer: "Stopping suddenly can worsen angina or cause a heart attack; talk to your provider, who can taper it."

   The black box warning says beta blocker therapy should not be stopped abruptly but tapered gradually, and clients should seek provider advice before discontinuing. Stopping or self-tapering without the provider ignores that warning.

5. Which findings or conditions call for caution or are contraindications when giving a beta blocker? Select all that apply.

   1. Migraines
   2. Moderate to severe asthma with a nonselective agent
   3. Diabetes mellitus
   4. Controlled hypertension
   5. Sinus bradycardia

   Answer: Moderate to severe asthma with a nonselective agent, Diabetes mellitus, Sinus bradycardia

   Beta blockers can aggravate sinus bradycardia, mask hypoglycemia in diabetes, and nonselective agents are contraindicated in moderate to severe asthma. Hypertension and migraines are conditions beta blockers are used to treat.

6. A client with type 1 diabetes takes bisoprolol. Which statement by the client shows correct understanding?

   1. "Bisoprolol keeps my blood sugar from dropping."
   2. "My heart will race if my sugar drops, so I will notice it right away."
   3. "I may not feel the usual signs of low blood sugar, so I need to check my glucose closely."
   4. "I can stop checking my sugar while I take this pill."

   Answer: "I may not feel the usual signs of low blood sugar, so I need to check my glucose closely."

   Beta blockers block the sympathetic response that is activated when blood sugar is low, so they can mask hypoglycemia; clients should monitor glucose closely. The other statements assume normal warning signs or a protective effect that the drug does not have.