Class II: Beta Adrenergic Blockers

Every question here, with the answer

1. A client with atrial fibrillation is due for oral metoprolol. The nurse finds an apical heart rate of 52 beats per minute. The client has no pacemaker. What should the nurse do?

   1. Hold the dose and check with the health care provider.
   2. Give the dose with food to slow absorption.
   3. Give half the dose to reduce the effect on heart rate.
   4. Give the dose and recheck the heart rate in one hour.

   Answer: Hold the dose and check with the health care provider.

   Beta blockers slow the heart rate and can cause bradycardia. With a baseline heart rate under 60 and no pacemaker, the nurse checks with the provider before giving the drug. Giving all or part of the dose, or changing how it is absorbed, still lowers an already slow rate.

2. A client with type 2 diabetes is starting metoprolol. Which teaching point is most important for this client?

   1. Metoprolol protects you from hypoglycemia.
   2. Metoprolol will lower your blood glucose, so reduce your diabetes medication.
   3. Take metoprolol only on days your blood glucose is high.
   4. The usual warning signs of low blood sugar, like a racing heart, may not show up.

   Answer: The usual warning signs of low blood sugar, like a racing heart, may not show up.

   Beta blockers can mask hypoglycemia because they blunt the heart-rate response, so a client with diabetes may not feel the typical warning symptoms. The other options invent effects the drug does not have or suggest skipping doses.

3. A nurse is teaching a client who is going home on a beta-adrenergic blocker. Which instructions should the nurse include? Select all that apply.

   1. Double the next dose if you miss one.
   2. Stop the medication if you feel tired.
   3. Stand up slowly from sitting or lying down.
   4. Do not stop the medication suddenly.
   5. Call the health care provider if you feel very dizzy.

   Answer: Stand up slowly from sitting or lying down., Do not stop the medication suddenly., Call the health care provider if you feel very dizzy.

   The client should move slowly to avoid orthostatic hypotension, never stop abruptly because that can cause arrhythmias and withdrawal effects, and report marked dizziness. Stopping for fatigue is abrupt discontinuation, and doubling a dose is not in the teaching.

4. An esmolol infusion is running through a peripheral IV. The nurse notices swelling and coolness at the insertion site. What is the nurse's first action?

   1. Slow the infusion rate by half.
   2. Apply a warm compress and continue the infusion.
   3. Stop the infusion.
   4. Flush the line to check patency.

   Answer: Stop the infusion.

   Esmolol is a vesicant, and extravasation can cause skin necrosis. When extravasation occurs, the infusion is stopped first, then the line aspirated and the limb elevated. Slowing, continuing or flushing pushes more drug into the tissue.

5. Which conditions are contraindications or reasons for caution with beta-adrenergic blockers? Select all that apply.

   1. Cardiogenic shock
   2. Controlled hypertension
   3. Acute exacerbation of heart failure
   4. Stable angina
   5. Severe bradycardia without a pacemaker

   Answer: Cardiogenic shock, Acute exacerbation of heart failure, Severe bradycardia without a pacemaker

   Beta blockers are contraindicated in severe bradycardia without a pacemaker and in cardiogenic shock, and should be used cautiously in acute heart failure exacerbations. Hypertension and angina are conditions they are used to treat.

6. A client asks why the health care provider started metoprolol at a low dose for heart failure instead of the full dose. Which response is accurate?

   1. Low doses work better than high doses for heart failure.
   2. The full dose is only used for high blood pressure.
   3. A low dose prevents the drug from lowering the heart rate.
   4. Starting too quickly or too high can make heart failure worse, because the drug reduces how hard the heart contracts.

   Answer: Starting too quickly or too high can make heart failure worse, because the drug reduces how hard the heart contracts.

   Beta blockers treat heart failure long term, but because they decrease contractility, starting too fast or too high can cause a heart failure exacerbation. The other statements are not supported by the section.