Question

Captopril, furosemide, and metoprolol are prescribed for a client with systolic heart failure. The client's blood pressure is 136/82 mm Hg and the heart rate is 65 bpm. Prior to medication administration at 0900, the nurse reviews the lab tests (see chart). What should the nurse do first?

1. Administer the medications.
2. Call the health care provider (HCP).
3. Withhold the captopril.
4. Question the metoprolol dose.

Answer 1

The nurse should first question the metoprolol dose before administering other medications, to avoid the risk of causing bradycardia.

Step-by-step explanation:

The question is about determining the nurse's first course of action prior to administrating medications to a client with systolic heart failure who is prescribed captopril, furosemide, and metoprolol. The vital signs provided are a blood pressure of 136/82 mm Hg and a heart rate of 65 bpm.

Given that metoprolol is a beta-blocker that lowers heart rate and blood pressure, and the client's heart rate is already at the lower limit of normal, the nurse should first consider whether administering the current dose of metoprolol could potentially cause bradycardia. Since there is a risk of overprescription leading to dangerously low heart rates, the nurse should first Question the metoprolol dose (Option 4) in line with evidence-based practice guidelines. After addressing the immediate safety concern regarding the heart rate, the nurse can then proceed with the other medications, provided that no other lab values or clinical indicators suggest the need to withhold or modify the doses.

Always consult with a healthcare provider when making decisions about medication administration. Individual patient factors and the context of the lab results and other clinical information may influence the decision.