Diabetes Mellitus Q 34 - Gyan Darpan : Learning Portal
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Friday 8 April 2022

Diabetes Mellitus Q 34

After suffering an acute MI, a client with a history of type 1 diabetes is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated with I.V. administration of metoprolol? Select all that apply.
    A. Monitor glucose levels closely.
    B. Monitor for heart block and bradycardia.
    C. Monitor blood pressure closely.
    D. Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 minutes.
    E. Be aware that the drug is not compatible with morphine.

Correct Answer: A, B, & C.

Metoprolol is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors at oral doses of less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects.

Option A: Metoprolol masks the common signs of hypoglycemia; therefore, glucose levels should be monitored closely in diabetic clients. The mechanism responsible for ?-blocker–induced hypoglycemia involves inhibition of hepatic glucose production, which is promoted by sympathetic nervous stimulation. In addition, adrenergic counter-regulation is diminished, resulting in a reduction in glycogenolysis.
Option B: When used to treat an MI, metoprolol is contraindicated in clients with heart rates less than 45 beats/minute and any degree of heart block, so the nurse should monitor the client for bradycardia and heart block.
Option C: Metoprolol masks common signs and symptoms of shock, such as decreased blood pressure, so blood pressure should also be monitored closely. Beta-blockers, including atenolol and metoprolol, may mask the signs of tachycardia and diaphoretic skin seen in patients in shock.
Option D: The nurse should give the drug undiluted by direct injection. Lopressor, metoprolol tartrate USP, is a selective betai-adrenoreceptor blocking agent, available in 5-mL ampoule for intravenous administration. Each ampul contains a sterile solution of metoprolol tartrate USP, 5 mg, and sodium chloride USP, 45 mg, and water for injection USP.
Option E: Although metoprolol should not be mixed with other drugs, studies have shown that it is compatible when mixed with morphine sulfate or when administered with alteplase infusion at a Y-site connection.

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