A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?
A. Monitor the apical pulse rate.
B. Instruct the client to take medication with food.
C. Question the physician about the order.
D. Caution the client to rise slowly when standing.
Correct Answer: C. Question the physician about the order.
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. Propranolol is also contraindicated in those with any lung pathologies, such as COPD, asthma, or emphysema. The pathophysiology of this mechanism is solely due to the effects that beta-2 receptors have on lung function. Normally, activation of beta-2 receptors vasodilates the smooth muscle in the lungs. When using agents like propranolol in patients with underlying lung issues, the blockage of beta-2 causes vasoconstriction of smooth muscle, worsening respiratory function.
Option A: The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician. Whenever a patient is receiving propranolol therapy, it is beneficial to routinely monitor their blood pressure, pulse, and respiratory rate. It is especially important in those with coronary artery disease, COPD, or any other condition that beta-blockade might negatively affect.
Option B: Beta-blockers are widely used in the management of cardiac conditions and thyrotoxicosis, and to reduce perioperative complications. Asthma and chronic obstructive pulmonary disease (COPD) have been classic contraindications to the use of beta-blockers because of their potential for causing bronchospasm.
Option D: Propranolol is contraindicated in patients with asthma, chronic obstructive pulmonary disease (COPD), atrioventricular (AV) block, intermittent claudication, and psychosis. The most frequent adverse effects are lightheadedness, fatigue, dyspnea upon exertion, bronchospasm, insomnia, impotence, and apathy. Reducing the dose of propranolol frequently controls these adverse effects.
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