A nurse prepares to administer the prescribed dose of propranolol (Inderal) to a patient recovering from acute myocardial infarction. When the pulse rate is checked, its is 52/minute and the rhythm is regular
What nursing action should the nurse take next?
a. Administer the drug as prescribed.
b. Only administer one half the dose and notify the prescriber.
c. Withhold the dose and document the pulse rate.
d. Withhold the dose and notify the prescriber.
ANS: D
A beta blocker, such as propranolol, should not be given with a pulse less than 60/minute, therefore the nurse should withhold the dose and notify the prescriber.
Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified.
It is not up to the nurse to redose the medication; that would be a violation of the Nurse Practice Act (nurses do not prescribe). Dosages can be changed only by a licensed prescriber and/or by an order left by a licensed prescriber that has sliding dosages and allows the nurse to determine the dosage within that prescribed range, depending on the patient's status.
Withholding the dose and documenting the pulse rate is appropriate but an incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication.
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