A patient who has been taking propranolol (Inderal) for 18 months reports, "I stopped taking the medication yesterday, because my blood pressure has been normal for the past 3 months."

Question

The most appropriate response by the nurse would be which of the following statements?
a. "Keep an accurate record of your blood pressure and come to the clinic next week."
b. "Have you had any chest pain or palpitations?"
c. "You should come to the emergency department immediately. The drug should be tapered over 2 weeks to prevent rebound hypertension."
d. "Continue taking the medication until another can be started to prevent withdrawal symptoms."

Answer 1

ANS: C
The patient should come to the emergency department immediately, because rebound hypertension can occur when propranolol is stopped without weaning or tapering.
The patient should not wait until next week to be seen, because rebound hypertension can become life-threatening. The patient should be instructed to come to the emergency department immediately.
Although asking about chest pain and palpitations may be important, sudden withdrawal from propranolol can lead to rebound hypertension, and the patient should be seen immediately.
The patient states that he has already stopped taking the medication, and having him resume taking it is not going to make up for the adverse effects that may occur from sudden withdrawal. The patient should be seen immediately.