Practice Question
A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further?
Answer Choices:
Correct Answer:
Diet-controlled Type 2 diabetes mellitus
Rationale:
💎 Metoprolol is a beta-1 adrenergic blocker that can mask the typical symptoms of hypoglycemia, especially tachycardia, in clients with diabetes.
💎 Clients with Type 2 diabetes mellitus who use only diet control might still experience episodes of low blood glucose, particularly if appetite or intake changes during illness.
💎 Because beta-blockers blunt the adrenergic response (shakiness, palpitations), the client may not recognize hypoglycemia until it becomes severe, increasing the risk of neuroglycopenic symptoms such as confusion or fainting.
💎 The nurse should therefore further investigate how well the client's blood glucose is monitored, their history of hypoglycemic episodes, and reinforce teaching about alternative signs of hypoglycemia (e.g., sweating, visual changes).
💎 This makes diet-controlled diabetes a priority safety concern that must be assessed and monitored closely when starting metoprolol therapy.
A history of left-sided heart failure
💎 Metoprolol is actually one of the preferred beta-blockers in carefully titrated doses for clients with chronic stable heart failure, as it reduces myocardial oxygen demand and improves survival.
💎 Rather than being a contraindication, left-sided heart failure is often an indication for beta-blocker therapy when the client is stable and monitored.
Recently treated bilateral pneumonia
💎 A past, successfully treated episode of pneumonia does not represent a specific or major risk with metoprolol use, especially if the client's respiratory status has returned to baseline.
💎 There is no direct, high-risk interaction between resolved pneumonia and beta-blockers that would require investigation over diabetes.
A concurrent prescription for tadalafil
💎 The serious interaction with tadalafil is with nitrates, causing profound hypotension; this risk is not typically associated with beta-blockers alone.
💎 While monitoring blood pressure is still important, tadalafil does not represent the same level of concern with metoprolol as diabetes-related hypoglycemia masking.
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This question is from Custom VN230 Pharmacology Quiz 7 which contains 21 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pharmacology
- Answer Choices: 4