A physician has prescribed Tab Atenolol 25 mg for a patient. On assessment the nurse finds that the patient's systolic blood pressure is 90 mmHg. The appropriate nursing action would be:

1. A

   advice the patient to increase sodium intake

2. B

   monitor serum potassium levels

3. C

   administer the drug and continue monitoring the blood pressure

4. D

   hold the drug and notify the prescriber

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• Atenolol is a beta-adrenergic blocker (beta-blocker), a class of medication that lowers blood pressure and heart rate.
• A systolic blood pressure (SBP) of 90 mmHg is at the lower limit of the normal range and is considered hypotensive for a patient being treated for hypertension.
• Administering a beta-blocker to a patient with a low SBP can cause a further, potentially dangerous, drop in blood pressure, compromising perfusion to vital organs.
• The standard of care and the safest nursing action is to withhold the medication and immediately notify the prescribing physician or healthcare provider for further instructions.
• Nursing guidelines often specify holding beta-blockers if the SBP is less than 90-100 mmHg or the heart rate is below 60 beats/min.

Why Other Options Were Wrong

• Option A: Increasing sodium intake causes fluid retention and raises blood pressure, which is the opposite of the therapeutic goal for a patient with hypertension.
• Option B: Atenolol is a cardioselective beta-blocker and does not typically cause significant changes in serum potassium levels. This is not the priority assessment.
• Option C: This action is unsafe and demonstrates poor clinical judgment. It ignores the critical assessment finding of hypotension and puts the patient at risk for severe adverse effects.

Related Visual

• Visual 1: Flowchart: Decision-making process for administering antihypertensive medication, showing the steps of checking vitals, comparing to hold parameters, and deciding to administer or hold/notify.
• Visual 2: Infographic: Signs and symptoms of hypotension (dizziness, lightheadedness, blurred vision, fainting, fatigue) vs. hypertension (often asymptomatic, 'the silent killer').

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing responsibilities and patient safety during the administration of antihypertensive medications, specifically beta-blockers to guide bedside assessment, documentation, and the next nursing action.
• This scenario highlights the nurse's crucial role as a patient safety advocate. The nurse is the last line of defense before a medication reaches the patient, and accurate pre-administration assessment is non-negotiable.
• Failure to hold the medication could lead to a hypotensive crisis, resulting in falls, syncope (fainting), and potentially ischemic injury to the brain or heart.
• What if? If the patient's SBP was 110 mmHg but their heart rate was 55 bpm, the correct action would still be to hold the drug and notify the prescriber. Beta-blockers also slow the heart rate, and a rate below 60 bpm (bradycardia) is another common parameter for holding the medication.

How to Approach the Question

• First, identify the drug mentioned: Atenolol. Recall or determine its drug class (beta-blocker) and primary action (lowers blood pressure and heart rate).
• Next, analyze the clinical data provided in the stem: The patient's systolic blood pressure is 90 mmHg.
• Synthesize these two pieces of information. Ask yourself: 'Is it safe to give a drug that lowers blood pressure to a person whose blood pressure is already low?' The answer is no.
• Evaluate the options based on this conclusion. The only option that prioritizes patient safety by addressing the low blood pressure is to withhold the drug and inform the prescriber.
• Eliminate the other options: increasing sodium is contraindicated, monitoring potassium is not the priority for this drug, and administering the drug is unsafe.

Concept Tested & Keywords

• Concept Tested: Nursing responsibilities and patient safety during the administration of antihypertensive medications, specifically beta-blockers.
• Stem keywords: Atenolol, systolic blood pressure, 90 mmHg, nursing action
• Lead-in keywords: appropriate
• Clinical cues: Systolic blood pressure of 90 mmHg: This is a critical value indicating hypotension or borderline hypotension, which directly influences the decision to administer a blood pressure-lowering medication.

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