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:

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

Atenolol is a beta-blocker medication that works by lowering heart rate and blood pressure.
A systolic blood pressure of 90 mmHg is considered low, and administering an antihypertensive drug could cause a further, dangerous drop, leading to severe hypotension.
Standard and safe nursing practice is to withhold medication when vital signs are outside the safe range (e.g., systolic BP less than 100 mmHg).
Notifying the prescriber is a critical step for collaborative care and to receive further instructions, ensuring patient safety and appropriate management.

Option A: Increasing sodium intake would counteract the goal of hypertension management, as sodium causes fluid retention and raises blood pressure.
Option B: Atenolol is a beta-blocker and does not primarily affect serum potassium levels. This intervention is not the priority and does not address the immediate safety risk of hypotension.
Option C: This action is unsafe and could lead to severe hypotension, compromising patient safety. It ignores a critical assessment finding.

Clinical Relevance

Nursing practice connection: Use the key finding related to Safe administration of antihypertensive medications and nursing judgment based on clinical assessment to guide bedside assessment, documentation, and the next nursing action.
This scenario highlights the nurse's critical role as a patient safety advocate, using clinical judgment to prevent medication errors and adverse events.
It reinforces the 'Five Rights of Medication Administration,' which includes the 'right assessment' and 'right evaluation' before and after giving a drug.
What if the patient's blood pressure was 130/80 mmHg, but their heart rate was 52 bpm? The answer would be the same: hold the drug and notify the prescriber. Beta-blockers also lower the heart rate, and a rate below 60 bpm is a common parameter for withholding the medication.

How to Approach the Question

First, identify the drug mentioned in the question: Atenolol.
Next, recall the drug's class and primary action: It is a beta-blocker that lowers both blood pressure and heart rate.
Analyze the clinical data provided in the scenario: The patient's systolic blood pressure is 90 mmHg, which is a low reading.
Connect the drug's action to the clinical data. Giving a medication that lowers blood pressure to a patient who already has low blood pressure is unsafe.
Evaluate the given options based on patient safety principles. The only option that prioritizes safety and follows standard nursing protocol is to withhold the medication and communicate the finding to the healthcare provider.

Concept Tested & Keywords

Concept Tested: Safe administration of antihypertensive medications and nursing judgment based on clinical assessment.
Stem keywords: Atenolol, systolic blood pressure, 90 mmHg, nursing action
Lead-in keywords: appropriate nursing action
Clinical cues: Systolic blood pressure: 90 mmHg - This is a borderline hypotensive reading and a critical parameter for deciding whether to administer an antihypertensive medication.
Negative lead-in flag: false

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Harrison's Principles of Internal Medicine, 21st Edition p. 476-478

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