A client with bronchial asthma and current wheezing has a first dose of propranolol prescribed for essential tremor. Which action should the nurse take?
1Give propranolol and place a rescue albuterol inhaler within the client's reach.
2Administer propranolol with food and reassess the respiratory rate in 1 hour.
3Give one-half of the prescribed dose and document the client's asthma history.
4Hold propranolol and notify the prescriber because bronchial asthma is a contraindication.✓ Correct answer
Explanation
Propranolol is a nonselective beta blocker and is contraindicated in bronchial asthma because beta-2 blockade can provoke severe bronchospasm and interfere with bronchodilation. Current wheezing heightens the immediate concern. The nurse should hold the first dose and notify the prescriber for an alternative plan rather than administer a full or partial dose or rely on rescue albuterol to prevent the reaction.
Clinical reasoning Propranolol blocks beta-1 and beta-2 receptors. Blocking beta-2 receptors in bronchial smooth muscle can trigger bronchospasm and blunt the response to beta-agonist rescue therapy.
Decision rule Do not administer a contraindicated first dose; hold it and clarify the order with the prescriber.
Nonselective beta blocker — A medication that blocks both cardiac beta-1 and bronchial beta-2 receptors; propranolol is an example.
Bronchospasm risk — Beta-2 blockade can narrow the airways and impair bronchodilation, making propranolol unsafe in bronchial asthma.