A nurse is caring for a client prescribed Metoprolol. Which nursing action is most appropriate regarding checking heart rate and blood pressure prior to administration?

• 1 Level may decrease due to nicotine's competitive inhibition of hepatic enzymes, requiring a higher dose to maintain therapeutic effect.
• 2 Level may remain unchanged because theophylline is primarily eliminated by renal excretion and smoking does not impair kidney function ✓ Correct answer
• 3 Level may rise toward toxicity; dose typically needs reduction because smoking induces CYP1A2 and quitting reverses this induction
• 4 Level may fall toward subtherapeutic; dose typically needs increase because smoking inhibits CYP1A2 and quitting reverses this inhibition

For study reference only. Always follow current clinical guidelines and your institution’s protocols.