Before a scheduled dose of metoprolol tartrate, a client reports dizziness. The heart rate is 44/min and blood pressure is 88/54 mm Hg. Which action should the nurse take?
1Administer the dose with food and reassess the vital signs in 1 hour.
2Give twice the prescribed dose to stabilize the client's heart rate.
3Tell the client to stop metoprolol permanently and leave the clinic without further evaluation.
4Hold the scheduled dose, assess the client, and notify the prescriber for further instructions.✓ Correct answer
Explanation
Metoprolol lowers heart rate and blood pressure. Symptomatic marked bradycardia with hypotension requires holding the scheduled dose, immediate assessment, and prescriber notification according to the clinical setting and medication parameters. Giving or doubling the dose can worsen hemodynamic instability. Chronic beta-blocker therapy also should not be stopped permanently without a supervised plan because abrupt cessation can worsen angina or precipitate myocardial infarction.
Clinical reasoning The client has symptoms plus marked bradycardia and hypotension before a beta-blocker dose. Prevent further rate and pressure reduction while the cause and treatment plan are evaluated.
Decision rule Hold and escalate an unsafe scheduled dose, but do not direct abrupt permanent beta-blocker cessation without prescriber guidance.
Scenario Adult on continuous central TPN; bag empty 1 hour early. Next TPN bag not yet available from pharmacy.
Abrupt beta-blocker withdrawal — Sudden cessation after chronic therapy can worsen angina and may precipitate myocardial infarction; tapering and monitoring are generally required.
TPN dedicated line — TPN requires dedicated line; do not piggyback medications or draw blood.