A client with life-threatening beta-blocker poisoning remains bradycardic and hypotensive despite initial vasopressor therapy. Which prescribed therapy should the nurse anticipate early?
1Begin long-acting subcutaneous insulin without dextrose or laboratory monitoring.
2Begin high-dose IV regular insulin with dextrose and frequent glucose and potassium monitoring.✓ Correct answer
3Begin an IV calcium-channel blocker infusion to restore the heart rate and blood pressure.
4Stop vasopressors and other hemodynamic support before starting antidotal therapy.
Explanation
The AHA recommends early high-dose insulin therapy for life-threatening beta-blocker poisoning, with dextrose and close glucose, potassium, volume, and hemodynamic monitoring.
Quick answer Expect high-dose IV regular insulin therapy.
Why this is correct High-dose insulin supports poisoned myocardium but can cause hypoglycemia, potassium shifts, and fluid burden, so it requires protocol-driven monitoring.
Easy analogy or mental picture Support the failing pump while watching the fuel and electrolyte gauges.
Memory hook Beta blocker shock: HIET plus glucose and potassium surveillance.
NCLEX decision rule Use an antidotal shock protocol, not routine outpatient diabetes dosing.
Why the other choices are wrong Long-acting subcutaneous insulin is not titratable rescue therapy; calcium-channel blockade and withdrawal of support worsen shock.