The statement that shows correct understanding
Her plan sets two separate hold limits for carvedilol: hold the dose and call the clinic if the pulse is below 55/min or the systolic blood pressure is below 90 mmHg. Either limit alone is enough to hold the dose. A pulse of 62/min with a systolic pressure of 88 mmHg meets the blood pressure limit, so she holds the dose and calls. This is the statement that shows correct understanding.
Why carvedilol is used and why it needs limits
Carvedilol is a nonselective beta blocker with additional alpha-blocking action. In cirrhosis with large varices that have never bled, it lowers portal pressure and reduces the risk of a first variceal bleed. The same actions can cause bradycardia and hypotension, which is why the plan includes hold limits. She must not skip, halve, or stop the drug on her own, because inconsistent dosing weakens protection against bleeding, and abrupt stopping of a beta blocker is avoided.
| Reading | Pulse below 55? | Systolic below 90? | Action |
|---|
| Pulse 54, systolic 110 | Yes | No | Hold and call; do not halve |
| Pulse 62, systolic 88 | No | Yes | Hold and call |
| Pulse 56, dizzy | No | Not stated | Report dizziness; do not stop on her own |
| Pulse 58, systolic 94 | No | No | Dose is due; take it |
Why the other statements are wrong
With a pulse of 54, she meets the hold limit, but taking half a tablet is a dose change made on her own; the plan says hold and call. Feeling dizzy with a pulse of 56 should be reported, but stopping the drug until the next visit is exactly what the plan forbids. With a pulse of 58 and systolic 94, both readings are above the limits, so skipping the dose leaves her unprotected without reason.
Teaching approach
Asking the client to apply the rules to sample readings is an effective way to check understanding. The nurse teaches her to check pulse and blood pressure before each dose, to record the readings, to treat the two limits as independent triggers, and to report dizziness, fainting, or black stools.
Exam takeaway
Watch out When a plan lists two hold limits joined by "or," one abnormal value is enough. Answers that modify the dose without contacting the prescriber are always unsafe.