# A nurse is teaching a patient newly started on metoprolol 25 mg twice daily for hypertension. Which statements should be included in patient teaching? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374879&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A nurse is teaching a patient newly started on metoprolol 25 mg twice daily for hypertension. Which statements should be included in patient teaching? Select all that apply.

1

"Take your pulse before each dose; if it is below 60 beats per minute or you feel dizzy, hold the dose and call the provider before taking the next dose."

2

"You may experience fatigue, cold extremities, or sexual dysfunction; report bothersome symptoms but do not stop on your own."

3

"Do NOT stop metoprolol abruptly; sudden discontinuation can cause rebound hypertension, tachycardia, angina, or even MI. Tapering must be supervised by your provider."

4

"Rise slowly from sitting or lying positions to reduce orthostatic hypotension and dizziness; this is especially important during the first weeks."

5

"If you develop fatigue, weakness, or dizziness, stop taking metoprolol immediately and contact your provider because these may indicate a serious heart problem."

## Explanation

Beta blocker patient teaching: check pulse and hold for HR < 60 or symptoms (dizziness), NEVER stop abruptly (rebound HTN, tachycardia, angina, MI risk), expect and report fatigue/cold extremities/sexual dysfunction without self-discontinuing, and rise slowly to prevent orthostasis. Choice 5 is dangerous — telling patients to stop a beta blocker on their own when feeling tired is the EXACT cause of the rebound MI complication. Tapering is supervised.

## In-depth explanation

The single most-tested beta blocker teaching point is "do NOT stop abruptly". Patients on beta blockers for HTN, angina, post-MI, or HF have the rebound risk; the medication must be tapered. Bronchospasm in asthmatics is also testable — non-selective beta blockers (propranolol) are avoided in asthma; cardio-selective (metoprolol, atenolol) are preferred but still cautious.

## Clinical scenario

**55-year-old started on metoprolol 25 mg twice daily for hypertension**. The patient is asking how to take the medication, what to monitor, and what to avoid. The nurse provides comprehensive medication teaching.

## Key concepts

- **Metoprolol** — Cardio-selective beta-1 blocker for HTN, angina, HF, and post-MI; checked HR and BP before each dose.
- **Beta blocker rebound** — Abrupt discontinuation causes rebound HTN, tachycardia, angina, or MI; tapering required.
- **Hold parameters** — Hold for HR < 60 or symptomatic hypotension; notify provider before next dose.

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