# A client with life-threatening beta-blocker poisoning remains bradycardic and hypotensive despite initial vasopressor therapy. Which prescribed therapy should the nurse anticipate early?

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> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with life-threatening beta-blocker poisoning remains bradycardic and hypotensive despite initial vasopressor therapy. Which prescribed therapy should the nurse anticipate early?

## Option

1. Begin long-acting subcutaneous insulin without dextrose or laboratory monitoring.
2. Begin high-dose IV regular insulin with dextrose and frequent glucose and potassium monitoring. **✔ Correct answer**
3. Begin an IV calcium-channel blocker infusion to restore the heart rate and blood pressure.
4. Stop vasopressors and other hemodynamic support before starting antidotal therapy.

**Correct answer: 2**

## 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.

## In-depth explanation

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.References
1AHA Focused Update: Life-Threatening PoisoningPoison-center consultation, sodium bicarbonate, and high-dose insulin recommendations

## Clinical scenario

Beta-blocker poisoning
Coordinate vasopressors, antidotal therapy, glucose, potassium, volume status, ECG, and toxicology consultation.

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