Page 65 - Saunders Comprehensive Review For NCLEX-RN

she is coughing and expectorating frothy white mucus. Her pulse rate
is 102 beats/min, and her blood pressure is 164/98 mm Hg. The nurse auscultates
Victoria’s lung sounds and notes the presence of bilateral crackles in the lower
lobes. Victoria is hospitalized. Her current home medications include betaxolol
hydrochloride for glaucoma and glimepiride for type 2 diabetes mellitus. She also
takes over-the-counter hydroxyaluminum sodium carbonate to help prevent acid
indigestion. Heart failure is diagnosed. In addition to the medication that Victoria
takes at home, the following medications are prescribed: captopril, furosemide,
metoprolol, and digoxin.
Enhanced Multiple Response

The nurse reviews Victoria’s admission data and prepares to collaborate with the
interprofessional health care team about Victoria’s plan of care. What should the
nurse discuss with the team? Select all that apply.

1. Victoria’s age as a risk for falls.
2. The need for respiratory treatments.
3. Victoria’s inability to tolerate activity.
4. That the antacid could affect the absorption of digoxin.
5. That metoprolol may mask symptoms of hypoglycemia.
6. That the antacid must be used with caution in clients with glaucoma.
7. That potential systemic side effects of betaxolol hydrochloride include heart
failure.
8. That betaxolol hydrochloride may contribute to hypertension when taken with
the newly prescribed medications.

Answer: 1, 2, 3, 4, 5, 7
Victoria is 76 years of age. In addition to her age, her poor respiratory status and
inability to tolerate activity place her at risk for falls. These factors require
implementing a plan of care that will meet her needs. Antacids increase the digoxin
level by increasing digoxin absorption or bioavailability. Antacids also decrease the
absorption of captopril. However, antacids are not a concern in clients with
glaucoma. Ophthalmic beta blockers can have additive therapeutic or adverse
effects when given with systemically administered beta blockers or other
cardiovascular medications. Toxic reactions to beta blockers are rare but primarily
involve the cardiovascular system. Symptoms include bradycardia, cardiac failure,
hypotension, and bronchospasm. Treatment involves discontinuation of the
medication and supportive care (e.g., administration of adrenergic and
anticholinergic medications). In addition, the nonselective beta blockers can
interfere with the normal responses to hypoglycemia, such as tremor, tachycardia,
and nervousness, in essence masking the signs and symptoms of hypoglycemia.
Hypotension is more likely than hypertension in clients taking beta-blocker
medications.
On the following morning (day 2 of hospitalization), the nurse checks Victoria’s
vital signs and notes a blood pressure (BP) of 98/64 mm Hg and a heart rate of 62
beats per minute. On review of the laboratory data, the nurse notes the following:

Hemoglobin 14 g/dL (140 g/L)

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