Free Trial #20
The nurse caring for a client performs a focused assessment after the client complained of dizziness two hours after the nurse administered propranolol hydrochloride. The heart rate prior to administration was 63 beats per minute (bpm). The heart rate is now 34 bpm. Which priority medication will the nurse prepare to administer?
- Sodium nitroprusside
The correct answer is A since atropine is a known antidote for propranolol. Initial dose may be 5 to 15 mg slow IVP followed by infusion rate of 5-15 mg/hr. Treatment may also include calcium gluconate 30 mL (if non central line) or 10 mL calcium chloride (usually through large bore or central line due to extravasation risks); and glucagon 50ug/kg or 3-5 mg up to 10 mg. Glucagon increases cardiac cyclic adenosine monophosphate (camp) and enhances inotropic effects. (note: glucagon may also help reverse CCB toxicity). Nitroprusside produces hypotension and may decrease heart rate and caution giving with propranolol may result in profound hypotension. Dobutamine may increase heart rate but cannot be used with propranolol since beta blockers may negate the effect of dobutamine.