Metoprolol nursing considerations
The core nursing considerations for metoprolol are to check the apical pulse and blood pressure before giving it, and to hold the dose and notify the provider if the heart rate is under 60 or the blood pressure is low. Never stop it abruptly, and teach diabetic patients that it can hide the early warning signs of a low blood sugar.
What metoprolol does, and why the NCLEX tests it
Metoprolol is a cardioselective beta blocker (suffix -olol). It blocks beta-1 receptors in the heart, which lowers the heart rate, the force of contraction, and the blood pressure, easing the heart's workload in hypertension, angina, heart failure, and after a heart attack. The exam tests whether you check the pulse and pressure before giving it and whether you know not to stop it suddenly.
Key nursing considerations for metoprolol
Check the apical pulse and blood pressure first. Hold and notify if the heart rate is under 60 or the systolic pressure is low.
Stopping suddenly can cause rebound tachycardia, hypertension, angina, or a heart attack. Taper over one to two weeks.
Beta blockers hide the early signs of a low blood sugar such as a racing heart and tremor in people with diabetes; sweating is preserved.
Report new or worsening shortness of breath, weight gain, or edema.
Metoprolol is cardioselective, so it is generally safer in asthma than nonselective agents like propranolol, but still use caution.
How the NCLEX turns metoprolol into a question
Report a heart rate under 60, new wheezing or shortness of breath, and signs of worsening heart failure such as weight gain or edema.
Priority assess the apical pulse and blood pressure before giving; hold and notify if the heart rate is under 60 or the pressure is low.
Teach check your pulse daily and hold the dose if it is under 60, rise slowly, do not stop suddenly, and check your blood sugar more often if you have diabetes.
An apical pulse of 48 charted before a scheduled metoprolol dose. Hold the dose and notify the provider.
Quick answers
Why do you check the pulse before giving metoprolol?
Beta blockers slow the heart, so you assess the apical pulse and blood pressure first and hold the dose if the heart rate is under 60 or the blood pressure is low, then notify the provider.
Can metoprolol be stopped suddenly?
No. Abrupt discontinuation can cause rebound tachycardia, high blood pressure, angina, or a heart attack. It must be tapered over one to two weeks.
Why is metoprolol risky in diabetes?
It masks the early adrenergic warning signs of hypoglycemia such as tachycardia and tremor, so diabetic patients should check their blood sugar more often.
Keep studying
These pages build on each other. Work through the related classes, then pressure-test yourself against the free cheat sheet and the full guide.
Digoxin
Apical pulse, the 0.8 to 2 level, the potassium trap, and DigiFab.
Read the guide →Carvedilol
Beta-blocker holds plus give-with-food and start-low heart-failure care.
Read the guide →Lisinopril
The dry cough, the angioedema emergency, and high potassium.
Read the guide →Calcium channel blockers
-dipine edema vs verapamil and diltiazem bradycardia, and grapefruit.
Read the guide →All high-yield drug classes
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