The nurse is reviewing the client's medical record. For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Metoprolol 15 mg IV bolus: While beta-blockers are often used for MI, a 15 mg IV bolus is an inappropriately high starting dose and can be dangerous in the acute phase of a STEMI if the client's hemodynamics are unstable. Furthermore, the client is currently tachycardic and hypertensive, but the primary focus should be on reperfusion and pain control first. Oxygen at 2 L/min via nasal cannula: The client’s oxygen saturation dropped to 89% on room air. Oxygen supplementation is anticipated to maintain adequate tissue oxygenation and reduce cardiac workload. Draw electrolytes along with Hgb and Hct: Monitoring electrolytes and hemoglobin/hematocrit is anticipated in MI management because electrolyte imbalances and anemia can exacerbate cardiac complications. Morphine 6 mg IV bolus every 3 hr as needed for pain: Morphine is anticipated for chest pain unrelieved by nitrates. It also reduces sympathetic stimulation, anxiety, and myocardial oxygen demand. Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin is anticipated for acute chest pain to reduce preload and myocardial oxygen demand, unless hypotension develops. The client’s blood pressure is currently elevated, making this safe. Obtain daily weight: Daily weight monitoring is nonessential in the acute MI setting unless managing heart failure or fluid status; it is not immediately critical. Atropine 0.5 mg IV bolus every 5 min up to 2 mg if heart rate drops below 60: While the client is currently tachycardic, it is standard "standing order" practice to have atropine available in case of a sudden drop in heart rate (bradycardia) caused by heart block or vagal response during the MI.