Registered Nurse (RN) Endocrine Licensure Exam

What health history should lead a nurse to question a doctor's order for Inderal in a patient with thyroid storm?

1. History of mental illness.

2. History of asthma.

3. History of tachycardia.

4. History of cancer.

The correct answer is: History of asthma.

Inderal, also known as propranolol, is a non-selective beta-blocker commonly used to manage symptoms of conditions such as hypertension and anxiety, but it is particularly relevant in the management of thyroid storm due to its ability to quickly reduce heart rate and alleviate symptoms like tachycardia. However, its use in patients with a history of asthma is problematic. Non-selective beta-blockers can cause bronchoconstriction by blocking beta-2 adrenergic receptors, which can exacerbate respiratory conditions like asthma. This adverse effect makes the use of Inderal in patients with a history of asthma a significant concern, as it could potentially lead to acute respiratory distress. While a history of mental illness, tachycardia, or cancer might warrant careful monitoring or consideration in the context of prescribing Inderal, they do not present as direct contraindications to the drug's use as it pertains to its mechanisms of action and potential side effects. Thus, the presence of asthma is critical in evaluating the appropriateness of administering Inderal in a patient experiencing thyroid storm.