Beta Betty — Beta Blockers: Apical Pulse, Masked Hypoglycemia & Rebound
Metoprolol keeps her heart calm — but check the apical pulse first, and never let her stop it cold turkey
Betty takes metoprolol every morning since her heart attack. Today her apical pulse is 54 and she feels lightheaded. She also mentions she sometimes skips doses when she feels fine.
Betty takes metoprolol after her myocardial infarction. Beta blockers slow the heart, lower blood pressure and reduce myocardial oxygen demand — but the same mechanism creates the three traps the NCLEX loves. First, always check the apical pulse for one full minute and hold for bradycardia (commonly below 60) or hypotension. Second, beta blockers mask the classic adrenergic warning signs of hypoglycemia — tremor, tachycardia, palpitations — so a diabetic on a beta blocker may only sweat. Third, abrupt withdrawal causes rebound tachycardia, hypertension and even ischemia, so beta blockers are tapered, never stopped suddenly.
Read Beta Betty's full story →The story arc
The setup
Betty is discharged after an MI on metoprolol, taught that it protects her heart by slowing it down and lowering its workload.
The turn
Before her morning dose, Betty's apical pulse is 54 beats per minute and her blood pressure is 96/58.
The crisis
Betty admits she stopped the medication for three days while traveling, and now her heart is racing at 118 and her blood pressure is 178/104.
The save
The nurse holds the dose for the bradycardia, teaches Betty to check her pulse before every dose, and explains the medication must be tapered — never stopped abruptly.
NCLEX study section — Beta Blockers: Apical Pulse, Masked Hypoglycemia & Rebound
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
Take this chapter into practice questions on the same topic.