Nokea
The nurse administers IV push hydralazine (Apresoline) to a client with severe hypertension. Which assessment finding requires immediate action?
- A. Blood pressure of 140/90 mmHg
- B. Heart rate of 110 beats per minute
- C. Headache
- D. Flushing
Correct Answer: B
Rationale: Hydralazine, a vasodilator, lowers blood pressure but triggers reflex tachycardia. A heart rate of 110 bpm indicates significant compensation, risking ischemia or strain, requiring immediate action (e.g., slowing infusion, notifying physician). BP of 140/90 is improved, not critical. Headache and flushing are expected from vasodilation, less urgent. Tachycardia's potential to destabilize circulation, especially in severe hypertension, aligns with hydralazine's pharmacology'arteriolar relaxation prompts sympathetic response. This finding demands swift intervention to prevent cardiovascular collapse, making B the priority over manageable side effects.
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Which of the following agents exerts its therapeutic effect in multiple sclerosis via potassium channel blockade?
- A. Dalfampridine
- B. Donepezil
- C. Riluzole
- D. Bromocriptine
Correct Answer: A
Rationale: Dalfampridine treats MS by blocking potassium channels in demyelinated axons, enhancing nerve conduction and improving walking ability. Exposed potassium channels in MS leak current, impairing signal propagation; dalfampridine's blockade restores function. Donepezil boosts acetylcholine for Alzheimer's. Riluzole reduces glutamate in ALS. Bromocriptine, a dopamine agonist, manages Parkinson's. Dalfampridine's unique potassium channel action directly addresses MS's neurological deficit, supported by clinical evidence, making it the correct agent here.
Depression that occurs during cold winter months would be classified as
- A. baby blues
- B. bipolar disorder
- C. seasonal affective disorder
- D. obsessive-compulsive disorder
Correct Answer: C
Rationale: Seasonal affective disorder (SAD) ties depression to winter-less light, per psychiatry-unlike baby blues (postpartum), bipolar (cycles), or OCD (obsessions). SAD's seasonal link defines it, matching symptoms.
A 59-year-old man with a history of depression cuts his wrists in a suicide attempt. He is brought to the local emergency department for care. He has bilateral medial 3-cm lacerations through the skin and subcutaneous tissues that will require sutures. A review of his prior medical history indicates an allergy to 2% lidocaine. The most likely explanation for this is which of the following?
- A. Allergic
- B. Mast cell mediated
- C. Neurogenic
- D. Psychogenic
Correct Answer: A
Rationale: Lidocaine allergy causing an issue with suturing suggests an allergic reaction , likely IgE-mediated (overlapping with B, but A is broader). Neurogenic , psychogenic , and vascular (E) don't fit. True local anesthetic allergies are rare but explain this history.
What is a side effect of Heparin?
- A. nausea
- B. diarrhea
- C. bleeding
- D. bronchospasms
Correct Answer: C
Rationale: Heparin is an anticoagulant medication that works by preventing the formation of blood clots. One of the main side effects of heparin therapy is an increased risk of bleeding. Since heparin inhibits the body's ability to clot blood, it can lead to easy bruising, nosebleeds, gastrointestinal bleeding, or bleeding at the injection site. Patients on heparin therapy must be closely monitored for signs of bleeding, and their dosage may need to be adjusted to minimize this risk.
Which of the following 'overdoses' is most commonly associated with respiratory alkalosis, but when more severe a metabolic acidosis?
- A. Methanol
- B. Lead
- C. Paracetamol
- D. Salicylate
Correct Answer: D
Rationale: Overdose toxicities differ in acid-base effects. Methanol causes metabolic acidosis via formic acid, not respiratory alkalosis. Lead poisoning leads to anemia or neurologic issues, rarely acid-base shifts. Paracetamol overdose induces lactic acidosis from liver failure, not respiratory changes initially. Salicylate (e.g., aspirin) overdose stimulates the respiratory center early, causing hyperventilation and respiratory alkalosis (low pCO2), but severe cases add metabolic acidosis (high anion gap) from uncoupled oxidative phosphorylation and lactic acid buildup. Codeine, an opioid, depresses respiration, causing acidosis, not alkalosis. Salicylate's dual pattern is distinctive, requiring urgent recognition—initial alkalosis shifts to acidosis as toxicity worsens, guiding bicarbonate or dialysis treatment.