Nokea
The nurse is caring for a heart client on digoxin and notes a potassium level of 2.5. What is the appropriate priority nursing intervention?
- A. Do nothing as this is a normal potassium level.
- B. The potassium level is low so the nurse asks for an order for potassium.
- C. The nurse asks to check the digoxin level as low potassium can increase digoxin toxicity.
- D. The nurse stops the digoxin.
Correct Answer: C
Rationale: The correct answer is C because low potassium levels can increase the risk of digoxin toxicity. Digoxin and potassium have a reciprocal relationship, so low potassium levels can lead to digoxin toxicity. Checking the digoxin level is important to monitor for toxicity.
A is incorrect because a potassium level of 2.5 is low and requires intervention. B is not the appropriate action as giving potassium without checking the digoxin levels first can worsen toxicity. D is incorrect because abruptly stopping digoxin can be harmful and should only be done under the guidance of a healthcare provider.
You may also like to solve these questions
What is a surgical procedure to redirect blood flow around a blocked or narrowed artery, often involving the use of a graft from another part of the body?
- A. Coronary artery bypass graft (CABG)
- B. Valve replacement
- C. Aneurysm repair
- D. Atherectomy
Correct Answer: A
Rationale: The correct answer is A: Coronary artery bypass graft (CABG). This procedure is used to redirect blood flow around a blocked or narrowed artery by creating a bypass using a graft from another part of the body. Step 1: The blocked or narrowed artery is identified through diagnostic tests. Step 2: A graft, often taken from the chest, leg, or arm, is used to create a new pathway for blood to flow around the blockage. Step 3: This helps improve blood flow to the heart muscle, relieving symptoms such as chest pain and reducing the risk of a heart attack. Summary: B (Valve replacement) involves replacing a damaged heart valve, C (Aneurysm repair) deals with treating a weakened area in a blood vessel, and D (Atherectomy) is a procedure to remove plaque from arteries, none of which match the description provided.
What is a condition where the heart's electrical system malfunctions, leading to an irregular heartbeat or arrhythmia?
- A. Arrhythmia
- B. Bradycardia
- C. Tachycardia
- D. Ventricular fibrillation
Correct Answer: A
Rationale: The correct answer is A: Arrhythmia. Arrhythmia refers to an irregular heartbeat caused by malfunctioning of the heart's electrical system. Bradycardia (B) is a slow heart rate, Tachycardia (C) is a fast heart rate, and Ventricular fibrillation (D) is a life-threatening arrhythmia characterized by rapid, irregular heartbeats. Arrhythmia encompasses various types of irregular heart rhythms, making it the most appropriate choice in this context.
Which structure serves as the normal pacemaker of the heart?
- A. SA node
- B. AV node
- C. Purkinje fibers
- D. Atria
Correct Answer: A
Rationale: The correct answer is A: SA node. The SA node is known as the natural pacemaker of the heart because it initiates the electrical impulses that regulate the heartbeat. It is located in the right atrium and generates the electrical signals that coordinate the heart's contractions. The other choices, B: AV node, C: Purkinje fibers, and D: Atria, do play roles in the heart's electrical conduction system, but they do not serve as the primary pacemaker. The AV node delays the electrical impulses, the Purkinje fibers distribute the impulses to the heart muscles, and the atria contract to pump blood into the ventricles. However, none of these structures serve as the primary pacemaker like the SA node does.
What is a condition where the heart muscle becomes thickened without an obvious cause, leading to a reduction in the heart's ability to pump blood?
- A. Hypertrophic cardiomyopathy
- B. Dilated cardiomyopathy
- C. Restrictive cardiomyopathy
- D. Myocarditis
Correct Answer: A
Rationale: The correct answer is A: Hypertrophic cardiomyopathy. In this condition, the heart muscle becomes thickened, affecting the heart's ability to pump blood efficiently. This is due to genetic mutations causing the muscle cells to grow abnormally. This leads to poor relaxation and filling of the heart, impairing its pumping function.
B: Dilated cardiomyopathy involves the heart muscle becoming weak and stretched, leading to reduced pumping ability.
C: Restrictive cardiomyopathy involves the heart muscle becoming stiff and rigid, impairing its ability to fill with blood properly.
D: Myocarditis is inflammation of the heart muscle, typically caused by infections or autoimmune conditions, leading to temporary reduction in heart function.
Hence, the correct answer is A as it specifically describes the scenario of a thickened heart muscle without an obvious cause impacting the heart's pumping ability.
What advice about sexual activity should the nurse give to a male patient who has had an MI?
- A. The patient should use the superior position
- B. Foreplay may cause too great an increase in heart rate
- C. Prophylactic nitroglycerin may be used if angina occurs
- D. Performance can be enhanced with the use of sildenafil (Viagra)
Correct Answer: C
Rationale: Nitroglycerin prevents angina during activity.