Nokea
A 58-year-old man undergoes open heart surgery for a triple coronary artery bypass graft. His surgery goes smoothly, but the next day, he develops chest palpitations. Verapamil is started to keep his supraventricular tachycardia from interfering with ventricular rhythm. Under which Singh-Vaughan Williams class of antiarrhythmics does verapamil fall?
- A. Class Ia
- B. Class Ib
- C. Class Ic
- D. Class IV
Correct Answer: D
Rationale: Verapamil, a calcium channel blocker, is a Class IV antiarrhythmic, slowing AV nodal conduction.
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Which of the following agents is an alfa2-selective agonist with ability to promote constriction of the nasal mucosa?
- A. Xylometazoline
- B. Phenylephrine
- C. Methoxamine
- D. Epinephrine
Correct Answer: A
Rationale: The correct answer is A: Xylometazoline. Xylometazoline is an alpha2-selective agonist, which means it specifically targets alpha2-adrenergic receptors. By activating these receptors, xylometazoline promotes constriction of the nasal mucosa, leading to reduced swelling and congestion. Phenylephrine (B) and methoxamine (C) are alpha1-selective agonists, not alpha2-selective, so they would not promote constriction of nasal mucosa. Epinephrine (D) is a non-selective agonist that acts on both alpha and beta receptors, leading to a broader range of effects, not specifically nasal constriction.
The client has a heart rate of 40 with electrical activity beginning at the AV node. What type of rhythm is the client having?
- A. Normal sinus rhythm
- B. Atrial flutter
- C. Atrial fibrillation
- D. Junctional escape rhythm
Correct Answer: D
Rationale: A rate of 40 bpm originating from the AV node (no P waves) is a junctional escape rhythm, a backup pacemaker.
A 75-year-old man with a history of intermittent angina presents to his primary physician. The anginal attacks are becoming more frequent, and therapy is considered for this reason. His blood pressure is 160/95 mm Hg. Which of the following agents would be least likely to be administered as a first-line agent for this patient?
- A. Diltiazem
- B. Nifedipine
- C. Nitroglycerine
- D. Ranolazine
Correct Answer: D
Rationale: Ranolazine is a second-line agent for chronic angina, targeting sodium channels, while diltiazem, nifedipine, nitroglycerin, and verapamil are first-line due to vasodilation or heart rate control.
The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that the heart failure is improving?
- A. Pale and cool extremities
- B. Absence of peripheral edema
- C. Urine output of 60 mL every 4 hours
- D. Complaints of increasing dyspnea
Correct Answer: B
Rationale: The correct answer is B: Absence of peripheral edema. Improvement in heart failure is indicated by reduced fluid retention, leading to decreased peripheral edema. This suggests better cardiac function and reduced congestion in the body. Pale and cool extremities (A) can indicate poor circulation. Urine output of 60 mL every 4 hours (C) may be inadequate for adequate fluid removal. Complaints of increasing dyspnea (D) suggest worsening heart failure.
Class of I.V. IgG preparation is:
- A. Monoclonal antibodies
- B. Immunosuppressive agents
- C. Interferons
- D. Immunoglobulins
Correct Answer: D
Rationale: The correct answer is D: Immunoglobulins. Intravenous Immunoglobulin (IV IgG) preparations are derived from pooled human plasma containing a broad spectrum of antibodies. IV IgG is used for replacement therapy in immunodeficiency disorders and autoimmune diseases. Monoclonal antibodies (A) are specific antibodies produced by identical immune cells, not a class of IV IgG. Immunosuppressive agents (B) are drugs that suppress the immune system to prevent rejection in organ transplant patients. Interferons (C) are signaling proteins released by cells in response to pathogens, not a class of IV IgG. In summary, IV IgG preparations belong to the class of immunoglobulins, not monoclonal antibodies, immunosuppressive agents, or interferons.