Nokea
An adult who is receiving heparin asks the nurse why it cannot be given by mouth. The nurse responds that heparin is given parenterally because:
- A. it is destroyed by gastric secretions.
- B. it irritates the gastric mucosa.
- C. it irritates the intestinal lining.
- D. therapeutic levels can be achieved more quickly.
Correct Answer: AUG
Rationale: Heparin is a protein and is destroyed by gastric secretions, requiring parenteral administration (intravenously or subcutaneously). It does not irritate the gastric or intestinal lining, and while parenteral administration allows faster therapeutic levels, the primary reason is its destruction in the stomach.
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Which finding would strongly indicate that the cardioversion procedure has been successful?
- A. The client regains consciousness immediately.
- B. Normal sinus cardiac rhythm is restored.
- C. The physical examination of the patient is a second.
- D. The pulse pressure is approximately 40 mm Hg.
Correct Answer: B
Rationale: Restoration of normal sinus rhythm is the primary goal of cardioversion.
Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)?
- A. Creatine kinase (CK-MB).
- B. Lactate dehydrogenase (LDH).
- C. Troponin.
- D. White blood cells (WBCs).
Correct Answer: C
Rationale: Troponin (C) rises within 3–4 hours post-MI, making it the earliest marker. CK-MB (A) rises in 4–6 hours, LDH (B) in 24–48 hours, and WBCs (D) are nonspecific.
The client is exhibiting ventricular tachycardia. Which intervention should the nurse implement first?
- A. Administer amiodarone, an antidysrhythmic, IVP.
- B. Prepare to defibrillate the client.
- C. Assess the client's apical pulse and blood pressure.
- D. Start basic cardiopulmonary resuscitation.
Correct Answer: C
Rationale: Ventricular tachycardia requires assessing pulse/BP (C) to determine if it’s pulseless (defibrillation, B) or stable (amiodarone, A). CPR (D) is for pulseless states.
Which data would cause the nurse to question administering digoxin to a client diagnosed with congestive heart failure?
- A. The potassium level is 3.2 mEq/L.
- B. The digoxin level is 1.2 mcg/mL.
- C. The client's apical pulse is 64.
- D. The client denies yellow haze.
Correct Answer: A
Rationale: Hypokalemia (K+ 3.2, A) increases digoxin toxicity risk, warranting caution. Digoxin level 1.2 (B) is therapeutic, pulse 64 (C) is normal, and no yellow haze (D) is expected.
An adult male has a high level of high-density lipoproteins (HDL) in proportion to low-density lipoproteins (LDL). How does this relate to his risk of developing coronary artery disease (CAD)?
- A. His risk for CAD is low.
- B. There is no direct correlation.
- C. His risk may increase with exercise.
- D. His risk will increase with age.
Correct Answer: A
Rationale: A high HDL-to-LDL ratio is protective against coronary artery disease, lowering risk due to HDL’s role in removing cholesterol from arteries.