Nokea
One of the most serious complications of myocardial infarction that Mrs. Payer could develop is
- A. constipation
- B. dehydration
- C. elevated blood pressure
- D. ventricular tachycardia
Correct Answer: D
Rationale: Ventricular tachycardia poses significant risk for hemodynamic instability.
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A patient with cardiogenic shock receives a nursing diagnosis of decreased cardiac output. With the appropriate interventions, the anticipated outcome is for the patient to achieve:
- A. baseline activity level.
- B. baseline cardiac function.
- C. decreased afterload.
- D. reduced anxiety.
Correct Answer: B
Rationale: Restoring baseline cardiac function is the goal in managing decreased cardiac output.
Which condition refers to the heart being unable to pump sufficient blood to meet the body's needs?
- A. Heart failure
- B. Myocardial infarction
- C. Cardiomyopathy
- D. Pericarditis
Correct Answer: A
Rationale: The correct answer is A: Heart failure. This condition occurs when the heart is unable to pump enough blood to meet the body's needs. It can result from various factors such as high blood pressure, heart muscle damage, or heart valve disorders. In contrast, B (Myocardial infarction) refers to a heart attack caused by a blockage in the coronary arteries, C (Cardiomyopathy) is a disease of the heart muscle, and D (Pericarditis) is inflammation of the pericardium surrounding the heart. These conditions may affect the heart's function but do not specifically indicate the inability to pump sufficient blood like heart failure does.
The healthcare provider is administering IV nitroglycerin to a patient for chest pain. What is the most critical parameter to monitor?
- A. Heart rate
- B. Blood pressure
- C. Oxygen saturation
- D. Respiratory rate
Correct Answer: B
Rationale: The correct answer is B: Blood pressure. When administering IV nitroglycerin for chest pain, monitoring blood pressure is critical due to its vasodilatory effect, which can cause hypotension. Monitoring blood pressure helps prevent potential adverse effects like hypotension-related symptoms or complications. Heart rate, oxygen saturation, and respiratory rate are also important parameters to monitor, but blood pressure takes precedence in this scenario due to the potential for significant hemodynamic changes.
What is a condition where the airways become swollen and produce extra mucus, making it difficult to breathe, often associated with COPD?
- A. Chronic bronchitis
- B. Pneumonia
- C. Emphysema
- D. Tuberculosis
Correct Answer: A
Rationale: Rationale:
1. Chronic bronchitis is characterized by inflammation of the airways leading to excess mucus production.
2. It is a common symptom of COPD, obstructing airflow and causing breathing difficulties.
3. Pneumonia, emphysema, and tuberculosis do not primarily involve airway inflammation and mucus production as seen in chronic bronchitis.
The client on warfarin has an INR of 4.5. What is the most appropriate action by the nurse?
- A. Administer vitamin K.
- B. Hold the next dose of warfarin.
- C. Increase the dose of warfarin.
- D. Monitor the client's INR closely.
Correct Answer: A
Rationale: The correct answer is A: Administer vitamin K. When a client on warfarin has an INR of 4.5, it indicates over-anticoagulation, putting them at risk of bleeding. Vitamin K helps reverse the effects of warfarin by promoting clotting factors. Administering vitamin K will lower the INR back into the therapeutic range. Holding the next dose of warfarin (B) is not enough to rapidly reverse the effects. Increasing the dose of warfarin (C) would worsen the over-anticoagulation. Monitoring the INR closely (D) is important but not the immediate action needed for a high INR.