Nokea
The cardiac monitor of the client diagnosed with Prinzmetal’s angina shows a prolonged PR interval of 0.32 seconds. Which prescribed medication should the nurse question administering to the client?
- A. Isosorbide mononitrate 20 mg oral daily
- B. Amlodipine 10 mg oral daily
- C. Nitroglycerin 0.4 mg sublingual prn
- D. Atenolol 50 mg oral daily
Correct Answer: D
Rationale: Atenolol (Tenormin), a beta blocker, blocks stimulation of beta1 (myocardial)-adrenergic receptors, causing a reduction in BP and HR. A side effect of the medication is a prolongation of the PR interval (normal PR interval is 0.12 to 0.20 second). Continued use of the drug can result in heart block. The nurse should question administering atenolol. Other medications do not prolong the PR interval.
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The nurse is admitting the client with a new diagnosis of persistent atrial fibrillation with rapid ventricular response. The client has been in atrial fibrillation for more than 2 days and has had no previous cardiac problems. Which initial interventions should the nurse anticipate? Select all that apply.
- A. Ablation of the AV node
- B. Immediate cardioversion
- C. Oxygen 2 liters per nasal cannula
- D. Heparin intravenous (IV) infusion
- E. Amiodarone IV infusion
- F. Diltiazem IV infusion
Correct Answer: C;D;E;F
Rationale: The nurse should anticipate: C) Oxygen to enhance tissue oxygenation due to decreased cardiac output; D) Heparin to prevent thromboembolism from atrial stasis; E) Amiodarone for pharmacological cardioversion; F) Diltiazem to slow ventricular response. Ablation and cardioversion are considered only if medications fail or after ruling out atrial clots.
The nurse is caring for the client with varicose veins. Which action should indicate to the nurse that an expected outcome has been met?
- A. States will walk daily to promote venous return
- B. Reports decreased need for compression stockings
- C. States can finally stand for prolonged periods of time
- D. Chooses diet high in potassium and low in magnesium
Correct Answer: A
Rationale: Walking promotes venous return; verbalizing intent to increase activity indicates an expected outcome has been met for the client with varicose veins. Decreased stocking use, prolonged standing, and specific diets are not beneficial.
Upon assessing the client who has distal foot pain due to vascular insufficiency, the nurse notes the wound illustrated. When reviewing the client’s medical record, which notation is the nurse likely to find?
- A. Venous ulcer on left foot
- B. Arterial ulcer on right foot
- C. Diabetic ulcer on left foot
- D. Stress ulcer on right foot
Correct Answer: B
Rationale: The nurse should find a notation of an arterial ulcer on the right foot. Arterial ulcers typically occur on the feet; they are deep, and the ulcer bed is pale with even, defined edges and limited granulation tissue. Venous ulcers are at the ankle, diabetic ulcers are plantar, and stress ulcers are gastric.
The nurse is teaching the client newly diagnosed with chronic stable angina. Which instructions on measures to prevent future angina should the nurse incorporate? Select all that apply.
- A. Increase isometric arm exercises to build endurance.
- B. Wear a facemask when outdoors in cold weather.
- C. Take nitroglycerin before a stressful event even if pain free.
- D. Perform most exertional activities in the morning.
- E. Take a daily laxative to avoid straining with bowel movements.
- F. Discontinue use of all tobacco products if you use these.
Correct Answer: B;C;F
Rationale: The nurse should instruct: B) Wearing a facemask in cold weather to prevent vasoconstriction; C) Taking nitroglycerin prophylactically to improve coronary blood flow; F) Discontinuing tobacco to reduce vasoconstriction. Isometric exercises, morning exertion, and daily laxatives are not recommended as they may increase cardiac workload or cause other issues.
The nurse fails to obtain scheduled VS at 0200 hours for the client who had cardiac surgery 2 days ago. After assessing the client at 0600 hours, the nurse documents the 0600 HR for both the 0200 and 0600 VS. Which conclusion should a supervising charge nurse make about the nurse’s actions? Select all that apply.
- A. The nurse’s action was acceptable; neither complications nor harmful effects occurred.
- B. The nurse’s action is concerning legally; the nurse fraudulently falsified documentation.
- C. The nurse’s action demonstrates beneficence; the nurse decided what was best for the client.
- D. The nurse’s action is extremely concerning; it involves the ethical issue of veracity.
- E. The nurse’s action demonstrates distributive justice; other clients’ needs were priority.
Correct Answer: B;D
Rationale: The charge nurse should conclude: B) Falsifying documentation is a legal concern; D) The action involves the ethical issue of veracity (truthfulness). The action is not acceptable (A), does not show beneficence (C), and there’s no evidence of distributive justice (E).