Nokea
The client has had heparin-induced thrombocytopenia. How is this treated?
- A. Give clotting factors.
- B. Give vitamin K.
- C. Give warfarin
- D. Give lepirudin
Correct Answer: D
Rationale: Correct Answer: D - Give lepirudin
Rationale:
1. Heparin-induced thrombocytopenia (HIT) is a condition where heparin causes a decrease in platelet count.
2. Lepirudin is a direct thrombin inhibitor used to treat HIT by preventing thrombin formation.
3. Clotting factors (A) are not indicated as HIT involves excessive clotting, not clotting factor deficiency.
4. Vitamin K (B) and warfarin (C) are used to treat other conditions like Vitamin K deficiency and as an oral anticoagulant, not HIT.
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Why does the nurse instruct the client to avoid Valsalva maneuvers?
- A. Client's BP will decrease momentarily.
- B. Client may suffer from a myocardial infarction.
- C. Client may lose consciousness.
- D. Client's BP will increase momentarily.
Correct Answer: D
Rationale: Valsalva maneuvers can cause a temporary rise in BP, potentially exacerbating hypertension.
If a hypertensive client with asthma takes the maximal dose of his diuretic and his blood pressure still isn't controlled, the nurse understands the next step in controlling his hypertension would be to:
- A. Add enalapril, an ACE inhibitor
- B. Change him to Metoprolol, a beta blocker
- C. Add another diuretic
- D. Increase the drug dosage above recommended dosing levels
Correct Answer: A
Rationale: Rationale:
1. ACE inhibitors like enalapril are recommended as second-line therapy for hypertension.
2. ACE inhibitors are effective in managing hypertension in patients with asthma.
3. Adding another diuretic may lead to electrolyte imbalances.
4. Beta blockers like Metoprolol may worsen asthma symptoms.
5. Increasing drug dosage above recommended levels can be harmful and ineffective.
Summary:
Adding enalapril is the best choice as it is effective, safe in asthma, and avoids potential adverse effects of other options like beta blockers or excessive diuretics.
Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and
- A. increases cardiac output
- B. causes reflex hypotension
- C. may lead to atrial dysrhythmias
- D. impairs perfusion of the coronary arteries
Correct Answer: D
Rationale: Tachycardia reduces diastolic filling time, impairing coronary perfusion.
A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, “It was just a little chest pain. As soon as I get out of here, I’m going for my vacation as planned.” Which reply would be most appropriate for the nurse to make?
- A. “What do you think caused your chest pain?”
- B. “Where are you planning to go for your vacation?”
- C. “Sometimes plans need to change after a heart attack.”
- D. “Recovery from a heart attack takes at least a few weeks.”
Correct Answer: C
Rationale: Rationale: Choice C is correct because it addresses the patient's perception and gently introduces the idea that plans may need to change post-MI. It acknowledges the patient's experience while subtly hinting at the importance of considering adjustments for health reasons.
Summary of Incorrect Choices:
A: This choice focuses on the cause of chest pain, which is not the immediate concern post-MI.
B: While discussing vacation plans is relevant, it does not address the patient's potentially unrealistic expectations.
D: While recovery time is important, stating a specific timeline may not be necessary or applicable to every patient's situation.
Which of the following is the best action by the nurse?
- A. Administer the metoprolol (Lopressor) and the hydrochlorothiazide (HydroDiuril), hold the captopril (Copoten), and notify the physician.
- B. Administer the captopril (Capoten) and the hydrochlorothiazide (HydroDiuril), hold the metoprolol (Lepressor), and notify the physican.
- C. Administer all the medications and notify the physician.
- D. Withhold all the medications and notify the physician.
Correct Answer: A
Rationale: The correct answer is A: Administer the metoprolol (Lopressor) and the hydrochlorothiazide (HydroDiuril), hold the captopril (Copoten), and notify the physician.
Rationale:
1. Metoprolol and hydrochlorothiazide are commonly prescribed medications for hypertension.
2. Captopril is an ACE inhibitor and should be held due to potential interactions with the other medications.
3. Notifying the physician is crucial to ensure proper management and prevent adverse effects.
Summary of other choices:
B: Incorrect because holding metoprolol is not recommended as it is a common antihypertensive drug.
C: Incorrect because administering all medications without addressing the potential interaction with captopril is unsafe.
D: Incorrect because withholding all medications without administering any could lead to uncontrolled hypertension, risking the patient's health.