Nokea
The client is on nitroglycerin patches. What should the nurse include in the client's education?
- A. Rotate the application site with each new patch.
- B. Apply the patch at the same time each day.
- C. Leave the patch on for 24 hours, then remove it for 12 hours before applying a new one.
- D. Apply the patch to the same site each time.
Correct Answer: A
Rationale: The correct answer is A: Rotate the application site with each new patch. This is important to prevent skin irritation and tolerance development. Rotating sites ensures consistent drug absorption and reduces the risk of skin reactions. Applying the patch at the same site each time (choice D) can lead to localized skin irritation. Applying the patch at the same time each day (choice B) is not as crucial as rotating sites. Leaving the patch on for 24 hours and then removing it for 12 hours (choice C) can disrupt the therapeutic effect of the medication.
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What term describes the phenomenon wherein decreased BP causes a reflex SNS response with increased pulse, increased contractility, and vasoconstriction; and increased BP causes reflex vagal responses resulting in decreased heart rate and passive vasodilation in the systemic arterioles?
- A. Baroreflex
- B. Cheyne-Stokes breathing
- C. Frank-Starling Law
- D. Starling reflex
Correct Answer: A
Rationale: The correct answer is A: Baroreflex. The baroreflex is a physiological mechanism that helps regulate blood pressure by responding to changes in pressure. When blood pressure decreases, the baroreceptors detect this change and trigger a sympathetic nervous system (SNS) response, leading to increased heart rate, contractility, and vasoconstriction to raise blood pressure. Conversely, when blood pressure increases, the baroreceptors trigger a parasympathetic (vagal) response, resulting in decreased heart rate and vasodilation to lower blood pressure.
Summary of other choices:
B: Cheyne-Stokes breathing is a pattern of breathing characterized by periodic waxing and waning of tidal volume.
C: Frank-Starling Law describes the relationship between preload and stroke volume, not the response to changes in blood pressure.
D: Starling reflex is not a recognized physiological mechanism related to blood pressure regulation.
Which medication is used to lower high blood pressure and reduce the risk of heart attacks and strokes?
- A. ACE inhibitor
- B. Beta-blocker
- C. Diuretic
- D. Calcium channel blocker
Correct Answer: A
Rationale: The correct answer is A: ACE inhibitor. ACE inhibitors work by dilating blood vessels to lower blood pressure and reduce the risk of heart attacks and strokes. They also help protect the heart and improve its function. Beta-blockers (B) lower heart rate, diuretics (C) reduce fluid retention, and calcium channel blockers (D) relax blood vessels, but they do not offer the same comprehensive benefits for high blood pressure and cardiovascular health as ACE inhibitors.
The client on warfarin has an INR of 3.8. 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. Notify the healthcare provider immediately.
Correct Answer: A
Rationale: The correct answer is A: Administer vitamin K. When a client on warfarin has an INR above the therapeutic range (usually 2-3), like in this case (3.8), administering vitamin K is appropriate to reverse the anticoagulant effects. This helps prevent bleeding complications. Holding the next dose of warfarin (B) may not be sufficient to lower the INR quickly. Increasing the dose of warfarin (C) would further elevate the INR, leading to higher bleeding risk. Notifying the healthcare provider (D) is important, but immediate action with vitamin K is necessary to address the high INR.
The client is receiving intravenous dopamine. What is the most important nursing assessment?
- A. Monitor heart rate and rhythm
- B. Monitor blood pressure
- C. Monitor respiratory rate
- D. Monitor oxygen saturation
Correct Answer: A
Rationale: The correct answer is A: Monitor heart rate and rhythm. Dopamine is a medication that can affect the heart rate and rhythm. Monitoring these parameters is crucial to detect any potential adverse effects such as tachycardia or arrhythmias. Monitoring blood pressure is also important, but assessing heart rate and rhythm takes precedence due to the direct impact of dopamine on cardiac function. Respiratory rate and oxygen saturation are generally not directly affected by dopamine administration.
What is the ability of cardiac cells to respond to an impulse by transmitting the impulse along cell membranes?
- A. Contractility
- B. Automaticity
- C. Conductivity
- D. Rhythmicity
Correct Answer: C
Rationale: The correct answer is C: Conductivity. Cardiac cells have the ability to transmit impulses along cell membranes, allowing for the coordinated contraction of the heart. Conductivity refers to this specific property of cardiac cells to propagate electrical signals.
Contractility (A) refers to the ability of cardiac muscle cells to generate force during contraction. Automaticity (B) refers to the ability of cardiac cells to spontaneously generate electrical impulses. Rhythmicity (D) refers to the regularity of these electrical impulses in the heart. Conductivity is the most relevant choice as it directly addresses the transmission of impulses along cell membranes in cardiac cells.