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The family member of a child scheduled for heart surgery states, 'I just don't understand this open-heart or closed-heart business. I'm so confused! Can you help me understand it?' The nurse explains that patent ductus arteriosus repair is:
- A. Open-heart surgery. The child will be placed on a heart-lung machine while the surgery is being performed.
- B. Closed-heart surgery. It does not require that the child be placed on the heart-lung machine while the surgery is being performed.
- C. A pediatric version of the coronary artery bypass graft surgery performed on adults. It is an open-heart surgery.
- D. A pediatric version of percutaneous transluminal coronary angioplasty performed on adults. It is a closed-heart surgery.
Correct Answer: B
Rationale: Patent ductus arteriosus repair is a closed-heart procedure. The client is not placed on a heart-lung machine. Patent ductus arteriosus is a ductus arteriosus that does not close shortly after birth but remains patent. Repair is a closed-heart procedure involving ligation of the patent ductus arteriosus. Coronary artery bypass graft surgery is an open-heart surgical procedure in which blocked coronary arteries are bypassed using vessel grafts. Percutaneous transluminal coronary angioplasty is a closed-heart procedure that improves coronary blood flow by increasing the lumen size of narrowed vessels.
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Which of the following electrolyte imbalances is likely to result in a shortened QT interval?
- A. Hypercalcemia
- B. Hyponatremia
- C. Hypomagnesemia
- D. Hyperphosphatemia
Correct Answer: A
Rationale: Hypercalcemia shortens the QT interval on an ECG by accelerating cardiac repolarization. Hyponatremia hypomagnesemia and hyperphosphatemia are more likely to prolong the QT interval or have other ECG effects.
The following are all nursing diagnoses appropriate for a gravida 1 para 0 in labor. Which one would be most appropriate for the primigravida as she completes the early phase of labor?
- A. Impaired gas exchange related to hyperventilation
- B. Alteration in placental perfusion related to maternal position
- C. Impaired physical mobility related to fetal-monitoring equipment
- D. Potential fluid volume deficit related to decreased fluid intake
Correct Answer: D
Rationale: In early labor primigravidas may have reduced fluid intake due to nausea or restrictions increasing the risk of fluid volume deficit. This is more common than impaired gas exchange placental perfusion issues or mobility limitations at this stage.
A client with a history of pulmonary embolism is admitted with complaints of chest pain. The nurse should give priority to:
- A. Administering anticoagulants
- B. Monitoring respiratory status
- C. Administering pain medication
- D. Monitoring blood pressure
Correct Answer: A
Rationale: Anticoagulants prevent further clot formation in pulmonary embolism, making them the priority to reduce complications.
The physician orders fluoxetine (Prozac) for a depressed client. Which of the following should the nurse remember about fluoxetine?
- A. Because fluoxetine is a tricyclic antidepressant, it may precipitate a hypertensive crisis.
- B. The therapeutic effect of the drug occurs 2-4 weeks after treatment is begun.
- C. Foods such as aged cheese, yogurt, soy sauce, and bananas should not be eaten with this drug.
- D. Fluoxetine may be administered safely in combination with monoamine oxidase (MAO) inhibitors.
Correct Answer: B
Rationale: Fluoxetine is not a tricyclic antidepressant. It is an atypical antidepressant. This statement is true. These foods are high in tyramine and should be avoided when the client is taking MAO inhibitors. Fluoxetine is not an MAO inhibitor. Fatal reactions have been reported in clients receiving fluoxetine in combination with MAO inhibitors.
A client on the psychiatric unit is threatening other clients and staff,and interventions to distract him have not been successful. What action should the nurse take?
- A. Call security for assistance and administer PRN medication to calm the client
- B. Tell the client to calm down and ask him again if he would like to play cards
- C. Tell the client that if he continues this behavior he will lose recreational privileges
- D. Ignore the client since it is unlikely he will actually harm anyone
Correct Answer: A
Rationale: Threatening behavior that persists despite de-escalation attempts requires immediate intervention. Calling security ensures safety and PRN medication may help calm the client. The other options are unsafe or ineffective in managing acute agitation.