Nokea
The nurse administers IV push hydralazine (Apresoline) to a client with severe hypertension. Which assessment finding requires immediate action?
- A. Blood pressure of 140/90 mmHg
- B. Heart rate of 110 beats per minute
- C. Headache
- D. Flushing
Correct Answer: B
Rationale: Hydralazine, a vasodilator, lowers blood pressure but triggers reflex tachycardia. A heart rate of 110 bpm indicates significant compensation, risking ischemia or strain, requiring immediate action (e.g., slowing infusion, notifying physician). BP of 140/90 is improved, not critical. Headache and flushing are expected from vasodilation, less urgent. Tachycardia's potential to destabilize circulation, especially in severe hypertension, aligns with hydralazine's pharmacology'arteriolar relaxation prompts sympathetic response. This finding demands swift intervention to prevent cardiovascular collapse, making B the priority over manageable side effects.
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The following are anticoagulants that do not require monitoring of INR:
- A. Rivaroxaban
- B. Apixaban
- C. Dabigatran
- D. All of the above
Correct Answer: D
Rationale: These are direct oral anticoagulants (DOACs), which do not require regular INR monitoring.
Which of the following agents exerts its therapeutic effect in multiple sclerosis via potassium channel blockade?
- A. Dalfampridine
- B. Donepezil
- C. Riluzole
- D. Bromocriptine
Correct Answer: A
Rationale: Dalfampridine treats MS by blocking potassium channels in demyelinated axons, enhancing nerve conduction and improving walking ability. Exposed potassium channels in MS leak current, impairing signal propagation; dalfampridine's blockade restores function. Donepezil boosts acetylcholine for Alzheimer's. Riluzole reduces glutamate in ALS. Bromocriptine, a dopamine agonist, manages Parkinson's. Dalfampridine's unique potassium channel action directly addresses MS's neurological deficit, supported by clinical evidence, making it the correct agent here.
ACE inhibitors…
- A. Block the vasoconstrictor and aldosterone from producing effects of angiotensin II at the receptor site
- B. Blocks stimulation of beta 1 and beta 2 at the receptor sites
- C. Blocks the conversion of angiotensin I to the vasoconstrictor angiotensin II
- D. None of the above
Correct Answer: A
Rationale: ACE inhibitors, such as enalapril and lisinopril, work by blocking the enzyme angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I into angiotensin II. By inhibiting this conversion, ACE inhibitors prevent the vasoconstrictor and aldosterone-stimulating effects of angiotensin II at the receptor sites. This leads to vasodilation, decreased blood pressure, and reduced aldosterone secretion. This mechanism of action makes ACE inhibitors an important class of medications for managing conditions such as hypertension, heart failure, and chronic kidney disease.
Why is it important to monitor ins and outs with patients using ACE inhibitors?
- A. To assess for renal impairment
- B. You must make sure the patient is receiving adequate fluid intake
- C. To assess the patient for potential heart failure
- D. To assess for decreased blood pressure
Correct Answer: D
Rationale: It is important to monitor ins and outs with patients using ACE inhibitors to assess for decreased blood pressure. ACE inhibitors are known to lower blood pressure by dilating blood vessels, which can sometimes lead to hypotension (low blood pressure). Monitoring the patient's fluid intake and output helps healthcare providers evaluate the patient's blood pressure response to the medication and make necessary adjustments to prevent complications such as dizziness, falls, or fainting. Regular monitoring is crucial to ensure the patient's safety and optimize the effectiveness of ACE inhibitor therapy.
Which of the following 'overdoses' is most commonly associated with respiratory alkalosis, but when more severe a metabolic acidosis?
- A. Methanol
- B. Lead
- C. Paracetamol
- D. Salicylate
Correct Answer: D
Rationale: Overdose toxicities differ in acid-base effects. Methanol causes metabolic acidosis via formic acid, not respiratory alkalosis. Lead poisoning leads to anemia or neurologic issues, rarely acid-base shifts. Paracetamol overdose induces lactic acidosis from liver failure, not respiratory changes initially. Salicylate (e.g., aspirin) overdose stimulates the respiratory center early, causing hyperventilation and respiratory alkalosis (low pCO2), but severe cases add metabolic acidosis (high anion gap) from uncoupled oxidative phosphorylation and lactic acid buildup. Codeine, an opioid, depresses respiration, causing acidosis, not alkalosis. Salicylate's dual pattern is distinctive, requiring urgent recognition—initial alkalosis shifts to acidosis as toxicity worsens, guiding bicarbonate or dialysis treatment.