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The nurse is administering digoxin to a client with a heart rate of 45 bpm. What is the nurse's priority action?
- A. Hold the digoxin and notify the healthcare provider.
- B. Administer the digoxin as ordered.
- C. Increase the dose of digoxin.
- D. Monitor the client's heart rate and reassess in 30 minutes.
Correct Answer: A
Rationale: The correct answer is A: Hold the digoxin and notify the healthcare provider. Digoxin is a medication that can slow down the heart rate, and a heart rate of 45 bpm is below the normal range. Holding the medication and informing the healthcare provider is the priority to prevent potential harm from further slowing the heart rate. Administering the digoxin as ordered (B) would worsen the bradycardia. Increasing the dose of digoxin (C) would be dangerous. Monitoring the client's heart rate and reassessing in 30 minutes (D) may delay necessary intervention.
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Which serum enzyme would elevate first after an infarction?
- A. Serum glutamic-oxaloacetic transaminase (SGOT)
- B. Lactic acid dehydrogenase (LDH)
- C. Creatine phosphokinase isoenzymes (CPK-MB)
- D. Serum glutamic-pyruvic transaminase (SGPT)
Correct Answer: C
Rationale: CPK-MB rises early after MI onset.
The client on spironolactone (Aldactone) has a potassium level of 5.6 mEq/L. What is the nurse's priority action?
- A. Hold the spironolactone and notify the healthcare provider.
- B. Administer potassium supplements.
- C. Continue the spironolactone as ordered.
- D. Increase the dose of spironolactone.
Correct Answer: A
Rationale: The correct answer is A: Hold the spironolactone and notify the healthcare provider. A potassium level of 5.6 mEq/L is elevated (normal range is 3.5-5.0 mEq/L). Spironolactone is a potassium-sparing diuretic, so the priority action is to hold the medication to prevent further elevation of potassium levels, which can lead to serious cardiac arrhythmias. Notifying the healthcare provider is crucial for further management. Administering potassium supplements (B) would further increase potassium levels. Continuing spironolactone as ordered (C) would exacerbate hyperkalemia. Increasing the dose of spironolactone (D) would be contraindicated in this situation.
The diagnostic test that is most useful in differentiating the dyspnea related to pulmonary effects of heart failure from the dyspnea of pulmonary disease is
- A. Exercise stress testing
- B. A cardiac catheterization
- C. B-type natriuretic peptide (bNP) levels
- D. Serum blood urea nitrogen (BUN) levels
Correct Answer: C
Rationale: bNP is released from the ventricles in response to ventricular stretch and is a good marker for heart failure. If the bNP is elevated, shortness of breath is due to heart failure.
ECG changes in myocardial infarction.
- A. ST elevation
- B. Q waves
- C. Both A and B
- D. None of the above
Correct Answer: C
Rationale: ECG shows characteristic ST elevation and Q waves during MI.
Which of the following is a type of heart attack that occurs when the blood supply to part of the heart muscle is severely reduced or stopped?
- A. Myocardial infarction
- B. Angina
- C. Stroke
- D. Congestive heart failure
Correct Answer: A
Rationale: The correct answer is A: Myocardial infarction. A myocardial infarction, commonly known as a heart attack, happens when the blood flow to a part of the heart muscle is blocked, leading to damage or death of the tissue due to lack of oxygen. Angina (B) is chest pain due to reduced blood flow to the heart but does not cause permanent damage like a heart attack. Stroke (C) is a brain-related condition caused by interrupted blood flow to the brain. Congestive heart failure (D) is when the heart cannot pump blood effectively, leading to fluid buildup in the body.