Nokea
What is the priority nursing assessment for a client with atrial fibrillation started on verapamil?
- A. Monitor blood pressure and heart rate.
- B. Assess for signs of hyperglycemia.
- C. Monitor urine output and kidney function.
- D. Assess for signs of peripheral edema.
Correct Answer: A
Rationale: Verapamil can cause hypotension and bradycardia, so these must be monitored closely.
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A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
- A. Teach the patient the reasons for remaining on bed rest
- B. Change the peripheral IV site according to agency policy
- C. Monitor the patient's blood pressure and heart rate every hour
- D. Titrate the rate to keep the systolic blood pressure >90 mm Hg
Correct Answer: C
Rationale: An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive drugs, and inserting a new peripheral IV catheter require RN level education and scope of practice.
A 45-year-old woman presents with a chief complaint of fatigue. Her BMI is 27, and her sleep experience includes frequent loud snoring and witnessed apneas. A polysomnography is performed and reveals an apnea hypopnea index of 11 (normal less than 5). Patient is started on continuous positive airway pressure (CPAP) therapy, as well as dietary modification and recommended an exercise program. At follow-up visit patient reports compliance with CPAP therapy and improved energy. She has also lost 6 kg because of lifestyle modifications. Her BMI is now 24. Which of the following management strategies would be most appropriate for this patient?
- A. Discontinue CPAP therapy and evaluate symptoms in 4 weeks
- B. Schedule a repeat polysomnography and CPAP titration
- C. Decrease CPAP settings by 20% and reevaluate response in 4 weeks
- D. Continue CPAP therapy at current settings
Correct Answer: B
Rationale: Weight loss and lifestyle changes may reduce OSA severity, but the current AHI and optimal CPAP settings need reassessment. A repeat polysomnography with CPAP titration is the most appropriate step to ensure therapy aligns with her current condition, per sleep medicine guidelines.
Which type of lipoproteins acts as a reservoir of apolipoproteins for the other lipoproteins?
- A. Chylomicrons
- B. VLDL
- C. LDL
- D. HDL
Correct Answer: D
Rationale: HDL serves as a reservoir, donating apolipoproteins to other lipoproteins.
Which of the following does not dilate arterioles in the skin?
- A. Increased body temperature
- B. Epinephrine
- C. Bradykinin
- D. Vasopressin
Correct Answer: D
Rationale: Vasopressin causes vasoconstriction, not dilation, unlike the others which dilate skin arterioles.
Which information should the nurse include when teaching a patient with newly diagnosed hypertension?
- A. Increasing physical activity will control blood pressure(BP) for most patients.
- B. Most patients are able to control BP through dietary changes.
- C. Annual BP checks are needed to monitor treatment effectiveness.
- D. Hypertension is usually asymptomatic until target organ damage occurs.
Correct Answer: D
Rationale: Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes(e.g., physical activity, dietary changes) are used to help manage blood pressure, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months once stable.