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When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol:
- A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
- B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
- C. Is a diuretic that reduces peripheral vascular resistance and lowers blood pressure.
- D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.
Correct Answer: A
Rationale: Propranolol, a beta-blocker, blocks beta-adrenergic receptors, reducing heart rate, contractility, and conduction, lowering blood pressure.
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The nurse is planning care for a client being admitted with bleeding esophageal varices. Vital signs are: Pulse 100; respiratory rate 22; and blood pressure 100/58. The nurse should prepare the client for which of the following? Select all that apply.
- A. Administration of intravenous Octreotide (Sandostatin).
- B. Endoscopy.
- C. Administration of a blood product.
- D. Minnesota tube insertion.
- E. Transjugular intrahepatic portosystemic shunt (TIPS).
Correct Answer: A,B,C,D
Rationale: Octreotide (A) reduces portal pressure, endoscopy (B) diagnoses and treats bleeding, blood products (C) correct hypovolemia, and a Minnesota tube (D) controls bleeding. TIPS (E) is a later intervention.
A client is discharged after being hospitalized for thrombophlebitis. She will be driving home with her daughter, who lives 2 hours away. During the 2-hour ride, the nurse should advise the client to:
- A. Perform arm circles while riding in the car
- B. Perform ankle pumps and foot range-of-motion exercises
- C. Elevate her legs while riding in the car
- D. Take an ambulance home
Correct Answer: B
Rationale: Ankle pumps and foot range-of-motion exercises during the car ride promote venous return, preventing stasis and recurrent thrombophlebitis. Arm circles are irrelevant, elevating legs is impractical, and an ambulance is unnecessary for a discharged client.
A client who had a left thoracoscopy sustained an injury secondary to the surgery position. The nurse should assess the client for:
- A. Footdrop.
- B. Knee swelling and pain.
- C. Tingling in the arm.
- D. Absence of the Achilles reflex.
Correct Answer: C
Rationale: Thoracoscopy positioning (lateral decubitus) can compress nerves in the arm, causing tingling due to brachial plexus injury. Footdrop or Achilles reflex issues are unrelated to this position.
The nurse should assess clients with chronic open-angle glaucoma (COAG) for:
- A. Eye pain.
- B. Excessive lacrimation.
- C. Colored light flashes.
- D. Decreasing peripheral vision.
Correct Answer: D
Rationale: Chronic open-angle glaucoma typically presents with a gradual loss of peripheral vision due to optic nerve damage from increased intraocular pressure.
A client with a fractured right femur has not had any immunizations since childhood. Which of the following biological products should the nurse administer to provide the client with passive immunity for tetanus?
- A. Tetanus toxoid.
- B. Tetanus antigen.
- C. Tetanus vaccine.
- D. Tetanus antitoxin.
Correct Answer: D
Rationale: Tetanus antitoxin provides passive immunity, neutralizing existing toxin in unvaccinated clients.