Nokea
Which of the following diuretics inhibits sodium reabsorption in the kidneys while saving K+ and Hydrogen ions?
- A. Spironolactone
- B. Furosemide
- C. Hydrochlorothiazide
- D. Bumetanide
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic, which means it inhibits sodium reabsorption in the kidneys, while saving potassium and hydrogen ions. It accomplishes this by acting as an aldosterone antagonist, blocking the action of aldosterone. Aldosterone is a hormone that normally promotes sodium reabsorption in the kidneys and leads to potassium and hydrogen ion excretion. By inhibiting aldosterone, spironolactone promotes sodium excretion while conserving potassium and hydrogen ions.
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When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use
- A. ? (Select all that apply.)
- B. The patient reports seeing colorful halos around lights.
- C. The patient™s serum potassium level is above 5 mEq/L.
- D. The patient is experiencing nausea and anorexi
Correct Answer: D
Rationale: When a patient is experiencing digoxin toxicity, severe sinus bradycardia that does not respond to cardiac pacing is a clinical situation that would necessitate the use of digoxin-specific antibody fragments (Digibind). This intervention is required to counteract the toxic effects of digoxin on the heart, especially in cases of severe bradycardia that can compromise cardiac output and lead to serious consequences. In this scenario, Digibind works by binding to digoxin molecules, thereby neutralizing their effects and helping to restore normal cardiac function.
The nurse is teaching a patient about taking aspirin. Which are important points to include? (Select all that apply.)
- A. Advise the patient to avoid alcohol while taking aspirin.
- B. Instruct the patient to take aspirin before meals on an empty stomach.
- C. Instruct the patient to inform the dentist of the aspirin dosage before having dental work.
- D. Instruct the patient to inform the surgeon of the aspirin dosage before having surgery.
Correct Answer: D
Rationale: Aspirin is an antiplatelet agent that can increase the risk of bleeding, especially when combined with alcohol or during invasive procedures like dental work or surgery. Patients should avoid alcohol to reduce the risk of gastrointestinal bleeding. Additionally, informing healthcare providers about aspirin use is crucial to prevent excessive bleeding during procedures. Taking aspirin on an empty stomach is not recommended, as it can increase the risk of gastric irritation. Therefore, the correct teaching points are to avoid alcohol, inform the dentist, and inform the surgeon about aspirin use.
A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?
- A. Digoxin 0.25 mg PO daily
- B. Digoxin 1 mg PO now; then 0.25 mg PO daily
- C. Digoxin 0.5 mg IV push daily
- D. Digoxin 1 mg IV push now; then 0.25 mg IV daily
Correct Answer: D
Rationale: When a patient requires immediate treatment for atrial fibrillation with digoxin, the fastest way to achieve a therapeutic effect is through intravenous administration. Option D, Digoxin 1 mg IV push now; then 0.25 mg IV daily, is the most appropriate order in this scenario. Intravenous administration allows for rapid absorption and onset of action, making it the preferred route for urgent situations like atrial fibrillation. By giving an initial loading dose intravenously, followed by a lower maintenance dose IV daily or orally, the patient can quickly achieve therapeutic digoxin levels to help stabilize the heart rhythm. Option D provides the most rapid and effective way to manage new-onset atrial fibrillation with digoxin.
A patient is scheduled to receive chemotherapy drugs that will cause myelosuppression. Which action by the nurse will be most important?
- A. Monitor for a change in temperature.
- B. Evaluate gastrointestinal function.
- C. Assess for evidence of cardiac compromise.
- D. Question the patient about changes in sense of taste.
Correct Answer: A
Rationale: Myelosuppression, a common side effect of chemotherapy, leads to a decrease in white blood cells, red blood cells, and platelets. A drop in white blood cells, particularly neutrophils, increases the risk of infection. Monitoring for a change in temperature is critical because fever is often the first sign of infection in neutropenic patients. Early detection allows for prompt intervention, such as administering antibiotics, to prevent life-threatening complications. While gastrointestinal function, cardiac compromise, and changes in taste are important to assess, they are not as immediately life-threatening as an undetected infection in a myelosuppressed patient.
The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication?
- A. Atropine
- B. Carvedilol (Coreg)
- C. Lisinopril (Prinivil)
- D. Nesiritide (Natrecor)
Correct Answer: D
Rationale: In the scenario described, the patient presents with acute decompensated heart failure (HF) with dyspnea at rest, indicating severe symptoms. Nesiritide, a recombinant B-type natriuretic peptide, is commonly used in the management of acute decompensated HF to improve symptoms of dyspnea and congestion. It acts as a vasodilator and promotes natriuresis and diuresis, helping to alleviate the symptoms of heart failure exacerbation. While other medications like Carvedilol (Coreg) and Lisinopril (Prinivil) are commonly used in chronic HF management, in this acute scenario with severe symptoms, Nesiritide would be the appropriate medication to anticipate for administration in the ICU setting. Atropine is not indicated for acute decompensated heart failure.