Question

A nurse is caring for a patient taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring due to which comorbidity?

Answer 1

Correct Answers:

Chronic obstructive pulmonary disease (COPD)

Rationale :

📗 Clients with COPD require careful monitoring when receiving beta-blockers because blockade of beta₂-adrenergic receptors can cause bronchial smooth-muscle constriction.

📗 Nonselective beta-blockers, such as propranolol, block both beta₁ receptors in the heart and beta₂ receptors in the lungs, increasing the risk for bronchospasm.

📗 Bronchospasm can worsen wheezing, dyspnea, airflow limitation, and hypoxemia in a client who already has compromised pulmonary function.

📗 Cardioselective beta₁-blockers, such as metoprolol, generally have less effect on the lungs and may be used cautiously when clinically indicated, particularly in stable COPD.

📗 The nurse should monitor respiratory rate, breath sounds, oxygen saturation, dyspnea, and changes in exercise tolerance when beta-blocker therapy is initiated or adjusted.

📗 Beta-blockers also decrease heart rate and blood pressure, while nitrates produce vasodilation and can further decrease blood pressure.

📗 The combination therefore requires monitoring for hypotension, dizziness, bradycardia, and syncope, in addition to respiratory effects related to COPD.

📗 Careful medication selection and monitoring allow the cardiovascular benefits of beta-blockade to be balanced against the potential for worsening respiratory symptoms, particularly with nonselective agents.

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Answer 2

Correct Answers:

Confirming drug dosage calculation

Rationale :

⚽ Digoxin is a high-alert medication with a narrow therapeutic index, meaning the difference between a therapeutic and toxic dose is small.

⚽ Infants are particularly vulnerable to medication errors because digoxin doses are calculated precisely according to weight and prescribed dosing parameters.

⚽ Before administration, the nurse should carefully verify the prescribed dose and dosage calculation to prevent potentially life-threatening toxicity.

⚽ Pediatric digoxin doses are very small, so even a minor decimal-point or calculation error can result in a significant overdose.

⚽ Digoxin toxicity can produce bradycardia, dysrhythmias, vomiting, poor feeding, lethargy, and other cardiac manifestations in infants.

⚽ The nurse should also measure the infant's apical pulse for a full minute before administration and follow the prescribed parameters for withholding the medication.

⚽ Serum digoxin and potassium levels may also require monitoring because electrolyte disturbances, particularly hypokalemia, can increase susceptibility to digoxin toxicity.

⚽ Therefore, among the listed interventions, confirming the accuracy of the dosage calculation before administration is the priority for preventing a potentially serious medication error.

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Answer 3

Correct Answers:

"When was your last menstrual period?"

Rationale :

🌹 Angiotensin II receptor blockers (ARBs), such as losartan and valsartan, can cause serious fetal harm when used during pregnancy.

🌹 Asking about the client's last menstrual period (LMP) helps the nurse assess the possibility of a current pregnancy before the medication is administered.

🌹 ARBs interfere with the fetal renin-angiotensin system, which is essential for normal fetal renal development and function.

🌹 Exposure during pregnancy, particularly later pregnancy, can result in fetal renal dysfunction, oligohydramnios, impaired skull development, and fetal or neonatal death.

🌹 A delayed or missed menstrual period should prompt further assessment and, when indicated, pregnancy testing before continuing therapy.

🌹 Clients who could become pregnant should receive counseling regarding the pregnancy risks associated with ARBs and appropriate pregnancy planning.

🌹 If pregnancy occurs during ARB therapy, the medication should be reported promptly to the prescribing provider so safer treatment alternatives can be considered.

🌹 Therefore, determining the last menstrual period is the priority question because it helps identify the possibility of an existing pregnancy and prevent fetal exposure.

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Answer 4

Correct Answers:

Administer digoxin immune fab as prescribed

Rationale :

♠️ Digoxin immune Fab is the specific antidote used for severe or life-threatening digoxin toxicity.

♠️ It consists of antibody fragments that bind circulating digoxin, forming complexes that prevent digoxin from continuing to exert toxic effects on target tissues.

♠️ The digoxin–Fab complexes are subsequently eliminated primarily through the kidneys, reducing the amount of active free digoxin.

♠️ Severe toxicity can produce dangerous bradyarrhythmias, ventricular dysrhythmias, AV conduction abnormalities, hyperkalemia, hypotension, and altered mental status.

♠️ Older adults are particularly vulnerable because decreased renal function can reduce digoxin clearance and cause drug accumulation even when prescribed doses have previously been tolerated.

♠️ Continuous cardiac monitoring is essential because life-threatening dysrhythmias are a major immediate complication of severe digoxin toxicity.

♠️ The nurse should also monitor serum potassium, renal function, vital signs, and clinical response during treatment, recognizing that measured total digoxin levels after Fab administration can be misleading.

♠️ When severe digoxin toxicity has already been identified, promptly administering prescribed digoxin immune Fab directly treats the toxicity and takes priority over additional nonessential assessments.

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Answer 5

Correct Answers:

"The left ventricle needs to pump blood through the entire body."

Rationale :

🍊 The left ventricle has a substantially thicker and more muscular wall than the right ventricle because it must generate enough pressure to propel blood through the systemic circulation.

🍊 Oxygenated blood enters the left ventricle from the left atrium and is then pumped through the aortic valve into the aorta.

🍊 From the aorta, blood must travel to tissues and organs throughout the body, including the brain, kidneys, gastrointestinal tract, and extremities.

🍊 Systemic circulation has significantly greater vascular resistance than pulmonary circulation, requiring the left ventricle to generate much higher pressures.

🍊 The thicker myocardium of the left ventricle provides the contractile strength necessary to overcome this systemic vascular resistance.

🍊 In contrast, the right ventricle only needs to pump blood through the relatively low-pressure pulmonary circulation to the lungs.

🍊 Both ventricles normally pump approximately the same volume of blood with each heartbeat, but they pump against very different levels of resistance and pressure.

🍊 Therefore, the left ventricle's greater muscular thickness reflects its demanding role of delivering oxygenated blood throughout the entire body.

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Answer 6

Correct Answers:

Assess the patient's blood pressure

Rationale :

👉 Nifedipine is a dihydropyridine calcium channel blocker that produces arterial vasodilation, thereby decreasing systemic vascular resistance and blood pressure.

👉 Dizziness after starting nifedipine can indicate hypotension, particularly when it develops shortly after the initial doses.

👉 The nursing process requires the nurse to assess first before deciding whether the medication should be withheld or the provider should be notified.

👉 Measuring the client's blood pressure determines whether the dizziness is associated with clinically significant hypotension.

👉 The nurse should also assess for orthostatic changes, weakness, syncope, tachycardia, and other manifestations of decreased perfusion when appropriate.

👉 Nifedipine can also cause headache, flushing, peripheral edema, and reflex tachycardia because of its vasodilatory effects.

👉 The blood pressure findings will guide subsequent interventions, such as implementing safety precautions, withholding the medication according to prescribed parameters, or notifying the healthcare provider.

👉 Therefore, the priority is to assess the patient's blood pressure before taking further action.

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Answer 7

Correct Answers:

245

Rationale :

✍️ Calculation

✍️ Ordered dose: 671 mg

✍️ Available dose: 486 mg in 68 mL

✍️ Infusion time: 23 min

Step 1: Calculate the volume to administer

671 mg × 68 mL ÷ 486 mg

= 93.88 mL

Step 2: Convert 23 min to hours

23 ÷ 60

= 0.3833 hr

Step 3: Calculate the infusion rate

93.88 mL ÷ 0.3833 hr

= 244.91 mL/hr

Rounded to the nearest whole number:

🎯 245 mL/hr

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Answer 8

Correct Answers:

1

Rationale :

♦️ Calculation

♦️ Desired dose: 5 mg

♦️ Available dose: 5 mg/tablet

Formula:

5 mg × 1 tablet ÷ 5 mg

= 1 tablet

🎯 Answer: 1 tablet

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Answer 9

Correct Answers:

Atrial fibrillation

Rationale :

🎯 Dofetilide is a Class III antiarrhythmic medication primarily used for the management of atrial fibrillation and atrial flutter.

🎯 It works by blocking cardiac potassium channels, which prolongs repolarization and increases the cardiac action potential duration.

🎯 Dofetilide can help convert atrial fibrillation or atrial flutter to normal sinus rhythm and is also used to maintain sinus rhythm after conversion.

🎯 The medication requires careful monitoring because excessive QT prolongation can produce the potentially fatal ventricular dysrhythmia torsades de pointes.

🎯 Initiation or reinitiation of dofetilide generally requires inpatient ECG monitoring for at least 3 days or according to the approved monitoring protocol.

🎯 The nurse should closely monitor the client's QTc interval, cardiac rhythm, renal function, potassium, and magnesium levels.

🎯 Dofetilide dosage is adjusted according to creatinine clearance because the medication is primarily eliminated through the kidneys.

🎯 Therefore, a client taking dofetilide twice daily most likely has a history of atrial fibrillation or atrial flutter requiring rhythm-control therapy.

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Answer 10

Correct Answers:

Release of renin

Rationale :

✳️ When the kidneys experience decreased blood flow or decreased perfusion pressure, specialized juxtaglomerular cells respond by releasing renin.

✳️ Renin initiates the renin-angiotensin-aldosterone system (RAAS), an important mechanism for restoring circulating volume and blood pressure.

✳️ Renin converts liver-produced angiotensinogen into angiotensin I, which is subsequently converted by angiotensin-converting enzyme into angiotensin II.

✳️ Angiotensin II is a powerful vasoconstrictor, increasing systemic vascular resistance and therefore raising blood pressure.

✳️ Angiotensin II also stimulates the adrenal cortex to release aldosterone, which increases renal sodium reabsorption.

✳️ Water follows retained sodium, increasing intravascular volume, venous return, and blood pressure.

✳️ Persistent reduction in renal perfusion can therefore cause prolonged RAAS activation and contribute to sustained hypertension, such as the client's blood pressure around 150/100 mmHg.

✳️ This mechanism is especially important in conditions such as renal artery stenosis, where the kidney interprets reduced renal blood flow as inadequate circulating pressure despite systemic hypertension.

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QLexNursing

1 :
A nurse is caring for a patient taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring due to which comorbidity?

2 :
The nurse is preparing to administer digoxin to an infant. What is the nurse's priority intervention for this patient?

3 :
What is the nurse's priority assessment question before administering an angiotensin II receptor blocker (ARB) to a female patient?

4 :
A nurse is assessing a 78-year-old patient in the emergency department. The nurse determines the patient is experiencing severe digoxin toxicity. What is the nurse's priority action?

5 :
A patient asks the nurse to explain why the left ventricle is so much larger than the right ventricle. Which explanation will the nurse provide?

6 :
A patient diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The patient has received the first two doses of the medication and reports dizziness. What is the nurse's PRIORITY action?

7 :
The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what nurse set the infusion? mL/hr (If needed, round to the nearest whole number)

8 :
The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer?. needed, round to the nearest whole number.)

9 :
The nurse is reviewing the medication regimen of a newly admitted patient. The patient currently takes dofetilide 250 mcg PO twice a day. The patient's health history likely includes what diagnosis?

10 :
The nurse is caring for a patient with decreased blood flow to the kidneys. The patient's blood pressure has been in the range of 150/100 mmHg for several days. What is the most likely cause of this patient's hypertension?

QLexNursing

1 : A nurse is caring for a patient taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring due to which comorbidity?

2 : The nurse is preparing to administer digoxin to an infant. What is the nurse's priority intervention for this patient?

3 : What is the nurse's priority assessment question before administering an angiotensin II receptor blocker (ARB) to a female patient?

4 : A nurse is assessing a 78-year-old patient in the emergency department. The nurse determines the patient is experiencing severe digoxin toxicity. What is the nurse's priority action?

5 : A patient asks the nurse to explain why the left ventricle is so much larger than the right ventricle. Which explanation will the nurse provide?

6 : A patient diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The patient has received the first two doses of the medication and reports dizziness. What is the nurse's PRIORITY action?

7 : The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what nurse set the infusion? mL/hr (If needed, round to the nearest whole number)

8 : The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer?. needed, round to the nearest whole number.)

9 : The nurse is reviewing the medication regimen of a newly admitted patient. The patient currently takes dofetilide 250 mcg PO twice a day. The patient's health history likely includes what diagnosis?

10 : The nurse is caring for a patient with decreased blood flow to the kidneys. The patient's blood pressure has been in the range of 150/100 mmHg for several days. What is the most likely cause of this patient's hypertension?

1 :
A nurse is caring for a patient taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring due to which comorbidity?

2 :
The nurse is preparing to administer digoxin to an infant. What is the nurse's priority intervention for this patient?

3 :
What is the nurse's priority assessment question before administering an angiotensin II receptor blocker (ARB) to a female patient?

4 :
A nurse is assessing a 78-year-old patient in the emergency department. The nurse determines the patient is experiencing severe digoxin toxicity. What is the nurse's priority action?

5 :
A patient asks the nurse to explain why the left ventricle is so much larger than the right ventricle. Which explanation will the nurse provide?

6 :
A patient diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The patient has received the first two doses of the medication and reports dizziness. What is the nurse's PRIORITY action?

7 :
The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what nurse set the infusion? mL/hr (If needed, round to the nearest whole number)

8 :
The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer?. needed, round to the nearest whole number.)

9 :
The nurse is reviewing the medication regimen of a newly admitted patient. The patient currently takes dofetilide 250 mcg PO twice a day. The patient's health history likely includes what diagnosis?

10 :
The nurse is caring for a patient with decreased blood flow to the kidneys. The patient's blood pressure has been in the range of 150/100 mmHg for several days. What is the most likely cause of this patient's hypertension?