Practice Question
A nurse is planning to teach a client who has peptic ulcer disease about medications.
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Rationale:
🟦 The ECG shows atrial fibrillation with a rapid ventricular response (HR increased from 122/min to 156/min) and an irregular rhythm, which makes the priority problem the abnormal cardiac rhythm.
🟦 Diltiazem is a calcium channel blocker used to slow AV-node conduction, which helps control the ventricular rate in atrial fibrillation.
🟦 Rate control improves cardiac filling time, which can reduce symptoms like dyspnea, chest heaviness, and decreased oxygen saturation by improving overall cardiac output.
🟦 The client’s worsening status at 0930 (HR 156, RR 28, O₂ 92%, chest heaviness) fits a need to treat the unstable rhythm before focusing on secondary symptoms.
🟦 Although the client reports anxiety, the clinical pattern points to physiologic distress from A-fib with RVR, so a medication targeting rate/rhythm control is most appropriate to anticipate.
Albuterol nebulizer
🟦 Albuterol treats bronchospasm (e.g., asthma), but this client has clear lung sounds and the problem is not wheezing.
🟦 It can also increase heart rate, potentially worsening tachycardia in atrial fibrillation.
Alprazolam
🟦 Alprazolam may reduce anxiety, but it does not correct the dangerous cardiac rhythm causing the symptoms.
🟦 Sedation could also mask worsening cardiopulmonary status while the dysrhythmia continues.
Furosemide
🟦 Furosemide addresses fluid overload and edema, but the acute deterioration here is driven by rapid A-fib and falling oxygen saturation.
🟦 Non-pitting pedal edema is present, yet the immediate priority is rate control, not diuresis first.
Dopamine
🟦 Dopamine is used for hypotension/shock and can increase heart rate and myocardial workload.
🟦 With HR 156/min, dopamine could worsen tachyarrhythmia unless profound shock is present (not shown here).
Dyspnea
🟦 Dyspnea is present, but it is best explained by the rapid irregular rhythm reducing cardiac output and perfusion.
🟦 Treating the cardiac rhythm addresses the underlying trigger of dyspnea more directly.
Edema
🟦 Edema suggests chronic fluid issues from heart failure, not the sudden change in HR and symptoms at 0930.
🟦 The urgent issue is the new/worsening tachyarrhythmia.
Blood pressure
🟦 BP decreased from 132/68 to 110/62, but it is not the primary abnormality compared to A-fib with RVR.
🟦 The rhythm problem is the main driver requiring immediate targeted therapy.
Anxiety
🟦 Anxiety can occur as a response to hypoxia and palpitations, but it is not the primary cause of instability here.
🟦 Treating anxiety alone would not correct the arrhythmia producing the symptoms.
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This question is from ☑️ ATI RN Pharmacology 2023 VIII which contains 68 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pharmacology
- Answer Choices: 0