A nurse is caring for a client in the emergency department (... | RN Pharmacology 2023 Exam A

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A nurse is caring for a client in the emergency department (ED).

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Rationale:

🔷The ECG confirms atrial fibrillation with a rapid ventricular response (HR ↑ to 156/min), making ventricular rate control the immediate priority to restore cardiac output and relieve symptoms.

🔷Diltiazem (non-dihydropyridine CCB) slows AV nodal conduction, producing a prompt reduction in ventricular rate, which helps resolve chest heaviness, dyspnea, and anxiety arising from poor hemodynamics.

🔷With a blood pressure of 110/62 mm Hg and no evidence presented of decompensated heart failure, short-acting, titratable IV diltiazem is appropriate and guideline-supported for urgent rate control in AF with RVR.

🔷Rapid control of the cardiac rhythm rate reduces myocardial oxygen demand, prevents ischemia, and limits progression to hypotension or pulmonary congestion, especially crucial in a patient with HF and OSA.

🔷Continuous monitoring is essential: track BP, HR, and rhythm, and reassess for signs of hemodynamic instability; once rate is controlled, address anticoagulation needs and precipitating factors (e.g., hyperthyroidism).

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This question is from RN Pharmacology 2023 Exam A which contains 67 questions.

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A nurse is caring for a female client in an outpatient clinic.

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A. Nurses' Notes Day 1: Client is seen by provider for routine follow-up after being started on oxcarbazepine 150mg PO twice a day, last week. Client reports no nausea, headache. dizziness. or ataxia. Provider increased oxcarbazepine to 300 mg PO twice a day. Client is to return for a follow-up in 2 weeks. Day 14: Client returns for follow-up after increasing oxcarbazepine dosage. Client reports starting to have mild headaches earlier this week. Also states. "Yesterday I was very nauseated and threw up before breakfast.” When talking to client they have difficulty remembering the times they are taking their oxcarbazepine. Client reports using oral contraceptives as the only means of birth control. Laboratory-Results Day 1: Hct (37% to 47%) Hgb 14g/dL (12 to 16g/dL) Sodium 140 mEq/L (136 to 145 mEq/L) Day 14: Hct (37% to 47%) Hgb 13g/dL (12 to 16g/dL) Sodium 124 mEq/L (136 to 145 mEq/L)

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