Nursing Elites

1. The client on nitroglycerin complains of a headache. What is the most appropriate response by the nurse?

• A. Administer acetaminophen as prescribed for the headache.
• B. Hold the next dose of nitroglycerin.
• C. Discontinue the nitroglycerin immediately.
• D. Notify the healthcare provider immediately.

Correct answer: A

Rationale: The correct response is to administer acetaminophen as prescribed for the headache. Headaches are a common side effect of nitroglycerin due to vasodilation. Administering acetaminophen can help relieve the headache. Holding the next dose of nitroglycerin (Choice B) may not address the current headache, and discontinuing nitroglycerin immediately (Choice C) without healthcare provider guidance can be dangerous due to the potential for rebound hypertension. Notifying the healthcare provider immediately (Choice D) is not necessary for a common side effect like a headache, and the nurse can manage this symptom independently.

2. Which structure serves as the normal pacemaker of the heart?

• A. SA node
• B. AV node
• C. Purkinje fibers
• D. Atria

Correct answer: A

Rationale: The correct answer is the SA node. The sinoatrial (SA) node is known as the natural pacemaker of the heart as it generates electrical impulses initiating each heartbeat. The SA node is located in the right atrium and sets the rhythm and rate of the heartbeat. The AV node (choice B) is responsible for delaying the electrical impulse to allow the atria to contract before the ventricles. Purkinje fibers (choice C) are specialized cardiac fibers responsible for the rapid conduction of impulses to the myocardial cells, and the atria (choice D) are the upper chambers of the heart involved in receiving blood from the veins.

3. The healthcare provider is administering IV nitroglycerin to a patient for chest pain. What is the most critical parameter to monitor?

• A. Heart rate
• B. Blood pressure
• C. Oxygen saturation
• D. Respiratory rate

Correct answer: B

Rationale: The correct answer is 'Blood pressure.' Nitroglycerin is a vasodilator that can cause a rapid drop in blood pressure, leading to hypotension. Monitoring the blood pressure is crucial to prevent potential complications such as hypotension-induced dizziness, syncope, or organ hypoperfusion. While heart rate, oxygen saturation, and respiratory rate are important parameters to monitor in a clinical setting, the immediate concern with IV nitroglycerin administration is the risk of hypotension, making blood pressure the most critical parameter to assess.

4. What is the procedure where a catheter is used to open a blocked or narrowed coronary artery, often involving the placement of a stent?

• A. Angioplasty
• B. Valve replacement
• C. Stent placement
• D. Coronary artery bypass graft (CABG)

Correct answer: A

Rationale: The correct answer is Angioplasty. Angioplasty is a procedure where a catheter is used to open a blocked or narrowed coronary artery, often involving the placement of a stent to keep the artery open and improve blood flow to the heart. Choice B, Valve replacement, is incorrect as it involves replacing a heart valve, not opening a blocked artery. Choice C, Stent placement, is similar to angioplasty but not as specific, as it does not involve the catheter-based procedure. Choice D, Coronary artery bypass graft (CABG), is a different procedure where blocked arteries are bypassed using a blood vessel from another part of the body.

5. The client is on dobutamine. Adverse effects of Dobutrex (dobutamine) include the following: Select all that apply.

• A. Heart failure
• B. Bradycardia
• C. Tachycardia
• D. Respiratory distress

Correct answer: C

Rationale: The correct answer is C: Tachycardia. Dobutamine is a medication that primarily increases heart rate (tachycardia) and blood pressure. Therefore, the adverse effects of dobutamine include tachycardia. Choices A, B, and D are incorrect. Heart failure is not an adverse effect of dobutamine; in fact, it is used to treat heart failure by increasing heart contractility. Bradycardia (slow heart rate) is not an expected adverse effect of dobutamine, as it usually increases heart rate. Respiratory distress is not a common adverse effect of dobutamine.

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