NRS301 EAQ #7

The nurse is discussing pain management with a patient diagnosed with hemophilia. Which statement made by the patient indicates an understanding of safe over-the-counter pain management therapy? 1 "I can take acetaminophen for my pain." 2 "I understand that ibuprofen is safe if I have mild pain." 3 "Ibuprofen is the only medication I can take for pain." 4 "I will use the minimal dose of aspirin for headaches."

1 Acetaminophen is the drug of choice for pain in a patient diagnosed with hemophilia. It does not affect blood coagulation, so it is safe for patients with hemophilia. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). NSAIDs are contraindicated for patients with hemophilia because many inhibit platelet aggregation and can cause gastrointestinal ulcers and bleeding. Like NSAIDs, aspirin inhibits platelet aggregation which is irreversible in the case of aspirin. Therefore, aspirin must be avoided.

Before the nurse administers isosorbide mononitrate, what is a priority nursing assessment? 1 Assess blood pressure. 2 Assess serum electrolytes. 3 Monitor level of consciousness. 4 Measure blood urea nitrogen and creatinine.

1 Isosorbide mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering. The nurse also may assess electrolyte levels, level of consciousness, and renal function; however, these are not the priority assessments in relation to the known expected and side effects of vasodilators.

Which form of nitroglycerin is likely to have a large first-pass effect? 1 Oral 2 Sublingual 3 Intravenous 4 Transdermal

1 Oral nitroglycerin goes to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from circulation. This is known as a large first-pass effect. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly because the area under the tongue is highly vascular. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris because it allows for the continuous, slow delivery of nitroglycerin. Intravenous nitroglycerin is quickly absorbed in the blood and has an onset of action of 1 to 2 minutes.

The patient is being treated with a continuous intravenous (IV) infusion of heparin. What is the nurse's highest priority? 1 Ensure that protamine sulfate is readily available at all times. 2 Ensure that the patient's laboratory values are monitored correctly. 3 Ensure that a loading dose was initially administered when treatment began. 4 Ensure that the patient is taught dietary restrictions while on the medication.

1 Protamine sulfate must be kept readily available because it is the antidote for an overdose of heparin. Although it is important to monitor the patient's laboratory values, this is not the priority. Teaching about limiting foods high in vitamin K is appropriate for warfarin, not heparin. Administering a loading dose before beginning the maintenance IV dose may not always occur.

A patient is prescribed a therapeutic lifestyle change (TLC) diet. The patient understands the diet when he states which of the following? 1 "The TLC diet was prescribed to help me reduce my low-density lipoproteins (LDL) cholesterol and maintain a healthy weight." 2 "The TLC diet was prescribed to help me reduce my high-density lipoproteins (HDL) and gain weight." 3 "The TLC diet was prescribed to help me lose weight and keep if off." 4 "The TLC diet was prescribed for me to eat more trans fats (T), lean (L) meat, and have few carbohydrates (C) each day."

1 The TLC diet stands for therapeutic lifestyle changes and was prescribed to help reduce LDL cholesterol and maintain a healthy weight. The diet is not used to reduce HDL, gain weight, nor eat more trans fats and fewer carbohydrates.

Before administering amiodarone, what is the most important assessment for the nurse to complete? 1 Heart rate 2 Temperature 3 Skin integrity 4 Respiratory rate

1 The nurse should assess heart rate before administering amiodarone. Altered skin integrity, elevated temperature, and decreased or increased respiratory rate are not contraindications. The other absolute contraindications include severe sinus bradycardia or second- or third-degree heart block.

A patient with cardiovascular disease is taking rosuvastatin. Which finding would indicate a potential adverse effect of this drug? 1 Muscle pain and tenderness 2 Platelet count of 100 × 10 3/mm 3 3 Blood pressure of 140/90 mm Hg 4 Wheezing and shortness of breath

1 The statins, such as rosuvastatin, typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. The nurse will immediately notify the healthcare provider of which findings? Select all that apply. 1 Nosebleeds 2 aPTT of 40 seconds 3 aPTT of 100 seconds 4 Platelet count of 300,000/µL 5 Activated partial thromboplastin time (aPTT) of 65 seconds

1, 2, 3 Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/µL is within normal limits, indicating no evidence of thrombocytopenia.

Which are common causes of dysrhythmias? Select all that apply. 1 Hypoxia 2 Hypertension 3 Cardiac surgery 4 Myocardial infarction 5 Electrolyte imbalance

1, 3, 4, 5 Dysrhythmias arise from two fundamental causes: disturbances in impulse formation and disturbances of impulse conduction. These disturbances most likely are caused by electrolyte imbalance, myocardial infarction, cardiac surgery, hypoxia, reduced coronary blood flow, and antidysrhythmic drugs. Hypertension does not cause dysrhythmias.

The nurse in the emergency department receives a report on a patient diagnosed with ST-elevation myocardial infarction (STEMI). What are the common biochemical markers and symptoms for a STEMI? Select all that apply. 1 Elevated troponin T level 2 Decreased troponin I level 3 Weakness and diaphoresis 4 Elevated creatinine kinase level 5 Chest pain and electrocardiographic (ECG) changes

1, 3, 4, 5 Patients experiencing STEMI typically present with chest pain, an elevated ST segment on the ECG, elevated (not decreased) levels of cardiac cell components (eg, troponin and creatinine kinase), sweating, weakness, and a sense of impending doom.

Which best describes the mechanism of action of an anticoagulant? 1 Decreases platelet production 2 Reduces the formation of fibrin 3 Suppresses platelet aggregation 4 Removes thrombi that have formed

2 An anticoagulant reduces the formation of fibrin either by inhibiting the synthesis of clotting factors and/or thrombin. Anticoagulants do not decrease platelet production. Platelet aggregation is suppressed with an antiplatelet drug, such as aspirin. Thrombolytic drugs remove thrombi that have already formed.

The nurse is assessing a patient who has been prescribed atorvastatin. What instruction should the nurse provide for the patient to ensure proper administration of the medication? 1 "Take the drug after breakfast." 2 "Take the drug in the evening." 3 "Take the drug with an antacid." 4 "Take the drug on an empty stomach."

2 Cholesterol production by the liver usually occurs at night; thus, statin drugs such as atorvastatin work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug because it does not cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.

The nurse would question an order for colesevelam if the patient has which condition in the medical history? 1 Glaucoma 2 Constipation 3 Renal disease 4 Hepatic disease

2 Colesevelam binds with bile acids and other substances in the gastrointestinal tract, thereby preventing their absorption and promoting their excretion. Constipation is the main complaint. Glaucoma, hepatic disease, and renal disease are not contraindications to using this medication.

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? 1 Filgrastim 2 Epoetin alfa 3 Oprelvekin 4 Sargramostim

2 Epoetin alfa is used to increase red blood cell counts in patients with anemia from several causes including chronic renal failure. Filgrastim is used to elevate neutrophil counts in cancer patients and for the treatment of severe chronic neutropenia. Sargramostim is used to accelerate recovery from bone marrow transplantation. Oprelvekin is given to stimulate platelet production during chemotherapy.

A patient with deep vein thrombosis receiving an intravenous heparin infusion asks the nurse how this medication works. What is the nurse's best response? 1 "Heparin converts plasminogen to plasmin, which in turn dissolves the clot matrix" 2 "Heparin suppresses coagulation by helping antithrombin perform its natural functions." 3 "Heparin prevents activation of vitamin K and thus blocks synthesis of some clotting factors." 4 "Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels."

2 Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots. Thrombolytics (e.g., alteplase) dissolve existing clots. Blocking vitamin k-dependent clotting factors occurs with warfarin, not heparin. Platelet aggregation is blocked with antiplatelets such as aspirin, not with anticoagulants such as heparin.

Which medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain? 1 Aspirin 2 Morphine 3 Lorazepam 4 Hydromorphone

2 Morphine treats pain and improves hemodynamics. By promoting venodilation, the drug reduces cardiac preload. By promoting modest arterial dilation, it may cause some reduction in afterload. The combined reductions in preload and afterload lower the cardiac oxygen demand, thereby helping to preserve the ischemic myocardium and relieving the patient's pain. Aspirin and hydromorphone may provide pain relief but are not the best choice. Lorazepam would not treat the pain, nor is it a drug of choice for STEMI treatment.

The nurse is caring for a patient who is taking the drug amiodarone. The patient has also been on a treatment regimen that includes digoxin. Based on this information, the nurse should monitor the patient closely for evidence of what? 1 Tachycardia 2 Atrioventricular block 3 Prolonged QT interval 4 Decreased digoxin levels

2 The interaction of amiodarone and digoxin can result in atrioventricular block. The interaction would lead to decrease heart rate and increased digoxin levels. There is no effect on the QT interval with these medications.

The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. The nurse realizes bile acid sequestrants may cause what interaction? Select all that apply. 1 Decreased urination 2 Binding with digoxin 3 Binding with warfarin 4 Inactivation with food 5 Elevated blood pressure

2, 3

Which are beneficial effects that can be derived from simvastatin and other drugs in this class? Select all that apply. 1 Improvement of liver function 2 Reduction of risk of cardiovascular events 3 Reduction of low-density lipoproteins (LDLs) 4 Elevation of high-density lipoproteins (HDLs) 5 Stabilization of the plaque in coronary arteries

2, 3, 4, 5 The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.

A patient with coronary artery disease complains of chest pain. On assessment, the nurse notes the patient was sitting when the pain occurred. What other factors may have contributed to the chest pain? Select all that apply. 1 Fluid intake 2 A large meal 3 Very cold weather 4 Increased pulse rate 5 Emotional excitement

2, 3, 5 Stable angina is triggered most often by an increase in physical activity. Emotional excitement, large meals, and cold exposure also may precipitate an attack. Because stable angina usually occurs in response to strain, this condition is also known as exertional angina or angina of effort. Fluid intake is not a precipitating factor for chest pain. An increase in heart rate that is sustained, may contribute; however, it is not typical.

Which are the main types of drugs used to prevent or relieve anginal pain? Select all that apply. 1 Statins 2 Nitrates 3 Beta blockers 4 Platelet inhibitors 5 Calcium channel blockers

2, 3, 5 The three main types of antianginal drugs are beta blockers, organic nitrates, and calcium channel blockers. Platelet inhibitors and statins (unless contraindicated) are incorporated into the treatment plan to reduce the risk of myocardial infarction and atherosclerosis.

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? 1 Anxiety 2 Medication reaction 3 Embolus to the lungs 4 Fatigue from the extra work of walking with pain

3 A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that fatigue, anxiety, or a medication reaction would cause chest pain and dyspnea in this case.

The nurse is caring for a patient who takes warfarin for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. How should the nurse interpret this finding? 1 INR is too high; vitamin K may be needed. 2 INR is within normal limits; no action is indicated. 3 INR is too low; the dose may need to be increased. 4 INR is too high; intravenous protamine may be needed.

3 An INR in the range of 2 to 3 is considered the therapeutic level for warfarin therapy; however, it may take several days to obtain peak effects. For a level of 1.2, the nurse should contact the healthcare provider, who will determine whether a dose adjustment is needed. Reversal with vitamin K would occur if the INR is greater than 8 or the patient is actively bleeding. Protamine sulfate reverses heparin, not warfarin.

The nurse is caring for a patient who takes multiple cholesterol-lowering drugs. Which drug is least likely to cause systemic side effects? 1 Gemfibrozil 2 Simvastatin 3 Colesevelam 4 Nicotinic acid

3 Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The most common complication of bile acid sequestrants is constipation. The other agents have potential systemic adverse effects as they are systemically absorbed.

A nurse is preparing to administer enoxaparin sodium to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? 1 Rub the administration site after injecting. 2 Use the Z-track method to inject the medication. 3 Administer the medication into subcutaneous tissue of the abdomen. 4 Draw up the medication in a syringe with a 22-gauge, 1½-inch needle.

3 Enoxaparin is a low-molecular-weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method should never be used to administer enoxaparin sodium. The use of a 22-gauge, 1½-inch needle is more appropriate for administration of an intramuscular injection.

Which assessment finding could indicate a myocardial infarction (MI) in a patient who is taking nitroglycerin for angina? 1 The patient has a headache after taking the drug. 2 There is sudden and severe hypotension in the patient. 3 Chest pain is not relieved by administering nitroglycerin. 4 The patient complains of feeling dizzy when trying to move.

3 If chest pain is not relieved after taking nitroglycerin, it indicates possible MI in the patient. In this case, the patient needs to report to the emergency department immediately to seek prompt treatment. Headache is a common side effect of nitroglycerin. It diminishes soon after the therapy is started. The patient feels dizzy because of the drug-induced hypotension. However, the patient can be asked to restrict movement or turn slowly to avoid dizziness. Sudden and severe hypotension is seen when a patient is administered intravenous nitroglycerin rapidly.

A patient with hyperlipidemia is treated with atorvastatin. On the follow-up visit, the nurse discovers that the patient has had no improvement in cholesterol levels. What could be the reason for this? 1 The patient has a history of rhabdomyolysis. 2 The patient took atorvastatin with gemfibrozil. 3 The patient is taking the medication in the morning. 4 The patient consumed more than 8 ounces of grapefruit juice per day.

3 Patients who take statins such as atorvastatin should be taught to take the medication in the evening to get the best effects. Grapefruit juice increases the risk of rhabdomyolysis but only if more than one quart per day is taken. The drug increases the risk of rhabdomyolysis, but having a history of this disorder does not cause the drug to be ineffective.

Which structure in the heart is referred to as the pacemaker? 1 Bundle of His 2 Purkinje fibers 3 Sinoatrial (SA) node 4 Atrioventricular (AV) node

3 The SA node is the pacemaker because it can spontaneously depolarize easier and faster than the other areas. The His-Purkinje system acts to rapidly conduct electrical excitation to fill the ventricles. The AV node is responsible for transmitting the electrical impulse from the atria to the ventricle.

The nurse is teaching a patient whose dysrhythmia is being treated with medication therapy. Which fact should the nurse include in the teaching plan? 1 "Drug therapy is only used for bradydysrhythmias." 2 "Medication therapy often does not work for dysrhythmias." 3 "Almost all drugs used to treat dysrhythmias can cause dysrhythmias." 4 "Medication is only taken during the time the dysrhythmia is occurring."

3 The patient should understand that almost all drugs used to treat dysrhythmias can cause dysrhythmias. The nurse should teach the patient the effects of the drug as well as how to assess their pulse rate. These medications may be taken to prevent the dysrhythmia from recurring. Although these medications are effective to treat dysrhythimas, they have many side and adverse effects and are used for both bradydysrhythmias and tachydysrhythmias.

Which instruction should be included in the discharge teaching for a patient with atrial fibrillation? Select all that apply. 1 Atrial fibrillation is not treatable. 2 Patients cannot live with atrial fibrillation. 3 Atrial fibrillation may cause rapid ventricular rates. 4 Atrial fibrillation is the most common dysrhythmia. 5 There is a high risk of stroke with atrial dysrhythmia.

3, 4, 5 Atrial fibrillation is the most common sustained dysrhythmia, affecting about 2.6 million people in the United States. The disorder is caused by multiple atrial ectopic foci firing randomly; each focus stimulates a small area of atrial muscle. This chaotic excitation produces a highly irregular atrial rhythm. Depending on the extent of impulse transmission through the atrioventricular node, ventricular rate may be very rapid or nearly normal. In addition to compromising cardiac performance, atrial fibrillation carries a high risk of stroke because, in patients with atrial fibrillation, some blood can become trapped in the atria (rather than flowing straight through to the ventricles), thereby permitting formation of a clot. When normal sinus rhythm is restored, the clot may become dislodged, and then may travel to the brain to cause stroke. Atrial fibrillation is treatable, and patients can live with this dysrhythmia.

Which effect will beta blockers have on the conduction system in the heart? Select all that apply. 1 Increased cardiac output 2 Increased sympathetic stimulation 3 Reduced contractility in the atria and ventricles 4 Slowed conduction in the atrioventricular (AV) node 5 Reduction of automaticity in the sinoatrial (SA) node

3, 4, 5 Beta blockers are classified as class II antidysryhthmic drugs. They decrease calcium entry during fast and slow potentials and depress phase 4 depolarization in slow potentials only. They decrease the automaticity of the SA node, slow conduction through the AV node, and decrease contractility in the atria and ventricles. These medications may decrease cardiac output and decrease sympathetic stimulation.

The nurse is monitoring a patient receiving ferrous sulfate for treatment of iron deficiency anemia. Which finding indicates that the therapy is effective? 1 Black stools 2 Decrease in energy 3 Absence of emesis 4 Increased hemoglobin

4 A patient who has increased hemoglobin would be evaluated as having a positive response to ferrous sulfate therapy. Increase in energy would also be therapeutic. Black stools are a side effect of therapy. Emesis is not a measure of therapeutic effect.

The patient is receiving anticoagulant therapy. The international normalized ratio (INR) value for the patient today is 1.5. In response to this, the nurse could anticipate the healthcare provider placing which order? 1 Administer protamine sulfate. 2 Increase the heparin drip rate. 3 Hold the next dose of warfarin. 4 Administer an additional dose of warfarin.

4 A therapeutic INR is 2 to 3.5. The patient needs more warfarin to reach a therapeutic level. It should not be held because that would increase the risk of clotting. Heparin is not ordered; that would be indicated by monitoring the activated partial thromboplastin time, not prothrombin time and INR. Protamine sulfate is the antidote for heparin overdose.

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? 1 T wave 2 P wave 3 ST segment 4 QRS complex

4 An ECG has several components. The QRS complex is caused by depolarization of the ventricles, the P wave is caused by depolarization in the atria, and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions.

Which instructions should the nurse include in the plan of care for a patient receiving ferrous sulfate therapy? 1 "Iron does not absorb." 2 "Iron should only be taken at night." 3 "Iron compounds are not taken orally." 4 "Antacids should not be taken with iron."

4 Antacids can decrease the absorption of iron. Iron is typically taken in the morning. It is absorbed readily and is taken orally.

Which statement reflects a patient's accurate understanding of dietary restrictions while taking a vitamin K antagonist? 1 "I should avoid most green, leafy vegetables to prevent an interaction with my medication." 2 "I should avoid most fatty or high-cholesterol foods to prevent an interaction with my medication." 3 "I should be consistent in my intake of high-fat foods once a maintenance dose of my medication has been established." 4 "I should be consistent in my intake of green vegetables once a maintenance dose of my medication has been established."

4 Educate patients to maintain consistency in their intake of leafy, green vegetables. Many patients are under the misconception that they must avoid all leafy, green vegetables; however, this is not true. Once their maintenance warfarin dose is established, patients may still eat greens, but they need to be consistent in their intake of green vegetables because increasing or decreasing their intake can affect the international normalized ratio. Increased fat and cholesterol will not interfere with vitamin K antagonists.

In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles? 1 Bundle of His 2 Purkinje system 3 Internodal pathways 4 Atrioventricular node

4 Impulses originate in the sinoatrial node and then travel through the atrioventricular node to reach the ventricles. The impulse is delayed at the atrioventricular node to provide time for the ventricles to fill before they contract. The His-Purkinje system acts to rapidly conduct electrical excitation to fill the ventricles. The intermodal pathways allow the atria to contract in unison.

Which statement by the nursing student about the use of organic nitrates indicates understanding? 1 Nitrates slow conduction. 2 Nitrates are used for atrial fibrillation. 3 These drugs have no adverse effects. 4 Organic nitrates dilate all blood vessels.

4 Nitrates dilate all blood vessels because they have a vasodilator effect. They have cardiovascular effects like tachycardia and postural hypotension. The beta blockers slow conduction through the atrioventricular node. Calcium channel blockers are used for the management of atrial fibrillation. All drugs have the potential for adverse effects.

Which statement by a patient demonstrates a need for further teaching regarding nitroglycerin? 1 "I should keep my nitroglycerin in a cool, dry place." 2 "I will change positions slowly to avoid getting dizzy." 3 "If I get a headache, I should use acetaminophen for pain relief." 4 "I will take up to five tablets at 3-minute intervals for chest pain."

4 Patients are instructed to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablet, they should seek medical assistance. Acetaminophen is administered if there is a drug-related headache. The nurse instructs the patient to keep nitroglycerin in a cool, dry place as exposure to heat can result in a loss of drug potency. The patient is instructed to change positions slowly to prevent syncope or dizziness.

A patient with hyperlipidemia has been prescribed simvastatin. The nurse instructs the patient to undergo a liver function test and a kidney function test every 3 to 6 months. Which drug therapy-related complication is the nurse trying to prevent? 1 Cirrhosis 2 Hepatitis 3 Nephritis 4 Rhabdomyolysis

4 Simvastatin may cause rhabdomyolysis, which is characterized by the breakdown of muscle protein. The elimination of myoglobin from the body may impair kidney functioning and cause acute renal failure. The nurse should monitor the levels of liver enzymes that indicate liver function. To prevent the development of rhabdomyolysis, the nurse should suggest the patient undergo liver and renal function testing every 3 to 6 months. Simvastatin does not cause cirrhosis, hepatitis, or nephritis. Cirrhosis is caused by chronic alcohol consumption. Nephritis is caused by aminoglycosides.

Which event is likely to induce a cardiac event in a patient who is prescribed sublingual nitroglycerin? 1 Migraine 2 Syncope 3 A late-night dinner 4 Sexual intercourse

4 Sublingual nitroglycerin is prescribed for patients in whom any physical activity may cause an unexpected angina episode. Sexual intercourse is a physical activity that may cause chest pain or angina in the patient. Syncope and migraine are side effects of the drug and do not cause a cardiac event. Large meals, not a late-night dinner, may be stressful for the patient with angina and may induce a cardiac event.

The nurse teaches a patient that supraventricular dysrhythmia is less serious than a ventricular dysrhythmia. What is the rationale for this statement? 1 Atrial dysrhythmias are easily treated. 2 Atrial conduction is not influenced by medication. 3 Atrial heart rate does not influence ventricular rate. 4 Atrial action does not significantly reduce cardiac output.

4 Supraventricular dysrhythmias are dysrhythmias that arise in the areas of the heart above the ventricles. Supraventricular dysrhythmias are not as harmful because dysrhythmic activity within the atria does not significantly reduce cardiac output except in patients with valvular disorders and heart failure. Atrial conduction is influenced by a variety of medications. Atrial dysrhythmias can be treated; however, it may not be easy to control these dysrhythmias. Atrial heart rate directly affects ventricular heart rate via the conduction pathway.

Which adverse effect is the greatest concern with thrombolytic therapy? 1 Hemophilia 2 Anaphylaxis 3 Cerebral edema 4 Intracranial hemorrhage

4 The major complication of thrombolytic therapy is bleeding. Intracranial hemorrhage is the greatest concern. Anaphylaxis, cerebral edema and hemophilia are also concerns; however, hemorrhage is the greatest concern because of the effects of thrombolytics on clotting.

The nurse is caring for a patient with anemia. Which of the following is a common cause of iron deficiency in patients in the United States? 1 Vegetarian eating patterns 2 Rapid growth during adolescence 3 Decreased intestinal uptake of iron 4 Chronic blood loss through the gastrointestinal tract

4 The most common causes of anemia in patients the United States are changes in blood volume during pregnancy, infancy and early childhood, and chronic blood loss (usually of gastrointestinal or uterine origin). In rare cases, decreased iron uptake is a cause of anemia. Vegetarian eating patterns can lead to vitamin B 12 deficiency. Intestinal uptake is not a common cause of iron deficiency and iron does not contribute to growth during adolescence.

Which conditions are indications for amiodarone? Select all that apply. 1 Hypertension 2 Unstable angina 3 Preload reduction 4 Atrial dysrhythmias 5 Ventricular dysrhythmias 6 Intractable dysrhythmias

4, 5, 6 Use of amiodarone is reserved for treatment of either atrial or ventricular dysrhythmias that are intractable to other medications. The drug is not a first-line therapy because of the many side effects and toxicities that can develop. This medication is not approved for the treatment of hypertension, unstable angina, or preload reduction.