NR-324 Adult Health I - Set 3 - Part 1

Correct Answer: Call emergency services and stop the drug

Swelling of the lips and tongue with difficulty swallowing is angiedema, a bradykinin mediated airway emergency that can occur years into therapy. The drug is stopped permanently and emergency care is obtained immediately. Option a is incorrect because angiedema from an ACE inhibitor is driven by bradykinin rather than histamine, so antihistamines are unreliable. Waiting a day allows the airway to close while the client is at home. Option b is incorrect because holding one dose does nothing for swelling that is already obstructing the throat. A routine appointment schedules care for a problem that is measured in minutes, not days. Option d is incorrect because cold compresses treat local tissue swelling and cannot reverse an expanding airway reaction. Resting at home removes the client from the only setting where the airway can be secured.

Correct Answer: Report the cough and anticipate an ARB

The dry cough is caused by bradykinin accumulating in the lung during ACE inhibition. It is not dangerous but it is intolerable, and the usual management is substitution of an ARB, which does not raise bradykinin. Option b is incorrect because suppressants do nothing about bradykinin, which is the chemical driving the cough. Masking a drug effect leaves the client on an agent that will keep producing the symptom. Option c is incorrect because fluids do not alter the mechanism, and false reassurance invites the client to quietly stop the medication. This cough frequently persists for as long as the drug continues. Option d is incorrect because withholding a scheduled antihypertensive without a prescriber order risks losing blood pressure control. The cough is bothersome rather than urgent, so the provider decides on the change.

Correct Answer: The presence and shape of the P waves

Step one of the method examines the P wave: whether it is present, upright in lead two, and one before every QRS. That finding establishes the chamber of origin before anything else is measured. Option a is incorrect because measuring the QRS is step three, not step one. Its width separates supraventricular from ventricular origin, but that call is made only after the P wave has already been inspected. Option b is incorrect because regularity is judged at step four. Walking calipers along the R to R intervals sorts atrial fibrillation from the regular tachycardias, yet it cannot identify where the impulse started. Option d is incorrect because rate falls at step five, after the rhythm has been called regular or irregular. The regularity finding decides whether the six second method or the big box method applies.

Correct Answer: Obtain a twelve-lead electrocardiogram within ten minutes

Jaw pain, nausea and unusual fatigue without chest pain are classic anginal equivalents in women, and these clients are triaged lower and miss reperfusion. Any atypical cluster with risk factors earns an immediate twelve-lead tracing. Option a is incorrect because treating the nausea symptomatically masks the presentation and burns an hour of a closing reperfusion window. Antiemetics may be given later, but only after ischemia has been ruled out. Option b is incorrect because low triage acuity is exactly what harms women with atypical symptoms. Placing her in the waiting area delays the tracing that decides whether she belongs in a catheterization laboratory. Option c is incorrect because referred jaw discomfort in ischemia arises from cardiac afferent fibers entering the spinal cord beside somatic nerves. A dental consultation addresses the wrong organ and postpones cardiac evaluation.

Correct Answer: Measure and record the vital signs

Measuring and recording vital signs is a routine task within the assistive role, with the nurse interpreting the values. Assessment, evaluation and teaching all require nursing judgment and stay with the licensed nurse. Option b is incorrect because the access site must be inspected by the nurse every fifteen minutes during the first hour. Bleeding and hematoma at a femoral puncture can become life threatening very quickly. Option c is incorrect because judging pulse strength distal to the puncture is a neurovascular assessment reserved for the nurse. A weakening pulse may be the first clue to arterial occlusion or dissection. Option d is incorrect because client education cannot be handed to unlicensed staff. This teaching is critical, since stopping dual antiplatelet therapy early causes stent thrombosis that presents as a sudden infarction.

Correct Answer: A serum digoxin level of 1.0 ng/mL

Digoxin is reported in nanograms per milliliter, and the therapeutic range taught in this course is 0.8 to 2.0 ng/mL. A level of 1.0 sits inside that range and needs no dose change. Option a is incorrect because 0.3 ng/mL falls below the lower limit of 0.8, so the client is unlikely to gain symptom relief or rate control. A subtherapeutic value calls for review of the dose. Option b is incorrect because toxicity risk climbs once the level passes 2.0 ng/mL. A value of 2.6 means the dose should be held while the nurse checks potassium, renal function and the apical rate. Option d is incorrect because milligrams per deciliter is the wrong unit entirely for this drug. Reading a digoxin result in that unit is a million fold error, and the value given would also be toxic.

Correct Answer: Oxygen is withheld while the saturation stays adequate

Supplemental oxygen is indicated only for a saturation below ninety percent or for respiratory distress. Giving it to a normoxic client causes vasoconstriction, may increase infarct size and provides no benefit, which is where the old mnemonic misleads. Option a is incorrect because routine administration to everyone with chest pain is exactly the practice that has been abandoned. The letter in the old mnemonic survives, but the blanket instruction behind it does not. Option c is incorrect because high flow delivery in a client who is already well saturated has shown possible harm rather than benefit. When oxygen is truly indicated it starts low and is titrated to target. Option d is incorrect because no sequence links the opioid to oxygen therapy. Opioids are reserved for pain unrelieved by nitrates, and the decision about oxygen rests entirely on the saturation and the work of breathing.

Correct Answer: The impulse arose below the bundle of His

A QRS of 0.12 second or more means the impulse bypassed the fast His Purkinje cable and spread slowly through ventricular muscle. Wide and bizarre complexes without P waves indicate a ventricular origin. Option a is incorrect because a sinoatrial impulse produces an upright P wave before each narrow QRS. No P waves are visible here, so the sinus node is not driving these complexes. Option b is incorrect because atrioventricular nodal delay lengthens the PR interval and leaves the QRS narrow. Slowed conduction above the ventricles cannot widen a complex, since the ventricles still depolarize through the normal pathway. Option c is incorrect because normal Purkinje conduction depolarizes both ventricles almost at once, finishing in under 0.12 second. A complex this broad proves the high speed pathway was not used.

Correct Answer: Withhold the nitroglycerin and notify the provider

Phosphodiesterase-five inhibitors and nitrates together allow cyclic GMP to accumulate without limit, causing profound refractory hypotension and death. Tadalafil requires at least forty-eight hours before any nitrate, so the dose is held and the provider told. Option a is incorrect because a normal starting pressure offers no protection. The interaction produces vasodilation that no longer has an off switch, and collapse can follow a single tablet in a client who looked stable. Option b is incorrect because this is an absolute contraindication, not a dosing problem that a smaller amount solves. Splitting the tablet also gives an unreliable dose and still exposes the client to catastrophic vasodilation. Option d is incorrect because positioning does not neutralize the pharmacology. Lying the client down reduces the chance of a fall but cannot prevent the refractory hypotension and myocardial ischemia the combination produces.

Correct Answer: Clean and dry the skin before applying electrodes

A surface electrocardiogram is noninvasive and painless, so no fasting or sedation is involved. Dry, clean skin is the key preparation, because poor electrode contact is the commonest cause of a poor tracing. Option b is incorrect because nothing is swallowed and no sedation is given for this test. Fasting belongs to a transesophageal echocardiogram or an endoscopy, where a probe is passed into the throat. Option c is incorrect because a gag reflex check follows numbing spray applied to the back of the throat. Electrodes rest on the skin, so the airway is never touched during this recording. Option d is incorrect because the client lies flat and still while the tracing runs. A specific head elevation is part of recovery after a sedated esophageal procedure, not part of this test.

Correct Answer: Take the dose in the morning and rise slowly

A morning dose keeps the diuresis out of the night and protects sleep. Rising slowly from bed or chair guards against the orthostatic drop this drug causes, which is a genuine fall risk at home. Option a is incorrect because a bedtime dose sends the client to the bathroom repeatedly through the night. Lost sleep and night walking to the toilet also raise the chance of a fall in the dark. Option c is incorrect because loop diuretics waste potassium rather than retain it. Clients on furosemide alone are usually encouraged to eat potassium rich foods, and restricting them invites cramps, weakness and dysrhythmias. Option d is incorrect because skipping doses on good days lets fluid rebuild silently. The drug is what keeps the swelling away, and stopping it when symptoms settle drives many readmissions for decompensation.

Correct Answer: "The unit is seconds, so normal runs 0.12 to 0.20 second."

Intervals on ECG paper are expressed in seconds. A normal PR interval is 0.12 to 0.20 second, or 120 to 200 milliseconds. Written as milliseconds the stated range would be one thousand times too short. Option b is incorrect because 0.12 millisecond is a fraction of a thousandth of a second, far briefer than any cardiac depolarization. Endorsing the millisecond unit repeats the very error the student made. Option c is incorrect because 0.08 to 0.12 second is the QRS duration this course teaches, not the PR interval. Swapping the two ranges would make every normal PR interval look prolonged. Option d is incorrect because the PR interval runs from the beginning of the P wave to the beginning of the QRS. Measuring to the end of the QRS describes no recognized interval.

Correct Answer: Only the first client has NSTEMI

Unstable angina and NSTEMI look identical at the bedside, and the troponin is the only thing separating them. A value above the reference limit with a rise and fall means necrosis, so the first client has NSTEMI. Option a is incorrect because the second client has no troponin elevation on serial sampling, and necrosis is what NSTEMI requires. Without a marker of cell death the label is unstable angina, not infarction. Option b is incorrect because a troponin at or above the ninety-ninth percentile reclassifies the first client. By definition unstable angina carries a normal troponin, so an elevated result rules that diagnosis out. Option d is incorrect because it reverses the assignment. Necrosis belongs to the client whose marker rose, while the client with repeatedly normal values had ischemia without cell death and is therefore the one with unstable angina.

Correct Answer: Replace potassium and magnesium as prescribed

Multifocal premature ventricular contractions in couplets during an acute infarction signal ventricular irritability. Correcting potassium and magnesium is the highest yield intervention, since both electrolytes provoke ectopy and prolong the QT interval. Option a is incorrect because defibrillation is delivered only for ventricular fibrillation and pulseless ventricular tachycardia. This client has a perfusing rhythm with a pulse, and an unsynchronized shock would create the arrest it treats. Option b is incorrect because routine antidysrhythmic suppression of these beats is no longer practiced. Class one and class three agents raised mortality after infarction, so they are not started to quiet ectopy. Option c is incorrect because doing nothing ignores a correctable trigger. Multifocal beats and couplets in an ischemic ventricle can initiate ventricular tachycardia or fibrillation, so the low potassium must be treated promptly.

Correct Answer: Established necrosis has left a permanent electrical scar

Pathological Q waves mark dead, electrically silent muscle and they persist for life. Resolution of the ST elevation with new Q waves is the expected evolution, showing the injury phase has passed into established infarction. Option a is incorrect because ST elevation is the marker of acute injury happening at that moment, and the segments have returned to baseline. Persistent elevation weeks later would instead suggest a ventricular aneurysm. Option b is incorrect because reversible ischemia appears as ST depression or T wave inversion that comes and goes with the pain. Neither is described, and the client reports no discomfort at present. Option d is incorrect because a deep wide Q wave is itself abnormal and will remain on every future tracing. Settled ST segments describe only part of the picture, and the scar is permanent.

Correct Answer: Chronic right-sided failure with dependent edema

Dependent edema that collects through the day and clear lung fields describe systemic venous congestion behind a failing right ventricle. The pattern waxes and wanes with position and activity, which marks it as chronic. Option a is incorrect because left-sided failure announces itself in the lungs with dyspnea, orthopnea and crackles. This client has clear lung fields, so the pulmonary capillary bed is not congested. Option b is incorrect because pulmonary edema presents as sudden severe breathlessness, crackles rising through the chest and frothy sputum in a client who will not lie down. Swollen ankles alone are not an emergency. Option c is incorrect because volume deficit would show weight loss, thirst, poor skin turgor and falling blood pressure rather than tissue swelling. Edema signals retained fluid, which is the opposite problem.

Correct Answer: Crackles at both lung bases on inspiration

Left-sided failure backs blood up into the pulmonary veins, so fluid is forced from pulmonary capillaries into the alveoli. Crackles at the bases are the sound of those fluid filled alveoli reopening on inspiration. Option b is incorrect because distended neck veins register rising right atrial pressure, which develops when the right ventricle cannot empty into the lungs. This is a systemic congestion sign and belongs to right-sided failure. Option c is incorrect because hepatic congestion enlarges the liver and stretches its capsule only when systemic venous pressure climbs behind a failing right ventricle. The abdomen is a body finding, not a lung finding. Option d is incorrect because dependent pitting edema collects where gravity takes it once systemic capillary pressure rises, which happens when the right side fails. Swollen ankles point away from the left ventricle.

Correct Answer: A client with ST elevation for two hours

Fibrinolysis is for ST elevation infarction only, within twelve hours of symptom onset, when percutaneous intervention cannot be delivered in time and no bleeding contraindication exists. Door-to-needle time should be within thirty minutes. Option a is incorrect because fibrinolytics are never indicated in non-ST-elevation acute coronary syndrome. The thrombus there is platelet rich and non-occlusive, and trials showed bleeding harm without any survival benefit. Option c is incorrect because a recent ischemic stroke is a contraindication. The question a lysing drug asks is whether anywhere in this client could bleed uncontrollably, and a fresh cerebral infarct answers yes. Option d is incorrect because the symptom onset window for reperfusion closes at about twelve hours. Twenty hours out, most salvageable muscle is already scar, and the bleeding risk then outweighs any remaining gain.

Correct Answer: Cor pulmonale from the underlying lung disease

Chronic hypoxia constricts the pulmonary vessels, raising the pressure the right ventricle must eject against until it fails. Cor pulmonale is right ventricular failure caused by primary lung disease, and the lungs stay clear. Option a is incorrect because failure of the left ventricle congests the pulmonary capillary bed and produces crackles, orthopnea and dyspnea. Clear lung fields argue directly against that side being the problem. Option b is incorrect because alveolar flooding announces itself with severe breathlessness, crackles and frothy sputum in a client who refuses to lie flat. None of that appears in this presentation. Option d is incorrect because no infusion is described and the findings have a clear pulmonary explanation. Overload from intravenous fluid would also congest the lungs, which contradicts the clear breath sounds recorded here.

Correct Answer: Coaching the client to bear down

Supraventricular tachycardia is a reentry circuit that runs through the atrioventricular node. Vagal maneuvers such as bearing down raise vagal tone, block the node and are the first step for a stable client. Option a is incorrect because synchronized cardioversion is reserved for the unstable client with hypotension, altered mentation, ischemic chest pain or acute heart failure. This client shows none of those findings. Option c is incorrect because a calcium channel blocker sits third in the sequence, after vagal maneuvers and adenosine have been tried. Starting there skips a step that is free and often effective. Option d is incorrect because amiodarone comes late in the treatment order for this rhythm. It carries a long half life and significant toxicity, so gentler measures are attempted before it is loaded.