A 55-year-old patient currently receiving other drugs for another condition is to be started on diuretic therapy for mild heart failure. Thiazides are known to reduce the excretion of

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Lithium. Thiazide diuretics, commonly used in the management of heart failure, reduce the excretion of lithium by the kidneys. This can lead to an increase in lithium levels in the body, potentially resulting in lithium toxicity. Therefore, it is crucial to monitor lithium levels closely when a patient on lithium therapy is started on thiazide diuretics. Now, let's discuss why the other options are incorrect: A) Diazepam: Thiazide diuretics do not significantly affect the excretion of diazepam. B) Fluoxetine: Thiazide diuretics do not impact the excretion of fluoxetine. C) Imipramine: Thiazide diuretics do not alter the excretion of imipramine. Educational Context: Understanding drug interactions is essential in clinical practice, especially when managing patients with multiple comorbidities and medications. Pharmacokinetic principles play a vital role in predicting and managing drug interactions. Healthcare professionals need to be aware of how different drugs can affect each other's metabolism, distribution, and elimination to prevent adverse effects and ensure optimal therapeutic outcomes for patients. In this case, recognizing the potential interaction between thiazide diuretics and lithium is crucial for safe and effective patient care.

Correct Answer: B

Rationale: The correct sequence of conduction of the cardiac action potential is from the SA node to the atria to the AV node to the bundle of His. This sequence is essential for the coordinated contraction of the heart and efficient blood pumping. Option A is incorrect because the atria are activated before the AV node. Option C is incorrect because the AV node is located between the atria and the ventricles, so it should come after the atria in the sequence. Option D is incorrect as it reverses the order of activation of the atria and the AV node. Understanding the sequence of cardiac conduction is crucial in cardiovascular drug therapy. Medications targeting specific parts of this conduction system can have significant effects on heart rate, rhythm, and overall cardiac function. Knowing the correct conduction pathway helps healthcare professionals make informed decisions when prescribing or administering cardiovascular drugs.

Correct Answer: B

Rationale: The correct answer is B) An alpha agonist. In this scenario, tissue necrosis at the IV site is a known side effect of administering drugs that cause vasoconstriction or reduced blood flow to the surrounding tissues. Alpha agonists, which stimulate alpha-adrenergic receptors causing vasoconstriction, can lead to tissue ischemia and subsequent necrosis when administered through an IV. Option A) Digoxin is a cardiac glycoside used to treat heart conditions like heart failure and atrial fibrillation. It does not typically cause tissue necrosis at the IV site. Option C) A beta blocker works by blocking beta-adrenergic receptors, leading to reduced heart rate and blood pressure. It does not directly cause tissue necrosis at the IV site. Option D) A calcium channel blocker inhibits the influx of calcium ions into cardiac and smooth muscle cells, leading to vasodilation and reduced blood pressure. It does not typically cause tissue necrosis at the IV site. Educationally, understanding the side effects of different drug classes is crucial for safe and effective patient care. Recognizing the adverse effects associated with specific medications can help healthcare professionals prevent, identify, and manage complications that may arise during treatment. In this case, identifying the culprit drug causing tissue necrosis can prompt timely intervention to prevent further harm to the patient.

Correct Answer: D

Rationale: The correct answer is D) The client must stop the Ticlid 7 days prior to surgery. Rationale: 1. The reason the client must stop Ticlid 7 days before surgery is due to its effect on platelet function. Ticlid is an antiplatelet medication that inhibits platelet aggregation. Stopping Ticlid before surgery helps reduce the risk of excessive bleeding during and after the procedure. 2. Option A is incorrect because withholding Ticlid only on the day of surgery may not provide enough time for the medication's effects on platelet function to diminish. 3. Option B is incorrect because taking Ticlid on the day of surgery, even with a small sip of water, can still pose a risk of increased bleeding during the surgical procedure. 4. Option C is incorrect as stopping Ticlid a month before surgery is not necessary and may expose the client to an increased risk of thrombotic events if the antiplatelet effect wears off too soon. Educational context: Understanding the timing of withholding Ticlid before surgery is crucial for nurses caring for patients on this medication. It is essential to ensure patient safety by following evidence-based guidelines on the management of antiplatelet therapy perioperatively. Nurses play a key role in educating patients about the importance of medication management in relation to surgical procedures to prevent potential complications.

Correct Answer: B

Rationale: In this scenario, the most appropriate agent for intraoperative blood pressure control during the lengthy surgical procedure is Esmolol (Option B). Esmolol is a short-acting ß-blocker with a quick onset and short duration of action, making it ideal for situations where rapid titration and adjustment of blood pressure are needed. Acebutolol (Option A) and Metoprolol (Option C) are longer-acting ß-blockers, which may not provide the necessary flexibility in managing blood pressure fluctuations during the extended surgery. Nadolol (Option D) is also a long-acting ß-blocker and is not suitable for this situation due to its prolonged duration of action. From an educational perspective, it is crucial to understand the pharmacokinetic properties of different cardiovascular drugs when selecting appropriate agents for specific clinical scenarios. Choosing the right medication based on onset, duration of action, and titratability is essential in managing patients with complex medical histories undergoing surgical procedures. This case highlights the importance of selecting Esmolol for precise blood pressure control during a lengthy surgical intervention in a hypertensive patient on ß-blocker therapy.