A 64-year-old man is discharged from the intensive care unit to home after suffering a myocardial infarction. He has a history of atrial arrhythmias. Which of the following agents would be best for this patient to prevent recurrence of arrhythmia and decrease his risk of mortality?

Correct Answer: B

Rationale: In this scenario, the most appropriate choice for the patient to prevent recurrence of arrhythmia and decrease mortality risk is option B) Sotalol. Sotalol is a non-selective beta-blocker with Class III antiarrhythmic properties. It helps in controlling atrial arrhythmias by prolonging repolarization and refractoriness of the cardiac muscle, thus preventing abnormal electrical activity. This action makes it effective in managing atrial fibrillation and flutter, which are common arrhythmias associated with myocardial infarction. Now, let's analyze why the other options are incorrect: A) Imipramine: Imipramine is a tricyclic antidepressant that is not indicated for managing arrhythmias. It does not possess antiarrhythmic properties and would not be effective in this case. C) Procainamide: Procainamide is a Class Ia antiarrhythmic drug that is not commonly used for atrial arrhythmias. It is more indicated for ventricular arrhythmias and has a different mechanism of action compared to Sotalol. D) Propafenone: Propafenone is a Class Ic antiarrhythmic drug that is also more commonly used for ventricular arrhythmias. It is not the first-line choice for managing atrial arrhythmias post-myocardial infarction. Educational Context: Understanding the mechanisms of action and appropriate use of different classes of antiarrhythmic drugs is crucial in nursing pharmacology. It is essential for nurses to be able to select the most appropriate medication based on the patient's clinical presentation, history, and desired outcomes. In this case, selecting Sotalol for a patient with a history of atrial arrhythmias post-myocardial infarction highlights the importance of tailoring pharmacological interventions to individual patient needs to optimize outcomes and reduce risks.

Correct Answer: D

Rationale: Thiazide diuretics are commonly used in managing essential hypertension due to their ability to promote diuresis and lower blood pressure. In the context of uncomplicated essential hypertension, thiazides offer several benefits. Option D, "Reduce plasma renin," is the correct answer as thiazide diuretics actually increase plasma renin levels due to volume depletion, leading to compensatory renin-angiotensin-aldosterone system activation. Option A, "Reduce the risk of stroke," is a benefit of thiazide diuretics as they help decrease blood pressure, which in turn reduces the risk of stroke by improving overall cardiovascular health. Option B, "Are natriuretic," is true as thiazide diuretics act on the distal convoluted tubule to enhance sodium and water excretion, thereby promoting natriuresis and diuresis. Option C, "Are associated with impotence," is a potential side effect of thiazide diuretics due to their impact on electrolyte balance and potential effects on blood flow, but this is not a universal occurrence. It is essential for nursing pharmacology students to understand the mechanisms of action, benefits, and potential side effects of cardiovascular drugs like thiazide diuretics to provide safe and effective care to patients with hypertension. Understanding the nuances of each drug class helps in making informed decisions regarding drug selection, dosage adjustments, and monitoring for adverse effects in clinical practice.

Correct Answer: B

Rationale: The correct answer is B) Ventricular fibrillation - unsynchronized DC cardioversion. In the case of ventricular fibrillation, which is a life-threatening emergency due to the heart quivering ineffectively, unsynchronized DC cardioversion is the first-line treatment. This involves delivering a shock without synchronizing it to the heart's electrical activity, in order to reset the heart's rhythm immediately. A) Ventricular fibrillation - synchronized DC cardioversion is incorrect because synchronization would delay the delivery of the life-saving shock. C) Ventricular tachycardia post myocardial infarction - esmolol is incorrect because esmolol is a beta-blocker used for controlling heart rate, not for acute treatment of ventricular tachycardia. D) Rapid chronic atrial fibrillation - flecainide is incorrect because flecainide is contraindicated in structural heart disease like atrial fibrillation post-myocardial infarction. Understanding the appropriate first-line treatments for different dysrhythmias is crucial for nurses caring for patients at risk of cardiac events. This knowledge helps in providing timely and effective interventions in emergency situations to improve patient outcomes and prevent complications.

Correct Answer: D

Rationale: The correct answer is D) Raises intracellular cGMP levels. Nitroglycerin is a vasodilator that works primarily by being converted into nitric oxide (NO) in the body. Nitric oxide activates the enzyme guanylate cyclase, leading to an increase in intracellular cyclic guanosine monophosphate (cGMP) levels. This increase in cGMP causes relaxation of vascular smooth muscle, leading to vasodilation and improved blood flow to the myocardium, reducing anginal symptoms. Option A) Blocks alpha-adrenergic receptors is incorrect because nitroglycerin works independently of adrenergic receptors. Option B) Forms cyanide, much like the metabolism of nitroprusside does is incorrect as nitroglycerin does not undergo metabolism to form cyanide. Option C) Increases local synthesis and release of adenosine is incorrect as nitroglycerin primarily acts through the NO-cGMP pathway, not by affecting adenosine synthesis. Understanding the mechanism of action of nitroglycerin is crucial for nurses caring for patients with angina pectoris. By knowing how nitroglycerin works, nurses can better assess its effectiveness, monitor for side effects, and educate patients on its proper use and expected outcomes. This knowledge also helps nurses make informed decisions regarding nitroglycerin administration and adjustments in the treatment plan based on the patient's response.