A 68-year-old man was diagnosed with systolic heart failure with normal ejection fraction and normal sinus rhythm at rest. A treatment with captopril was started. Which of the following actions most likely mediated the therapeutic effect of captopril in this patient?

Correct Answer: C

Rationale: The correct answer is C: Reduction of preload and afterload. Captopril, an ACE inhibitor, reduces preload (volume of blood returning to the heart) by inhibiting the conversion of angiotensin I to angiotensin II, which decreases aldosterone secretion and fluid retention. It also reduces afterload (resistance the heart has to pump against) by decreasing peripheral vascular resistance. This dual action helps improve cardiac output and decrease workload on the heart in systolic heart failure. Explanation for why the other choices are incorrect: A: Increased cardiac contractility - Captopril does not directly increase cardiac contractility, it mainly affects afterload and preload. B: Reduction of angiotensin-mediated vasoconstriction in the kidney - While captopril does inhibit angiotensin production, its primary mechanism of action is not specific to the kidney. D: Stimulation of epinephrine release from adrenergic nerves - Captopril does not stimulate ep

Correct Answer: A

Rationale: In this context, the correct answer is A) Thallous chloride 201 TI USP. Thallium-201 is a cyclotron-produced radiopharmaceutical used in nuclear medicine for assessing regional myocardial perfusion during an exercise stress test. Thallium-201 has a high affinity for myocardial tissue, making it an ideal tracer for detecting areas of reduced blood flow to the heart muscle. Option B) Sodium iodide 123 is used in thyroid imaging and not for assessing myocardial perfusion. Option C) Gallium citrate 67 Ga USP is typically used for imaging infections and tumors, not myocardial perfusion studies. Option D) Indium In pentetate is used for brain imaging, renal function studies, and detecting infections, not for assessing myocardial perfusion. In an educational context, understanding the correct radiopharmaceuticals used in different nuclear medicine studies is crucial for nursing students specializing in cardiovascular care. Knowing the specific indications and contraindications of each radiopharmaceutical ensures accurate diagnostic results and patient safety. This knowledge also contributes to providing comprehensive patient care and collaborating effectively with the healthcare team to interpret and act upon diagnostic test results.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) All of the above. The patient's symptoms of diffuse chest and upper abdominal pain relieved by sublingual glyceryl trinitrate can be indicative of various conditions. Angina pectoris is characterized by chest pain or discomfort due to reduced blood flow to the heart muscles. The patient's response to glyceryl trinitrate suggests a cardiac origin of the pain. Biliary colic refers to pain caused by gallstones obstructing the bile ducts. Although the pain is typically localized to the upper abdomen, it can radiate to the chest, mimicking cardiac conditions. Esophageal spasm presents with chest pain similar to cardiac conditions and can be relieved by medications like glyceryl trinitrate. Educationally, understanding the differential diagnosis of chest pain is crucial in nursing practice to provide prompt and accurate care. Recognizing the varying presentations of different conditions helps nurses make informed clinical decisions and prioritize interventions effectively. This quiz question highlights the importance of considering multiple differential diagnoses based on patient symptoms and responses to treatment.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Astemizole. Polymorphic ventricular tachycardia can be a complication of this drug due to its potential to prolong the QT interval, leading to a life-threatening arrhythmia known as Torsades de pointes. Astemizole is a known QT-prolonging agent and has been withdrawn from the market due to its cardiac side effects. Option A) Loratadine and B) Cetirizine are second-generation antihistamines that do not have significant effects on the QT interval and are generally considered safe for use in patients with cardiovascular conditions. Option D) C+D is also incorrect as neither Loratadine nor Cetirizine individually or in combination are associated with polymorphic ventricular tachycardia. Understanding the potential cardiac side effects of medications is crucial for nurses to ensure patient safety. Knowing which drugs can prolong the QT interval and lead to serious arrhythmias allows nurses to monitor patients effectively, recognize early signs of adverse effects, and provide appropriate interventions to prevent complications. Nurses must stay updated on drug information to make informed clinical decisions and promote patient well-being.

Correct Answer: D

Rationale: In the context of treating paroxysmal supraventricular tachycardia (PSVT), the drug of choice is Adenosine. Adenosine is a class V antiarrhythmic medication that works by slowing conduction through the AV node, which can help terminate the reentry circuit causing PSVT. It is administered rapidly via IV push to quickly stop the abnormal rhythm. Option A, Flecainide, is a class Ic antiarrhythmic drug that is contraindicated in PSVT as it can actually worsen the condition by increasing the risk of ventricular arrhythmias. Option B, Lidocaine, is primarily used for ventricular arrhythmias and is not effective in treating PSVT. Option C, Metoprolol, is a beta-blocker that can be used for rate control in atrial fibrillation but is not the first-line choice for acute termination of PSVT like Adenosine. Understanding the appropriate medications for specific cardiac arrhythmias is crucial for nurses to provide safe and effective care to patients with cardiovascular conditions. Being able to differentiate between various antiarrhythmic drugs and their indications is essential in managing patients with cardiac rhythm disturbances. Adenosine's rapid onset of action and specific mechanism of action make it the preferred choice for terminating PSVT in clinical practice.