A 78-year-old man is admitted with deterioration of chronic heart failure. He is house-bound and has had three similar admissions in the past nine months. There is a history of ischaemic heart disease. His medication comprises furosemide, ramipril in full dose, valsartan, spironolactone, simvastatin and aspirin. He is dyspnoeic on minimal exertion, looks unwell, pulse 100/min regular, BP 90/70 mmHg, jugular venous pressure (JVP) is at 4 cm, gallop rhythm, chest clear, pretibial oedema. ECG shows sinus rhythm, an old inferior infarct and poor anterior R wave progression. Serum urea 15 mmol/L, creatinine 90 μmol/L, Na+ 140, K+ 4.6. Which of the following would be most appropriate?

Correct Answer: C

Rationale: Chronic heart failure (CHF) decompensation needs optimization. Morphine relieves acute dyspnea but not chronic management here. Hydralazine/isosorbide reduces afterload/preload, useful in advanced CHF, but less immediate. Carvedilol, a beta-blocker, risks decompensation with low BP. Metolazone, a potent diuretic, aids fluid overload but overlaps with furosemide. Digoxin improves contractility and rate control in sinus rhythm CHF, reducing hospitalizations, most appropriate given his recurrent admissions and stable renal function. Its inotropic benefit stabilizes this patient, enhancing quality of life.

Correct Answer: A

Rationale: Altered nutrition is often the priority nursing diagnosis for clients undergoing chemotherapy because the treatment can cause side effects such as nausea, vomiting, anorexia, and mucositis, leading to malnutrition and weight loss. Proper nutrition is essential for maintaining strength, supporting the immune system, and promoting recovery. While fear, anxiety, and decreased cardiac output are valid concerns, addressing nutritional deficits is critical to the client's overall well-being and ability to tolerate treatment.

Correct Answer: C

Rationale: Nystatin is an antifungal medication used to treat fungal infections caused by yeast. It works by binding to ergosterol, a component of fungal cell membranes, causing them to become porous and leaky, ultimately leading to the death of the fungus. Nystatin does not have bactericidal action because it specifically targets fungal cells and is not effective against bacteria.

Correct Answer: C

Rationale: The statement "I'll have my physician lower my dosage once I start to feel okay" indicates an understanding of the treatment regimen because it shows that the client recognizes the need to continue the medication as prescribed and not discontinue it abruptly. It highlights that the client intends to follow up with their physician for appropriate adjustments to the dosage as needed. This demonstrates a responsible approach to managing their alcohol withdrawal with diazepam (Valium).

Correct Answer: B

Rationale: Before administering Digoxin, the nurse should count the apical pulse for 1 minute. Digoxin is a cardiac medication that primarily works by increasing the force of contractions of the heart muscle. It is important to assess the patient's heart rate to ensure it is within the recommended range before administering Digoxin. This is because Digoxin can cause serious complications such as heart arrhythmias if given when the heart rate is too low. Counting the apical pulse for a full minute provides a more accurate assessment of the heart rate compared to shorter durations.

Correct Answer: A

Rationale: Sleep trouble from exams is situational anxiety-transient, event-driven stress, per psychiatry. Social anxiety involves interaction fears, not events. OCD features obsessions/rituals, not sleep-specific. Performance anxiety ties to tasks, less sleep focus. Situational fits, triggered by circumstance.

Correct Answer: D

Rationale: Antibiotics have a maximum dose beyond which efficacy plateaus-more risks toxicity (e.g., ototoxicity), not faster cure, a pharmacodynamic limit. Checking with the doctor delays a clear answer. Interactions aren't the sole issue-toxicity is. Time-based increase lacks basis. Maximum dose explains efficacy ceiling, educating safely.

Correct Answer: B

Rationale: Carbonic anhydrase inhibitors are a class of medications used to treat edema by decreasing the production of aqueous humor in the eye and reducing fluid in the body. One common side effect of carbonic anhydrase inhibitors is metabolic acidosis, which can lead to increased blood glucose levels in patients with diabetes. The medication may interfere with the body's ability to regulate blood glucose levels, leading to elevated blood glucose. Therefore, when monitoring a patient with diabetes who is receiving a carbonic anhydrase inhibitor, the nurse should closely monitor for signs of elevated blood glucose levels to prevent potential complications.

Correct Answer: B

Rationale: The persistent dry cough mentioned by the patient is a well-known adverse effect of ACE inhibitors. This side effect is due to the accumulation of bradykinin in the lungs, leading to irritation and stimulation of cough receptors. If a patient taking an ACE inhibitor develops a persistent dry cough, it is essential to notify the healthcare provider to consider alternative antihypertensive medications to manage the hypertension effectively without causing this bothersome side effect.