A client on a beta blocker has a heart rate of 52 bpm. What is the nurse's priority action?

Correct Answer: A

Rationale: The correct answer is A: Hold the beta blocker and notify the healthcare provider. With a heart rate of 52 bpm, the client may be experiencing bradycardia, a potential side effect of beta blockers. Holding the medication and informing the healthcare provider is crucial to prevent further complications. Administering the beta blocker (B) can exacerbate bradycardia. Increasing the dose (C) can further decrease the heart rate. Continuing to monitor (D) without intervention can lead to worsening of the bradycardia.

Correct Answer: A

Rationale: The correct answer is A: Hold the digoxin and notify the healthcare provider. Digoxin is a medication that can slow down the heart rate, and a heart rate of 45 bpm is below the normal range. Holding the medication and informing the healthcare provider is the priority to prevent potential harm from further slowing the heart rate. Administering the digoxin as ordered (B) would worsen the bradycardia. Increasing the dose of digoxin (C) would be dangerous. Monitoring the client's heart rate and reassessing in 30 minutes (D) may delay necessary intervention.

Correct Answer: C

Rationale: In the context of differentiating dyspnea related to heart failure from that of pulmonary disease, the correct answer is C) B-type natriuretic peptide (BNP) levels. BNP is a hormone released by the heart in response to increased ventricular wall tension, which occurs in conditions like heart failure. Elevated BNP levels indicate heart failure, while normal levels suggest pulmonary disease as the cause of dyspnea. Exercise stress testing (Option A) is useful for evaluating cardiac function under stress but does not specifically differentiate between heart failure and pulmonary disease. Cardiac catheterization (Option B) provides detailed information about the heart's structure and function but is an invasive procedure not typically used as an initial diagnostic test for dyspnea. Serum blood urea nitrogen (BUN) levels (Option D) are not specific to either heart failure or pulmonary disease. Educationally, understanding the rationale behind choosing the correct diagnostic test is crucial for healthcare professionals to make informed decisions in clinical practice. By knowing the specific indicators and implications of different tests, practitioners can provide accurate diagnoses and appropriate treatment plans for patients presenting with dyspnea. This knowledge enhances patient care and improves outcomes by ensuring timely and targeted interventions based on a thorough understanding of the underlying pathology.

Correct Answer: C

Rationale: In this scenario, option C is the correct answer, indicating that the patient coughs often during the visit. This symptom suggests a potential adverse effect of enalapril, a medication known to cause a persistent cough in some patients due to its mechanism of action on the renin-angiotensin system. This adverse effect is termed ACE Inhibitor-induced cough. Option A, frequent urination, is a common side effect of enalapril but not typically a cause for concern unless severe or persistent. Option B, a blood pressure of 138/86, is within the normal range for blood pressure control in hypertensive patients, so it does not immediately warrant a change in drug therapy. Option D, occasional dizziness, is also a common side effect of enalapril but is not as urgent or specific as the cough in indicating a need for medication adjustment. Educationally, this question highlights the importance of recognizing and managing common side effects of medications used in the treatment of hypertension. It emphasizes the need for healthcare providers to monitor patients for both expected and potentially serious adverse effects to optimize therapeutic outcomes and patient safety. Understanding medication side effects and when to escalate concerns to the prescribing physician is crucial in clinical practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) Sinus bradycardia, rate 50, as evidenced by ECG. The most concerning symptom in a patient who recently started carvedilol is sinus bradycardia because carvedilol, a beta-blocker, can slow down the heart rate. This can be particularly risky in patients with heart failure who rely on a certain heart rate to maintain adequate cardiac output. Sinus bradycardia can lead to decreased cardiac output and exacerbate heart failure symptoms. Option A) Complaints of increased fatigue and dyspnea could be expected initially as the body adjusts to the medication but are not as concerning as a significant decrease in heart rate. Option B) A weight increase of 0.5 kg in 2 weeks could be due to fluid retention, a common side effect of heart failure medications, but it is not as immediately concerning as a sudden change in heart rate. Option C) Bibasilar crackles audible in the posterior chest are indicative of fluid accumulation in the lungs, which is a common sign of heart failure exacerbation but is not as critical as a significant drop in heart rate. Educationally, this question highlights the importance of monitoring heart failure patients closely when initiating new medications, especially those that can affect heart rate. It underscores the need for healthcare providers to be vigilant for changes in vital signs and symptoms that could indicate worsening heart failure or medication side effects. Regular assessment and close monitoring are essential in managing heart failure effectively.