A patient is admitted to your acute coronary care unit with the diagnosis of ACS. The nurse has seen ECG changes that are indicative of an anterior wall infarction and is observing the patient for signs/symptoms of complications. The nurse has noted the following vital sign trends: 1100-HR 92, RR 24, BP 140/88, Cardiac rhythm NSR 1115-HR 96, RR 26, BP 128/82, Cardiac rhythm NSR 1130-HR 104, RR 28, BP 102/68, Cardiac rhythm ST 1145-HR 120, RR 32, BP 80/52, Cardiac rhythm ST with frequent PVC's The nurse should be alert for which of the following complications? Choose all that apply.

Correct Answer: C

Rationale: The correct answer is C - Cardiogenic shock. In this scenario, the vital sign trends indicate a progressive decline in blood pressure (BP) along with an increasing heart rate (HR) and respiratory rate (RR), which are signs of hemodynamic instability. Cardiogenic shock is a serious complication of acute coronary syndrome (ACS) and occurs when the heart is unable to pump enough blood to meet the body's demands. The decreasing BP and increasing HR in this patient suggest a failing cardiac output, leading to inadequate tissue perfusion and subsequent shock. Syncope (choice A) is possible but less likely given the progressive decline in vital signs. Pericarditis (choice B) typically presents with chest pain and ECG changes different from those seen in this case. Cardiac tamponade (choice D) is characterized by Beck's triad (muffled heart sounds, hypotension, and jugular venous distention), which is not evident in the vital sign trends provided.

Correct Answer: C

Rationale: The correct answer is C: Hydrochlorothiazide decreases potassium, increasing the risk of digoxin toxicity. Rationale: 1. Hydrochlorothiazide is a diuretic that can cause potassium loss. 2. Digoxin is a medication that requires adequate potassium levels for proper function. 3. Low potassium levels can potentiate the toxicity of digoxin, leading to adverse effects. Summary: A: Incorrect, hydrochlorothiazide does not increase digoxin levels. B: Incorrect, hydrochlorothiazide's potassium-lowering effect can increase digoxin toxicity. D: Incorrect, digoxin does not affect the effectiveness of hydrochlorothiazide.

Correct Answer: C

Rationale: The correct answer is C because a client with asthma would benefit from a cardio-selective beta blocker since it has less effect on beta-2 receptors in the lungs, thus reducing the risk of bronchoconstriction. Choice A is incorrect because beta blockers do not cause blockage in blood vessels. Choice B is incorrect as hypotension is not a reason for cardio-selective beta blockers. Choice D is incorrect as hypoglycemia is not typically worsened by non-cardio-selective beta blockers.

Correct Answer: B

Rationale: Step-by-step rationale: 1. Class IB anti-arrhythmic drugs work by blocking sodium channels. 2. Procainamide is a Class IB anti-arrhythmic drug. 3. Lidocaine (A) is a Class IB anti-arrhythmic drug but more commonly used for acute arrhythmias. 4. Mexiletine (C) is a Class IB anti-arrhythmic drug but less commonly used. 5. Metoprolol (D) is a beta-blocker (Class II) used for other cardiac conditions. In summary, Procainamide is the correct choice as it belongs to the Class IB anti-arrhythmic drugs, while the other options are either less common in this class or belong to different drug classes.

Correct Answer: A

Rationale: The correct answer is A: Cough. ACE inhibitors commonly cause a dry, persistent cough due to their effect on bradykinin levels. This side effect is important to educate the client about. Bradycardia (B) is not a typical side effect of ACE inhibitors. Hypokalemia (C) is a possible side effect due to increased potassium excretion but is less common than cough. Weight gain (D) is not associated with ACE inhibitors but may occur with other medications like corticosteroids. It's crucial to focus on the most common and relevant side effect when teaching clients.