A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use glyceryl trinitrate. Which route/method of administration would be most suitable.

Correct Answer: D

Rationale: In the case of a patient with acute myocardial infarction and left ventricular failure, the most suitable route/method of administration for glyceryl trinitrate is a slow intravenous infusion (Option D). The rationale behind choosing slow intravenous infusion is that it provides a controlled and gradual delivery of the medication, allowing for a more sustained effect on the patient's condition. This is crucial in managing acute heart conditions like myocardial infarction, where precise dosing and continuous monitoring are essential. Sublingual administration (Option A) is not ideal in this situation because the patient is in the intensive care unit with a critical condition, and sublingual administration may not provide the rapid and consistent absorption needed for immediate effect. Oral administration (Option B) is also not preferred due to the delayed onset of action and potential variability in absorption, which is not suitable for a patient requiring prompt and precise treatment. Intravenous bolus injection (Option C) may lead to rapid fluctuations in blood levels of the medication, potentially causing adverse effects or inadequate therapeutic response in this critical condition. In an educational context, understanding the rationale behind the choice of medication administration route is crucial for healthcare professionals to make informed decisions in clinical practice. It highlights the importance of patient-specific factors, drug pharmacokinetics, and the need for individualized treatment strategies in managing cardiovascular emergencies.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Wolff-Parkinson White (WPW) syndrome. Explanation of why C is correct: WPW syndrome involves an accessory electrical pathway in the heart that can lead to rapid heart rates and potentially dangerous arrhythmias. Calcium channel blockers can exacerbate this condition by slowing conduction through the atrioventricular node while the accessory pathway remains unaffected. This can increase the risk of arrhythmias and adverse cardiac events in patients with WPW syndrome. Explanation of why others are wrong: A) Hypertension: Calcium channel blockers are commonly used to treat hypertension, so it is not a contraindication for giving the client this drug. B) First degree AV block: This is a relatively mild conduction abnormality and not a contraindication to using calcium channel blockers in the context of arrhythmia treatment. D) Glaucoma: Calcium channel blockers can actually be used to treat certain types of glaucoma, so it is not a contraindication in this case. Educational context: Understanding contraindications to medications is crucial in healthcare to ensure patient safety and optimal treatment outcomes. In the context of cardiovascular drugs, such as calcium channel blockers, knowing contraindications like WPW syndrome can prevent potential harm and guide appropriate treatment decisions. Healthcare providers must carefully assess each patient's medical history and condition to make informed decisions regarding drug therapy.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 120. The systolic blood pressure is the top number in a blood pressure reading and represents the pressure in the arteries when the heart beats and pumps blood out. A systolic blood pressure of 120 mmHg is within the normal range (typically considered 90-120 mmHg) for a healthy adult. Option A) 16 is the respiratory rate (RR) which measures the number of breaths a person takes per minute. Option C) 60 represents the diastolic blood pressure, which is the pressure in the arteries when the heart is at rest between beats. Option D) 99 is the oxygen saturation level, which indicates the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen. Understanding vital signs is crucial in assessing a patient's overall health status. Knowledge of normal ranges and their significance helps healthcare providers identify potential issues or changes in a patient's condition. Monitoring vital signs like blood pressure is essential in diagnosing and managing various cardiovascular conditions. By correctly identifying the systolic blood pressure, healthcare professionals can make informed decisions regarding a patient's treatment and care.

Correct Answer: D

Rationale: The correct answer is D) Mitochondria release of calcium. In cardiac contractility, intracellular calcium plays a crucial role in regulating muscle contraction. While calcium release from intracellular stores like the sarcoplasmic reticulum is essential, the mitochondria's contribution is relatively minor compared to other sources. Option A) Exchange with sodium is incorrect because the sodium-calcium exchanger is vital for regulating calcium levels in cardiac cells. Option B) Intracellular transport via voltage-sensitive channels is incorrect as voltage-gated calcium channels are crucial for calcium influx during cardiac muscle contraction. Option C) Intracellular vacuolar release of calcium is also incorrect as calcium release from intracellular stores like the sarcoplasmic reticulum is essential for cardiac contractility. Understanding the sources and regulation of intracellular calcium in cardiac muscle is fundamental in grasping the mechanisms behind cardiac contractility. It is essential for healthcare professionals to have a solid understanding of these concepts to effectively manage cardiovascular conditions and administer appropriate medications targeting cardiac function.

Correct Answer: C

Rationale: The correct answer is C) Converts plasminogen to plasmin. Alteplase is a thrombolytic medication that works by activating plasminogen, an enzyme that dissolves blood clots, into plasmin. This process helps to break down the clot causing the ischemic stroke, restoring blood flow to the affected area of the brain. Option A) Binds to glycoprotein receptor IIb/IIIa is incorrect because this mechanism is associated with antiplatelet drugs like abciximab, not alteplase used for thrombolysis in ischemic stroke. Option B) Blocks ADP receptors is incorrect as this mechanism is attributed to antiplatelet medications like clopidogrel, which inhibit platelet aggregation, not thrombolytics like alteplase. Option D) Inhibits COX-1 and COX-2 is incorrect as this mechanism is related to nonsteroidal anti-inflammatory drugs (NSAIDs), not thrombolytics like alteplase. Understanding the mechanism of action of cardiovascular drugs is crucial in the management of cardiovascular emergencies like ischemic stroke. Thorough knowledge of how each drug works allows healthcare providers to make informed decisions on the appropriate treatment regimen for each patient, optimizing patient outcomes and reducing the risk of complications.