During the assessment, the nurse identifies crackles in the lungs and an S3 heart sound. Which complication of MI should the nurse suspect and further investigate?

Correct Answer: B

Rationale: Crackles and S3 indicate heart failure.

Correct Answer: A

Rationale: Certainly! Bradycardia is the correct answer because it refers to a slow heart rate, leading to reduced blood flow to the body. This condition can result in symptoms like dizziness, fatigue, and fainting. Tachycardia, on the other hand, is the opposite - a fast heart rate that can also impact blood flow. Atrial fibrillation and ventricular fibrillation are irregular heart rhythms rather than slow heart rates, causing rapid and chaotic heartbeats that can be life-threatening. Therefore, the correct answer is A, bradycardia, as it specifically addresses the scenario of the heart beating too slowly.

Correct Answer: A

Rationale: The correct answer is A: Carotid body. The carotid body is the major chemoreceptor of the heart, detecting changes in oxygen levels in the blood. It sends signals via the glossopharyngeal nerve to regulate heart rate and blood pressure. The aortic body primarily monitors blood pressure, not chemoreception. The vagus nerve plays a role in regulating heart rate but is not a chemoreceptor. The SA node is the pacemaker of the heart, responsible for initiating the electrical signals for heart contraction, not chemoreception. Therefore, the carotid body is the correct choice for the major chemoreceptor of the heart.

Correct Answer: D

Rationale: A P wave notch on an ECG suggests mitral stenosis, indicating delayed conduction through the atria.

Correct Answer: A

Rationale: The correct answer is A: Bradycardia. Beta blockers slow down the heart rate by blocking the effects of adrenaline. Therefore, the nurse should monitor for bradycardia as it is a common side effect of beta blockers. Tachycardia (B) is unlikely due to the medication's mechanism. Hypertension (C) is already being treated by the beta blocker. Respiratory distress (D) is not a typical side effect of beta blockers.

Correct Answer: C

Rationale: Nurses collect data and interpret findings to guide interventions.

Correct Answer: A

Rationale: The correct answer is A: Hold the digoxin and notify the healthcare provider. A heart rate of 48 bpm is below the normal range, indicating bradycardia, a potential side effect of digoxin toxicity. Holding the medication and informing the healthcare provider is crucial to prevent further harm. Administering the digoxin (B) can worsen the bradycardia. Atropine (C) is not the first-line treatment for digoxin-induced bradycardia. Increasing the dose of digoxin (D) can exacerbate toxicity. Overall, prompt action to address the underlying cause is essential in this situation.

Correct Answer: A

Rationale: The correct answer is A: Hold the spironolactone and notify the healthcare provider. Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. With a potassium level of 6.0 mEq/L, the client is at risk for serious cardiac complications. Holding the medication and notifying the healthcare provider is the priority to prevent further increase in potassium levels. Administering a potassium supplement (B) would exacerbate the hyperkalemia. Continuing the spironolactone as ordered (C) or increasing the dose (D) would also worsen the situation.

Correct Answer: A

Rationale: The correct answer is A: Foods high in potassium. Spironolactone is a potassium-sparing diuretic that can increase potassium levels in the body. Consuming foods high in potassium while taking spironolactone can lead to hyperkalemia, a serious condition characterized by high levels of potassium in the blood. The other choices (B: Foods high in sodium, C: Foods high in calcium, D: Foods high in chloride) are not directly contraindicated with spironolactone use. Sodium intake is typically restricted in patients taking diuretics, but it is not specifically related to spironolactone. Calcium and chloride levels are not significantly affected by spironolactone, so foods high in these minerals do not need to be avoided.