Prior to the patient being given medication, he becomes hypotensive, mottled, and cold. His heart rate is 240. The next therapeutic step should be

Correct Answer: B

Rationale: In this scenario, the correct next therapeutic step should be synchronized DC cardioversion (Option B). When a patient presents with hypotension, mottled skin, coldness, and a heart rate of 240, it indicates a life-threatening arrhythmia like supraventricular tachycardia (SVT). Synchronized DC cardioversion is the immediate intervention to restore normal sinus rhythm in cases of unstable tachyarrhythmias. Option A, digoxin, is used for heart failure and atrial fibrillation, not for acute tachyarrhythmias requiring immediate intervention like in this case. Option C, lidocaine, is used for ventricular arrhythmias, not for SVT. Option D, defibrillation, is used for ventricular fibrillation or pulseless ventricular tachycardia, not for stable SVT with a pulse. In an educational context, understanding the appropriate interventions for different cardiac arrhythmias is crucial for nurses caring for pediatric patients with cardiovascular conditions. Recognizing the signs of unstable arrhythmias and knowing the appropriate interventions can potentially save lives and prevent complications. It is essential for nursing students to grasp the urgency of interventions like synchronized DC cardioversion in critical situations to provide safe and effective care.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Oxygen saturation increased from 88% to 96%. Beta blockers are medications that work by blocking the effects of adrenaline on the beta receptors in the body, specifically in the heart. By blocking these receptors, beta blockers reduce the heart rate and cardiac output, leading to a decrease in oxygen demand by the heart muscle. This decrease in oxygen demand can result in an increase in oxygen saturation levels as the heart works more efficiently. Option A is incorrect because beta blockers typically lower blood pressure by reducing the force of contraction of the heart and dilating blood vessels, not increasing it. Option B is incorrect as beta blockers can cause a slight decrease in respiratory rate due to their effect on the central nervous system, but a decrease from 25 to 14 breaths/min is too drastic and would be concerning. Option C is incorrect as beta blockers are known to decrease the heart rate, so a drop from 100 to 80 beats/min is expected and not a cause for concern. Educationally, understanding the pharmacological effects of beta blockers is crucial for nurses caring for patients receiving these medications, especially in cardiovascular conditions. Monitoring vital signs and oxygen saturation post-administration is essential to assess the medication's effectiveness and potential side effects. This rationale highlights the importance of knowing the expected outcomes of medication administration and recognizing normal and abnormal assessment findings in patients receiving beta blockers.

Correct Answer: C

Rationale: In the context of an older adult experiencing a myocardial infarction (MI), the correct clinical manifestation the nurse should expect is disorientation and confusion (Option C). This is because older adults, in particular, may present atypically during an MI, with cognitive symptoms often being more prominent than chest pain. Option A, excruciating pain on inspiration, is not typically associated with an MI. Chest pain related to an MI is usually described as pressure, tightness, or squeezing. Option B, left lateral chest wall pain, is a common presentation of cardiac chest pain, but in older adults, symptoms may not always localize to the typical areas. Option D, numbness and tingling of the arm, is more characteristic of peripheral vascular issues or neurological conditions rather than an MI. Educationally, it is crucial for nurses to understand that older adults may present with subtle or atypical symptoms during an MI. This highlights the importance of a comprehensive assessment that includes cognitive changes and not solely relying on chest pain as a hallmark symptom in this population. Early recognition of these atypical symptoms can lead to prompt intervention and improved outcomes for the patient.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to take first is to compare the current pulmonary artery pressure reading with previous readings (Option A). This is crucial as it provides a baseline for comparison and helps in understanding the trend of the client's condition post-myocardial infarction. This action is essential for effective monitoring and management of cardiovascular conditions in pediatrics. Option B, increasing the intravenous fluid rate because the readings are low, is incorrect as solely relying on numerical values without proper assessment can lead to potential harm. Pulmonary artery pressure readings are not solely indicative of fluid status, and other factors need to be considered. Option C, immediately notifying the healthcare provider of the elevated pressures, is incorrect because the pressure readings are not significantly elevated to warrant urgent notification. It is important to assess the situation thoroughly before escalating to the healthcare provider. Option D, documenting the finding as the only action, is incorrect because action should be taken based on the assessment findings before documentation. In healthcare, timely and appropriate interventions are crucial in providing safe and effective care. Educationally, understanding how to interpret and prioritize assessments in cardiovascular conditions is vital for nursing practice. By comparing current readings with previous ones, nurses can make informed decisions and collaborate effectively with the healthcare team to optimize patient outcomes.

Correct Answer: C

Rationale: The correct answer to the question is option C: "Tell me more about your concerns about the surgery." This response is the most therapeutic and supportive approach in this situation. By encouraging the client to express their fears and concerns, the nurse can establish trust, provide emotional support, and address any specific worries the client may have. This approach allows for open communication and helps the nurse to better understand the client's emotional state, enabling them to provide appropriate care and support. Option A is incorrect because minimizing the client's fears by stating that the surgery is routine and has a low risk of death may come across as dismissive and invalidating of the client's emotions. It does not address the client's specific concerns or provide emotional support. Option B, suggesting speaking with a chaplain, may be appropriate for some clients, but in this case, the client is expressing fear of death related to the surgery itself. Referring to a chaplain may not directly address the client's concerns about the surgery and may not be the most immediate or appropriate response. Option D, asking about the client's support systems, is also not the best response in this situation as it does not directly address the client's expressed fear of death. While support systems are important, the immediate priority is addressing the client's emotional needs and concerns about the upcoming surgery. In an educational context, it is crucial for nurses to develop strong communication skills to effectively address and support clients' emotional needs. Encouraging open dialogue, active listening, and providing emotional support are essential components of holistic nursing care, especially in situations where clients are facing significant medical procedures or uncertainties. By acknowledging and validating the client's emotions, nurses can build trusting relationships and provide individualized, compassionate care.