Priority nursing interventions when a client is on heparin include the following:

Correct Answer: B

Rationale: The correct answer is B: Monitor the IV site for extravasation. This is crucial because heparin is an anticoagulant medication that can cause bleeding if not administered properly. Monitoring the IV site helps prevent potential complications such as bleeding, hematoma, or tissue damage. Other choices are incorrect: A: Providing antacids for digestive upset is not a priority when a client is on heparin. C: Monitoring signs of acute blood loss is important, but the immediate concern is preventing complications related to heparin administration. D: Monitoring the respiratory rate is not directly related to heparin therapy and is not a priority intervention in this case.

Correct Answer: B

Rationale: The correct answer is B: To reduce total and LDL cholesterol. Statin medications are primarily used to lower cholesterol levels, specifically total cholesterol and LDL cholesterol, to reduce the risk of cardiovascular events. This is achieved by inhibiting an enzyme involved in cholesterol synthesis. Incorrect answers: A: Thinning blood is the function of anticoagulants, not statins. C: Statins do not break up plaques in the arteries; they prevent further plaque buildup. D: Statins do not destabilize cholesterol plaques; they primarily focus on lowering cholesterol levels.

Correct Answer: A

Rationale: The correct answer is A: The sino-atrial node. The SA node is the natural pacemaker of the heart, responsible for initiating the electrical impulses that regulate the heartbeat. A resting heart rate of 80 with a regular rhythm indicates normal sinus rhythm, which is typically driven by the SA node. The SA node is located in the right atrium and generates electrical impulses that spread through the atria, causing them to contract. Choice B (The atrio-ventricular node) is incorrect because the AV node serves to delay the electrical impulse to allow the atria to contract before the ventricles. Choice C (The Purkinje fibers) is incorrect as they are responsible for rapid conduction of the electrical impulse to the ventricles. Choice D (The bundle of HIS) is incorrect as it is part of the electrical conduction system that transmits the impulse from the AV node to the bundle branches.

Correct Answer: B

Rationale: The correct answer is B: Premature atrial contractions. This is because the client's heart rate is normal (70) and the P wave is coming early and malformed, indicating an early atrial depolarization. This is characteristic of premature atrial contractions, where an ectopic focus in the atria causes an early impulse. The other choices are incorrect because in a normal sinus rhythm (A), the P wave would be normal and not early or malformed. Frequent PVCs (C) would show wide and bizarre QRS complexes, not a malformed P wave. A ventricular escape rhythm (D) would have a slower heart rate and a different pattern of electrical activity.

Correct Answer: D

Rationale: The correct answer is D because the client should record the time of any palpable events, such as palpitations, during the Holter Monitor test to correlate symptoms with the recorded heart rhythm. This information helps healthcare providers make an accurate diagnosis. Choice A is incorrect as the client can go about their usual activities during the test. Choice B is incorrect as the client can bathe normally while wearing the Holter monitor. Choice C is incorrect as the test typically lasts for 24 to 48 hours, not just 30 minutes.