Ten hours following thrombolysis for an ST elevation myocardial infarction (STEMI), a client is receiving a lidocaine infusion for isolated runs of ventricular tachycardia (VT). Which finding should the nurse document in the electronic medical record as a therapeutic response to the lidocaine infusion?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Decreased frequency of episodes of VT. Lidocaine is a class Ib antiarrhythmic medication that works by stabilizing the neuronal membrane and decreasing automaticity in the ventricles. It is commonly used to treat ventricular arrhythmias like ventricular tachycardia (VT). Therefore, a therapeutic response to lidocaine would be a reduction in the frequency or cessation of VT episodes, indicating that the medication is effectively managing the arrhythmia. Option A) Stabilization of blood pressure ranges may not be directly related to the therapeutic response of lidocaine for VT. Lidocaine primarily targets cardiac arrhythmias, and its impact on blood pressure may be secondary or indirect. Option B) Cessation of chest pain is not a typical response to lidocaine infusion for VT. While chest pain may be associated with myocardial infarction, lidocaine's primary action is on cardiac arrhythmias, not pain relief. Option C) Reducing heart rate is not the primary goal of using lidocaine for VT. The focus is on restoring normal cardiac rhythm and preventing life-threatening arrhythmias, rather than specifically targeting heart rate reduction. In an educational context, understanding the mechanism of action and therapeutic indications of antiarrhythmic medications like lidocaine is crucial for nurses caring for patients with cardiovascular conditions. By grasping the specific responses expected from these medications, nurses can effectively monitor and evaluate the effectiveness of treatment interventions, ensuring optimal patient outcomes.

Correct Answer: D

Rationale: In this scenario, the priority intervention for the nurse after the client's rhythm converts to supraventricular tachycardia (SVT) is to give an IV dose of adenosine rapidly over 1-2 seconds (Option D). The correct answer is D because adenosine is the drug of choice for terminating SVT by interrupting the reentry pathway through the AV node. Adenosine works by slowing conduction through the AV node, which can help restore normal sinus rhythm in cases of SVT. Option A (Prepare for transcutaneous pacing) is incorrect because transcutaneous pacing is not indicated for SVT. It is used for bradycardias or unstable tachycardias that do not respond to medications. Option B (Deliver another defibrillator shock) is incorrect because defibrillation is used for shockable rhythms like ventricular fibrillation (VF) or pulseless ventricular tachycardia, not for SVT. Option C (Administer IV Epinephrine per ACLS protocol) is incorrect because epinephrine is indicated for cardiac arrest situations or severe bradycardia, not for SVT. Educationally, it is crucial for nurses to understand the appropriate pharmacological interventions for different cardiac rhythms to provide safe and effective care to pediatric patients. Adenosine administration requires proper dosing, administration technique, and close monitoring of the patient's response to ensure successful conversion of SVT. Nurses should also be familiar with ACLS protocols and algorithms to manage various cardiac emergencies confidently.

Correct Answer: C

Rationale: In the context of an older adult with heart failure experiencing an acute exacerbation, the correct intervention of providing a bedside commode for toileting is crucial in reducing cardiac workload. This is because having the commode nearby minimizes the need for the client to walk to the bathroom, thus decreasing physical exertion and stress on the heart. Option A, assisting with ambulation in the hallway, would increase physical activity and cardiac workload, which is contraindicated during an acute exacerbation of heart failure. Option B, encouraging active range of motion exercises, may also increase cardiac workload and should be avoided in this scenario. Option D, teaching to sleep in a side-laying position, while important for some patients with heart failure to reduce shortness of breath, is not directly related to reducing cardiac workload during an acute exacerbation. In an educational context, understanding the rationale behind each intervention is essential for nurses to provide safe and effective care to patients with heart failure. It highlights the importance of individualizing care based on the patient's condition and needs to optimize outcomes and prevent complications.

Correct Answer: A

Rationale: In the context of a male client with osteomalacia, which is characterized by softening of the bones due to a deficiency in vitamin D and calcium, the most important food to encourage in his daily diet is fortified milk and cereals (Option A). Fortified milk is an excellent source of calcium and vitamin D, essential nutrients for bone health. Cereals fortified with vitamin D and calcium provide additional support in addressing the deficiency underlying osteomalacia. This combination helps to strengthen bones and prevent further deterioration in the client's condition. Lean red meat and poultry (Option B) are good sources of protein but do not directly address the vitamin D and calcium deficiencies associated with osteomalacia. Fresh fruits and vegetables (Option C) are important for overall health but do not specifically target the nutritional needs of someone with osteomalacia. Whole grains and legumes (Option D) are valuable sources of nutrients but do not provide the necessary focus on calcium and vitamin D crucial for treating osteomalacia. In an educational context, it is important for nurses to understand the specific dietary recommendations for various health conditions. By grasping the rationale behind the correct answer, nurses can effectively educate and support clients in making appropriate dietary choices to manage their health conditions effectively. This question highlights the significance of targeted nutrition interventions in addressing specific health issues like osteomalacia.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to implement is option A) Determine if the client is using an inhaler before exercising. This choice is the most appropriate because the client's history of asthma and symptoms of bronchoconstriction and increased mucous production during exercise indicate exercise-induced asthma. Using an inhaler before exercising can help prevent or reduce these symptoms by opening up the airways and reducing inflammation. Option B) Advising the client to avoid all physical activity is incorrect as it is not a practical or healthy solution. Regular exercise is important for overall health, and with proper asthma management, individuals with asthma can safely engage in physical activities. Option C) Encouraging the client to increase fluid intake before exercise is not directly related to managing asthma symptoms during exercise. While staying hydrated is important, it will not address the underlying issue of bronchoconstriction in this case. Option D) Recommending the client wear a mask while exercising is not as effective as using an inhaler specifically designed to manage asthma symptoms. Masks may not provide the necessary bronchodilation and anti-inflammatory effects needed to alleviate symptoms during exercise. Educationally, understanding the importance of proper asthma management during exercise is crucial for nurses caring for pediatric clients with asthma. Recognizing the signs and symptoms of exercise-induced asthma and knowing the appropriate interventions, such as using an inhaler before exercise, can significantly improve the quality of life for these individuals and help them safely participate in physical activities.