The client has atrial fibrillation. What can the nurse say about the P wave?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) The P wave is absent. In atrial fibrillation, the atria are quivering and do not contract effectively, leading to an absence of a distinct P wave on the ECG. This absence is a characteristic feature of atrial fibrillation. Option A) It precedes a long PR interval is incorrect because in atrial fibrillation, the irregular and rapid firing of electrical signals results in an irregular and often shortened PR interval. Option B) It falls on the previous T wave is incorrect as it does not accurately describe the relationship between the P wave and T wave. In atrial fibrillation, the chaotic atrial activity causes the P wave to be obscured rather than falling on the T wave. Option D) It is peaked is also incorrect as a peaked P wave is more indicative of conditions like right atrial enlargement rather than atrial fibrillation. Educationally, understanding the ECG changes associated with different cardiac arrhythmias is crucial for nurses caring for patients with cardiovascular conditions. Recognizing the absence of the P wave in atrial fibrillation can aid in prompt identification and appropriate management of this common arrhythmia.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Bradycardia. Morphine is an opioid analgesic that acts on the central nervous system and can lead to bradycardia, or a decreased heart rate, as one of its side effects. Opioids like morphine can stimulate the vagus nerve, leading to a decrease in heart rate. Option B) Hypertension is unlikely because opioids like morphine typically cause vasodilation, which can result in decreased blood pressure rather than hypertension. Option C) Hypotension is a more likely effect of subtherapeutic doses of morphine due to its vasodilatory effects leading to a decrease in blood pressure. Option D) No change in heart rate is less likely as opioids, including morphine, commonly affect heart rate through their action on the central nervous system. In an educational context, understanding the cardiovascular effects of drugs like morphine is crucial for medical students to ensure safe and effective patient care. This knowledge helps students anticipate and manage potential side effects of medications, contributing to better clinical outcomes. It also underscores the importance of proper dosing and monitoring when administering pharmacological agents that can impact cardiovascular function.

Correct Answer: B

Rationale: In clinical pharmacology, understanding the properties of cardiovascular drugs like Nifedipine is crucial for safe and effective patient care. The correct answer is B) Can be combined with beta blockers in the management of hypertension. Nifedipine is a dihydropyridine calcium channel blocker that primarily dilates arteries more than veins. It is commonly used to treat hypertension and angina. When used alone, it can cause reflex tachycardia, which can be attenuated by combining it with a beta blocker. This combination therapy is often utilized in managing hypertension to achieve better blood pressure control without the negative effects of reflex tachycardia. Options A, C, and D are incorrect: A) Nifedipine dilates arteries more than veins due to its selective action on vascular smooth muscle. C) Nifedipine does not increase plasma calcium concentration; rather, it inhibits the influx of calcium ions into vascular smooth muscle cells. D) Nifedipine is not contraindicated in asthma; however, caution is advised in patients with heart failure or bradycardia. Educationally, this question highlights the importance of understanding the mechanisms of action and appropriate combinations of cardiovascular drugs to optimize treatment outcomes in patients with hypertension. It reinforces the concept of combination therapy in managing complex conditions and underscores the need for a comprehensive understanding of drug actions to make informed clinical decisions.

Correct Answer: C

Rationale: In the context of clinical pharmacology of cardiovascular drugs, understanding the adverse effects of beta-blockers is crucial for healthcare professionals. The correct answer is C) Tachycardia. Beta-blockers, as the name suggests, work by blocking beta-adrenergic receptors, leading to a decreased heart rate and reduced contractility. Therefore, tachycardia, which is an increased heart rate, is not an adverse effect of beta-blockers but rather the desired therapeutic outcome. Let's analyze why the other options are incorrect: A) Hypotension: Beta-blockers are known to cause hypotension due to their mechanism of action in reducing the force of contraction of the heart and dilating blood vessels. B) Cold extremities: Beta-blockers can lead to peripheral vasoconstriction, causing reduced blood flow to the extremities and resulting in cold hands and feet. D) Bronchospasm especially in asthmatic patients: Beta-blockers are contraindicated in asthmatic patients due to their potential to cause bronchospasm by blocking beta-2 receptors in the lungs. Educationally, understanding the adverse effects of medications like beta-blockers is essential for safe and effective patient care. Healthcare professionals need to be able to differentiate between the desired therapeutic effects and potential adverse reactions to make informed clinical decisions and provide optimal patient care.

Correct Answer: A

Rationale: In the case of a pregnant hypertensive patient like Om Khamis, it is crucial to consider the safety of antihypertensive medications for both the mother and the fetus. The correct answer, A) Captopril, is known to be contraindicated during pregnancy due to its potential to cause renal damage in the fetus. Captopril is an ACE inhibitor that has been associated with fetal renal malformations and even death when used during pregnancy. Therefore, advising Om Khamis to avoid Captopril is essential to protect the health of her unborn child. Now, let's analyze why the other options are incorrect: B) Diazoxide is a vasodilator used to treat severe hypertension and is generally considered safe during pregnancy. C) Fenoldopam is a selective dopamine receptor agonist used for the treatment of severe hypertension and is not known to cause renal damage in the fetus. D) Guanethidine is an older antihypertensive agent that has largely been replaced by newer, safer medications. While it may have side effects, renal damage in the fetus is not a known concern. In an educational context, this question highlights the importance of considering the safety profiles of medications, especially in vulnerable populations like pregnant women. Understanding the risks and benefits of different antihypertensive agents is essential for healthcare providers to make informed decisions and provide optimal care to their patients. It also emphasizes the need for thorough counseling and personalized treatment plans to ensure the well-being of both the mother and the fetus.