The nurse is administering digoxin to a client with a heart rate of 45 bpm. What is the nurse's priority action?

Correct Answer: A

Rationale: The correct answer is A: Hold the digoxin and notify the healthcare provider. Digoxin is a medication that can slow down the heart rate, and a heart rate of 45 bpm is below the normal range. Holding the medication and informing the healthcare provider is the priority to prevent potential harm from further slowing the heart rate. Administering the digoxin as ordered (B) would worsen the bradycardia. Increasing the dose of digoxin (C) would be dangerous. Monitoring the client's heart rate and reassessing in 30 minutes (D) may delay necessary intervention.

Correct Answer: C

Rationale: In this scenario, option C is the correct answer, indicating that the patient coughs often during the visit. This symptom suggests a potential adverse effect of enalapril, a medication known to cause a persistent cough in some patients due to its mechanism of action on the renin-angiotensin system. This adverse effect is termed ACE Inhibitor-induced cough. Option A, frequent urination, is a common side effect of enalapril but not typically a cause for concern unless severe or persistent. Option B, a blood pressure of 138/86, is within the normal range for blood pressure control in hypertensive patients, so it does not immediately warrant a change in drug therapy. Option D, occasional dizziness, is also a common side effect of enalapril but is not as urgent or specific as the cough in indicating a need for medication adjustment. Educationally, this question highlights the importance of recognizing and managing common side effects of medications used in the treatment of hypertension. It emphasizes the need for healthcare providers to monitor patients for both expected and potentially serious adverse effects to optimize therapeutic outcomes and patient safety. Understanding medication side effects and when to escalate concerns to the prescribing physician is crucial in clinical practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) Sinus bradycardia, rate 50, as evidenced by ECG. The most concerning symptom in a patient who recently started carvedilol is sinus bradycardia because carvedilol, a beta-blocker, can slow down the heart rate. This can be particularly risky in patients with heart failure who rely on a certain heart rate to maintain adequate cardiac output. Sinus bradycardia can lead to decreased cardiac output and exacerbate heart failure symptoms. Option A) Complaints of increased fatigue and dyspnea could be expected initially as the body adjusts to the medication but are not as concerning as a significant decrease in heart rate. Option B) A weight increase of 0.5 kg in 2 weeks could be due to fluid retention, a common side effect of heart failure medications, but it is not as immediately concerning as a sudden change in heart rate. Option C) Bibasilar crackles audible in the posterior chest are indicative of fluid accumulation in the lungs, which is a common sign of heart failure exacerbation but is not as critical as a significant drop in heart rate. Educationally, this question highlights the importance of monitoring heart failure patients closely when initiating new medications, especially those that can affect heart rate. It underscores the need for healthcare providers to be vigilant for changes in vital signs and symptoms that could indicate worsening heart failure or medication side effects. Regular assessment and close monitoring are essential in managing heart failure effectively.

Correct Answer: C

Rationale: In understanding the cardiovascular system, it is crucial to grasp the specific functions and characteristics of each heart chamber. The correct answer to this question is C) Left ventricle. The left ventricle has the highest pressure among the heart chambers because it is responsible for pumping oxygenated blood out to the entire body through the systemic circulation. This chamber has thicker muscular walls compared to the other chambers, especially the right ventricle, to generate the necessary force to propel blood to all tissues and organs. The left ventricle receives oxygenated blood from the left atrium and then contracts forcefully to push this blood into the aorta, which then distributes it to the rest of the body. Regarding the other options: A) Right atrium: This chamber receives deoxygenated blood from the body and pumps it into the right ventricle. It has low pressure compared to the left ventricle as it is the initial chamber in the venous circulation. B) Right ventricle: The right ventricle receives deoxygenated blood from the right atrium and pumps it to the lungs for oxygenation. While it generates more pressure than the right atrium, it still has lower pressure than the left ventricle due to the shorter distance it needs to pump blood to the lungs. D) Left atrium: This chamber receives oxygenated blood from the lungs and passes it to the left ventricle. It has lower pressure compared to the left ventricle, as its main role is to facilitate blood flow into the left ventricle. Understanding the pressure variations in the heart chambers is vital for comprehending the efficiency and mechanics of the cardiovascular system. It showcases how different chambers are specialized for distinct functions to ensure effective blood circulation throughout the body.

Correct Answer: A

Rationale: In the context of aortic regurgitation, the first sign is often a Water-hammer pulse, also known as a collapsing pulse. This occurs due to the rapid runoff of blood back into the left ventricle during diastole, leading to a forceful pulse followed by a rapid collapse. This phenomenon is characteristic of aortic regurgitation and is caused by the widened pulse pressure associated with the condition. Tachycardia, flushed skin, and heart murmur are not typically the first signs of aortic regurgitation. Tachycardia may occur later as a compensatory mechanism to maintain cardiac output. Flushed skin may be seen in conditions causing increased cardiac output, but it is not specific to aortic regurgitation. A heart murmur is a classic finding in aortic regurgitation but usually appears after the onset of other symptoms like the Water-hammer pulse. In an educational context, understanding the sequential development of symptoms in aortic regurgitation is crucial for clinical assessment and diagnosis. Recognizing the Water-hammer pulse as the initial sign can prompt further evaluation and timely intervention. This knowledge enhances the student's ability to correlate pathophysiology with clinical manifestations, leading to improved patient care and management.