The nurse is caring for a client on enalapril (Vasotec). What is the most important side effect to monitor?

Correct Answer: A

Rationale: The correct answer is A: Cough. Enalapril is an ACE inhibitor that can cause a dry, persistent cough as a common side effect. It is important to monitor for this because it can indicate a potentially serious adverse reaction called angioedema. Hyperkalemia (B) is a possible side effect of enalapril but is typically not as urgent to monitor as cough. Hypotension (C) is a common side effect but is usually monitored during the initial dose titration. Dizziness (D) is a less common side effect and is often transient. Monitoring for cough is crucial to detect and manage any potential angioedema promptly.

Correct Answer: D

Rationale: In this scenario, the most important information to communicate to the physician regarding the use of fibrinolytic therapy with tPA for a patient with acute myocardial infarction is option D) The patient has had continuous chest pain since 1:00 PM. The correct answer is D because the duration of chest pain is a critical factor in determining the eligibility for fibrinolytic therapy. The time frame of symptom onset is crucial as fibrinolytic therapy is most effective when administered within a specific window period from the onset of symptoms. Option A is incorrect because a history of alteplase use 8 months ago does not impact the current decision-making process for acute management of AMI. Option B is not directly relevant to the decision to administer fibrinolytic therapy. Option C, T wave inversions on the ECG, while important for diagnosing AMI, are not as time-sensitive as the duration of chest pain in determining the need for immediate fibrinolytic therapy. Educationally, understanding the time-sensitive nature of interventions in acute conditions like AMI is crucial for healthcare providers. Timely communication of critical information to the healthcare team can significantly impact patient outcomes, making it essential for healthcare professionals to prioritize and convey relevant details accurately and promptly.

Correct Answer: C

Rationale: In this scenario, option C, "The patient's vision is becoming 'fuzzy'," is the correct answer that would warrant notifying the physician. This symptom could indicate digoxin toxicity, as visual disturbances are a common sign. It is crucial to address this promptly to prevent serious complications. Option A, "The patient's apical pulse is 68 and very irregular," may be concerning due to the irregularity, but in a patient with atrial fibrillation on digoxin, an irregular pulse is expected. It is not necessarily an immediate cause for concern unless accompanied by other symptoms. Option B, "The patient takes the digoxin with meals," is incorrect as taking digoxin with meals does not raise immediate concerns; however, adherence to dosing instructions should still be reinforced for optimal drug effectiveness. Option D, "The patient has lung crackles that clear after coughing," is unrelated to digoxin therapy and suggests a potential respiratory issue that would require further assessment but is not directly related to the medication. Educationally, this question highlights the importance of recognizing early signs of digoxin toxicity, emphasizing the need for close monitoring of patients on this medication, especially the elderly. It also underscores the significance of assessing for drug-related side effects and differentiating them from unrelated symptoms for appropriate intervention.

Correct Answer: A

Rationale: The correct answer is A) Transesophageal echocardiography (TEE). In TEE, the nurse instructs the client to avoid eating or drinking until sensation and the gag reflex return because the procedure involves passing a probe through the mouth and into the esophagus to obtain detailed images of the heart. This requires the client to have a numb throat to prevent gagging during the procedure, hence the need to wait until sensation returns. Option B) Magnetic resonance imaging (MRI) does not require the client to avoid eating or drinking for an extended period of time. Option C) Echocardiography is a non-invasive test that does not involve any restrictions on eating or drinking. Option D) Cardiac catheterization involves inserting a catheter into a blood vessel but does not require the client to avoid eating or drinking for an extended period. In an educational context, understanding the specific instructions and preparations for different cardiovascular tests is crucial for nurses to ensure the safety and well-being of their patients. Educating nurses on the rationale behind these instructions helps them provide optimal care and support to clients undergoing cardiovascular procedures.

Correct Answer: A

Rationale: In this question, the correct answer is A) Aortic regurgitation. A water hammer pulse, also known as a Corrigan pulse, is a characteristic sign of aortic regurgitation. This condition is caused by the backflow of blood from the aorta into the left ventricle during diastole, leading to a rapid rise and fall in arterial pressure, resulting in a bounding and forceful pulse. Option B) Mitral valve stenosis is incorrect because it is associated with a low-pitched rumbling diastolic murmur and not a water hammer pulse. Option C) Mitral regurgitation is incorrect as it is characterized by a holosystolic murmur radiating to the axilla, not a water hammer pulse. Option D) Aortic stenosis presents with a crescendo-decrescendo systolic ejection murmur, not a water hammer pulse. Understanding these clinical correlations is essential for healthcare professionals, especially those in cardiology. Recognizing the specific characteristics of different heart conditions not only aids in diagnosis but also informs appropriate treatment strategies. This knowledge is crucial for providing quality patient care and ensuring positive health outcomes.