The nurse recognizes that thrombolytic therapy for the treatment of an MI has not been successful when the patient displays which manifestation?

Correct Answer: A

Rationale: In the context of thrombolytic therapy for myocardial infarction (MI), it is crucial for the nurse to recognize signs indicating treatment failure. The correct answer, option A, "Continues to have chest pain," signifies unsuccessful thrombolysis. Chest pain persistence suggests ongoing myocardial ischemia due to inadequate clot dissolution, necessitating further interventions like rescue angioplasty. This outcome highlights the importance of prompt recognition and action in managing MI. Option B, "Has a marked increase in CK enzyme levels within 3 hours of therapy," is incorrect as elevated CK levels are expected after MI and thrombolysis due to myocardial damage, not necessarily indicating treatment failure. Option C, "Develops major GI or GU bleeding during treatment," is also incorrect as bleeding is a known side effect of thrombolytic therapy but does not inherently denote treatment failure. Option D, "Develops premature ventricular contractions and ventricular tachycardia during treatment," is incorrect as these arrhythmias can occur post-MI and are not specific indicators of thrombolytic therapy failure. Educationally, understanding the nuances of post-MI care, including thrombolytic therapy outcomes, is crucial for nurses caring for cardiac patients. This rationale emphasizes the importance of clinical vigilance, prompt assessment, and appropriate response to patient responses to therapy to optimize outcomes and prevent complications.

Correct Answer: C

Rationale: Congestive heart failure (CCF) is a complex condition that requires a comprehensive approach to management. The correct answer, option C (Both A and B), is the most appropriate choice because the medical and nursing management of CCF typically involves a combination of medications and lifestyle changes. Medications play a crucial role in managing CCF by addressing underlying causes, reducing symptoms, and improving heart function. Common medications include ACE inhibitors, beta-blockers, diuretics, and vasodilators. These medications help to reduce the workload on the heart, control blood pressure, and prevent fluid retention. On the other hand, lifestyle changes are equally important in managing CCF. Patients with CCF benefit from adopting a heart-healthy lifestyle, which includes maintaining a balanced diet low in sodium, engaging in regular physical activity, quitting smoking, managing stress, and monitoring weight and fluid intake. These lifestyle modifications can help improve heart function, reduce symptoms, and enhance overall quality of life. Option A (Medications) alone is incorrect because managing CCF solely with medications without addressing lifestyle factors may not lead to optimal outcomes. Similarly, option B (Lifestyle changes) alone is insufficient as lifestyle modifications alone may not be able to address the underlying physiological imbalances seen in CCF. In an educational context, understanding the multifaceted approach to managing CCF is crucial for healthcare professionals. By comprehensively addressing both medications and lifestyle changes, healthcare providers can optimize patient outcomes, reduce hospital readmissions, and improve quality of life for individuals living with CCF. This integrated approach underscores the importance of a holistic and patient-centered care model in managing chronic cardiovascular conditions.

Correct Answer: A

Rationale: The correct answer is option A) Take his blood pressure in his right arm while he is sitting and resting. This is the most appropriate nursing action because measuring blood pressure in a standardized and consistent manner is crucial for accurate assessment. Taking the blood pressure in a specific arm while the patient is sitting and at rest allows for a reliable baseline measurement. This is important for monitoring trends and making informed decisions about treatment. Option B is incorrect because it is not the nurse's role to diagnose or prescribe medication. It is essential to follow proper protocols and consult with a healthcare provider for diagnosis and treatment decisions. Option C is also incorrect as immediate referral to a physician may not be necessary based solely on one high blood pressure reading. Nurses play a critical role in initial assessment and monitoring before escalating care. Option D is incorrect because it is not appropriate to reassure a patient that elevated blood pressure is normal. It is essential to address high blood pressure with further assessment and potential interventions to prevent complications. In an educational context, understanding the correct procedure for measuring blood pressure and the role of the nurse in initial assessment is fundamental for nursing practice. This question highlights the importance of accurate assessment and appropriate nursing actions in managing patients with high blood pressure.

Correct Answer: B

Rationale: The correct answer is B) vasodilating action. Nitrates are medications commonly used to treat angina by dilating blood vessels, which helps increase blood flow and oxygen delivery to the heart muscle. The side effects of nitrates, such as headaches and dizziness, are primarily a result of their vasodilating action. When blood vessels dilate, it can lead to a drop in blood pressure, causing these side effects. Option A) rapid action is incorrect because the speed of action of nitrates is not the primary cause of their side effects. Option C) direct cellular action is incorrect because while nitrates do have a direct effect on smooth muscle cells in blood vessels, it is the resulting vasodilation that leads to side effects. Option D) poor absorption is incorrect as nitrates are well absorbed when taken orally or sublingually. In an educational context, understanding the side effects of medications like nitrates is crucial for healthcare professionals to effectively manage patient care. By knowing that the side effects are primarily due to the vasodilating action of nitrates, healthcare providers can anticipate and address these issues in patients taking these medications, ultimately improving patient outcomes and quality of care.

Correct Answer: B

Rationale: The correct answer is B) Walking or bicycling 20 minutes at least three times a week. After an inferior-wall myocardial infarction, also known as a heart attack, it is crucial for Mr. Bradley to engage in a regular aerobic exercise program to improve his cardiovascular health. Walking or bicycling at least three times a week for 20 minutes helps in improving cardiovascular fitness, strengthening the heart, and enhancing overall well-being without putting excessive strain on the heart. Option A) Golf or bowling two or three times a week may not provide a consistent level of aerobic exercise required for cardiovascular benefits. These activities are not as effective in improving cardiovascular fitness as sustained aerobic exercises like walking or cycling. Option C) Running the quarter mile daily may be too strenuous for someone recovering from a heart attack, especially if they are just starting an exercise program. High-intensity exercises like running may put excessive strain on the heart and lead to complications. Option D) Lifting weights daily is more focused on strength training rather than cardiovascular fitness. While strength training is beneficial, especially when supervised and tailored to the individual, aerobic exercise is more critical initially for cardiovascular recovery. In an educational context, it is essential for healthcare providers to educate patients on the appropriate type and intensity of exercise post-myocardial infarction. Emphasizing the importance of aerobic exercises like walking or cycling can help patients like Mr. Bradley improve their heart health, reduce the risk of future cardiac events, and enhance their overall quality of life. Monitoring and gradually increasing the intensity of exercise under medical supervision is key to a safe and effective recovery.