Which of the following changes in the pharmacokinetics of propranolol and hydrochlorothiazide was most likely to occur when the patient began to take cholestyramine?

Correct Answer: C

Rationale: The correct answer is C because cholestyramine can bind to propranolol in the gut, preventing its absorption and leading to an increase in oral bioavailability. This occurs due to the cholestyramine-propranolol complex being excreted in the feces, reducing the amount of propranolol available for systemic circulation. Choice A is incorrect because propranolol clearance would decrease, not increase, as less drug is absorbed and more is excreted in the feces. Choice B is incorrect as cholestyramine does not directly affect the clearance of hydrochlorothiazide. Choice D is incorrect as there is a clear pharmacokinetic interaction between cholestyramine and propranolol.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Is coadministered with fluconazole. Terfenadine is a non-sedating antihistamine that was withdrawn from the market due to its potential to cause fatal arrhythmias by prolonging the QT interval. Fluconazole is an antifungal medication that inhibits the metabolism of terfenadine, leading to increased levels of terfenadine in the body. This increased concentration can further prolong the QT interval, predisposing the individual to polymorphic ventricular tachycardia like Torsades de Pointes. Option A) Is coadministered with azithromycin is incorrect because azithromycin does not have a significant interaction with terfenadine. Option C) Is given in higher doses is incorrect because the risk of polymorphic ventricular tachycardia is related to drug interactions and not just higher doses of terfenadine alone. Option D) Reduces QT interval is incorrect because terfenadine actually prolongs the QT interval, which is why it can lead to serious cardiac arrhythmias. This question highlights the importance of understanding drug interactions, particularly those that can impact cardiac electrophysiology. Healthcare providers need to be aware of potential drug interactions that can lead to QT prolongation and associated arrhythmias to ensure patient safety when prescribing medications that affect the cardiovascular system.

Correct Answer: C

Rationale: In the context of cardiovascular health and preventive medicine, understanding the appropriate threshold for initiating hypocholesterolemic drugs is crucial. The correct answer to this question is option C) 190 mg/dl. This threshold is based on current clinical guidelines that recommend initiating cholesterol-lowering medications, such as statins, in individuals without other coronary artery disease risk factors when their serum LDL cholesterol level exceeds 190 mg/dl. Option A) 130 mg/dl is below the recommended threshold for initiating hypocholesterolemic drugs in individuals without additional risk factors. Option B) 160 mg/dl is also below the guideline-recommended level for treatment initiation in this specific patient population. Option D) 240 mg/dl is higher than the threshold at which treatment should be considered in this scenario. Educationally, it is important to emphasize the individualization of treatment decisions in clinical practice. Guidelines provide general recommendations, but healthcare providers must consider each patient's unique risk factors, overall health status, and preferences when making treatment decisions. Understanding these nuances is essential for providing high-quality, patient-centered care in the field of cardiovascular medicine.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Monitor for hemorrhage. When a client is on low molecular weight heparin (LMWH), a priority nursing intervention is to monitor for hemorrhage due to the anticoagulant effects of heparin. LMWH works by inhibiting the formation of blood clots and can increase the risk of bleeding, especially if the client is receiving higher doses or has other risk factors for bleeding. Option A) Monitor the heparin level is incorrect because LMWH levels are not routinely monitored like heparin levels are in unfractionated heparin therapy. Option B) Monitor the aPTT is incorrect because LMWH does not significantly affect the activated partial thromboplastin time (aPTT). Monitoring aPTT is more relevant in unfractionated heparin therapy. Option D) Monitor the blood sugar is unrelated to the use of LMWH and is not a priority nursing intervention in this context. Educational Context: Understanding the priority nursing interventions when administering anticoagulants like LMWH is crucial for nursing practice. Monitoring for adverse effects, such as bleeding, is essential to ensure patient safety. Nurses need to be aware of the specific monitoring parameters and interventions associated with different anticoagulants to provide effective care and prevent complications in patients receiving these medications.

Correct Answer: D

Rationale: Rationale: The correct answer is D) The client should record the time of any palpable events, such as palpitations. In preparation for a Holter Monitor test, it is essential for the client to record any palpable events like palpitations as this information is crucial for the healthcare provider to analyze the heart's activity accurately over an extended period. The Holter Monitor is a portable device that continuously records the heart's electrical activity for 24 to 48 hours, or even longer. Therefore, documenting the time of any symptoms helps correlate them with the recorded data for a comprehensive analysis. Option A) The client should lie motionless for the test is incorrect because the purpose of the Holter Monitor is to record the heart's activity during regular daily activities, including exercise and sleep. Option B) The client can shower but cannot bathe is incorrect as the Holter Monitor is designed to be worn continuously, even during bathing. Waterproof covers are available to protect the device during such activities. Option C) The test will take about 30 minutes is incorrect as the Holter Monitor is worn for an extended period, usually 24 to 48 hours, to capture a broader range of heart activities beyond a brief monitoring period. Educational Context: Understanding the instructions for preparing for a Holter Monitor test is crucial for both the client and the healthcare provider. Educating the client on the importance of documenting any symptoms experienced during the monitoring period enhances the accuracy of the test results and aids in diagnosing potential cardiac issues. As educators, we must emphasize the significance of following preparation instructions to ensure the effectiveness of diagnostic procedures in healthcare settings.