Which of the following drugs was most likely the second drug administered to a patient with atrial fibrillation and wide QRS after being given amiodarone?

Correct Answer: F

Rationale: The correct answer is B: Mexiletine. After administering amiodarone for atrial fibrillation and wide QRS, the next drug should target the wide QRS complex, indicating possible ventricular involvement. Mexiletine, a Class IB antiarrhythmic, is commonly used to treat ventricular arrhythmias. Lidocaine (A) is also a Class IB antiarrhythmic, but Mexiletine is preferred in this scenario due to its longer half-life. Phenytoin (C) is not indicated for atrial fibrillation or wide QRS. Nifedipine (D) is a calcium channel blocker and is not appropriate for treating ventricular arrhythmias.

Correct Answer: A

Rationale: In the acute management of angina pectoris, the agent given sublingually is Glyceryl trinitrate (Option A). Rationale: 1. **Correct Answer**: Glyceryl trinitrate is a fast-acting vasodilator that helps to dilate coronary arteries, increasing blood flow to the heart. Administered sublingually, it quickly enters the bloodstream, providing rapid relief from angina symptoms. 2. **Incorrect Options**: - B) Amyl nitrite: While also a vasodilator, it is typically used in the past for angina attacks but is not commonly used today. - C) Erythrital tetranitrate: This drug is not a commonly used medication for acute angina attacks. - D) Pentoerythritol tetranitrate: This medication is not typically administered sublingually for acute angina treatment. 3. **Educational Context**: Understanding the appropriate medications for the management of acute conditions like angina pectoris is crucial for healthcare providers, especially nurses. By knowing the correct medication and route of administration, nurses can promptly and effectively manage patients experiencing angina attacks, potentially preventing serious complications like myocardial infarction. In conclusion, Glyceryl trinitrate is the preferred choice for sublingual administration in acute angina attacks due to its rapid onset of action and effectiveness in relieving symptoms. Nurses must be well-versed in the appropriate use of cardiovascular drugs to provide optimal care to patients in various clinical settings.

Correct Answer: D

Rationale: Rationale: The correct answer is D) It is a competitive inhibitor of the rate-limiting step in cholesterol synthesis. Lovastatin is a member of the statin drug class, which works by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. By blocking this enzyme, lovastatin reduces the production of cholesterol in the liver, leading to decreased levels of LDL (bad) cholesterol in the bloodstream. This mechanism of action makes option D the correct statement about lovastatin. Option A is incorrect because lovastatin primarily affects cholesterol levels, especially LDL cholesterol, rather than triglycerides. Statins are more effective in lowering LDL cholesterol than triglycerides. Option B is incorrect as lovastatin is not typically used in conjunction with gemfibrozil for type III hyperlipoproteinemia. Statins are the first-line treatment for elevated cholesterol levels, while fibric acid derivatives like gemfibrozil are more commonly used for high triglyceride levels. Option C is also incorrect as lovastatin is effective in treating hypercholesterolemia, including in patients with diabetes. In fact, statins are recommended for diabetic patients due to their proven benefits in reducing cardiovascular risk in this population. In an educational context, understanding the mechanism of action of cardiovascular drugs like lovastatin is crucial for healthcare professionals, especially nurses, to make informed decisions regarding drug therapy for patients with dyslipidemia. Knowing how lovastatin works allows nurses to educate patients on medication adherence, potential side effects, and lifestyle modifications to optimize treatment outcomes.

Correct Answer: B

Rationale: In the scenario where a client is toxic on heparin, the appropriate antidote to use is Protamine, making option B the correct answer. Protamine works by binding to heparin, forming a stable complex that neutralizes the anticoagulant effects of heparin. This action helps to reverse the effects of heparin and prevent further bleeding complications. Option A, giving vitamin K, is not the correct choice in this situation as vitamin K is used to reverse the effects of warfarin, another type of anticoagulant. Option C, giving warfarin, is also incorrect as warfarin is not the antidote for heparin toxicity. Option D, giving platelets, is not the appropriate intervention for heparin toxicity as platelets are not effective in reversing the anticoagulant effects of heparin. In an educational context, it is crucial for nurses to be knowledgeable about antidotes for common medications, especially anticoagulants like heparin. Understanding the actions of antidotes and their specific indications is essential for providing safe and effective patient care. This knowledge helps nurses intervene promptly in situations of medication toxicity, like heparin overdose, to prevent adverse outcomes and ensure patient safety.

Correct Answer: D

Rationale: The correct answer is D) Junctional escape rhythm. In this scenario, the client's presentation of a heart rate of 70, slightly irregular rhythm, and P waves that come in multiples indicates a junctional escape rhythm. A junctional escape rhythm occurs when the atrioventricular (AV) node or the bundle of His takes over as the heart's pacemaker due to the failure of the sinoatrial (SA) node. This results in a heart rate that is typically slower than normal (around 40-60 bpm) and may present with an irregular rhythm. Now, let's discuss why the other options are incorrect: A) Third degree AV block: In a third-degree AV block, there is complete dissociation between the atria and ventricles, leading to an atrial rate that is typically faster than the ventricular rate. This is not consistent with the client's presentation. B) Type 2 second degree AV block: In this type of block, there are intermittent AV conduction disturbances leading to dropped beats. The client's ECG findings do not align with this type of block. C) None of the above: This option is incorrect as we have identified the correct rhythm based on the given information. Educational context: Understanding different cardiac rhythms is crucial for healthcare professionals, especially nurses, as they are often the first to identify and respond to changes in a patient's condition. Recognizing ECG patterns and understanding the underlying physiology helps in providing appropriate and timely interventions to ensure patient safety and well-being.