You are observing the cardiac rhythms for patients in the coronary care unit. Which of these patients will need immediate intervention?

Correct Answer: C

Rationale: In this scenario, the correct immediate intervention is needed for the patient described in option C. This patient, who has just arrived on the unit with an acute MI and has sinus rhythm with a rate of 76, along with frequent premature ventricular contractions, requires immediate attention due to the risk of developing life-threatening arrhythmias or worsening of the myocardial infarction. Option A may seem concerning due to atrial fibrillation, but the heart rate of 88 while at rest is not critically high and may not require immediate intervention. Option B describes a patient with a newly implanted demand ventricular pacemaker, which is functioning within normal parameters with occasional sinus rhythm periods, making this option less urgent compared to option C. Option D presents a patient with a first-degree heart block and a heart rate of 58, which, although lower than normal, may not warrant immediate intervention if the patient is stable and asymptomatic. In an educational context, understanding the urgency of different cardiac rhythms is crucial in a clinical setting, especially in coronary care units where patients are at high risk for cardiovascular complications. Proper assessment and prioritization of patients based on their cardiac rhythms can significantly impact patient outcomes and guide appropriate interventions. This case highlights the importance of recognizing critical arrhythmias and responding promptly to ensure patient safety and well-being.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Bradycardia. When administering quinidine, a nurse should observe for bradycardia in a client with a valvular disorder of the heart because quinidine is an antiarrhythmic medication that can slow down the heart rate. This adverse effect is important to monitor as it can lead to further complications in a client with a pre-existing valvular disorder. Option A) Ringing of the ears is not typically associated with quinidine administration but can be a side effect of other medications like aspirin or certain antibiotics. Option B) Stiff neck is not a common adverse effect of quinidine. Option D) Bluish discoloration of the palms is not a known side effect of quinidine and would not be a typical symptom to observe in this context. Educationally, understanding the potential adverse effects of medications used in cardiovascular disorders is crucial for nurses to provide safe and effective care to their patients. Monitoring for these adverse effects can help prevent complications and improve patient outcomes. It is important for nurses to be knowledgeable about the medications they administer and to closely monitor patients for any signs of potential adverse reactions.

Correct Answer: B

Rationale: The correct answer is B) Troponin. Troponin is considered the gold standard laboratory test in identifying heart damage from an acute myocardial infarction because it is a cardiac-specific biomarker released into the bloodstream when there is damage to the heart muscle. Troponin levels rise within a few hours of a heart attack and remain elevated for an extended period, making it a reliable indicator of cardiac injury. Option A) Myoglobin is an early marker for myocardial infarction but lacks specificity for cardiac muscle damage, as it can also be elevated in skeletal muscle injury. Option C) Creatine kinase (CK) is an enzyme found in the heart, brain, and skeletal muscle. While CK can be elevated in myocardial infarction, it is less specific to the heart compared to troponin. Option D) Aspartate aminotransferase (AST) is an enzyme found in various tissues, including the heart and liver. Elevated AST levels can indicate heart or liver damage, but it is not as specific to cardiac injury as troponin. Educationally, understanding the significance of troponin as the gold standard for identifying heart damage in myocardial infarction is crucial for healthcare providers working in cardiovascular care. It helps in accurate and timely diagnosis, monitoring, and management of patients presenting with chest pain or suspected heart attacks. This knowledge enhances patient outcomes by guiding appropriate treatment interventions based on reliable biomarker levels.

Correct Answer: A

Rationale: The correct answer is A) Stage 2 hypertension. In this scenario, the client's blood pressure reading of 160/90 falls into the Stage 2 hypertension category according to the American Heart Association guidelines. Stage 2 hypertension is characterized by a systolic pressure of 140 mmHg or higher and a diastolic pressure of 90 mmHg or higher. This level of hypertension indicates a significantly elevated blood pressure that requires intervention to prevent complications such as heart disease, stroke, and kidney damage. Option B) Prehypertension is incorrect because the client's blood pressure reading exceeds the range for prehypertension, which typically falls between 120-139/80-89 mmHg. Option C) Stage 1 hypertension is also incorrect as the client's blood pressure exceeds the criteria for Stage 1 hypertension, which is defined as a systolic pressure of 130-139 mmHg or a diastolic pressure of 80-89 mmHg. Option D) Hypertensive heart disease is not the correct answer as it refers to a condition where long-standing high blood pressure leads to complications in the heart, such as left ventricular hypertrophy or heart failure. While the client may be at risk for hypertensive heart disease if their hypertension is not managed, the blood pressure reading provided does not specifically indicate this condition. Educationally, understanding the classification of hypertension levels is essential for healthcare professionals to accurately assess and manage patients' blood pressure readings. Recognizing the various stages of hypertension helps guide treatment decisions and interventions to reduce the risk of complications associated with high blood pressure. Regular monitoring and appropriate management of hypertension are crucial in promoting cardiovascular health and preventing adverse outcomes.

Correct Answer: C

Rationale: The correct answer is C) 70-80 beats/minute for the average heart rate of a transplanted heart. This is because after heart transplantation, the denervated heart is regulated solely by intrinsic mechanisms, leading to a somewhat higher resting heart rate compared to a normal healthy heart. This range aligns with the typical resting heart rate for a transplanted heart. Option A) 50-60 beats/minute is incorrect because it falls below the average heart rate range for a transplanted heart. A heart transplant recipient would typically have a higher resting heart rate. Option B) 60-70 beats/minute is also incorrect as it is still lower than the average heart rate of a transplanted heart, which tends to be slightly higher due to the denervation of the heart post-transplant. Option D) 80-90 beats/minute is incorrect as it exceeds the average heart rate range for a transplanted heart. A heart transplant recipient would generally have a slightly elevated heart rate compared to the lower end of this range. Educationally, understanding the nuances of heart rate regulation in transplanted hearts is crucial for healthcare providers caring for heart transplant recipients. This knowledge helps in monitoring and interpreting heart rate variations post-transplant accurately, aiding in providing optimal care and early identification of any potential issues.