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A 59-year-old client is brought into the emergency room with complaints of chest pain. The client states that the pain is a crushing, constrictive pressure that is not relieved with position change. He states that the pain started 3 hours ago in the middle of his chest and radiates down his left arm. The client has a history of diabetes, asthma, and hypertension.

T: 99

BP: 138/72

HR: 106

RR: 19

ECG-ST segment depression

Troponin - Negative

The client is given medication for his unstable angina. Soon after, the client states that he is having difficulty breathing with audible wheezing heard on auscultation. Which of the following is most likely responsible for the symptoms experienced by this client?

Heparin

Morphine

Propranolol

Nitroglycerin

Answer: C

Answer and Explanation

The Correct Answer is C

A. Heparin is an anticoagulant and does not typically cause bronchospasm or wheezing.

B. Morphine can cause respiratory depression but not bronchospasm.

C. Propranolol, a non-selective beta-blocker, can cause bronchospasm, particularly in clients with asthma.

D. Nitroglycerin primarily causes vasodilation and does not typically lead to bronchospasm or wheezing.

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Correct Answer is A

Explanation

A. Clients with ICDs should avoid strong electromagnetic fields, which can interfere with the device’s function. This is crucial for safety.

B. Discontinuing antidysrhythmic medication is not recommended unless instructed by the healthcare provider, as it could increase the risk of arrhythmias.

C. Strenuous exercise may be too strenuous for someone with an ICD and could increase the risk of arrhythmias or lead to ICD activation.

D. A snug-fitting shirt is generally not recommended because it may place pressure on the ICD site and cause discomfort.

A. Test the equipment by delivering a smaller shock at 50 J. B. Administer 2 mg of intravenous epinephrine. C. Make sure that the defibrillator is set to the synchronous mode. D. Ensure that everyone is clear of contact with the client and the bed.

Correct Answer is D

Explanation

A. Testing the equipment with a smaller shock is unnecessary when preparing to defibrillate in an emergency.

B. Epinephrine is used in cases of cardiac arrest with no pulse, particularly in asystole or pulseless electrical activity (PEA), not immediately before defibrillation in ventricular fibrillation.

C. Synchronous mode is used for cardioversion, not for defibrillation. Defibrillation should be delivered in unsynchronized mode.

D. Before delivering a shock, it is essential to ensure that everyone, including the nurse, is clear of the client and any conductive surfaces like the bed. This prevents injury from the electrical shock.

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Naxlex Comprehensive Predictor Exams

After teaching a client who has an implantable cardioverter- defibrillator (ICD), a nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching?

Correct Answer is A

Explanation

A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which intervention is appropriate for the nurse to perform prior to defibrillating this client?

Correct Answer is D

Explanation

A client who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the client may have been taken too much warfarin. The nurse anticipates that client will receive which antidote?

A client is in the emergency department after being rescued from a house fire. After the initial assessment, the client develops a loud, brassy cough. What intervention by the nurse takes priority?

The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with hypertensive emergency. Which of the following is most important to report to the healthcare provider?

The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which statement by the client indicates a lack of understanding?

A client with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the client's ventilation?

The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect the health care provider to order to make an accurate diagnosis?