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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 C

Explanation

A. Blood glucose elevation is a concern for statins, but it is not a primary reason for questioning the order.

B. A history of high cholesterol is common and would not trigger concern regarding lovastatin.

C. Lovastatin can cause liver toxicity, so elevated liver enzymes are a contraindication or cause for concern when prescribing this medication. The nurse should verify this before starting the medication.

D. A history of peptic ulcers is unrelated to the use of lovastatin and would not be a concern in this case.

A. 13 B. 140 C. 14 D. 134

Correct Answer is C

Explanation

A. This is an underestimation due to a miscalculation of the dose rate.

B. This is an overestimation due to a miscalculation of the dose rate.

C. 1. Calculate the desired dose of dobutamine:

Desired dose (mcg/min) = Dose per kg (mcg/kg/min) x Weight (kg)

Desired dose (mcg/min) = 12 mcg/kg/min x 75 kg = 900 mcg/min

2. Convert mcg/min to mg/hr:

900 mcg/min x 60 min/hr = 54,000 mcg/hr

54,000 mcg/hr ÷ 1000 mcg/mg = 54 mg/hr

3. Calculate the concentration of dobutamine in the solution:

Concentration (mg/mL) = Total amount of dobutamine (mg) / Total volume (mL)

Concentration (mg/mL) = 1000 mg (1 g) / 250 mL = 4 mg/mL

4. Calculate the infusion rate (mL/hr):

Infusion rate (mL/hr) = Desired dose (mg/hr) / Concentration (mg/mL)

Infusion rate (mL/hr) = 54 mg/hr / 4 mg/mL = 13.5 mL/hr

5. Round to the nearest whole number:

Infusion rate (mL/hr) = 14 mL/hr

Therefore, the IV pump should be programmed for 14 mL/hr.

D. This is an overestimation due to a miscalculation of the dose rate.

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Naxlex Comprehensive Predictor Exams

After reviewing the client's chart upon admission to the unit, the nurse consults the healthcare provider about a new order for lovastatin (Mevacor). What triggered the nurse's action?

Correct Answer is C

Explanation

The healthcare provider orders dobutamine at 12 mcg/kg/min. The client weighs 75 kg. The pharmacy provides 250 mL of D5W with 1 g of dobutamine. How many mL/hr should the IV pump be programmed for? (Round to a whole number.)

Correct Answer is C

Explanation

While working in the outpatient clinic, the nurse notes that the client has a history of intermittent claudication. Which statement by the client would support this information?

A client is in the hospital and has received two doses of an angiotensin-converting enzyme (ACE) inhibitor for hypertension. When the nurse answers the client's call light, the client presents an appearance as shown below. What action by the nurse is most appropriate?

A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take?

The nurse is teaching a client diagnosed with benign prostatic hyperplasia (BPH). What statement indicates the client needs further information?

The health care provider orders: Epinephrine 0.25 mg IV stat Pharmacy provides: Epinephrine 0.1 mg/mL. How many mL will the nurse prepare to administer? (Round to one decimal place.)

A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count