A client is prescribed diltiazem for the treatment of a cardiac disorder. Which finding would require the nurse to hold the ordered dose and notify the provider for further orders?
Heart rate 46 beats per minute.
EKG shows atrial fibrillation with rapid ventricular response.
Client reports feeling palpitations and dizziness.
Blood pressure 198/102.
The Correct Answer is A
A. Heart rate 46 beats per minute: Diltiazem is a calcium channel blocker that slows conduction through the AV node and decreases heart rate. A heart rate below 50 bpm is considered bradycardia and may be exacerbated by diltiazem, increasing the risk of symptomatic hypotension, dizziness, or syncope. The nurse should hold the dose and notify the provider.
B. EKG shows atrial fibrillation with rapid ventricular response: Diltiazem is often prescribed to control ventricular rate in atrial fibrillation with RVR. In this context, the medication is appropriate, and the nurse would generally administer as ordered while monitoring vital signs and rhythm.
C. Client reports feeling palpitations and dizziness: While these symptoms warrant assessment, they are nonspecific. The nurse would evaluate for hemodynamic instability, but a documented bradycardia takes precedence as a reason to withhold the dose.
D. Blood pressure 198/102: Diltiazem can be used to lower elevated blood pressure in certain situations. Unless there is evidence of hypotension or other contraindications, elevated blood pressure alone is not a reason to hold the medication; in fact, the dose may help manage hypertension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Pericardial friction rub: Pericarditis is inflammation of the pericardial sac. The classic auscultatory finding is a high-pitched, scratchy pericardial friction rub heard best at the left lower sternal border. It is caused by the inflamed pericardial layers rubbing against each other and is a hallmark sign of pericarditis.
B. Mitral murmur: A mitral murmur is associated with mitral valve disorders such as mitral stenosis or mitral regurgitation, not inflammation of the pericardium.
C. Pleural friction rub: A pleural friction rub is heard with pleuritis and is related to lung and pleural inflammation. It is respiratory in origin and changes with breathing, unlike a pericardial friction rub.
D. S3 or S4: An S3 is commonly associated with heart failure, and an S4 is often linked to decreased ventricular compliance, such as in hypertension. These are not characteristic findings of acute pericarditis.
Correct Answer is A
Explanation
A. Hoarseness and difficulty swallowing: A thoracic aortic aneurysm can compress adjacent structures such as the recurrent laryngeal nerve and esophagus. Compression of the nerve can cause hoarseness, while pressure on the esophagus can result in dysphagia. These are classic symptoms associated with TAA rather than abdominal aneurysms.
B. Bruit and thrill in upper abdomen: A bruit or thrill in the abdomen is more characteristic of an abdominal aortic aneurysm (AAA), not a thoracic aortic aneurysm. TAAs are usually located in the chest and may not produce abdominal auscultatory findings.
C. Disruption of bowel patterns: Bowel pattern changes are generally unrelated to thoracic aortic aneurysms. They may occur in abdominal pathology or mesenteric ischemia but are not typical manifestations of a TAA.
D. Abdominal, flank, or back pain: While abdominal or back pain is a hallmark of AAA, a TAA more commonly produces chest pain, back pain localized to the thoracic region, or symptoms from compression of mediastinal structures. Abdominal pain is not a primary finding in TAA.
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