A nurse is caring for a client with acute coronary syndrome.

The client is ordered weight based heparin.

The order reads, "Give Heparin bolus 60 units/kg IV push now.”. The nurse notes the client's weight is 231 pounds.

How many units of heparin will the nurse give for the bolus?

Choice A rationale

A history of migraine headaches is generally not a contraindication for propranolol. In fact, propranolol is often prescribed for migraine prophylaxis due to its beta-blocking effects, which can stabilize vascular tone in the brain and reduce the frequency and severity of migraine attacks.

Choice B rationale

Propranolol can mask the symptoms of hyperthyroidism, such as tachycardia and tremors, and may worsen hypothyroidism. Beta-blockers can also interfere with the peripheral conversion of thyroxine (T4) to triiodothyronine (T3). Therefore, a history of hypothyroidism warrants careful consideration and monitoring.

Choice C rationale

A history of hypertension is an indication for propranolol, as it is a beta-blocker commonly used to manage elevated blood pressure. Its mechanism involves reducing heart rate and myocardial contractility, leading to decreased cardiac output and renin release, thereby lowering systemic vascular resistance.

Choice D rationale

A history of bronchial asthma is a significant contraindication for propranolol. As a non-selective beta-blocker, propranolol can cause bronchoconstriction by blocking beta-2 adrenergic receptors in the bronchial smooth muscles, potentially precipitating severe asthmatic attacks or exacerbating respiratory distress.

Choice A rationale

Chemotherapy is not solely used as palliative therapy. While it can provide palliation by alleviating symptoms and improving quality of life in advanced cancers, it is also used with curative intent in various cancers, especially when combined with other modalities like surgery or radiation, or as neoadjuvant/adjuvant therapy to reduce tumor burden or prevent recurrence.

Choice B rationale

Chemotherapy does not typically cure prostate cancer that has metastasized to the bone. Metastatic prostate cancer is generally considered incurable, though treatable. Chemotherapy aims to control disease progression, reduce tumor burden, alleviate symptoms such as bone pain, and extend life expectancy. It is a systemic treatment targeting rapidly dividing cells throughout the body.

Choice C rationale

Chemotherapy can effectively help control the spread of cancer and improve quality of life. By targeting rapidly dividing cells, chemotherapy reduces tumor size and inhibits further metastasis, thereby slowing disease progression. This can lead to symptom relief, such as decreased pain from bone metastases, allowing for an enhanced quality of life for the client.

Choice D rationale

Chemotherapy is an effective treatment for bone metastasis, particularly in prostate cancer. While it may not cure the metastasis, it plays a crucial role in disease management. It can reduce the tumor burden in the bones, alleviate pain, decrease the risk of skeletal-related events like fractures, and improve overall client outcomes by controlling systemic disease. .