A nurse is discussing with a client who knows someone taking metoprolol for blood pressure management. The client inquires whether metoprolol would be suitable for her as well. Based on the client's medical record, which of the following should the nurse recognize as a contraindication to metoprolol?

Recently treated bilateral pneumonia

A concurrent prescription for tadalafil

Diet-controlled diabetes mellitus Type 2

A history of sinus bradycardia

Answer and Explanation

The Correct Answer is D

Choice A reason : Recently treated bilateral pneumonia is not a contraindication to metoprolol. Metoprolol is a beta-blocker used primarily for the management of hypertension and is not affected by a history of pneumonia.

Choice B reason : While tadalafil is known to interact with medications that lower blood pressure, it is not a direct contraindication to metoprolol. However, caution is advised when they are used concurrently due to the potential for additive blood pressure-lowering effects.

Choice C reason : Diabetes mellitus Type 2, especially when diet-controlled, is not a contraindication to metoprolol. Beta-blockers like metoprolol can mask hypoglycemic symptoms, so patients with diabetes should be monitored closely, but it does not preclude the use of the medication.

Choice D reason : A history of sinus bradycardia is a contraindication to metoprolol. Metoprolol can exacerbate bradycardia, leading to hemodynamic instability and is therefore contraindicated in patients with a history of significant bradycardia.

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Correct Answer is A

Explanation

Choice A reason : Hepatomegaly, or the enlargement of the liver, is a common finding in right-sided heart failure. This condition occurs because the heart does not pump blood effectively, leading to congestion and increased pressure in the venous system, including the hepatic veins. As a result, the liver becomes engorged with blood, causing it to enlarge. The normal liver span in adults is about 10-12 cm in the midclavicular line, and any measurement above this can indicate hepatomegaly.

Choice B reason : Orthopnea, which is shortness of breath while lying flat, is more commonly associated with left-sided heart failure. In right-sided heart failure, symptoms are more related to systemic congestion, such as swelling in the legs and abdomen, rather than pulmonary symptoms like orthopnea.

Choice C reason : Dyspnea, or difficulty breathing, can be a symptom of both left and right-sided heart failure. However, in the context of right-sided heart failure, dyspnea is usually due to the accumulation of fluid in the abdominal cavity (ascites) and the increased pressure in the abdominal veins, which can compress the diaphragm and make breathing difficult.

Choice D reason : Frothy sputum is typically not a symptom of right-sided heart failure. It is more indicative of pulmonary edema, which is associated with left-sided heart failure. In right-sided heart failure, the primary issues are related to the systemic circulation and venous congestion.

A. Hemoglobin (Hgb) : 16 g/dL B. Prothrombin Time (PT) : 45 seconds C. Activated Partial Thromboplastin Time (aPTT) : 36 seconds D. Platelets : 190,000/mm

Correct Answer is B

Explanation

Choice A reason : A hemoglobin (Hgb) level of 16 g/dL is within the normal range for adults, which typically falls between 13.8 to 17.2 g/dL for men and 12.1 to 15.1 g/dL for women. Therefore, this value does not warrant reporting to the provider as it does not indicate an immediate concern.

Choice B reason : A prothrombin time (PT) of 45 seconds is significantly higher than the normal range of 11 to 13.5 seconds for individuals not on anticoagulation therapy. For patients on warfarin, the target PT is usually 1.5 to 2 times the normal value, depending on the indication for therapy. However, a PT of 45 seconds suggests a high risk of bleeding and requires immediate medical attention.

Choice C reason : The activated partial thromboplastin time (aPTT) of 36 seconds is within the normal range of approximately 21 to 35 seconds⁸. This result indicates that the blood's intrinsic clotting pathway is functioning within expected parameters and does not need to be reported.

Choice D reason : A platelet count of 190,000/mm is within the normal range, which is typically 150,000 to 450,000 platelets/mm. This value is not concerning and does not need to be reported to the provider.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with teaching a class about documenting blood pressure. The nurse should include documenting which of the following information?

Correct Answer is A

Explanation

A nurse on a telemetry unit is reviewing the laboratory results for a client who has atrial fibrillation and is taking warfarin. Which of the following laboratory values should the nurse report to the provider?

Correct Answer is B

Explanation

A nurse is caring for a client who has hypertension and is to start taking atenolol. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of this medication?

A nurse is caring for a client who recently had surgery for the insertion of a permanent pacemaker. Which of the following prescriptions should the nurse question?

A nurse is contributing to the plan of care for a client who is admitted with deep vein thrombosis (DVT) of the left leg. Which of the following interventions should the nurse include in the plan?

A nurse is collecting data on a client who has bradycardia. Which of the following findings should the nurse expect?

A nurse is reinforcing teaching about warfarin with a client who has a new onset of atrial fibrillation. Which of the following statements should the nurse include in the teaching?

A nurse is reviewing the laboratory results for a male adult client who is at risk for peripheral arterial disease due to atherosclerosis. The nurse should identify which of the following results places the client at risk :

A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril. Which of the following instructions should the nurse plan to include? (Select all that apply)

A nurse is assisting with the care of a client who was admitted to the telemetry unit after experiencing chest pain, dyspnea, and diaphoresis. Which of the following ECG findings is a manifestation of acute myocardial infarction?