A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.
The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

Albuterol (Proventil)

Oxygen

Nitroglycerin

Aspirin

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Albuterol (Proventil) is a bronchodilator that is used to treat acute asthma attacks and chronic obstructive pulmonary disease (COPD). It works by relaxing the smooth muscles in the airways, which allows more air to flow into the lungs. While albuterol can be helpful in relieving shortness of breath, it is not the first-line treatment for a patient with chest pain and low oxygen saturation. This is because albuterol does not address the underlying cause of the chest pain, which is likely a lack of oxygen to the heart muscle.

Choice C rationale:

Nitroglycerin is a vasodilator that is used to treat angina (chest pain) and heart failure. It works by relaxing the blood vessels, which allows more blood to flow to the heart. Nitroglycerin can be helpful in relieving chest pain, but it is not the first-line treatment for a patient with low oxygen saturation. This is because nitroglycerin can actually worsen hypoxemia (low oxygen levels in the blood) by dilating blood vessels in the lungs.

Choice D rationale:

Aspirin is a blood thinner that is used to prevent and treat blood clots. It is often given to patients with chest pain who are suspected of having a heart attack. However, aspirin is not the first-line treatment for a patient with low oxygen saturation. This is because aspirin does not address the underlying cause of the low oxygen saturation, which is likely a problem with the lungs or heart.

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Correct Answer is C

Explanation

Choice A rationale:

Norepinephrine is a potent vasoconstrictor, meaning it narrows blood vessels. It primarily acts on arteries, but it can also constrict veins to a lesser extent.

Its primary actions are to increase systemic vascular resistance and blood pressure.

It is often used in conditions such as shock to raise blood pressure and improve perfusion to vital organs.

It is not a vasodilator and would not be appropriate for a patient requiring dilation of both arteries and veins.

Choice B rationale:

Nitroglycerin is a vasodilator that primarily acts on veins. It relaxes the smooth muscle in the walls of veins, which allows them to dilate and hold more blood.

This reduces the amount of blood returning to the heart, which in turn lowers preload and reduces cardiac workload.

Nitroglycerin is often used to treat angina pectoris, a condition characterized by chest pain due to insufficient blood flow to the heart.

While it can also have some vasodilatory effects on arteries, its primary action is on veins.

Choice C rationale:

Nitroprusside sodium (Nitropress) is a potent vasodilator that acts on both arteries and veins. It directly relaxes smooth muscle in the blood vessel walls, leading to dilation.

It is a very powerful vasodilator and can rapidly lower blood pressure.

It is often used in hypertensive emergencies to quickly reduce blood pressure and improve cardiac function.

It is also used in conditions such as congestive heart failure and acute aortic dissection to reduce afterload and improve cardiac output.

Choice D rationale:

Lidocaine is a local anesthetic agent that is primarily used to block nerve conduction. It does not have any direct vasodilatory effects.

It is sometimes used in the treatment of cardiac arrhythmias, but its mechanism of action in this setting is not related to vasodilation.

A. Sildenafil (Viagra) B. Aspirin C. Adenosine D. Oxygen

Correct Answer is A

Explanation

Choice A rationale:

Sildenafil (Viagra) is a phosphodiesterase-5 (PDE-5) inhibitor that is primarily used to treat erectile dysfunction. However, it also has vasodilatory effects, meaning it widens blood vessels. This can lead to a significant drop in blood pressure, especially when combined with nitroglycerin, another potent vasodilator.

Nitroglycerin is commonly used to treat chest pain (angina) and heart failure. It works by relaxing the smooth muscles in blood vessels, which allows them to widen and increase blood flow to the heart. This can help to relieve chest pain and improve heart function.

When sildenafil and nitroglycerin are taken together, their combined vasodilatory effects can cause a severe drop in blood pressure, known as hypotension. This can lead to a number of serious complications, including: dizziness, lightheadedness, fainting, heart attack, stroke.

The risk of hypotension is particularly high in patients who are already taking other medications that can lower blood pressure, such as alpha-blockers or nitrates. It is also important to note that the effects of sildenafil can last for up to 24-48 hours, so it is important to avoid taking nitroglycerin within this timeframe.

Due to the significant risk of hypotension, it is generally recommended that sildenafil be avoided within 24-48 hours of nitroglycerin administration.

Rationales for other choices:

Choice B: Aspirin

Aspirin is an antiplatelet medication that is often used to prevent blood clots. It does not have significant vasodilatory effects and does not interact with nitroglycerin in a way that would contraindicate its use.

Choice C: Adenosine

Adenosine is a medication that is used to treat certain types of arrhythmias (irregular heartbeats). It can cause a brief drop in blood pressure, but this effect is usually mild and transient. Adenosine does not interact with nitroglycerin in a way that would contraindicate its use.

Choice D: Oxygen

Oxygen is a gas that is often used to treat patients with respiratory problems. It does not have any direct vasodilatory effects and does not interact with nitroglycerin.

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A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

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Naxlex Comprehensive Predictor Exams

Which medication is recognized by the Registered Nurse (RN) as a dilator for both arteries and veins?

Correct Answer is C

Explanation

Which medication, if taken within the last 24-48 hours, would prevent a nurse from administering nitroglycerin?

Correct Answer is A

Explanation

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A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.
The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?