Following an acute myocardial infarction a previously healthy 67-year-old develops clinical manifestations of left heart failure. The nurse knows which of the following drugs is the most important for treating left ventricular failure?
Digitalis preparations
Anticoagulants
B-adrenergic agonists
Angiotensin-converting enzyme (ACE) inhibitors
The Correct Answer is D
A. Digitalis preparations: Digitalis can improve contractility and control heart rate, but it does not address the underlying hemodynamic abnormalities or prevent remodeling that contribute to left ventricular failure post-MI. It is generally used for symptom management rather than as first-line therapy.
B. Anticoagulants: Anticoagulants prevent thromboembolic complications but do not treat the hemodynamic problem of left ventricular failure. They are supportive, not primary therapy for left heart failure.
C. B-adrenergic agonists: These drugs can increase contractility acutely, but they also increase myocardial oxygen demand and may worsen ischemia. They are typically used short-term in acute decompensation, not as primary therapy.
D. Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors reduce afterload and preload, improve cardiac output, and prevent ventricular remodeling after an MI. They are considered first-line therapy for left ventricular failure and have been shown to improve survival and reduce progression of heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Sit at least 12 feet from analog television sets: Pacemaker interference from televisions is not a concern with modern devices. Routine household electronics, including TVs, do not produce significant electromagnetic fields, so this precaution is unnecessary for discharge teaching.
B. Avoid large sports fields: Open outdoor areas pose no electromagnetic risk to pacemakers. There is no evidence that sports fields interfere with device function, so this option does not represent appropriate safety guidance.
C. Do not stand near a microwave oven: Modern microwave ovens are shielded and safe for clients with pacemakers. Avoidance is outdated and unnecessary, and providing this instruction may increase anxiety without clinical value.
D. Monitor your pulse daily: Daily pulse monitoring is essential to detect pacemaker malfunction, such as failure to capture or pace. Tracking pulse changes helps the client identify abnormalities early and promotes timely reporting for follow-up care.
Correct Answer is C
Explanation
A. The arterial line shows a blood pressure of 108/60: This blood pressure is within an acceptable range and does not immediately indicate the need to adjust ventilator settings. Hemodynamic monitoring must consider overall trends, not a single reading within normal limits.
B. The pulmonary artery wedge pressure (PAWP) is increased: An elevated PAWP indicates increased left ventricular preload or fluid overload, which may require fluid management but does not directly necessitate changing PEEP unless it is contributing to cardiac compromise.
C. The cardiac output drops from 5 to 3: A significant decrease in cardiac output indicates that the high PEEP may be impeding venous return and reducing stroke volume. This is a critical sign that ventilator settings may need adjustment to prevent hemodynamic compromise while maintaining adequate oxygenation.
D. The pulmonary artery pressure (PAP) is decreased: A decrease in PAP is generally not concerning in isolation and may reflect effective oxygenation or reduced pulmonary vascular resistance. It does not typically signal the need to change ventilator settings.
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