The nurse would contact the prescriber for safety concerns about using carvedilol in which of the following clients?

A 60 year old woman with cardiac dysrhythmias post myocardial infarction. Her HR is 39 & irregular, BP 147/65

A 55-year-old woman with HTN due to renal failure from chronic pyleonephritis. HR 92. BP 145/72

A 78-year-old man with a history of hyperlipidemia & cardiac dysfunction. He is in 3rd degree heart block. HR 42. BP 92/65

A 49-year-old male, BMI 36, history of type 2 diabetes & HTN. HR 105, BP 158/92

Answer and Explanation

The Correct Answer is C

A. A 60-year-old woman with cardiac dysrhythmias post myocardial infarction. Her HR is 39 & irregular, BP 147/65: Although her heart rate is low, carvedilol is commonly used post-MI to reduce mortality, especially in patients with dysrhythmias. However, caution is warranted, and dosage adjustments or withholding may be necessary due to bradycardia.

B. A 55-year-old woman with HTN due to renal failure from chronic pyelonephritis. HR 92. BP 145/72: This client has stable vitals, and carvedilol can be safely used to help manage hypertension. Renal impairment requires monitoring, but it is not a contraindication if renal function is closely followed.

C. A 78-year-old man with a history of hyperlipidemia & cardiac dysfunction. He is in 3rd degree heart block. HR 42. BP 92/65: Carvedilol is contraindicated in clients with 2nd or 3rd degree heart block without a functioning pacemaker. It can worsen bradycardia and conduction delays, making its use unsafe in this client without rhythm control support.

D. A 49-year-old male, BMI 36, history of type 2 diabetes & HTN. HR 105, BP 158/92: This client is hypertensive and tachycardic, both of which carvedilol can help manage. Although diabetes requires careful monitoring for hypoglycemia, there is no contraindication in this scenario.

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Correct Answer is B

Explanation

A. Run of premature ventricular beats: While adenosine can occasionally provoke brief ventricular ectopy, this is not its primary or most expected effect. Premature ventricular contractions may occur transiently but are not the hallmark response to this medication.

B. Short period of asystole: Adenosine briefly blocks AV node conduction and can interrupt re-entry pathways, often resulting in a short period of asystole lasting a few seconds. This is an expected effect and reflects the drug’s mechanism in terminating supraventricular tachycardia by interrupting the reentrant pathway.

C. Brief seizure episode: Adenosine does not typically cause seizures. It acts primarily on cardiac tissue and has no significant pro-convulsant effects. A seizure would be an atypical and concerning adverse reaction rather than an expected response.

D. Dramatic increase in blood pressure: Adenosine causes transient vasodilation and may lead to a brief drop in blood pressure or flushing. A dramatic increase in blood pressure would not be expected and could suggest an alternate diagnosis or drug reaction.

A. the P-P and R-R distances are equal and regular B. the rhythm rate using a 3-second strip C. the duration of the U waves D. there is a QRS complex after each P wave E. P waves are present, upright and rounded

Correct Answer is ["A","B","D","E"]

Explanation

A. The P-P and R-R distances are equal and regular: Equal and regular spacing between P-P and R-R intervals indicates that both atrial and ventricular rhythms are regular. This is a fundamental aspect of rhythm interpretation, helping to distinguish between regular and irregular rhythms such as atrial fibrillation or sinus arrhythmia.

B. The rhythm rate using a 3-second strip: Assessing the heart rate using a 3-second or 6-second ECG strip helps determine whether the rhythm is bradycardic, tachycardic, or within normal limits, which is crucial for accurate rhythm classification.

C. The duration of the U waves: U waves are typically small and follow the T wave. Although their presence can suggest conditions like hypokalemia, they are not routinely assessed in basic rhythm identification. Evaluating U wave duration is more relevant in electrolyte imbalance analysis than in identifying rhythm type.

D. There is a QRS complex after each P wave: A consistent QRS following every P wave indicates effective conduction from the atria to the ventricles. Each atrial depolarization (P wave) should be followed by a ventricular depolarization (QRS complex) if the signal is being conducted properly through the AV node. This finding supports a diagnosis of sinus rhythm and helps rule out AV blocks, where conduction may be delayed or blocked entirely.

E. P waves are present, upright and rounded: P waves that are upright and rounded in lead II suggest the electrical impulse is originating from the SA node. Their presence and morphology are essential criteria for identifying sinus rhythm and differentiating it from atrial arrhythmias like flutter or fibrillation.

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The nurse would contact the prescriber for safety concerns about using carvedilol in which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is to receive an intravenous dose of adenosine. What immediate response to this medication should the nurse expect?

Correct Answer is B

Explanation

To properly identify a cardiac rhythm, the nurse will determine if the client's rhythm contains the following factors: (Select All that Apply.)

Correct Answer is ["A","B","D","E"]

Explanation

The nurse is caring for a client in the coronary care unit and the monitor depicts the rhythm shown below. What is the nurse's interpretation of this rhythm?

When using an ECG rhythm strip to quickly estimate the ventricular rate for a client, the nurse should:

The client is to receive an oral suspension of Drug H 75 mg PO. The nurse has Drug H available in a suspension 0.15 Gm per 5 mL. What should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A client in the coronary care unit is receiving a diltiazem infusion for atrial fibrillation. The nurse observes on the cardiac monitor that the client's heart rate has converted to sinus bradycardia at a rate of 50 beats/minute. Which nursing action should be performed first?

A client with paroxysmal supraventricular tachycardia asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective?

A client is prescribed oral amiodarone for recurrent ventricular dysrhythmias. The nurse should teach the client to notify the physician if which symptom develops?

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The nurse is caring for a client with heart failure who is being discharged on lisinopril 10 mg PO bid. Which teaching about this medication should be included in the discharge instructions?