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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Ensure all tubing connections are tightened: Tight tubing connections are critical in preventing accidental disconnection, which can result in rapid blood loss and air embolism. Arterial lines are under high pressure, so securing all connections is a top priority to ensure patient safety and maintain line integrity.
B. Apply a pressure dressing to the insertion site: A transparent occlusive dressing not a pressure dressing is used for arterial lines to allow for site visualization and reduce the risk of infection. A pressure dressing could obscure signs of bleeding or compromise the catheter’s position.
C. Perform an Allen's test: Allen’s test is performed prior to radial arterial line insertion to assess collateral circulation via the ulnar artery for preventing ischemic complications if the radial artery is compromised. Performing the test afterward does not prevent complications and is no longer relevant once the catheter is placed.
D. Obtain a portable x-ray to confirm placement: X-rays are used to confirm the placement of central lines, not peripheral arterial lines like the radial line. Arterial line placement is confirmed by waveform analysis and blood return, not imaging.
Correct Answer is C
Explanation
A. Radiofrequency ablation: This is used to treat tachyarrhythmias such as atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT). The ECG shown does not demonstrate any tachycardic rhythm rather, it shows a bradyarrhythmia with dropped QRS complexes, which suggests a conduction block, not a reentrant circuit.
B. Administration of amiodarone: Amiodarone is primarily used for ventricular arrhythmias or atrial fibrillation. It is not effective in treating bradyarrhythmias or heart blocks such as those seen in this rhythm strip.
C. Insertion of a pacemaker: The rhythm strip shows intermittent dropped QRS complexes with consistent P waves—this is indicative of second-degree AV block, Mobitz II. This type of conduction block can progress to complete heart block and is often treated with the insertion of a permanent pacemaker to maintain cardiac output.
D. Administration of adenosine: Adenosine is used to terminate SVT by temporarily blocking AV node conduction. It is contraindicated in heart blocks, especially Mobitz II or third-degree AV block, because it can worsen the block and cause asystole.
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