Your client is admitted with shortness of breath. The telemetry monitor shows an irregularly irregular rhythm with no visible P waves and a ventricular rate of 110 bpm. You recognize this dysrhythmia as atrial fibrillation. Which medication does you anticipate the physician may order to reduce the risk of complications associated with this rhythm?
Nitroglycerin
Hydrochlorothiazide
Atropine
Warfarin
None
None
The Correct Answer is D
A. Nitroglycerin: This vasodilator is used to treat anginal chest pain by reducing preload and dilating coronary arteries. It has no role in the management of atrial fibrillation, which is characterized by an irregularly irregular rhythm. Using a nitrate here would not address the underlying electrical disorganized activity in the atria.
B. Hydrochlorothiazide: As a thiazide diuretic, this medication is used primarily for the long-term management of hypertension and mild fluid retention. It does not possess any antiarrhythmic properties and would not be effective in controlling the ventricular rate. Diuretics are not the standard of care for treating an acute rhythm disturbance on a telemetry strip.
C. Atropine: This anticholinergic agent is indicated for the treatment of symptomatic bradycardia by increasing the heart rate. Atrial fibrillation often requires rate control to prevent tachycardia-induced cardiomyopathy rather than stimulation of a faster rate. Atropine could potentially worsen the clinical situation by causing a dangerously rapid ventricular response.
D. Warfarin: Atrial fibrillation causes blood to pool in the atria, which significantly increases the risk of mural thrombus formation and subsequent embolic stroke. Anticoagulation is a mandatory component of management to prevent these life-altering thromboembolic complications. Warfarin is a standard oral anticoagulant used to maintain a therapeutic INR in patients with this chronic dysrhythmia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "This medication should be taken before going to bed.": HMG-CoA reductase inhibitors like simvastatin are most effective when administered in the evening. Most endogenous cholesterol synthesis occurs during the night while the patient is fasting. Timing the dose at bedtime ensures peak drug levels coincide with the body's highest rate of production.
B. "You should take these medications first thing in the morning on an empty stomach.": Administering statins in the morning reduces their efficacy because the peak plasma concentration occurs when cholesterol synthesis is at its lowest. Unlike some medications, simvastatin does not require an empty stomach for absorption. Morning dosing is generally avoided for statins with shorter half-lives.
C. "You should take this medication in the morning with your breakfast to prevent upset stomach.": While taking medication with food can reduce gastric irritation, the morning timing is pharmacologically suboptimal for simvastatin. Standard nursing practice emphasizes evening administration to maximize the inhibition of the cholesterol-producing enzyme. This instruction would decrease the overall therapeutic benefit.
D. "You should take this medication with your mid-day meal with food.": Mid-day dosing does not align with the circadian rhythm of hepatic cholesterol synthesis. For maximal lipid-lowering effects, the medication must be present during the nocturnal hours. Afternoon administration is not the standard of care for short-acting statin therapy.
Correct Answer is ["2"]
Explanation
Dose prescribed: 40 mg
Dose available: 20 mg per tablet
Number of tablets= 40 ÷ 20
= 2 tablets
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