Page 1755 - Saunders Comprehensive Review For NCLEX-RN

601. Answer: 2

Rationale: Metformin needs to be withheld 24 hours before and for 48 hours after
cardiac catheterization because of the injection of contrast medium during the
procedure. If the contrast medium affects kidney function, with metformin in the
system the client would be at increased risk for lactic acidosis. The medications in
the remaining options do not need to be withheld before and after cardiac
catheterization.
Test-Taking Strategy: Eliminate glipizide and repaglinide first because they are
comparable or alike. Although these medications may be withheld on the morning
of the procedure because of the client’s NPO (nothing by mouth) status, there is no
indication for withholding the medication on the day prior to the procedure and
postprocedure. Regular insulin may be administered if elevated blood glucose levels
from infused intravenous solutions occur on the day of the procedure.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Pharmacology: Endocrine: Oral hypoglycemic
Health Problem: Adult Health: Cardiovascular: Coronary Artery Disease
Priority Concepts: Perfusion; Safety
Reference: Ignatavicius, Workman (2016), pp. 643, 1310.

602. Answer: 4

Rationale: Sinus bradycardia is noted with a heart rate less than 60 beats per
minute. This rhythm becomes a concern when the client becomes symptomatic.
Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous
pacing provides a temporary measure to increase the heart rate and thus perfusion
in the symptomatic client. Defibrillation is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation. Digoxin will further decrease the client’s
heart rate. Continuing to monitor the client delays necessary intervention.
Test-Taking Strategy: Focus on the subject, interventions for sinus bradycardia.
Eliminate the option indicating to continue to monitor the client, because the client is
symptomatic and requires intervention. Digoxin is eliminated because it will further
decrease the client’s heart rate. Defibrillation is used for treatment of pulseless
ventricular tachycardia and ventricular fibrillation, so that option can be eliminated.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Complex Care: Emergency Situations/Management
Health Problem: Adult Health: Cardiovascular: Dysrhythmias
Priority Concepts: Gas Exchange; Perfusion
Reference: Ignatavicius, Workman (2016), p. 664.

603. Answer: 1, 2, 3, 4

Rationale: Extreme dyspnea, tachycardia, and lung crackles in a client with heart

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