Page 1806 - Saunders Comprehensive Review For NCLEX-RN

Content Area: Pharmacology: Cardiovascular Medications: Cardiac Glycosides
Health Problem: N/A
Priority Concepts: Clinical Judgment; Safety
Reference: Burchum, Rosenthal (2016), p. 527.

628. Answer: 3

Rationale: Signs of toxicity from procainamide include confusion, dizziness,
drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the
client complains of dizziness, the nurse should assess the vital signs first. Although
measuring the QRS duration on the rhythm strip and obtaining a 12-lead
electrocardiogram may be interventions, these would be done after the vital signs
are taken. Dizziness directly following the procainamide indicates that the
medication was the likely cause and should be addressed before assessing for other
possible causes such as hypoglycemia.
Test-Taking Strategy: Note the strategic word, first. Also use the steps of the
nursing process to answer correctly. Remember to always assess the client first, not
the monitoring devices. Therefore, auscultating the apical pulse and taking the blood
pressure are the first actions.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pharmacology: Cardiovascular Medications: Antidysrhythmics
Health Problem: Adult Health: Cardiovascular: Dysrhythmias
Priority Concepts: Clinical Judgment; Perfusion
Reference: Gahart, Nazareno (2015), p. 1021.

629. Answer: 2

Rationale: Audible expiratory wheezes may indicate a serious adverse reaction,
bronchospasm. Beta blockers may induce this reaction, particularly in clients with
chronic obstructive pulmonary disease or asthma. Normal decreases in blood
pressure and heart rate are expected. Insomnia is a frequent mild side effect and
should be monitored.
Test-Taking Strategy: Focus on the subject, a potential adverse complication.
Eliminate options indicating a decrease in blood pressure and a decrease in heart
rate first, because these are expected effects from the medication. Next, focusing on
the subject will direct you to the correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology: Cardiovascular Medications: Beta blockers
Health Problem: Adult Health: Cardiovascular: Hypertension
Priority Concepts: Gas Exchange; Perfusion
Reference: Burchum, Rosenthal (2016), pp. 161, 163.

630. Answer: 2

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