Choice A rationale:

Feeling anxious is not a common side effect of metoprolol.

Choice B rationale:

Metoprolol is a beta-blocker that can lower blood pressure, so a blood pressure of 90/54 mm Hg could indicate a side effect of this medication.

Choice C rationale:

A normal sinus rhythm is expected and does not indicate a side effect of metoprolol.

Choice D rationale:

Restlessness and agitation are not typical side effects of metoprolol.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

Checking the pulse rate before taking nitroglycerin is not necessary.

Choice B rationale:

Sitting down before taking nitroglycerin can prevent dizziness and fainting, which are potential side effects of nitroglycerin.

Choice C rationale:

There is no need to remove the nitroglycerin patch before taking sublingual nitroglycerin.

Choice D rationale:

The nitroglycerin patch should not be used to treat acute chest pain.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

ST segment changes on an ECG are not typically associated with chronic constrictive pericarditis.

Choice B rationale:

Jugular venous distention (JVD) is a common sign of chronic constrictive pericarditis. If JVD is not present, it may indicate that the therapies are effective.

Choice C rationale:

While the sedimentation rate can indicate inflammation, it is not specific to chronic constrictive pericarditis.

Choice D rationale:

The presence of a paradoxical pulse is not typically associated with chronic constrictive pericarditis.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

Elevated troponin is a sign of heart damage, which could be caused by a heart attack or other stresses on the heart. This is a critical finding that needs immediate attention.

Choice B rationale:

Q waves on an ECG can indicate a previous heart attack or myocardial infarction. However, they can also be a normal variant, meaning they are a harmless variation in the electrical activity of the heart.

Choice C rationale:

Bilateral crackles in the lungs can indicate mucus or fluid in the base of the lungs, often associated with conditions like pneumonia, heart failure, or bronchitis.

Choice D rationale:

Hyperglycemia, or high blood glucose, can be a sign of diabetes. If untreated, it can lead to serious complications like ketoacidosis.

So, the correct answer is Choice A, after analyzing all choices.

Choice A rationale:

A weight increase from 120 pounds to 122 pounds over 3 days is within the normal fluctuation range.

Choice B rationale:

A serum potassium level of 3.0 mEq/L after 1 week of therapy is concerning because it’s below the normal range (3.5-5.0 mEq/L)171819. This could indicate hypokalemia, which can cause serious complications if left untreated.

Choice C rationale:

A palpable liver edge 2 cm below the ribs on the right side could suggest an abnormality such as an enlarged liver.

Choice D rationale:

The presence of 1+ to 2+ edema in the feet and ankles could indicate conditions like heart failure or venous insufficiency.

So, the correct answer is Choice B, after analyzing all choices.

Choice A rationale:

Tylenol, or acetaminophen, is a common over-the-counter medication used to reduce fevers and manage mild aches and pains. It does not directly affect blood pressure.

Choice B rationale:

While stress can cause temporary spikes in blood pressure, it’s not clear whether stress can cause long-term increases in blood pressure34.

Choice C rationale:

Cocaine or crack use can cause a significant and dangerous increase in blood pressure. Given the patient’s history of drug abuse and the current high blood pressure reading, this is a critical question to ask.

Choice D rationale:

Eating salty foods can contribute to high blood pressure over time, but it’s unlikely to cause an immediate severe increase in blood pressure.

So, the correct answer is Choice C, after analyzing all choices. .

Choice A rationale:

An increase in heart rate from 66 to 98 beats/min indicates that the heart is working harder, which could be a sign of stress or exertion. This is a significant increase and could indicate that the patient needs to rest.

Choice B rationale:

While a drop in O2 saturation from 99% to 95% is noticeable, it is still within the normal range (95-100%). Therefore, it would not necessarily indicate a need for the patient to rest.

Choice C rationale:

A respiratory rate increase from 14 to 20 breaths/min is within the normal range (12-20 breaths/min) and would not necessarily indicate a need for the patient to rest.

Choice D rationale:

A blood pressure change from 118/60 to 126/68 mm Hg is within the normal range and would not necessarily indicate a need for the patient to rest.

So, the correct answer is Choice A, after analyzing all choices.

Choice A rationale:

The right upper-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice B rationale:

The left upper-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice C rationale:

The left lower-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice D rationale:

The apex of the heart is the best place to hear a murmur typical of mitral regurgitation. This is where the sound will be most audible.

So, the correct answer is Choice D, after analyzing all choices.

Choice A rationale:

The pain level of 3 to 5 on a scale of 0 to 10 does not specifically indicate chronic stable angina.

Choice B rationale:

Pain that has worsened over the last week could indicate a number of conditions, not specifically chronic stable angina.

Choice C rationale:

Pain that wakes a patient up at night could be a sign of a number of conditions, not specifically chronic stable angina.

Choice D rationale:

Chronic stable angina is characterized by chest pain that is relieved by rest or nitroglycerin. Therefore, if the patient’s pain goes away with a nitroglycerin tablet, it would help confirm a diagnosis of chronic stable angina.

So, the correct answer is Choice D, after analyzing all choices.

Choice A rationale:

Nitroglycerin can cause side effects such as headache and dizziness, but nausea is not a common side effect.

Choice B rationale:

Nitroglycerin should be stored in a dark, cool place, not in a well-lit room.

Choice C rationale:

This is the correct answer. If chest pain is not relieved 5 minutes after taking nitroglycerin, it is recommended to call an ambulance.

Choice D rationale:

While nitroglycerin is taken when chest pain occurs, it can also be taken prior to activities that might cause chest pain.

So, the correct answer is Choice C, after analyzing all choices.