A client presents to the emergency department complaining of sudden onset of palpitations and chest pain. After assessment, the nurse notes the client to be diaphoretic, skin is cool to touch, BP is 80/40 mm Hg. Resp 26 and Sats of 89% [see image]. The nurse anticipates an order for which of the following interventions?

Syncronized cardioversion

Adenosine infusion over 30 minutes

Immediate defibrillation

Vagal manuevers

Answer and Explanation

The Correct Answer is A

A. Synchronized cardioversion: Synchronized cardioversion is indicated for unstable supraventricular tachycardia (SVT), especially when the client shows signs of hemodynamic instability, such as hypotension, altered mental status, or chest pain. This intervention delivers a timed shock to restore normal rhythm, prioritizing the client's immediate stabilization.

B. Adenosine infusion over 30 minutes: Adenosine is typically administered as a rapid intravenous push to terminate SVT by temporarily blocking atrioventricular nodal conduction. However, this client is unstable, and synchronized cardioversion is the preferred intervention in cases of hemodynamic compromise.

C. Immediate defibrillation: Defibrillation is used for life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia. In this case, the rhythm is SVT, and the client is not in cardiac arrest, so defibrillation is inappropriate.

D. Vagal maneuvers: Vagal maneuvers, such as carotid sinus massage or the Valsalva maneuver, are first-line interventions for stable SVT. However, in unstable clients with severe symptoms or hemodynamic compromise, these measures are insufficient, and synchronized cardioversion is urgently required.

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Correct Answer is ["A"]

Explanation

A) Unilateral facial drooping:
Unilateral facial drooping is the hallmark sign of Bell's palsy, a condition that results from inflammation of the facial nerve (cranial nerve VII). This inflammation causes muscle weakness or paralysis on one side of the face, leading to drooping of the mouth, eyelid, and other facial features on the affected side. The facial drooping may worsen with smiling, closing the eyes, or other facial expressions, making this a key finding in Bell’s palsy.

B) Unilateral arm weakness:
Unilateral arm weakness is not typically associated with Bell's palsy, which specifically affects the facial muscles due to nerve damage. While weakness can occur in other parts of the body due to neurological conditions, it is not a characteristic symptom of Bell’s palsy, which is primarily a cranial nerve issue. Therefore, arm weakness would prompt consideration of other potential neurological causes.

C) Alopecia:
Alopecia, or hair loss, is not a common symptom of Bell's palsy. Although it can be seen in many different conditions, it is not typically linked with Bell's palsy, which is a disorder of the facial nerve. Bell’s palsy affects facial muscles, leading to symptoms like drooping or inability to close the eye, but it does not directly cause hair loss.

D) Difficulty swallowing:
Difficulty swallowing (dysphagia) can occur in Bell's palsy, especially if the facial nerve affects the ability to control the muscles involved in swallowing. This may lead to difficulty with chewing, swallowing, or speaking clearly. While not always severe, dysphagia is a potential complication due to the involvement of the facial nerve, which controls facial muscles essential for these functions.

E) Inability to close the affected eye:
The inability to close the affected eye is a common symptom of Bell's palsy due to paralysis of the orbicularis oculi muscle, which is controlled by the facial nerve. This can lead to dryness or irritation of the eye and a risk for corneal damage if the eye is not properly closed or protected. This inability to close the eye is one of the hallmark features of Bell's palsy.

A. Take the medication with meals. B. Limit caffeine intake. C. Rinse the mouth after administration. D. Check the pulse before and after medication administration.

Correct Answer is C

Explanation

A) Take the medication with meals:
Inhaled beclomethasone is a corticosteroid, and it is generally not necessary to take it with meals. Oral corticosteroids are sometimes taken with meals to minimize gastric irritation, but this does not apply to inhaled corticosteroids like beclomethasone. The primary concern with inhaled corticosteroids is not related to meal timing but to oral hygiene to prevent side effects like oral thrush.

B) Limit caffeine intake:
There is no direct contraindication or requirement to limit caffeine intake when taking inhaled beclomethasone. While caffeine can have mild bronchodilatory effects, it does not interfere with the action of beclomethasone or exacerbate asthma symptoms. This is not a priority teaching point for the patient.

C) Rinse the mouth after administration:
One of the most important teaching points when using inhaled beclomethasone is to rinse the mouth after each use. This helps to prevent oral thrush (a fungal infection caused by Candida), which is a common side effect of inhaled corticosteroids. Rinsing the mouth with water after administration helps to remove any leftover medication and reduce the risk of infection, making this the most important instruction.

D) Check the pulse before and after medication administration:
While checking the pulse is important for some medications, such as bronchodilators like albuterol, it is not necessary for inhaled beclomethasone. Beclomethasone is a corticosteroid that primarily works by reducing inflammation in the airways, and it does not have a significant impact on heart rate. Therefore, it is not required to monitor pulse before and after its use.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has been recently diagnosed with Bell's palsy. Which of the following findings should the nurse expect? [Select all that apply.]

Correct Answer is ["A"]

Explanation

The nurse is providing discharge teaching for a client with asthma that has been prescribed inhaled beclomethasone. Which of the following instructions should the nurse include?

Correct Answer is C

Explanation

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require immediate intervention?

How many milligrams of carbidopa is this patient taking per dose/tablet?

The nurse working in the Neuro ICU is caring for a client with Guillain Barre Syndrome. Which of the following activities would be best assigned to the Licensed practical nurse (LPN)?

A client with Parkinson's disease is prescribed carbidopa-levadopa [Sinemet]. Which of the following side effects does the nurse recognize can occur with this medication?

The nurse is assessing a client who is diagnosed with heart failure and reports slight limitation of physical activity, is comfortable at rest but ordinary physical activity causes symptoms. What heart failure classification does this patient fall under?

A nurse is caring for a client who taking benztropine to treat Parkinson's disease. The nurse should instruct the client to monitor and report which of the following side effects of benztropine?

A nurse is caring for a group of clients on a hospital unit with the assistance of a licensed practical nurse [LPN]. Which aspect of client care would be the most appropriate for the nurse to delegate to the LPN?