A nurse cares for a patient who has a heart rate averaging 54 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate?

Avoid straining while having a bowel movement.

Limit your intake of caffeinated drinks to one a day.

Make certain that your bath water is warm.

Modify any strenuous exercise such as running.

Answer and Explanation

The Correct Answer is A

Choice A reason: Avoiding straining while having a bowel movement is important for patients with a low heart rate. Straining can stimulate the vagus nerve, which can lead to further bradycardia (slowing of the heart rate). By avoiding straining, patients can prevent additional vagal stimulation and help maintain a stable heart rate.

Choice B reason: Limiting the intake of caffeinated drinks to one a day is not directly related to avoiding further slowing of the heart rate. While excessive caffeine can have effects on heart rhythm and overall cardiovascular health, moderate caffeine intake is not typically associated with a significant risk of bradycardia.

Choice C reason: Ensuring that bath water is warm is not directly related to preventing further slowing of the heart rate. While warm water can promote relaxation and comfort, it does not have a direct impact on heart rate management for individuals with bradycardia.

Choice D reason: Modifying strenuous exercise such as running is a good general recommendation for individuals with heart conditions, but it is not specifically targeted at preventing further bradycardia. Exercise modification is more relevant for managing overall cardiovascular health and preventing tachycardia (increased heart rate).

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Correct Answer is ["B","C"]

Explanation

Choice A reason: Auscultating for irregular heart tones can provide useful information about the heart’s rhythm and potential arrhythmias. However, it is not the most specific or definitive assessment for diagnosing a myocardial infarction (MI).

Choice B reason: Assessing for ST elevations on continuous telemetry and 12-lead EKG is critical in diagnosing a myocardial infarction. ST-segment elevation is a key indicator of an acute MI, specifically indicating myocardial injury. Continuous telemetry and 12-lead EKG provide real-time and detailed views of the heart's electrical activity, helping to identify ischemic changes.

Choice C reason: Assessing for elevated Troponin levels is essential because Troponins are cardiac biomarkers that increase significantly when there is damage to the heart muscle, such as during an MI. Elevated Troponin levels are highly specific and sensitive indicators of myocardial infarction, making this assessment crucial.

Choice D reason: Assessing for low magnesium levels is not directly related to diagnosing a myocardial infarction. While magnesium levels are important for overall cardiac function, they do not specifically indicate an acute MI.

Choice E reason: Assessing the client's blood pressure is an important part of a comprehensive assessment and can provide information about the patient's hemodynamic status. However, it is not specific to diagnosing a myocardial infarction.

Choice F reason: Assessing if the pain radiates to the left arm is an important symptom of a myocardial infarction. However, while it supports the suspicion of an MI, it is not as definitive as ST elevation on an EKG or elevated Troponin levels.

A. Analgesic properties without sedation. B. Vasoconstriction and improved blood flow. C. Platelet inhibition to reduce clot formation. D. Cardiotonic properties and improved contraction.

Correct Answer is C

Explanation

Choice A reason: Aspirin does have analgesic properties, which help relieve pain. However, this is not the primary reason for its administration in the context of angina-like chest pain. The analgesic effect of aspirin without sedation is more relevant in the management of general pain or headaches.

Choice B reason: Vasoconstriction and improved blood flow are not effects of aspirin. In fact, aspirin's mechanism of action involves preventing platelet aggregation, which can indirectly improve blood flow by reducing the risk of clot formation. Vasoconstriction is not an effect associated with aspirin.

Choice C reason: The primary rationale for administering aspirin to a client with angina-like chest pain is its antiplatelet effect. Aspirin inhibits platelet aggregation, reducing the risk of clot formation. This is crucial in preventing further blockage of coronary arteries, which can exacerbate angina or lead to myocardial infarction.

Choice D reason: Cardiotonic properties and improved contraction are not associated with aspirin. Cardiotonic drugs enhance the strength of the heart's contractions, which is not an action of aspirin. Aspirin's role in this context is to prevent platelet aggregation and reduce the risk of clot-related complications.

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A nurse cares for a patient who has a heart rate averaging 54 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following cues should the nurse assess to determine if the client is experiencing a myocardial infarction? Pick 2 answers.

Correct Answer is ["B","C"]

Explanation

The nurse correlates which rationale with the administration of aspirin to the client experiencing angina-like chest pain?

Correct Answer is C

Explanation

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