A nurse is caring for a client who is receiving intravenous heparin therapy for deep vein thrombosis. The nurse evaluates for side effects of this drug by observing for:

Petechiae

Slowing pulse rate

Confusion

Pruritus

Answer and Explanation

The Correct Answer is A

Rationale:

A. Petechiae are small, pinpoint red or purple spots on the skin that may indicate bleeding or thrombocytopenia, which can be a side effect of heparin therapy.

B. Slowing pulse rate is not typically associated with heparin therapy.

C. Confusion is not typically associated with heparin therapy.

D. Pruritus (itching) is not typically associated with heparin therapy.

Nursing Test Bank

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Correct Answer is A

Explanation

Rationale:

A. Elevated Troponins indicate myocardial injury or infarction.

B. Elevated Creatine kinase (CK) is an enzyme found in skeletal muscle, brain, and myocardium. Elevated levels can indicate muscle damage.

C. Elevated Hemoglobin is not specific to cardiac injury.

D. Elevated B-type Natriuretic peptide (BNP) is used in the diagnosis and management of heart failure.

A. Sinus Tachycardia B. Ventricular Tachycardia C. Complete Heart Block D. Idioventricular Rhythm

Correct Answer is B

Explanation

A. A sinus tachycardia is characterized by a sinus P wave at a rate of more than 100 per minute followed by a narrow QRS complex unlike in the strip depicted above.

B. The above ECG strip shows a ventricular tachycardia based on the wide QRS with a rate more than 120 bpm, AV dissociation and the fusion beats.

C. A complete heart block is characterized by QRS complexes being conducted at their own rates and totally independent of the P wave.

D. An idioventricular rhythm is characterized by a slow regular ventricular rhythm with a rate less than 50 bpm unlike in the above strip. It also has a prolonged QRS interval with no P wave.

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A nurse is caring for a client who is receiving intravenous heparin therapy for deep vein thrombosis. The nurse evaluates for side effects of this drug by observing for:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with a possible acute myocardial infarction (AMI). The electrocardiogram (ECG) shows no ST segment elevations or depression. The nurse is aware that an elevation of which lab result will determine if there has been cardiac injury?

Correct Answer is A

Explanation

Identify the following Cardiac Rhythm:

Correct Answer is B

Explanation

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