A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril.

Which of the following instructions should the nurse plan to include? (Select all that apply)

Choice A reason : A fixed volume deficit, or hypovolemia, is not a direct finding associated with bradycardia. Bradycardia refers to a slower than normal heart rate, typically below 60 beats per minute in adults⁸. Hypovolemia can cause various compensatory mechanisms to activate, including an increase in heart rate to maintain cardiac output, which is the opposite of bradycardia. Therefore, a fixed volume deficit is not a typical finding in bradycardia unless it is part of a broader clinical picture⁹.

Choice B reason : Anxiety is a condition that can sometimes lead to an increased heart rate, known as tachycardia, rather than a decreased heart rate as seen in bradycardia. While anxiety can coexist with bradycardia, especially if the patient is anxious about their health, it is not a direct symptom or finding of bradycardia itself⁹.

Choice C reason : Lightheadedness is a common symptom of bradycardia. When the heart rate is too slow, it may lead to inadequate cerebral perfusion, which can cause a feeling of lightheadedness or dizziness. This symptom can be particularly evident when the patient changes positions, such as standing up quickly, which can exacerbate the effects of reduced cardiac output on cerebral blood flow⁸⁹.

Choice D reason : An elevated temperature is not typically associated with bradycardia. Fever can actually lead to an increased heart rate as the body attempts to manage the higher metabolic demands associated with a raised temperature. Bradycardia in the presence of fever might indicate a more complex clinical scenario, such as myocarditis or central nervous system infections, but it is not a direct finding of bradycardia⁹.

Choice A reason : Morphine is an opioid analgesic used to relieve severe pain and can be administered to patients with myocardial infarction to alleviate chest pain and anxiety. However, it is not the first medication given as it does not address the underlying cause of the myocardial infarction, which is the formation of a blood clot in the coronary arteries.

Choice B reason : Nitroglycerin is a nitrate that helps to dilate blood vessels and improve blood flow. It can be used to relieve chest pain in myocardial infarction, but similar to morphine, it is not the initial medication of choice. The priority is to prevent further blood clotting.

Choice C reason : Administered as soon as possible to inhibit platelet aggregation and reduce clot progression.

Choice D reason : When a myocardial infarction (MI) is suspected, the priority is to address tissue hypoxia and ensure adequate oxygenation to minimize myocardial damage. Administering oxygen helps increase oxygen availability to the ischemic heart tissue, reducing further damage.