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Choice A is wrong because tachycardia, or fast heart rate, is not an adverse effect of metoprolol. In fact, metoprolol can lower the heart rate by blocking the beta-1 receptors in the heart. A normal resting heart rate for adults ranges from 60 to 100 beats per minute (bpm). Metoprolol can cause bradycardia, or slow heart rate, which can be a serious side effect if it is too low.

Choice B is wrong because hyperglycemia, or high blood sugar, is not an adverse effect of metoprolol. Metoprolol does not affect the insulin secretion or glucose metabolism in the body. A normal blood sugar level for adults without diabetes is less than 140 mg/dL (7.8 mmol/L) two hours after eating. Metoprolol can cause hypoglycemia, or low blood sugar, in people who have diabetes and take insulin or other glucose-lowering medications. This is because metoprolol can mask the symptoms of hypoglycemia, such as palpitations and tremors.

Choice D is wrong because hyperkalemia, or high potassium, is not an adverse effect of metoprolol. Metoprolol does not affect the potassium balance in the body.

Choice A is wrong because the client has no edema in the lower extremities. This is not a specific outcome of lisinopril, an angiotensin II receptor blocker (ARB). Edema can be caused by many factors, such as heart failure, kidney disease, or venous insufficiency. Lisinopril does not directly affect fluid retention or edema.

Choice B is wrong because the client has a urine output of 30 mL/hr. This is a low urine output that may indicate dehydration, kidney impairment, or urinary obstruction. Lisinopril is expected to increase urine output by reducing the blood pressure and improving the renal blood flow.

Choice D is wrong because the client has a serum creatinine level of 1.2 mg/dL. This is a high serum creatinine level that may indicate kidney damage or reduced kidney function. Lisinopril is expected to lower the serum creatinine level by preventing the progression of kidney disease and protecting the kidney from further injury.

Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system. Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline

Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells. Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells

Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate. Direct acting vasodilators lower blood pressure by decreasing peripheral resistance

Choice A is wrong because angiotensin-converting enzyme (ACE) inhibitors do not increase the excretion of water and sodium by the kidneys. ACE inhibitors block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor and stimulator of aldosterone secretion. By reducing angiotensin II levels, ACE inhibitors lower blood pressure by dilating blood vessels and decreasing sodium and water retention.

Choice C is wrong because adrenergic drugs do not increase the excretion of water and sodium by the kidneys. Adrenergic drugs act on the sympathetic nervous system, which regulates heart rate, blood pressure, and other functions. Depending on the type and location of adrenergic receptors, adrenergic drugs can have different effects on blood pressure. Some adrenergic drugs can increase blood pressure by stimulating alpha receptors, which cause vasoconstriction. Other adrenergic drugs can decrease blood pressure by stimulating beta receptors, which cause vasodilation and decreased cardiac output.

Choice D is wrong because direct acting vasodilators do not increase the excretion of water and sodium by the kidneys. Direct acting vasodilators are drugs that relax the smooth muscle of blood vessels, causing them to widen and lower blood pressure. Direct acting vasodilators do not affect the renin-angiotensin-aldosterone system or the sympathetic nervous system, which regulate sodium and water balance.

Beta blockers are drugs that inhibit the sympathetic nervous system by blocking the beta adrenergic receptors, which are responsible for increasing heart rate and contractility. Beta blockers can lower blood pressure and reduce cardiac workload.

Calcium channel blockers are drugs that inhibit the movement of calcium ions across the cell membrane of smooth muscle cells, which are found in blood vessels and the heart.Calcium channel blockers can relax blood vessels and lower blood pressure, as well as reduce heart rate and contractility.

Angiotensin II receptor blockers (ARBs) are drugs that block the action of angiotensin II, a hormone that causes vasoconstriction and stimulates the release of aldosterone, which increases sodium and water retention.

Serum sodium level is wrong because sodium is not directly related to digoxin action or toxicity.

Sodium is another electrolyte that is important for fluid balance and blood pressure regulation.However, sodium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.

Therefore, the nurse does not need to monitor the serum sodium level to evaluate digoxin therapy.

Serum magnesium level is wrong because magnesium is not directly related to digoxin action or toxicity.

Magnesium is another electrolyte that is involved in many enzymatic reactions and neuromuscular function.However, magnesium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.

Therefore, the nurse does not need to monitor the serum magnesium level to evaluate digoxin therapy.

Serum calcium level is wrong because calcium is not directly related to digoxin action or toxicity.

Calcium is another electrolyte that is essential for bone health and muscle contraction.However, calcium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.

Therefore, the nurse does not need to monitor the serum calcium level to evaluate digoxin therapy.

Administer vitamin K as ordered by physician is wrong because vitamin K is not indicated unless the physician orders it based on the patient’s condition and INR level.

Vitamin K is an antidote for warfarin overdose and can reverse its anticoagulant effects.

However, administering vitamin K without a physician’s order may cause the INR to drop below the therapeutic range and increase the risk of clotting.

Administer heparin as ordered by physician is wrong because heparin is another anticoagulant that works by activating antithrombin, a natural inhibitor of clotting factors.

Heparin is used for acute treatment of thromboembolic disorders, such as deep vein thrombosis or pulmonary embolism.

It is not indicated for atrial fibrillation unless there is evidence of acute thrombosis.

Administering heparin to a patient with an elevated INR would increase the risk of bleeding.

Administer warfarin as ordered by physician is wrong because warfarin is the cause of the elevated INR and should be withheld until the INR returns to the therapeutic range.

Continuing to administer warfarin would further increase the INR and the risk of bleeding.

Administer diltiazem as ordered by physician is wrong because it does not address the patient’s complaint of dizziness and lightheadedness, which are side effects of the medication.

The nurse should monitor the patient’s blood pressure and heart rate before and after administering diltiazem, and report any abnormal findings to the physician.

Notify physician immediately is wrong because it is not necessary to notify the physician immediately for a common and mild side effect of diltiazem, unless the patient has other signs of severe hypotension, such as fainting, chest pain, or confusion.

The nurse should educate the patient about the possible side effects of diltiazem and how to prevent or manage them.

Hold diltiazem and notify physician if symptoms persist is wrong because it is not appropriate to hold a prescribed medication without a valid reason or an order from the physician.

Holding diltiazem could cause the patient’s blood pressure to rise and increase the risk of complications from atrial fibrillation, such as stroke or heart failure.

The nurse should administer diltiazem as ordered and monitor the patient’s response.

Serum sodium level is wrong because sodium level is not directly affected by digoxin therapy.

Sodium level may be altered in heart failure patients due to fluid retention or diuretic use, but it does not indicate the effectiveness of digoxin.

Serum magnesium level is wrong because magnesium level is not directly affected by digoxin therapy.

Magnesium level may be altered in heart failure patients due to diuretic use or renal impairment, but it does not indicate the effectiveness of digoxin.

Serum calcium level is wrong because calcium level is not directly affected by digoxin therapy.

Calcium level may be altered in heart failure patients due to renal impairment or vitamin D deficiency, but it does not indicate the effectiveness of digoxin.

Serum sodium level is wrong because carvedilol does not affect the sodium level significantly.Sodium level is more relevant for diuretics, which can cause hyponatremia (low sodium) or hypernatremia (high sodium) depending on the type and dose of the medication.

Serum magnesium level is wrong because carvedilol does not affect the magnesium level significantly.

Magnesium level is more relevant for digoxin, which is another medication used for heart failure that can cause hypomagnesemia (low magnesium) or hypermagnesemia (high magnesium).Hypomagnesemia can increase the risk of digoxin toxicity, while hypermagnesemia can decrease the effectiveness of digoxin.

Serum calcium level is wrong because carvedilol does not affect the calcium level significantly.

Calcium level is more relevant for calcium channel blockers, which are another class of medications used for heart failure that can lower the heart rate and blood pressure by blocking the entry of calcium into the cardiac and vascular smooth muscle cells.

Calcium channel blockers can cause hypocalcemia (low calcium) or hypercalcemia (high calcium), which can affect the cardiac contractility and conduction.

Choice B is wrong because Serum calcium is wrong because furosemide does not affect calcium levels significantly. Calcium levels are more likely to be affected by thiazide diuretics, which can cause hypercalcemia.

Choice C is wrong because Serum albumin is wrong because furosemide does not affect albumin levels significantly. Albumin levels are more likely to be affected by liver disease, malnutrition, or nephrotic syndrome.

Choice D is wrong because Serum glucose is wrong because furosemide does not affect glucose levels significantly. Glucose levels are more likely to be affected by diabetes mellitus, corticosteroids, or stress.

Choice A is wrong because “I have less swelling in my ankles.” This statement indicates a possible effect of a diuretic, which is a medication that reduces fluid retention and edema by increasing urine output. Metoprolol does not have a direct diuretic effect, although it may indirectly reduce fluid accumulation by improving cardiac function.

Choice C is wrong because “I don’t have chest pain anymore.” This statement indicates a possible effect of a nitrate, which is a medication that dilates the blood vessels and reduces the oxygen demand of the heart. Metoprolol may also help to prevent or treat angina by lowering the heart rate and blood pressure, but it is not the primary medication for chest pain relief.

Choice D is wrong because “I can breathe better at night.” This statement indicates a possible effect of an oxygen therapy, which is a treatment that delivers supplemental oxygen to the lungs and improves gas exchange. Metoprolol may also help to reduce dyspnea by improving cardiac function and reducing pulmonary congestion, but it is not the primary treatment for respiratory distress.

Choice A is wrong because using an electric razor for shaving is a safe practice for a client who is receiving warfarin, as it reduces the risk of bleeding from cuts or nicks.

Choice C is wrong because checking stools for blood is an important measure for a client who is receiving warfarin, as it can indicate gastrointestinal bleeding, which is a serious adverse effect of the medication.

Choice D is wrong because having blood drawn regularly is necessary for a client who is receiving warfarin, as it allows the monitoring of the international normalized ratio (INR), which reflects the degree of anticoagulation and guides the dosage adjustment of the medication.

Choice B is wrong because checking the blood pressure is not specific to mannitol administration. Mannitol can cause hypotension or hypertension depending on the fluid status of the client, but this is not the priority action before giving the medication.

Choice C is wrong because checking the blood glucose is not relevant to mannitol administration. Mannitol does not affect blood glucose levels.

Choice D is wrong because checking the oxygen saturation is not related to mannitol administration. Mannitol does not affect oxygen saturation levels.

Choice A is wrong because administering the medication as ordered could worsen the patient’s condition and increase the risk of digoxin toxicity.

Choice C is wrong because checking the patient’s serum digoxin level is not enough to prevent digoxin toxicity. The nurse should also check the patient’s serum potassium level and heart rate before giving digoxin.

Choice D is wrong because giving an additional dose of digoxin could cause a fatal overdose and lead to cardiac arrest. The nurse should never give more than the prescribed dose of digoxin without consulting the provider.

Choice A is wrong because fresh fruits and vegetables are good sources of potassium, magnesium, and fiber, which are beneficial for heart health. Potassium and magnesium help regulate fluid and electrolyte balance, and fiber helps lower cholesterol and blood pressure.

Choice B is wrong because whole grains and cereals are also rich in fiber, as well as complex carbohydrates, which provide energy and prevent rapid fluctuations in blood glucose levels. Whole grains and cereals may also contain phytochemicals that have antioxidant and anti-inflammatory effects.

Choice C is wrong because lean meats and poultry are low in saturated fat and cholesterol, which can contribute to atherosclerosis and coronary artery disease. Lean meats and poultry provide protein, which is essential for tissue repair and wound healing. Protein intake should be adequate but not excessive for patients with heart failure, as too much protein can increase the workload of the kidneys.