A patient is receiving ramipril for mitral regurgitation. Which of the following responses should the nurse expect the patient to have if the medication is achieving the desired therapeutic effect?
1. heart rate of 68 beats per minute
2. blood pressure of 110/70 mm hg
3. normal cardiac sinus rhythm
4. palpable peripheral pulses
2
Rationale: Reducing afterload lessens the degree of regurgitation and significantly improves symptoms. Angiotensin converting enzyme inhibitors, such as ramipril, are effective for afterload reduction and controlling hypertension. The other choices would not indicate that the medication is achieving the desired results in the patient.
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A client with borderline personality disorder has had 21 admissions to the mental health unit, each
precipitated by a suicide attempt, usually resulting in superficial cuts on the arm. On this admission the client has developed a relationship with a highly supportive nurse. The client has progressed to having a pass to spend an afternoon in a nearby shopping mall. The nurse is shocked when the emergency department calls to say that the client had just been brought in with multiple self-inflicted lacerations. The nurse asks a peer, "Why? Everything was going well. How could she do this to me?" What response by the other nurse reflects understanding of the client's borderline disorder? a. "I know what you mean. You put a lot of energy into working with this client. It must be disappointing to have her do something like this.". b. "I could have told you this would happen. A client like this always gets you in the end. I hope this will teach you not to get so involved.". c. "I know the client's behavior seems personal, but it's really not. Clients with borderline disorder act out to relieve anxiety, and I suspect having the pass provoked a great deal of anxiety.". d. "I wonder if all this could have been avoided if I'd clued you in on the client. This is a usual pattern for her. She burned me once, too, when I first worked here.".
Common causes for urinary incontinence that the nurse should always check in the elderly include:
a. lack of mobility and no toilet facilities b. urinary tract infections and electrolyte imbalances c. stress and multiple pregnancies d. birth defects and prior surgeries
A nurse administers riluzole to a patient with amyotrophic lateral sclerosis. Which neurotransmitter would be the most affected by this drug?
a. Dopamine b. Glutamate c. GABA d. Norepinephrine
A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes
What is the best explanation for a high glucose in a patient without diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia. 2. Insulin resistance is caused by pro-inflammatory factors. 3. Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction. 4. Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state. 5. Glucagon, cortisol, and epinephrine cause hyperglycemia.