A client with a suspected myocardial infarction has a normal oxygen saturation on room air. What is correct about supplemental oxygen for this client?
It is not routinely needed while saturation stays normal
✓
High-flow oxygen should be started for every client
It should replace nitroglycerin for chest pain
It is given only after the pain has fully resolved
Correct Answer
It is not routinely needed while saturation stays normal
Supplemental oxygen is given in acute coronary syndrome when oxygen saturation is low; giving it routinely to a client whose saturation is normal has not shown benefit. High-flow oxygen should be started for every client is an outdated practice. It should replace nitroglycerin for chest pain is wrong because oxygen does not dilate coronary vessels or relieve ischemic pain on its own. It is given only after the pain has fully resolved is wrong because a low saturation is treated as soon as it is found.
Category: Acute Coronary Syndrome Drugs
Question 2
For a client with ischemic chest pain from an acute myocardial infarction, when is IV morphine given?
As the first drug for every client with chest pain
When nitroglycerin does not relieve the pain
✓
Only when the blood pressure is very low
In place of aspirin for clients with ulcers
Correct Answer
When nitroglycerin does not relieve the pain
Morphine is reserved for ischemic pain that persists despite nitroglycerin; it eases pain and anxiety, which lowers heart rate and myocardial oxygen demand. As the first drug for every client with chest pain is not how it is used, because nitroglycerin and aspirin come first. Only when the blood pressure is very low is wrong because morphine can lower blood pressure further. In place of aspirin for clients with ulcers is wrong because morphine has no antiplatelet effect and cannot substitute for aspirin.
Category: Acute Coronary Syndrome Drugs
Question 3
During a norepinephrine infusion through a peripheral IV, the skin around the site becomes blanched, cold and painful. What should the nurse do first?
Increase the rate to keep the blood pressure up
Flush the catheter with saline to clear it
Stop the infusion at that site
✓
Apply a tight dressing and keep infusing
Correct Answer
Stop the infusion at that site
Blanching, coldness and pain at the site suggest extravasation, and norepinephrine leaking into tissue constricts local vessels and can cause necrosis, so the infusion at that site is stopped at once, the provider is notified and the drug is restarted through another line as ordered. Increase the rate to keep the blood pressure up would push more drug into the tissue. Flush the catheter with saline to clear it would also force drug into the tissue and could give a bolus. Apply a tight dressing and keep infusing hides the site and lets the injury grow.
Category: Vasopressors and Inotropes
Question 4
Nitroglycerin is contraindicated in a client with which condition?
Stable angina
Hypertension
Acute pulmonary edema
Increased intracranial pressure
✓
Correct Answer
Increased intracranial pressure
Nitroglycerin dilates cerebral as well as systemic vessels, which can raise intracranial pressure further, so increased intracranial pressure is a labeled contraindication. Stable angina is a main indication for nitroglycerin. Hypertension is not a contraindication; IV nitroglycerin can be used to lower blood pressure. Acute pulmonary edema is a setting where IV nitroglycerin is often used to reduce preload.
Category: Acute Coronary Syndrome Drugs
Question 5
Why should an IV push medication not be given through the line that is running a vasopressor infusion?
It would push a sudden bolus of the vasopressor into the client
✓
It would permanently dilute the vasopressor in the bag
It would make the catheter clot right away
The vasopressor would inactivate every other drug
Correct Answer
It would push a sudden bolus of the vasopressor into the client
The drug and flush push the vasopressor already in the tubing into the vein all at once, which can cause a dangerous surge in blood pressure and heart rate, so vasopressors run through their own dedicated, labeled line on an infusion pump. It would permanently dilute the vasopressor in the bag is wrong because a push does not enter the bag. It would make the catheter clot right away is not the concern. The vasopressor would inactivate every other drug is not true, although compatibility is always checked.
Category: Vasopressors and Inotropes
Question 6
A client with suspected myocardial infarction is vomiting and cannot take aspirin by mouth. Which route may be used instead?
Intramuscular injection
Rectal suppository
✓
Transdermal patch
Nebulized inhalation
Correct Answer
Rectal suppository
Aspirin is available as a rectal suppository, which allows prompt antiplatelet therapy when a client cannot chew and swallow a tablet. Intramuscular injection is not an available form of aspirin. Transdermal patch is not an aspirin product. Nebulized inhalation is not a route for aspirin.
Category: Acute Coronary Syndrome Drugs
Question 7
A client receiving IV lidocaine for a ventricular dysrhythmia also takes which drug that can raise lidocaine blood levels?
Rifampin
Acetaminophen
Propranolol
✓
Docusate
Correct Answer
Propranolol
Beta blockers such as propranolol, metoprolol and nadolol reduce liver blood flow and lidocaine clearance, which raises lidocaine levels and the risk of toxicity such as confusion, twitching and seizures. Rifampin induces liver enzymes and tends to lower levels of drugs it interacts with. Acetaminophen does not raise lidocaine levels. Docusate is a stool softener with no effect on lidocaine.
Category: Emergency Dysrhythmia Drugs
Question 8
Which finding helps distinguish neurogenic shock after a spinal cord injury from hypovolemic shock?
Low blood pressure
Rapid, weak pulse with cool, clammy skin
Confusion and restlessness
Slow heart rate with warm, dry skin
✓
Correct Answer
Slow heart rate with warm, dry skin
Neurogenic shock is a distributive shock in which loss of sympathetic tone leaves vessels dilated and vagal input to the heart unopposed, so the client is hypotensive with bradycardia and warm, dry skin. Low blood pressure occurs in both types and does not tell them apart. Rapid, weak pulse with cool, clammy skin is the compensating pattern of hypovolemic shock. Confusion and restlessness reflect poor brain perfusion in any type of shock.
Category: Shock Basics
Question 9
A client with a suspected myocardial infarction is receiving IV nitroglycerin. Which assessment shows that the drug is having its intended effect?
Relief of the chest pain
✓
A rise in blood pressure
A faster heart rate
An increase in urine output
Correct Answer
Relief of the chest pain
IV nitroglycerin dilates coronary and systemic vessels to improve oxygen delivery to the ischemic heart and lower its workload, so relief of chest pain is the sign that it is working; the nurse reassesses pain and blood pressure with each rate change. A rise in blood pressure is the opposite of its expected effect, since hypotension is a common adverse effect. A faster heart rate is a reflex adverse effect, not a therapeutic goal. An increase in urine output is not how nitroglycerin's effect is judged.
Category: Acute Coronary Syndrome Drugs
Question 10
In anaphylaxis, when is nebulized albuterol added to treatment?
Before epinephrine, as the first drug given
When epinephrine has not fully relieved bronchospasm
✓
To raise a low blood pressure
To replace IV fluids when no IV is available
Correct Answer
When epinephrine has not fully relieved bronchospasm
Albuterol, an inhaled beta-2 agonist, relaxes bronchial smooth muscle and is added when wheezing or bronchospasm persists after epinephrine. Before epinephrine, as the first drug given is wrong because epinephrine is always the first and most important drug in anaphylaxis. To raise a low blood pressure is wrong because albuterol does not constrict blood vessels. To replace IV fluids when no IV is available is wrong because albuterol does nothing to restore circulating volume.
Category: Epinephrine and Anaphylaxis
Question 11
Besides symptomatic bradycardia, IV atropine is used to treat which emergency?
Opioid overdose
Acetaminophen overdose
Organophosphate insecticide poisoning
✓
Hypovolemic shock
Correct Answer
Organophosphate insecticide poisoning
Organophosphates block acetylcholinesterase and flood receptors with acetylcholine, and atropine blocks muscarinic receptors to dry secretions and raise the heart rate. Opioid overdose is reversed with naloxone. Acetaminophen overdose is treated with acetylcysteine. Hypovolemic shock is treated by stopping blood loss and restoring volume.
Category: Emergency Dysrhythmia Drugs
Question 12
Why is IV nitroglycerin infused through special non-PVC tubing?
Light passing through PVC breaks the drug down
Nitroglycerin dissolves the PVC and releases particles
PVC tubing makes nitroglycerin form crystals
Standard PVC tubing absorbs much of the drug
✓
Correct Answer
Standard PVC tubing absorbs much of the drug
Nitroglycerin migrates into polyvinyl chloride, so ordinary tubing can soak up a large share of the drug and deliver far less than intended; the non-PVC sets supplied for it keep the delivered amount reliable. Light passing through PVC breaks the drug down is not the reason for the special set. Nitroglycerin dissolves the PVC and releases particles is not true. PVC tubing makes nitroglycerin form crystals is not a known problem.
Category: Acute Coronary Syndrome Drugs
Question 13
IV diltiazem is contraindicated in a client with which rhythm?
Ventricular tachycardia
✓
Atrial fibrillation with rapid ventricular response
Paroxysmal supraventricular tachycardia
Atrial flutter with a rapid rate
Correct Answer
Ventricular tachycardia
Calcium channel blockers given IV to a client with ventricular tachycardia or another wide-complex tachycardia can cause severe hypotension and collapse, so diltiazem is contraindicated in ventricular tachycardia. Atrial fibrillation with rapid ventricular response is a main indication for IV diltiazem. Paroxysmal supraventricular tachycardia is also an indication. Atrial flutter with a rapid rate can be rate-controlled with diltiazem.
Category: Emergency Dysrhythmia Drugs
Question 14
During CPR for cardiac arrest, what is the main benefit of IV epinephrine?
It dissolves the clot that caused the arrest
It constricts blood vessels to raise coronary and cerebral perfusion
✓
It slows conduction through the AV node
It blocks sodium channels in the ventricles
Correct Answer
It constricts blood vessels to raise coronary and cerebral perfusion
Epinephrine's alpha-adrenergic vasoconstriction raises aortic pressure during chest compressions, which improves blood flow to the heart and brain and the chance of restoring a pulse. It dissolves the clot that caused the arrest describes thrombolytics. It slows conduction through the AV node describes drugs such as adenosine and diltiazem. It blocks sodium channels in the ventricles describes lidocaine and procainamide.
Category: Epinephrine and Anaphylaxis
Question 15
A client who takes the nonselective beta blocker nadolol develops anaphylaxis. What effect might the beta blocker have on treatment?
Epinephrine is no longer needed
IV fluids become contraindicated
Epinephrine may be less effective
✓
Albuterol becomes more effective
Correct Answer
Epinephrine may be less effective
Beta blockers occupy the receptors epinephrine needs to raise heart rate and open the airways, so clients taking them may respond poorly and need close monitoring and additional treatment. Epinephrine is no longer needed is wrong because epinephrine remains the first drug for anaphylaxis. IV fluids become contraindicated is wrong because fluids are still needed for hypotension. Albuterol becomes more effective is wrong because beta blockers also blunt albuterol.
Category: Epinephrine and Anaphylaxis
Question 16
A client with a documented sulfite allergy develops anaphylaxis. The available epinephrine contains a sulfite preservative. What should the nurse know?
Epinephrine is contraindicated and must be withheld
Diphenhydramine should be given in its place
Albuterol should be used instead of epinephrine
Epinephrine should still be given for the emergency
✓
Correct Answer
Epinephrine should still be given for the emergency
Epinephrine labeling states that the sulfite it contains should not deter its use in a serious allergic emergency, even in a sulfite-sensitive client, because no other drug reverses anaphylaxis. Epinephrine is contraindicated and must be withheld is wrong because withholding it is far more dangerous. Diphenhydramine should be given in its place is wrong because antihistamines do not reverse airway obstruction or shock. Albuterol should be used instead of epinephrine is wrong because albuterol only relaxes the airways and does not support blood pressure.
Category: Epinephrine and Anaphylaxis
Question 17
At high infusion rates, dopamine raises blood pressure mainly by stimulating which receptors?
Alpha-1 receptors on blood vessels
✓
Dopamine receptors in the kidneys
Beta-2 receptors in the lungs
Muscarinic receptors in the heart
Correct Answer
Alpha-1 receptors on blood vessels
Dopamine's effects depend on the infusion rate: at high rates alpha-1 stimulation constricts blood vessels and raises blood pressure, while intermediate rates mainly stimulate beta-1 receptors in the heart. Dopamine receptors in the kidneys are the main target at low rates. Beta-2 receptors in the lungs are not a meaningful dopamine target. Muscarinic receptors in the heart respond to acetylcholine, not dopamine.
Category: Vasopressors and Inotropes
Question 18
A client with peripheral artery disease is receiving a dopamine infusion. Which effect requires close monitoring?
Hypoglycemia
Ischemia of the fingers and toes
✓
Bronchospasm
Hyperkalemia
Correct Answer
Ischemia of the fingers and toes
Dopamine constricts peripheral vessels, and in clients with occlusive vascular disease this can reduce limb blood flow enough to cause ischemia, so color, temperature and pulses of the extremities are checked often. Hypoglycemia is not a typical effect of dopamine. Bronchospasm is not caused by dopamine. Hyperkalemia is not a recognized adverse effect.
Category: Vasopressors and Inotropes
Question 19
A client in cardiogenic shock who takes a beta blocker responds poorly to dobutamine. Which inotrope strengthens contraction without acting on beta receptors?
Dopamine
Epinephrine
Milrinone
✓
Norepinephrine
Correct Answer
Milrinone
Milrinone inhibits phosphodiesterase-3, raising cyclic AMP inside heart muscle cells by a route that bypasses beta receptors, so it can still increase contractility when beta receptors are blocked; it also dilates vessels and can cause hypotension. Dopamine acts partly through beta-1 receptors, so a beta blocker blunts it. Epinephrine stimulates beta receptors and is also blunted. Norepinephrine acts on alpha-1 and beta-1 receptors.
Category: Vasopressors and Inotropes
Question 20
In distributive shock such as anaphylaxis, blood pressure falls mainly because of a drop in which hemodynamic factor?
Myocardial contractility
Heart rate
Blood viscosity
Systemic vascular resistance
✓
Correct Answer
Systemic vascular resistance
In distributive shock, widespread vasodilation lowers systemic vascular resistance and lets fluid leak out of the vessels, so blood pressure falls even though the heart itself is not failing. Myocardial contractility falls in cardiogenic shock. Heart rate usually rises in shock as the body compensates. Blood viscosity is not the factor that drives the drop in pressure.
Category: Shock Basics