Choice A rationale:

Feeling anxious is not a common side effect of metoprolol.

Choice B rationale:

Metoprolol is a beta-blocker that can lower blood pressure, so a blood pressure of 90/54 mm Hg could indicate a side effect of this medication.

Choice C rationale:

A normal sinus rhythm is expected and does not indicate a side effect of metoprolol.

Choice D rationale:

Restlessness and agitation are not typical side effects of metoprolol.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

Checking the pulse rate before taking nitroglycerin is not necessary.

Choice B rationale:

Sitting down before taking nitroglycerin can prevent dizziness and fainting, which are potential side effects of nitroglycerin.

Choice C rationale:

There is no need to remove the nitroglycerin patch before taking sublingual nitroglycerin.

Choice D rationale:

The nitroglycerin patch should not be used to treat acute chest pain.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

ST segment changes on an ECG are not typically associated with chronic constrictive pericarditis.

Choice B rationale:

Jugular venous distention (JVD) is a common sign of chronic constrictive pericarditis. If JVD is not present, it may indicate that the therapies are effective.

Choice C rationale:

While the sedimentation rate can indicate inflammation, it is not specific to chronic constrictive pericarditis.

Choice D rationale:

The presence of a paradoxical pulse is not typically associated with chronic constrictive pericarditis.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

Elevated troponin is a sign of heart damage, which could be caused by a heart attack or other stresses on the heart. This is a critical finding that needs immediate attention.

Choice B rationale:

Q waves on an ECG can indicate a previous heart attack or myocardial infarction. However, they can also be a normal variant, meaning they are a harmless variation in the electrical activity of the heart.

Choice C rationale:

Bilateral crackles in the lungs can indicate mucus or fluid in the base of the lungs, often associated with conditions like pneumonia, heart failure, or bronchitis.

Choice D rationale:

Hyperglycemia, or high blood glucose, can be a sign of diabetes. If untreated, it can lead to serious complications like ketoacidosis.

So, the correct answer is Choice A, after analyzing all choices.

Choice A rationale:

A weight increase from 120 pounds to 122 pounds over 3 days is within the normal fluctuation range.

Choice B rationale:

A serum potassium level of 3.0 mEq/L after 1 week of therapy is concerning because it’s below the normal range (3.5-5.0 mEq/L)171819. This could indicate hypokalemia, which can cause serious complications if left untreated.

Choice C rationale:

A palpable liver edge 2 cm below the ribs on the right side could suggest an abnormality such as an enlarged liver.

Choice D rationale:

The presence of 1+ to 2+ edema in the feet and ankles could indicate conditions like heart failure or venous insufficiency.

So, the correct answer is Choice B, after analyzing all choices.

Choice A rationale:

Tylenol, or acetaminophen, is a common over-the-counter medication used to reduce fevers and manage mild aches and pains. It does not directly affect blood pressure.

Choice B rationale:

While stress can cause temporary spikes in blood pressure, it’s not clear whether stress can cause long-term increases in blood pressure34.

Choice C rationale:

Cocaine or crack use can cause a significant and dangerous increase in blood pressure. Given the patient’s history of drug abuse and the current high blood pressure reading, this is a critical question to ask.

Choice D rationale:

Eating salty foods can contribute to high blood pressure over time, but it’s unlikely to cause an immediate severe increase in blood pressure.

So, the correct answer is Choice C, after analyzing all choices. .

Choice A rationale:

An increase in heart rate from 66 to 98 beats/min indicates that the heart is working harder, which could be a sign of stress or exertion. This is a significant increase and could indicate that the patient needs to rest.

Choice B rationale:

While a drop in O2 saturation from 99% to 95% is noticeable, it is still within the normal range (95-100%). Therefore, it would not necessarily indicate a need for the patient to rest.

Choice C rationale:

A respiratory rate increase from 14 to 20 breaths/min is within the normal range (12-20 breaths/min) and would not necessarily indicate a need for the patient to rest.

Choice D rationale:

A blood pressure change from 118/60 to 126/68 mm Hg is within the normal range and would not necessarily indicate a need for the patient to rest.

So, the correct answer is Choice A, after analyzing all choices.

Choice A rationale:

The right upper-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice B rationale:

The left upper-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice C rationale:

The left lower-sternal border is not the best place to hear a murmur typical of mitral regurgitation.

Choice D rationale:

The apex of the heart is the best place to hear a murmur typical of mitral regurgitation. This is where the sound will be most audible.

So, the correct answer is Choice D, after analyzing all choices.

Choice A rationale:

The pain level of 3 to 5 on a scale of 0 to 10 does not specifically indicate chronic stable angina.

Choice B rationale:

Pain that has worsened over the last week could indicate a number of conditions, not specifically chronic stable angina.

Choice C rationale:

Pain that wakes a patient up at night could be a sign of a number of conditions, not specifically chronic stable angina.

Choice D rationale:

Chronic stable angina is characterized by chest pain that is relieved by rest or nitroglycerin. Therefore, if the patient’s pain goes away with a nitroglycerin tablet, it would help confirm a diagnosis of chronic stable angina.

So, the correct answer is Choice D, after analyzing all choices.

Choice A rationale:

Nitroglycerin can cause side effects such as headache and dizziness, but nausea is not a common side effect.

Choice B rationale:

Nitroglycerin should be stored in a dark, cool place, not in a well-lit room.

Choice C rationale:

This is the correct answer. If chest pain is not relieved 5 minutes after taking nitroglycerin, it is recommended to call an ambulance.

Choice D rationale:

While nitroglycerin is taken when chest pain occurs, it can also be taken prior to activities that might cause chest pain.

So, the correct answer is Choice C, after analyzing all choices.

Choice A rationale:

While bilateral crackles at the lung bases indicate fluid accumulation, a common symptom of dilated cardiomyopathy, it’s not as immediately life-threatening as some other conditions.

Choice B rationale:

Acute aortic regurgitation can lead to a rapid and severe drop in blood pressure, which is a medical emergency. Therefore, this patient should be assessed first.

Choice C rationale:

While a murmur and splinter hemorrhages are symptoms of infective endocarditis, they are not as immediately life-threatening as acute aortic regurgitation.

Choice D rationale:

Sharp chest pain with a deep breath could be a symptom of rheumatic fever, but it’s not as immediately life-threatening as acute aortic regurgitation.

So, the correct answer is Choice B, after analyzing all choices.

Choice A rationale:

This is correct. Standing still for prolonged periods can cause blood to pool in the legs, increasing blood pressure.

Choice B rationale:

This is also correct. Stopping the medication abruptly can cause a rebound increase in blood pressure.

Choice C rationale:

This is incorrect. Furosemide is a diuretic that can cause the body to lose potassium, so it’s important to consume potassium-rich foods.

Choice D rationale:

This is correct. Furosemide can cause orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down.

So, the correct answer is Choice C, after analyzing all choices.

Choice A rationale:

A patient who had a myocardial infarction (MI) 4 days ago and is anxious about today’s planned discharge would need reassurance and education, but it’s not an immediate concern.

Choice B rationale:

A patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI) is at risk for hemorrhage from the arterial access site. Immediate assessment of blood pressure, pulses, and the access site is required.

Choice C rationale:

A patient with variant angina who is scheduled to receive nifedipine (Procardia) would need monitoring, but it’s not the most urgent.

Choice D rationale:

A patient with pericarditis complaining of sharp, stabbing chest pain would need evaluation, but the risk of complications is less immediate than for Choice B1.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

Pericarditis is an inflammation of the pericardium and would not directly cause an S4 heart sound.

Choice B rationale:

Arterial obstruction or aneurysm would cause changes in blood flow, but not specifically an S4 heart sound.

Choice C rationale:

An S4 heart sound is an extra sound that is heard late in diastole just before S1. It occurs due to resistance to blood flow in an enlarged ventricle, often due to forceful atrial contraction to overcome ventricular resistance.

Choice D rationale:

An infectious valvular disorder could cause a variety of heart sounds, but not specifically an S42.

So, the correct answer is C, after analyzing all choices.

Choice A rationale:

While aspirin is often given to patients with suspected myocardial infarction, asking if the patient took aspirin does not help determine the timing of the onset of symptoms.

Choice B rationale:

Knowing the patient’s allergies is important for medication safety, but it does not help determine eligibility for thrombolytic therapy.

Choice C rationale:

Rating the pain on a scale helps assess the severity of the pain, but it does not provide information about the timing of the onset of symptoms.

Choice D rationale:

The time of pain onset is crucial in determining eligibility for thrombolytic therapy. Thrombolytic therapy is most effective when given within a certain time frame from the onset of symptoms.

So, the correct answer is D, after analyzing all choices.

Choice A rationale:

Cardiac-specific troponin is a protein that is released into the bloodstream when there is damage to the heart muscle, such as during an acute myocardial infarction (AMI). It is considered the most specific marker for AMI because it is found only in heart muscle. The normal range for troponin I is between 0 and 0.04 ng/mL2.

Choice B rationale:

Myoglobin is a protein found in heart and skeletal muscles. While it can be elevated in AMI, it is not as specific as troponin because it is also found in skeletal muscles. The normal levels of myoglobin are 25 to 72 ng/mL4.

Choice C rationale:

Homocysteine is an amino acid in the blood, and high levels can increase the risk of heart disease. However, it is not specific for AMI5. The normal range of homocysteine levels are less than 15 micromoles per liter.

Choice D rationale:

C-reactive protein (CRP) is a marker of inflammation in the body and can be elevated in various conditions, including heart disease. However, it is not specific for AMI6. The normal CRP level is less than 0.9 milligrams per deciliter.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

An irregular pulse could indicate that myocarditis is affecting the heart’s electrical system, leading to an irregular heartbeat or arrhythmia. This could potentially affect the action of digoxin, a medication used to treat heart conditions, and therefore should be communicated to the healthcare provider.

Choice B rationale:

Leukocytosis, or a high white blood cell count, can be a sign of infection or inflammation, including myocarditis. However, it is not as specific as an irregular pulse in indicating a potential issue with the administration of digoxin.

Choice C rationale:

Generalized myalgia, or muscle pain, can be a symptom of myocarditis. However, it is not as directly related to the action of digoxin as an irregular pulse.

Choice D rationale:

Fatigue can be a symptom of myocarditis. However, it is not as directly related to the action of digoxin as an irregular pulse.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

A brief episode of ventricular tachycardia, or a rapid heart rate, can occur in patients receiving thrombolytic therapy. However, it is not typically a reason to stop the drug infusion.

Choice B rationale:

Bleeding from the gums can be a sign of excessive bleeding, which is a major risk of thrombolytic therapy. This would be a reason to stop the drug infusion.

Choice C rationale:

A decreased level of consciousness can have many causes and is not specifically associated with thrombolytic therapy.

Choice D rationale:

An increase in blood pressure is not typically a reason to stop thrombolytic therapy.

So, the correct answer is B, after analyzing all choices.

Choice A rationale:

While a history of heart attack indicates a general risk for heart disease, it is not specifically associated with an increased risk for infective endocarditis.

Choice B rationale:

Immunizations do not typically increase the risk for infective endocarditis.

Choice C rationale:

Family history of endocarditis does not necessarily increase the risk for infective endocarditis.

Choice D rationale:

Dental work can introduce bacteria into the bloodstream, which can lead to infective endocarditis, especially in individuals with prosthetic heart valves.

So, the correct answer is D, after analyzing all choices.

Choice A rationale:

A fasting triglyceride level of 167 mg/dL is above the desirable level of less than 150 mg/dL, indicating a higher risk for CAD34.

Choice B rationale:

An HDL level of 96 mg/dL is considered good and is protective against CAD34.

Choice C rationale:

An LDL level of 104 mg/dL is near optimal/above optimal, but it’s not high enough to be a priority risk factor for CAD34.

Choice D rationale:

Total serum cholesterol of 192 mg/dL is within the desirable range of less than 200 mg/dL34.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

Digoxin is used to treat heart failure and atrial fibrillation, but it doesn’t directly address the fluid accumulation in the lungs caused by pulmonary edema.

Choice B rationale:

Captopril, an ACE inhibitor, can help reduce fluid buildup and is typically beneficial for patients with pulmonary edema.

Choice C rationale:

Furosemide is a diuretic that helps remove excess fluid from the body, making it a key medication for treating pulmonary edema.

Choice D rationale:

Carvedilol, a beta blocker, can be used to treat heart failure and hypertension, conditions that can contribute to pulmonary edema.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

Chest pain that lasts for 20 minutes or more is characteristic of an acute myocardial infarction (AMI)123.

Choice B rationale:

Changes in pain that occur with deep breathing are more typical of musculoskeletal pain or pericarditis.

Choice C rationale:

Stable angina is usually relieved when the patient takes nitroglycerin.

Choice D rationale:

Pain that is reproducible when the patient raises the arms is more typical of musculoskeletal pain.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

In a patient with severe dyspnea and a dry, hacking cough, auscultating the breath sounds would be the first action to assess for any abnormalities.

Choice B rationale:

Checking the capillary refill would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.

Choice C rationale:

Auscultating the abdomen would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.

Choice D rationale:

Asking about the patient’s allergies would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

Limiting salt and fluid intake is crucial for patients with restrictive cardiomyopathy to manage their condition.

Choice B rationale:

Avoiding aspirin or other anti-inflammatory drugs is not specifically related to the management of restrictive cardiomyopathy.

Choice C rationale:

Taking antibiotics before dental cleaning is a general recommendation for patients with certain heart conditions to prevent endocarditis, but it’s not specific to restrictive cardiomyopathy.

Choice D rationale:

Restarting an exercise program should be done under medical supervision and depends on the patient’s overall health status.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

Teaching the patient to take deep, slow breaths might not be effective in controlling the pain due to acute pericarditis.

Choice B rationale:

Placing the patient in Fowler’s position, leaning forward on the table, can help relieve the pain associated with acute pericarditis.

Choice C rationale:

Forcing fluids to 3000 mL/day to decrease inflammation is not a recommended action for managing pain due to acute pericarditis.

Choice D rationale:

Providing a fresh ice bag every hour for the patient to place on the chest is not a recommended action for managing pain due to acute pericarditis.

So, the correct answer is B, after analyzing all choices.