Nurse 425 Case study & practice questions

patient education for statins

-effects the metabolic pathways necessary for cholesterol synthesis -decrease production of LDLs (and VLDL) and triglycerides · increase production of HDLs -risk for hepatic injury so check LFTS, limit alcohol intake -risk for rhabdomyolysis -take in evening because highest amount of cholesterol synthesis occurs between midnight and 5am

normal HDL

40-60

fasting blood glucose

80-100

normal LDL

<130

normal triglycerides

<150

normal cholesterol level

<200

A nurse is caring for a client who has a demand pacemaker inserted with the rate set at 72/min. Which of the following findings should the nurse expect? A.Telemetry monitoring shows QRS complexes occurring at a rate of 74/min with no pacing spikes. B.The client is experiencing PVCs at 12/min. C.Telemetry monitoring shows pacing spikes with no QRS complexes. D.The client is experiencing hiccups.

A

A nurse is providing teaching about lifestyle changes to a client who had an MI and has a new Rx for metoprolol. Which of the following client statements indicates an understanding of the teaching? A."I should eat foods high in saturated fat." B."Before taking my medication, I will count my radial pulse rate." C."I will exercise once per week for an hour at the health club." D."I will stop taking my medication when my blood pressure is within a normal range."

B

A nurse on a telemetry unit is caring for a client who has an irregular pulse. Which of the following ECG abnormalities should the nurse recognize as atrial flutter? A.P waves occurring at 0.16 seconds before each QRS complex B.Atrial rate of 300/min with QRS complex of 80/min C.Ventricular rate of 82/min with an atrial rate of 80/min D.Irregular ventricular rate of 125/min with a wide QRS pattern

B

The MD orders metoprolol 5mg IV in addition to the above prescriptions. Which of the following assessments should cause you to consider holding this medication? a.respirations 24/min b.oxygen saturation 92% c.BP 90/60 d.pulse 110 bpm

BP 90/60

A nurse is monitoring a client who had an MI. For which of the following complications should the nurse monitor in the first 24 hours? A.Infective endocarditis B.Pericarditis C.Ventricular dysrhythmias D.Pulmonary Emboli

C

A nurse is completing an assessment for a client who has a history of unstable angina. Which of the following findings should the nurse expect? A.Chest pain is relieved soon after resting. B.Nitroglycerine relieves chest pain. C.Physical exertion does not precipitate chest pain. D.Chest pain lasts longer than 15 min.

D

A nurse is planning care for a client who is having a PTCA with stent placement. Which of the following actions should the nurse anticipate in the post-procedures plan of care? A.Instruct the client on a long-term cardiac conditioning program B.Administer scheduled doses of acetaminophen C.Check for peak lab markers of myocardial damage. D.Monitor for bleeding.

D

Risk factors for CAD

Obesity sedentary lifestyle history of vascular disease tobacco and alcohol use hypertension

ischemic ECG changes

St depression, T wave inversion

A nurse is caring for a client who had an MI 5 days ago. The client has a sudden onset of SOB and begins coughing, frothy, pink sputum. The nurse auscultates loud, bubbly sounds on inspiration. Which of the following adventitious breath sounds should the nurse document? A.Course crackles B.Wheezes C.Ronchi D.Friction rub

a

A nurse is caring for a client with heart failure whose telemetry reading displays a flattening of the T wave. Which of the following lab results should the nurse anticipate as the cause of this ECG change? A.Potassium 2.8 mEq/L B.Digoxin level 0.7 ng/mL C.Hemoglobin 9.8 g/dL D.Calcium 8.0 mg

a) normal level is 3.6-5.2

PCI

angioplasty with or without stenting - now preferred method with best results if done within 2-3 hrs after onset of symptoms according to Iggy, but the "door to balloon" goal for cardiac centers is 90 minutes. Note: AHA ACS guidelines says reperfusion is indicated up to 12 hrs after onset of symptoms.

patient education for beta blockers

antihypertensive; beta blocker decreases HR, contractility and conduction through AV node · get up slowly - may cause orthostatic hypotension · do not discontinue abruptly

what is the first line treatment for HTN

lasix decrease reabsorption of sodium, chloride and water - decreased blood volume decreases BP

dietary changes for HTN

less salt season with herbs, carbs, sugar, dairy, more fruits n veggies not canned, if that is the only option then purchase low sodium and rinse before consumption exercise- incorporate moderate exercise into your routine, manage stress

what education might we give to men taking NTG

may interact with erectile dysfunction meds

when is NTG ointment or patch used? education

ointment is used for prevention of angina, not to treat acute symptoms. SL or NTG spray is indicated for acute symptoms ointment/patch should be removed at night to allow nitrate free interval to prevent tolerance

Prioritize the orders and indicate the rationale for each. List nursing interventions that are important when administering each medication. __Administer oxygen at 4 lpm by nasal cannula __Draw blood for chest pain panel (myglobin, total CK, CK-MB, troponin) __Run 12 lead ECG __Start nitroglycerin IV drip at 5 mcg/min and titrate up to 10 mcg/min __Administer morphine sulfate 2mg IV q. 1 hr prn for chest discomfort

oxygen NTG draw labs run 12 lead ECG morphine

why is aspirin used in CAD?

prophylaxis antiplatelet aggregation bc with CAD plaques can rupture and a clot will form which could occlude a major vessel and lead to MI -teach to monitor for signs of bleeding ex. nose, gum, brownish color to urine, or black stool which should be reported

post op care after cardiac cath

· Check CMS of extremity · Assess for bleeding · Assess V/S and look for any changes in cardiac or neuro status · Assess monitor pattern for dysrhythmias · Kept on BR for 4-6 hrs with extremity extended (less if collagen plug used to seal artery)

essential teaching points for NTG

· Stop activity when symptoms occur · Keep away from heat/light · Replace every six months · Keep on your person at all times · Place under the tongue - don't chew · Expect a tingling sensation and possibly flushing with HA · Take at first sign of symptoms. Repeat X 2 at 5 min intervals · Call 911 if no relief after 15-20 minutes (some texts say call 911 after 1st NTG) · Take before activity known to cause symptoms (ex. exercise, sex)

thrombolytic therapy

· more likely to cause bleeding (intracranial bleed could be devastating) - contraindicated with recent trauma, surgery, hx. of intracranial bleeding or vascular abnormalities - most effective if given in 4-6 hours and symptom onset no more than 12 hrs. ago.

pation education for lasix

· take in the morning so sleep is not disturbed at night · get up slowly - may cause orthostatic hypotension · consume foods high in potassium since Lasix also causes low K+ (fruits, potatoes)