HESI Case Studies - Coronary Artery Disease

HESI Case Studies - Coronary Artery Disease After discussing these test results with the HCP and the nurse, Kristin expresses interest in learning how to lower her cholesterol and lose weight. The HCP prescribes the antihyperlipidemic agent lovastatin (Mevacor) 20 mg PO daily. Which instruct ions should the nurse include in Kristin's teaching plan related to the use of antihyperlipidemic? - Report any side effects R: there are many side effects and possible drug reactions with statins. one example is rhabdomyolysis, especially when an antihyp erlipidemic is taken with other drugs, such as erythromycin. Client education should include the side effects, such as an increase in liver enzymes, rhabdomyolysis and CNS effects ECG findings indicate that Kristin has had a myocardial infarction (MI). Wh ich intervention should the nurse implement first? - Inform the ED physician of Kristin's recent surgery R: since Kristin has had recent surgery, she may not be a candidate for some post MI treatments, such as tPA. The ED physician should be notified imme diately, so that further evaluation can be done. tPA is a thrombolytic agent, or coagulation modifier., that breaks down clots in the coronary arteries. If the blood flow is established quickly, the heart muscle will not become ischemic or necrotic. To be most effective, tPA should be given within the first 4 hours following an MI How should the nurse explain the test results to Kristin? - An HDL of less than 50 mg/dL for women indicates increased risk R: HDL is considered the "good" cholesterol, which re duces the risk of heart disease. Current guidelines state that an HDL of less than 50 mg/dL for women is too low to safeguard the arteries In addition to Nitroglycerin, the HCP prescribes morphine sulfate 4mg IV for Kristin. Which reaction requires immedi ate intervention by the nurse? - Respiratory rate of 10 breaths/min R: profound respiratory depression may be caused by activation of mu and kappa receptors. Respiratory rate should remain about 12 breaths/min IV nitroglycerin (Tridil) is prescribed for Kristin. What is a primary goal of this medication? - Perfuse cardiac tissue by dilating coronary arteries R: Nitrates cause the coronary blood vessels to dilate, allowing improved oxygen delivery to cardiac muscle. In addition, nitrates cause systemic va sodilation, reducing the workload on the heart, which in turn reduces the myocardium's need for oxygen Kristin is scheduled for a stress echocardiogram. Which instructions should the nurse provide to Kristin prior to the test? - It is important to return to the exam table immediately after exercising R: This is important so the echocardiogram can be perfor med while the heart is still stressed from the exercise on the treadmill The nurse should immediately intervene to prevent violation of which client right? - The right to have information about the qualifications of caregivers R: The individuals in the g roup should wear name tags that clearly identify their roles, they should introduce themselves, and they should explain to Kristin why they would like to ask some questions. Clients have the right to privacy during examination and treatment, as well as the right to refuse observation why those not directly involved in their care The nurse should prepare Kristin for which adverse effect that can occur when a daily dose of transdermal nitroglycerin is started? - Dizziness R: Nitroglycerin is a nitrate, caus ing systemic vasodilation. This often leads to hypotension, which can cause Kristin to feel dizzy. She should be instructed to change positions slowly and to avoid prolonged standing. In addition, Kristin may experience tachycardia and a headache The prim ary HCP prescribes a continuous IV infusion of amiodarone (Cordarone) 1 mg/min for Kristin. The available drug is amiodarone (Cordarone) 900 mg in 500 mL of D5W. the nurse should set the IV pump at how many mL/hr? (Enter numerical value only. If rounding i s necessary, round to the whole number.) - 33 500/900= 0.555 0.555(60)= 33.3 33.3= 33 What is the best response by the nurse? - "Do you feel that you do not need to be involved in your health care?" R: clarification of the client's statement is a usef ul therapeutic technique that encourages further communication