PART 1 Read the simulation below and

PART 1 Read the simulation below and answer the following questions: George Jones is a 59-year-old male who went to the emergency department with chest pain. He had experienced this chest pain for 30 minutes and it was not relieved after taking three nitroglycerin tablets 5 minutes apart. He reports the pain feels “dull and like an elephant is sitting on my chest.” He is diaphoretic and appears anxious. His vital signs are temperature 99° F, blood pressure 100/68 mm Hg, heart rate 110 beats/min, and respiratory rate 24 breaths/min. Mr. Jones is overweight and has type 2 diabetes mellitus, hyperlipidemia, and hypertension. He quit smoking last year after a 40-year history of one pack of cigarettes a day. His troponin level is elevated and the EKG shows ST segment elevation. The nurse administers oxygen and draws blood for arterial blood gas analysis. Mr. Jones is told he will have a cardiac catheterization to locate the blockage, determine its severity, and evaluate left ventricular function. As you assess your patient here are your findings. Assessment Neuro assessment negative. No deficits. Strength equal and strong. Lung Sounds (crackles bilaterally) Pedal Edema (2+ pitting) Resp rate = 30 with Dyspnea Oxygen saturations (89%) I&O (I=300 O=50) Foley (dark amber 50ml) Vitals B/P = 170/90 Pulse = 130 Resp = 30 Pulse points (all present) Chest pain (yes) Telemetry = Sinus Tachycardia with S-T elevation Troponin Level = 0.45ng/mL Weight up 5 lbs from last week) Left groin (ok, no bruising or oozing) Pedal Pulses 2+ Color of toes (pale pink) Warmth of toes (slightly cool) QUESTIONS 1. What are you thinking is going on with this patient and what rationale do you have for your thought process? (hint….there are actually 2 exemplars occurring considering the symptoms exhibited with your assessment). 2. What medications do you anticipate will be ordered and why would they be ordered? (What would be the goal of the medication) PART 2 (Multiple Choice)NOTE: This part has nothing to do with the scenario in part 1. 3. The nurse is reinforcing teaching for a patient who is to wear a Holter monitor. Which of the following should the nurse include? (Select all that apply.) A. Avoid strenuous activity B. Take nothing by mouth for 6 hours before applying the monitor. C. Avoid intake of food or liquid 24 hours after application of device D. Keep an accurate diary of symptoms and activities E. Push the event button when symptoms occurr 4. Your client is asking you about the Troponin lab test. What is your best response? A. Troponin is a protein found in all healthy clients B. Lab results are the primary treatment for cardiac disease C. Troponin tests have a specific time frame so its is important you have taken at your at your earliest convenience D. An elevation (even if small) will indicate to your care provider that immediate treatment is needed. 5. The provider has told the client that she must reduce the amount of stress in her life because it is having a negative effect on her heart. When the provider leaves the room, the client asks the nurse why stress would affect her heart. The nurse best responds by explaining: A. “Stress causes a release of chemicals that cause blood vessels to narrow and heart rate to increase.” B. “Doctors feel women’s problems are caused by stress.” C. “Exercise raises blood pressure, which puts you at increased risk of heart disease.” D. “Stress causes the release of chemicals that destroy the liver, and this impacts the heart.” 6. The nurse is caring for a client who has been prescribed aspirin (Ecotrin) 325 mg PO daily. Which of the following should the nurse recognize as a possible side effect related to this medication? A. Constipation B. light- headedness C. gastric ulcers D. polyuria 7. The nurse determines that the client with venous stasis ulcers understood dietary teaching to promote healing when the client says: A. I need to decrease my carbohydrate intake. B. I have reduced my sugar intake. C. I have increased my protein intake D I have decreased my fat intake 8. The nurse is collecting data on a patient with a potentially leaking aortic aneurysm due to hypertension. Which of these manifestations would the nurse expect to find? Paralysis B. Chest Pain C. Ankle edema D. Back pain 9. Match the medication to the appropriate description Simvastin, propranolol, Lisinopril, Bumex, Norvasc Beta Blockers, 2. Lipid Lowering agent, 3. Loop Diuretic, 4. Calcium Channel Blocker. 5. Ace Inhibitor 10. Which of the following statements would tell the nurse that more teaching is necessary in regard to the medication Bumex? A. I will take the medication when I am awake B. I will rise slowly C. I should limit my potassium intake D. The medication will make me urinate, 11. A nurse is assisting in the plan of care for a client who had a surgical placement of a synthetic graft to repair an aneurysm. Which of the following interventions should the nurse include in the plan of care? A. Assess pedal pulses B. Monitor for an increase in pain below the graft C. Maintain client in high-Fowler’s position D. Administer prescribed antiplatelet agents E. Report an hourly urine output of 60 mL

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