After receiving change-of-shift report about the following four clients, which client should the nurse assess first?

56-year-old client with chronic stable angina who is due to receive a dose of nifedipine.

59-year-old with unstable angina who has just returned to the unit after having a heart catheterization with balloon angioplasty.

65-year-old who had a myocardial infarction (MI) 4days ago and is anxious about the planned discharge.

Client who is post coronary artery bypass, with potassium 4.2 mEq/L.

Answer and Explanation

The Correct Answer is B

A. A stable client with chronic angina is not in immediate danger, and the scheduled dose of nifedipine is not an urgent priority.

B. The client with unstable angina who has just undergone a heart catheterization with balloon angioplasty requires immediate assessment for complications such as bleeding, clot formation, or re-occlusion of the artery.

C. The 65-year-old post-MI client is stable, and while their anxiety is important to address, it is not an immediate concern compared to other clients.

D. The client post-coronary artery bypass with a potassium level of 4.2 mEq/L is stable and does not require urgent intervention.

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Correct Answer is C

Explanation

A. Mild hyponatremia (Sodium < 135 mEq/L) typically does not produce distinctive ECG changes. This value is unlikely to correlate with the presence of U waves.

B. Hyperkalemia (Potassium > 5.0 mEq/L) is associated with peaked T waves, widened QRS complexes, and flattened or absent P waves, not U waves.

C. Hypokalemia (Potassium < 3.5 mEq/L) is the primary cause of U waves. A potassium level of 2.1 mEq/L is significantly low and can result in ECG changes, including U waves, ST segment depression, and prolonged QT intervals. These changes reflect altered ventricular repolarization.

D. Hypermagnesemia (Magnesium > 2.5 mEq/L) can cause ECG changes such as prolonged PR and QRS intervals, bradycardia, and heart block. However, such an extreme magnesium level of 18 mEq/L would cause severe toxicity and is not associated with U waves.

A. "I will avoid sources of strong electromagnetic fields." B. "Now I can discontinue my antidysrhythmic medication." C. "I would participate in a strenuous exercise program." D. "I would wear a snug-fitting shirt over the ICD."

Correct Answer is A

Explanation

A. Clients with ICDs should avoid strong electromagnetic fields, which can interfere with the device’s function. This is crucial for safety.

B. Discontinuing antidysrhythmic medication is not recommended unless instructed by the healthcare provider, as it could increase the risk of arrhythmias.

C. Strenuous exercise may be too strenuous for someone with an ICD and could increase the risk of arrhythmias or lead to ICD activation.

D. A snug-fitting shirt is generally not recommended because it may place pressure on the ICD site and cause discomfort.

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After receiving change-of-shift report about the following four clients, which client should the nurse assess first?

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