The nurse is reviewing the client’s laboratory values. Which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

The client is at immediate risk for developing Cardiac arrest, Anaphylaxis, and Arrhythmias.

Choice A: Peripheral Edema

Peripheral edema refers to the swelling of tissues, usually in the lower limbs, due to the accumulation of fluid. While peripheral edema can be a concern in patients with heart conditions, it is not an immediate risk in the context of the patient’s current situation. The primary concerns for this patient, given her history of symptomatic bradycardia and atrial fibrillation, are more acute and life-threatening conditions such as cardiac arrest, anaphylaxis, and arrhythmias. Peripheral edema is typically a chronic condition that develops over time and is not considered an emergent risk in this scenario.

Choice B: Renal Failure

Renal failure, or kidney failure, is a condition where the kidneys lose their ability to filter waste from the blood effectively. While renal failure can be a serious complication, it is not an immediate risk for this patient. The patient’s primary issues are related to her cardiovascular system, specifically her low heart rate and history of atrial fibrillation. The immediate risks in this scenario are more likely to be related to acute cardiovascular events rather than renal complications. Additionally, there is no indication in the patient’s history or current treatment that suggests an imminent risk of renal failure.

Choice C: Necrosis

Necrosis refers to the death of body tissue due to a lack of blood flow or infection. While necrosis can occur in severe cases of prolonged ischemia or infection, it is not an immediate risk for this patient. The patient’s current condition and treatment plan do not indicate a high risk of tissue necrosis. The more pressing concerns are related to her cardiovascular health, specifically the risk of cardiac arrest, anaphylaxis, and arrhythmias. These conditions are more likely to occur suddenly and require immediate medical intervention.

Choice D: Cardiac Arrest

Cardiac arrest is a sudden loss of heart function, leading to a cessation of blood flow to the body’s organs. Given the patient’s history of symptomatic bradycardia and atrial fibrillation, she is at a high risk of developing cardiac arrest. Bradycardia can lead to insufficient blood flow and oxygen delivery to vital organs, potentially resulting in cardiac arrest. Additionally, the stress of the upcoming procedure and the discontinuation of anticoagulants can further increase this risk. Therefore, cardiac arrest is a significant immediate risk for this patient and requires close monitoring and preparedness for emergency intervention.

Choice E: Anaphylaxis

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur rapidly. The patient is receiving vancomycin, which is known to cause hypersensitivity reactions, including anaphylaxis, in some individuals. Symptoms of anaphylaxis include difficulty breathing, swelling, hives, and a drop in blood pressure. Given the patient’s current infusion of vancomycin, she is at risk for developing anaphylaxis, which requires immediate medical attention to prevent severe complications or death. The nurse must be vigilant for signs of anaphylaxis and be prepared to administer emergency treatment if necessary.

Choice F: Arrhythmias

Arrhythmias are irregular heartbeats that can range from benign to life-threatening. The patient has a history of atrial fibrillation, a type of arrhythmia, and symptomatic bradycardia, both of which put her at risk for developing further arrhythmias. The stress of the upcoming procedure, changes in medication, and the underlying heart conditions all contribute to the risk of arrhythmias. These irregular heartbeats can lead to decreased cardiac output, syncope, or even progression to more severe arrhythmias like ventricular fibrillation, which can be fatal. Therefore, arrhythmias are an immediate risk for this patient and require continuous cardiac monitoring and readiness to intervene.

Choice A Reason:

Providing a PRN NSAID for gum discomfort is not advisable in this situation. NSAIDs can increase the risk of bleeding, which is already a concern for a client on anticoagulants. Therefore, this action could exacerbate the client’s condition and should be avoided.

Choice B Reason:

Obtaining a soft bristle toothbrush for the client is a good practice to help minimize gum irritation and bleeding. Soft bristle toothbrushes are gentler on the gums and can help prevent further bleeding and discomfort, making this a suitable action for the nurse to implement.

Choice C Reason:

Reviewing the most recent coagulation lab values is crucial in this scenario. Coagulation tests, such as INR (International Normalized Ratio) or aPTT (activated partial thromboplastin time), can help determine if the anticoagulant dosage is appropriate or if adjustments are needed. This step is essential to ensure the client’s safety and effective management of their anticoagulation therapy.

Choice D Reason:

Completing a medication variance report is not immediately necessary unless there is evidence of a medication error. The priority should be to address the client’s symptoms and ensure their safety. While documentation is important, it should not take precedence over direct patient care in this situation.

Choice E Reason:

Reporting findings to the healthcare provider is essential. The development of bleeding and new bruises indicates a potential adverse reaction to the anticoagulant. The healthcare provider needs to be informed to assess the situation, possibly adjust the medication, and provide further instructions for managing the client’s condition.