The nurse is reviewing laboratory values of a client who was discharged two weeks ago after experiencing a myocardial infarction. Which finding most requires follow-up with the client?
Reference Range:
- Triglycerides [40 to 160 mg/dL (0.45 to 1.81 mmol/L)]
- Lipase [0 to 160 units/L (0 to 2.67 μkat/L)]
- Low-density lipoproteins (LDL) [less than 130 mg/dL (3.36 mmol/L)]
- High-density lipoproteins (HDL) [greater than 45 mg/dL (greater than 1.16 mmol/L)]
Low-density lipoproteins (LDL) 185 mg/dL (4.79 mmol/L).
Triglycerides 155 mg/dL (1.75 mmol/L).
Lipase 50 units/L (0.83 μkat/L).
High-density lipoproteins (HDL) 60 mg/dL (1.55 mmol/L).
The Correct Answer is A
A. Low-density lipoproteins (LDL) 185 mg/dL (4.79 mmol/L): This LDL value is significantly above the recommended level for a client with a history of myocardial infarction. Elevated LDL contributes to atherosclerotic plaque formation and increases the risk of further cardiac events.
B. Triglycerides 155 mg/dL (1.75 mmol/L): Although this value is at the higher end of the normal range, it is still within acceptable limits. While elevated triglycerides are a cardiovascular risk factor, this level alone does not require urgent follow-up.
C. Lipase 50 units/L (0.83 μkat/L): This lipase level is well within the normal range and is not relevant to cardiac health. Lipase is typically used to evaluate pancreatic function and has no direct bearing on post-myocardial infarction follow-up.
D. High-density lipoproteins (HDL) 60 mg/dL (1.55 mmol/L): This HDL value is above the recommended minimum and is actually considered protective against heart disease. No follow-up is needed for this value, as it reflects favorable cardiovascular risk status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bleeding from needle puncture sites: Minor bleeding is a common and expected side effect of tPA therapy. Although it should be monitored closely, it is not as urgent as signs of potential internal or cerebral bleeding, which require immediate action.
B. T wave inversion in leads II, III, aVF: T wave inversion may occur during the evolution of a myocardial infarction and after reperfusion. While it reflects changes in myocardial repolarization, it is not as critical as neurological changes.
C. Change in level of consciousness: A sudden change in LOC may indicate intracranial hemorrhage, the most severe and life-threatening complication of thrombolytic therapy. This finding requires immediate cessation of the tPA infusion and emergency evaluation.
D. Multifocal premature ventricular contractions (PVCs): Multifocal PVCs suggest ventricular irritability and require monitoring, especially post-MI. However, they are less urgent than neurological symptoms that could signal a catastrophic bleeding.
Correct Answer is A
Explanation
A. Assess oxygenation status: Palpitations and a rapid heart rate indicate tachycardia as evidenced by sinus tachycardia shown in the strip. The first nursing priority is to assess oxygenation, as hypoxia can trigger or worsen arrhythmias. Supplemental oxygen may be needed based on this assessment.
B. Administer IV atropine: Atropine is used to treat symptomatic bradycardia, not tachycardia. In this case, where the heart is racing, and ECG shows tachycardia, atropine would not be appropriate and could worsen the condition by increasing the heart rate further.
C. Prepare for a transcutaneous pacemaker: Transcutaneous pacing is indicated for unstable bradyarrhythmias, especially complete heart block or symptomatic sinus node dysfunction. It is not appropriate for a client who is experiencing tachycardia.
D. Administer IV heparin infusion: Heparin is an anticoagulant used to prevent or treat blood clots. It is not a primary intervention for managing sinus tachycardia. While some cardiac conditions might involve heparin, it's not the immediate and direct intervention for the rhythm shown or the patient's primary complaint of palpitations.
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