The nurse prepares discharge instructions for a patient recovering from percutaneous transluminal coronary intervention (PTCI). What medication information should the nurse include with this teaching?
Ibuprofen.
Warfarin.
Plavix.
Heparin.
The Correct Answer is C
Choice A rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug that is generally discouraged immediately following a myocardial infarction or coronary intervention. It can increase the risk of cardiovascular events, such as reinfarction or stroke, by interfering with the antiplatelet effects of aspirin. Additionally, it may cause sodium retention and increase blood pressure, which adds unnecessary strain on the healing cardiac muscle. Patients are instead educated to use acetaminophen for minor pain management to avoid these risks.
Choice B rationale
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors, typically used for atrial fibrillation or prosthetic heart valves. While it prevents systemic emboli, it is not the standard medication for maintaining stent patency after a percutaneous transluminal coronary intervention. The primary concern after stent placement is platelet aggregation on the foreign metal surface. Warfarin alone does not adequately inhibit the specific pathways of platelet activation required to prevent acute or subacute stent thrombosis.
Choice C rationale
Plavix, or clopidogrel, is a P2Y12 receptor antagonist that inhibits platelet aggregation. Following percutaneous transluminal coronary intervention, especially with stent placement, dual antiplatelet therapy is essential. It prevents the formation of thrombi on the stent surface while the vessel wall undergoes endothelialization. Patients must be educated on the importance of strict adherence to this regimen to prevent catastrophic stent thrombosis. Common side effects include an increased risk of bruising and minor bleeding episodes.
Choice D rationale
Heparin is an intravenous or subcutaneous anticoagulant used in the acute hospital setting to provide immediate anticoagulation by potentiating antithrombin III. It is frequently used during the actual percutaneous procedure to prevent clotting on catheters and wires. However, it is not a discharge medication because it requires frequent monitoring of the partial thromboplastin time and is not available in a practical oral form. Long-term outpatient management relies on oral antiplatelet agents rather than heparin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Transcutaneous pacing is the immediate treatment of choice for symptomatic sinus bradycardia that does not respond to atropine. This non-invasive method delivers electrical impulses through large electrode pads placed on the chest and back to stimulate ventricular contraction. It serves as a crucial bridge until more definitive treatments, like a transvenous or permanent pacemaker, can be established. It is rapid to initiate and effective in maintaining an adequate heart rate and cardiac output.
Choice B rationale
An implanted or permanent pacemaker is a long-term solution for chronic or irreversible bradycardia, but it is not the immediate treatment for an acute, sudden-onset event in an unstable patient. The placement of a permanent device requires a surgical procedure and time for preparation. In an emergency where a patient is not responding to atropine, a faster, temporary method like transcutaneous pacing must be used first to stabilize the patient before considering a permanent implant.
Choice C rationale
An asynchronous defibrillator is used to deliver high-energy shocks to treat pulseless rhythms like ventricular fibrillation or pulseless ventricular tachycardia. It is not used for bradycardia, as the heart still has organized, albeit slow, electrical activity. Applying an unsynchronized shock to a patient with a pulse could induce a more dangerous rhythm, such as ventricular fibrillation, by hitting the T wave. Defibrillation is entirely inappropriate for a slow heart rate with a pulse.
Choice D rationale
Synchronized cardioversion is used to treat unstable tachydysrhythmias, such as supraventricular tachycardia or atrial fibrillation with a rapid ventricular response. The goal is to slow down or reset a fast heart rate. Using cardioversion on a patient with sinus bradycardia would be counterproductive and dangerous, as the patient's heart rate is already too slow. This intervention is designed to interrupt fast circuits, not to provide the regular stimulus needed to increase a slow rate.
Correct Answer is A
Explanation
Choice A rationale
The normal range for serum creatinine is approximately 0.6 to 1.2 mg/dL for adults. A value of 2.1 mg/dL is significantly elevated, indicating a reduction in the glomerular filtration rate and impaired renal function. In the context of a myocardial infarction, low cardiac output can lead to pre-renal azotemia or acute tubular necrosis. This elevation serves as a primary marker for the development of acute kidney injury, reflecting the kidneys' inability to clear metabolic waste effectively.
Choice B rationale
Serum osmolality represents the concentration of particles dissolved in the blood, with a normal range typically between 275 and 295 mOsm/kg H2O. A value of 290 mOsm/kg H2O is within the normal physiological limits. This indicates a stable balance of electrolytes and water in the plasma. Since the value is normal, it does not suggest an increased risk or current state of acute kidney injury or fluid volume disturbances that would damage renal tissue.
Choice C rationale
The normal range for serum magnesium is approximately 1.3 to 2.1 mEq/L. A magnesium level of 2.0 mEq/L is within the normal therapeutic range. While electrolyte imbalances can occur during renal failure, a normal magnesium level does not indicate an increased risk of acute kidney injury. Magnesium is primarily excreted by the kidneys, so while its level might rise if injury occurs, the current value of 2.0 mEq/L indicates that renal clearance is currently sufficient.
Choice D rationale
The normal range for blood urea nitrogen (BUN) is typically 10 to 20 mg/dL. A BUN of 20 mg/dL is at the upper limit of the normal range but is not considered an elevated finding that signifies acute kidney injury on its own. BUN can be influenced by protein intake, hydration status, and liver function. Without an accompanying elevation in creatinine, this normal BUN level does not suggest that the patient is at high risk for kidney failure.
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