The practical nurse (PN) is auscultating a client's heart sounds. Which abnormal heart sound should the PN report to the charge nurse? (Please listen to the audio file to select the option that applies.)

Elevations in troponin I and CK-MB levels indicate myocardial damage, which can result from insufficient blood supply to the heart muscle due to coronary artery disease. When the heart muscle is damaged, it can lead to abnormal electrical activity and rhythm disturbances, known as cardiac dysrhythmias. These dysrhythmias can be life-threatening and require immediate attention.

Transient ischemic attack (TIA) refers to a temporary interruption of blood flow to the brain, which is not directly related to the elevated troponin I and CK-MB levels. Therefore, monitoring neurological vital signs for TIA is not the most significant risk in this case.

Pulmonary embolism, while it is a serious condition, is not directly indicated by the elevated troponin I and CK-MB levels. Lifestyle modifications may be important for managing coronary artery disease but are not the most significant risk based on the given information.

Recurrent long-term angina pain and subsequent myocardial infarction (MI) may be a concern for the client with coronary artery disease, but the elevated troponin I and CK-MB levels suggest that myocardial damage has already occurred. The focus at this point would be on managing the acute myocardial damage and the risk of cardiac dysrhythmias.

Based on the provided information, the following components should be included in the treatment regimen for this client:

• Oral anti-diabetic:

  While oral medications are common in managing type 2 diabetes, the current information does not suggest immediate initiation of pharmacotherapy based solely on the random blood sugar result without further evaluation.

• Weight-reduction treatment: With a BMI of 28, the client is considered overweight. Weight reduction is an important aspect of managing diabetes and improving overall health. The treatment regimen should include strategies to promote weight loss, such as dietary modifications and increased physical activity.
• Exercise planning: Regular exercise is beneficial for managing diabetes and promoting overall health. The treatment regimen should include an exercise plan tailored to the client's abilities and preferences. This may involve aerobic exercises, strength training, and flexibility exercises.
• Nutrition education: Nutrition plays a crucial role in diabetes management. The client should receive education on healthy eating habits, portion control, carbohydrate counting, and the importance of a balanced diet. The treatment regimen should include ongoing nutrition education and support.

The following options should not be included in the treatment regimen for this client:

• Short-acting insulin: Based on the information provided, there is no indication for the immediate use of short-acting insulin in this client.
• Long-acting insulin: Similar to short-acting insulin, there is no indication for the immediate use of long-acting insulin in this client.
• Extra carbohydrates: Extra carbohydrates may not be necessary for this client unless prescribed by a healthcare professional to manage hypoglycemia or specific dietary needs.