Which of the following patients would be a candidate for insertion of an Implantable Cardioverter-Defibrillator (ICD)? Select all that apply.

Choice A rationale

While statin medications are vital for lipid management and stabilization of atherosclerotic plaques in patients with coronary artery disease, an acute change in angina pattern is a much more immediate and life-threatening concern than the need for a new medication order. Statin use is a long-term strategy, not a priority response to acute symptom change.

Choice B rationale

Medication non-adherence is a common cause of symptom recurrence or worsening, yet the described change—more intense and prolonged pain—is the clinical definition of unstable angina. This acute coronary syndrome requires immediate intervention to prevent myocardial infarction and supersedes assumptions about patient compliance.

Choice C rationale

The change in the patient's chronic stable angina—new onset of more intense, longer-lasting chest pain—is the hallmark presentation of unstable angina. This indicates a critical shift, often due to a non-occlusive thrombus forming on a ruptured atherosclerotic plaque, demanding immediate emergency evaluation and treatment to prevent myocardial infarction.

Choice D rationale

High sodium intake exacerbates hypertension and can worsen heart failure symptoms by causing fluid retention, increasing cardiac workload. While dietary habits are important, an acute change in anginal pain pattern, suggestive of plaque instability and impending ischemia, is a far more immediate and critical concern than dietary salt intake. —.

Choice A rationale

The patient's medication history is important to review after a shock to determine if any drugs (e.g., antiarrhythmics) need adjustment or if a proarrhythmic drug could have contributed to the episode. However, this is a secondary assessment; the immediate priority is determining if the shock restored stable circulation.

Choice B rationale

The ICD insertion site should be assessed for signs of infection, swelling, or hematoma, especially following a shock which can indicate a device malfunction or lead fracture. While necessary for device integrity and infection control, it is not the immediate priority over assessing the patient's cardiac function and stability.

Choice C rationale

The patient's emotional state, including anxiety or fear following a high-voltage shock, requires therapeutic support and debriefing. While critical for holistic care, addressing the psychosocial impact is not the first step; immediate focus must be placed on the physical stability and circulatory status.

Choice D rationale

The patient's hemodynamic status (e.g., blood pressure, heart rate, rhythm, O_2 saturation, level of consciousness) must be assessed first. A shock indicates a potentially life-threatening arrhythmia; the nurse must immediately confirm if the shock was effective in terminating the arrhythmia and whether the patient is now stable or requires further intervention. —.