Cardioversion is ordered for a client who remains in atrial fibrillation with a rapid ventricular response despite pharmacological intervention.  What action should the nurse plan to take to ensure safety and prevent complications of this procedure?

A 62 y/o male is arriving from EMS with chest pain.   Nurse’s Note:  12/16/20xx 1010: 62 y/o male c/o crushing sternal pain, radiating down the left arm. States the pain becomes worse with activity and started approximately two hours ago while shoveling snow. Patient states he is also short of breath with activity. Pt is ALOx3. Lungs clear throughout. Abd soft, nontender, bowel sounds active. Pt states urinary output is “normal” with no c/o of odor, pain, pressure. Skin is C/D/I. 18G in the left forearm.      Vital Signs:  98.4 F, HR – 99, RR – 18, BP 162/89, Pulse Ox: 93% on RA  ECG:  Sinus Tachycardia rate 99 bpm. ST elevation noted in V3 and V4  Laboratory Results:  Lab  Results  Reference Range:  WBC  9 x 10^3 cells/mm3  4500–11,000/mm3  RBC  5.3 × 106/μL  4.7-6.1 × 106/μL  Hgb  15.8 g/dL  Male: 14–17.4 g/dL  Hct  44%  Male: 42–52%  Plts  254,000/mm3  140,000–400,000/mm3  Na  144 mEq/L  135-147 mEq/L  Cl  104 mEq/L  95-106 mEq/L  K  4.8 mEq/L  3.5-5.3 mEq/L  CO2  29 mEq/L  22-30 mEq/L  BUN  12 mg/dL  6-20 mg/dL  Cr  1.1 mg/dL  0.6-1.3 mg/dL  Troponin T  0.7 ng/mL  0-0.04 ng/mL  Creatine Kinase MB (CK-MB)  187 IU/L  5-25 IU/L  Cholesterol  265 mg/dL  240 high  The nurse completes the following H&P: H&P:  62 y/o male lives independently at home with spouse of 40 years. Came in on 12/16/23 after shoveling snow c/o crushing sternal pain, radiating down the left arm. States he stopped shoveling after 30mins of pain, and the pain continued. The pain becomes worse with activity and started approximately two hours ago. Patient states he also became short of breath with activity.   Wt: 102.3 kgs  Ht: 5’9”  BMI: 33.2  PMH: DMII, HDL, GERD, Asthma, Sleep apnea, Smoker 1/2 pack per day  Family Hx:  Mother – Alive – DMII, CAD, CHF, COPD  Father – Deceased at 52 – MI, CAD  Sibling – Alive – CAD, DMII   Diet: High in carbohydrates, protein; poor in fresh fruits/vegetables.   Occupation: Owns own business – landscaping   The nurse should recognize that the patient is most likely experiencing a ____blank 1____ (ST elevated myocardial infarction, non-ST elevated myocardial infarction, Printzmetal’s angina) caused by coronary artery ____blank 2____ (spasm, rupture, blockage).   _______ _______

A client is prescribed enalapril. Which of the following demonstrate the medication is promoting the desired outcomes?

A client post myocardial infarction is placed on a Heparin drip.  What is the purpose of this infusion?

A client is ordered Eptifibatide.  What would be an important assessment prior to the infusion?

A 62 y/o male is arriving from EMS with chest pain.   Nurse’s Note:  12/16/23 1010: 62 y/o male c/o crushing sternal pain, radiating down the left arm. States the pain becomes worse with activity and started approximately two hours ago while shoveling snow. Patient states he is also short of breath with activity. Pt is ALOx3. Lungs clear throughout. Abd soft, nontender, bowel sounds active. Pt states urinary output is “normal” with no c/o of odor, pain, pressure. Skin is C/D/I. 18G in the left forearm.      Vital Signs:  98.4 F, HR – 99, RR – 18, BP 162/89, Pulse Ox: 93% on RA    ECG:  Sinus Tachycardia rate 99 bpm. ST elevation noted in V3 and V4    Laboratory Results:  Lab  Results  Reference Range:  WBC  9 x 10^3 cells/mm3  4500–11,000/mm3  RBC  5.3 × 106/μL  4.7-6.1 × 106/μL  Hgb  15.8 g/dL  Male: 14–17.4 g/dL  Hct  44%  Male: 42–52%  Plts  254,000/mm3  140,000–400,000/mm3  Na  144 mEq/L  135-147 mEq/L  Cl  104 mEq/L  95-106 mEq/L  K  4.8 mEq/L  3.5-5.3 mEq/L  CO2  29 mEq/L  22-30 mEq/L  BUN  12 mg/dL  6-20 mg/dL  Cr  1.1 mg/dL  0.6-1.3 mg/dL  Troponin T  0.7 ng/mL  0-0.04 ng/mL  Creatine Kinase MB (CK-MB)  187 IU/L  5-25 IU/L  Cholesterol  265 mg/dL  240 high    H&P:  62 y/o male lives independently at home with spouse of 40 years. Came in on 12/16/23 after shoveling snow c/o crushing sternal pain, radiating down the left arm. States he stopped shoveling after 30mins of pain, and the pain continued. The pain becomes worse with activity and started approximately two hours ago. Patient states he also became short of breath with activity.     Wt: 102.3 kgs  Ht: 5’9”  BMI: 33.2    PMH: DMII, HLD, GERD, Asthma, Sleep apnea, Smoker 1/2 pack per day    Family Hx:  Mother – Alive – DMII, CAD, CHF, COPD  Father – Deceased at 52 – MI, CAD  Sibling – Alive – CAD, DMII     Diet: High in carbohydrates, protein; poor in fresh fruits/vegetables.     Occupation: Owns own business – landscaping     Order:  Morphine 0.5mg IV  Aspirin 325mg PO  Nitroglycerin – titrate gtt per protocol  Metoprolol 50mg PO  Oxygen Therapy- maintain O2 > 92%, up to 6L  Thrombolytic Therapy per protocol  Monitor neuro status  Insert 2nd IV  What is the nurse’s priority action?  

A client is prescribed Diltiazem.  Which of the following is a therapeutic effect of this medication?

The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include?

The nurse is caring for a client who has just undergone cardiac angiography. What is most important for the nurse to teach the client?

The signs/symptoms of alterations in which of the following laboratory values may be blocked in a client taking metoprolol?