Resource: Hinkle & Cheever, 14th edition, Chapter 27, pp. 769-770 The RN would expect which of these laboratory test results to be elevated in a client with an acute myocardial infarction? Correct Answer: Serum CK-MB, WBC, and sedimentation rate. a.Values are increased after an MI, creatine kinase (CK-MB) is an enzyme that is cardiac specific; begins to increase in an hour and peaks in 24 hours; WBC (4,500 – 11,000) increases due to inflammation; sedimentation rate is the rate that RBCs settle in unclotted blood; rate increases during acute inflammatory process, infection, and tissue damage. b.BUN (5-25mg/dL) is elevated due to dehydration or renal failure; serum creatinine (0.5- 1.5) elevated due to renal failure, shock, cancer, hypertension, acute MI c.AST (SGOT) (8-38 U/L); enzyme found in heart and liver; elevated after MI or liver damage; RBCs carry hemoglobin; platelets (thrombocyte count) used to diagnose hemorrhagic diseases and thrombocytopenia. d.LDH an indicator of cardiac damage and is elevated longer than other cardiac enzymes; thyroxine (T4) is major hormone secreted by thyroid; endorphins are produced by brain and act as opiate and produce analgesic effect.Rationale:
Resource: Hinkle & Cheever, 14th edition, Chapter 27, pp. 764-765 A client who has diabetes and coronary artery disease is being started on Metoprolol. Which instruction about side effects will the RN include in the discharge plan?
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C.Stomach upset not a s/e. Resource: Hinkle & Cheever, 14th edition, Chapter 27, pp. 759 What assessment finding in the client taking warfarin would result in the RN collaborating with the primary care provider? Correct answer: INR 1.0 Rationale: Therapeutic INR is at least 2.0 -3.0. Therapeutic level for PT is 1.3 -1.5 of normal which is 9.5 - 12. PTT is not affected by warfarin, it is affected by heparin, 60-70 is normal for a PTT. Normal platelets ae 150,00-450,000 mm3 Resource: Hinkle & Cheever, 14thedition, Chapter 25, pp. 694; Burchum & Rosenthal, 10th edition, Chapter 52, pg. 613 A client presents in the emergency room reporting severe pain in the left leg that is not relieved by rest or medication. Which assessment would likely accompany this finding?
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Resource: Hinkle & Cheever, 14 th edition, Chapter 30, pg. 857-858 The RN is planning discharge teaching for a client with peripheral vascular disease. Which client behavior is essential to address for improved medical management?