Nokea
The clinic nurse is caring for a 38-year-old male
Item 6 of 6
Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.
Physician Orders
• 12-lead electrocardiogram (ECG)
• atenolol 25 mg by mouth daily
• pitavastatin 1 mg by mouth daily
• fenofibrate 45 mg by mouth daily with food
The nurse performs education regarding metabolic syndrome and reminds the client to return in six weeks for a follow-up appointment. Click to specify the self-management goals for this client. Note: Each row must have one (1) response option selected
- A. Reduction in the HDL cholesterol
- B. Moderate exercise at least 150 minutes a week
- C. Reduce the consumption of complex carbohydrates
- D. Increase the intake of fiber-containing foods
- E. Reduction in psychosocial stressors
Correct Answer: B,D,E
Rationale: Moderate exercise (150 minutes/week), increased fiber intake, and stress reduction are appropriate goals for managing metabolic syndrome. Reducing HDL is undesirable, and complex carbohydrates should not be broadly reduced.
You may also like to solve these questions
The nurse has taught a client who has been prescribed nitroglycerin transdermal. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. It is okay for me to apply this patch to the area that has been shaven.
- B. This patch should be removed for 4 to 6 hours to avoid me developing a tolerance.
- C. It is okay for me to wear this patch while I shower.
- D. I should apply this patch below my knee to lessen my chance of getting a headache.
Correct Answer: A
Rationale: Applying a nitroglycerin transdermal patch to a shaved area ensures good adhesion and absorption, indicating correct understanding. Nitroglycerin patches are typically removed for 10-12 hours to prevent tolerance, not 4-6 hours. While water-resistant, applying below the knee is not standard and does not reduce headache risk.
The nurse has received a prescription for rivaroxaban. The nurse understands that this medication is prescribed to treat which condition?
- A. Pulmonary Hypertension
- B. Venous Thromboembolism (VTE)
- C. Congestive Heart Failure
- D. Hyperlipidemia
Correct Answer: B
Rationale: Rivaroxaban, a direct oral anticoagulant, is used to treat venous thromboembolism (VTE). It is not indicated for pulmonary hypertension, CHF, or hyperlipidemia.
The nurse is answering phones in the general practice clinic and receives a call from a client who is experiencing leg pain after starting atorvastatin. Which of the following should the nurse advise the client to do?
- A. Continue taking the medication as this is an expected side effect.
- B. Discontinue the medication and schedule an appointment for the next week.
- C. Stretch for 20 minutes or take a warm shower.
- D. Discontinue the medication and go to the emergency room as soon as possible.
Correct Answer: D
Rationale: Leg pain with atorvastatin may indicate myopathy or rhabdomyolysis, a serious side effect requiring immediate discontinuation and emergency evaluation.
The clinic nurse is caring for a 38-year-old male
Item 4 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.
The nurse reviews the physician's progress notes and formulates a care plan. For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. glycated hemoglobin (a1c) test
- B. antihypertensive medication
- C. consultation with occupational therapy
- D. consultation with dietician/nutritionist
- E. daily weights
- F. 12-lead electrocardiogram (ECG)
- G. serum cardiac enzymes
Correct Answer: A,B,D,F
Rationale: A1C test (to confirm diabetes risk given high glucose), antihypertensive medication (for hypertension), dietician consultation (for dietary changes), and ECG (to assess cardiac status) are indicated. Occupational therapy, daily weights, and cardiac enzymes are not necessary without specific indications.
The nurse is preparing to administer prescribed bumetanide to a client. Which clinical finding would indicate a therapeutic outcome?
- A. Increase in central venous pressure (CVP)
- B. Reduced cardiac preload and wall tension
- C. Decreased glomerular filtration rate (GFR)
- D. Increase in systemic vascular resistance (SVR)
Correct Answer: B
Rationale: Bumetanide, a loop diuretic, reduces fluid volume, leading to decreased cardiac preload and wall tension, indicating a therapeutic outcome in conditions like heart failure. Increased CVP, decreased GFR, or increased SVR are not desired effects.