You are working at the local cardiac rehabilitation center and R.M. is walking around the track. He summons you and asks if you could help him understand his recent laboratory report
He admits to being confused by the overwhelming data on the test and does not understand how the results relate to his
recent heart attack and need for a stent. You take a moment to locate his laboratory reports and review
his history. The findings are as follows.
R.M. is an active 61-year-old man who works full time for the postal service. He walks 3 miles every
other day and admits he doesn't eat a "perfect diet." He enjoys two or three beers every night, uses stick
margarine, eats red meat two or three times per week, and is a self-professed "sweet eater." He has tried
to quit smoking and is down to one pack per day. Cardiac history includes a recent inferior myocardial
infarction (MI) and a heart catheterization revealing three-vessel disease: in the left anterior descending
(LAD) coronary artery, a proximal 60% lesion; in the right coronary artery (RCA), proximal 100% occlusion
with thrombus; and a circumflex with 40% to 60% diffuse dilated lesions. A stent was deployed to the RCA
and reduced the lesion to 0% residual stenosis. He has had no need for sublingual nitroglycerin (NTG).
He was discharged on enteric-coated aspirin 325 mg daily, clopidogrel (Plavix) 75 mg daily, atorvastatin
(Lipitor) 10 mg at bedtime, and ramipril (Altace) 10 mg/day. Six weeks after his MI and stent placement, he
had a fasting advanced lipid profile with other blood work.
Six-Week Postprocedure Laboratory Work (Fasting)
Total cholesterol 188 mg/dL
HDL 34 mg/dL
LDL 98 mg/dL
Triglycerides 176 mg/dL
Homocysteine 18 mmol/dL
High-sensitivity C-reactive protein (hsCRP) 8 mg/dL
FBG 99 mg/dL
TSH 1.04 mU/L
When you start to discuss R.M.'s laboratory values with him, he is pleased about his results.
"My cholesterol level is below 200!—and my 'bad cholesterol' is good! That's good news,
right?" What would you say to him?
He needs further information! After review of his HDL and triglyceride levels, there is still more work
to be done. You might explain, "LDL particles are small, dense particles that transport fat into the
walls of the arteries, promoting atherosclerosis. LDL levels, when elevated, are positively correlated
to coronary artery disease. That is why LDL is often called the 'bad cholesterol.' HDL, however, has a
protective action, when levels are sufficient. Your HDL is too low (should be above 40 mg/dL), which
decreases your protection from plaque formation. In addition, your triglyceride level should be
below 150 mg/dL. When triglycerides are elevated, then triglycerides are deposited into the fatty
tissues. You need to work on reducing your triglyceride level and increasing your HDL levels."
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A newly diagnosed type I, insulin-dependent diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:
1. "Your baby may be smaller than average at birth." 2. "Your baby will probably be larger than average at birth." 3. "As long as you control your blood sugar, your baby will not be affected at all." 4. "Your baby might have high blood sugar for several days."
To assure effectiveness, when should the nurse stop rubbing antiseptic hand solution over all surfaces of the hands?
a. When fingers feel sticky b. After 5 to 10 seconds c. When leaving the client's room d. Once fingers and hands feel dry
The family member of a patient asks if vitamin C will prevent aging. In formulating an appropriate response, the nurse considers the:
a. Free radical theory b. Immunity theory c. Clinker theory d. Continuity theory
The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes what intervention?
a. Place a cool compress on eye during transport to the emergency department. b. Irrigate the eye copiously with a sterile saline solution. c. Remove the object with a lightly moistened gauze pad. d. Apply a Fox shield to the affected eye and any type of patch to the other eye.