CARDIAC CASE STUDY NGN WITH QUESTIONS AND WELL VERIFIED ANSWERS [GRADED A+] ACTUAL EXAM 100%

CARDIAC CASE STUDY
NGN WITH QUESTIONS
AND WELL VERIFIED
ANSWERS [GRADED A+]
ACTUAL EXAM 100%
A 49-year-old client is seen in clinic for a follow-up visit since starting
enalapril for primary hypertension at her last visit 1 month ago. She reports
nausea and diarrhea for the past few weeks and is not sure what is causing
these symptoms because she has implemented various lifestyle changes.
She has a medical history significant for dyslipidemia, which is treated with
simvastatin, and type 2 diabetes mellitus, which is managed with insulin.
Since her last visit, she has increased exercise, uses potassium
supplements instead of sodium when cooking, and has eliminated alcohol.
Vital signs are temperature of 98.6°F (37°C), heart rate of 80 beats per
minute, respiratory rate of 20 breaths per minute, blood pressure of 126/78,
and pulse oximetry reading of 97%. - ANS✔✔---Laboratory Value
Today's Result
Result From 1 Month Ago
Reference Range
Alanine aminotransferase (ALT)
17 U/L
19 U/L
4 to 36 U/L
Aspartate aminotransferase (AST)
20 U/L
21 U/L
0 to 35 U/L
Serum creatinine (Scr)
0.9 mg/dL
1.0 mg/dL
0.5 to 1.1 mg/dL
Potassium
5.2 mEq/L
4.9 mEq/L
3.5 to 5.0 mEq/L
The patient developed HYPERKALEMIA - ANS✔✔---As evidence by
change in POTASSIUM
Rationale - ANS✔✔---Angiotensin-converting enzyme (ACE) inhibitors,
such as enalapril, may cause hyperkalemia or elevated potassium levels
secondary to suppression of aldosterone release. This client has developed
hyperkalemia, as noted by the increase in the client's potassium level (i.e.,
from 4.9 mEq/L to 5.2 mEq/L), which is now above the upper limit of normal
(i.e., 5.0 mEq/L). Additionally, the client has reported nausea and diarrhea,
symptoms suggestive of hyperkalemia, within the time frame of initiating
enalapril and lifestyle changes. Notably, the client reports using potassium
supplements instead of sodium for cooking as a means of reducing her
sodium intake. Clients who are started on ACE inhibitors should be advised
to avoid salt substitutes that contain potassium in order to reduce the risk
for hyperkalemia. In addition to her current symptoms, hyperkalemia may
cause cardiovascular effects, such as abnormal heart rhythms, which can
potentially be fatal. The client does not have evidence of liver dysfunction
because her AST and ALT values are within normal limits. The client also
does not have evidence of renal impairment. Her serum creatinine remains
within the normal range. The client does not have uncontrolled
hypertension because her blood pressure reading is not elevated according
to the various evidence-based blood pressure goals.
Patient 2
Glucose
Today: 89 mg/dL
Last: 84 mg/dL
GOAL: 74 to 106 mg/dL
Serum creatinine (Scr)
1.0 mg/dL
1.1 mg/dL
0.5 to 1.1 mg/dL
Potassium
4.4 mEq/L
4.2 mEq/L
3.5 to 5.0 mEq/L - ANS✔✔---A client returns for a follow-up visit after the
initiation of metoprolol tartrate 25 mg PO BID at his last visit 4 weeks ago.
The client reports some sleep disturbances but denies any other
symptoms. He has brought his home blood pressure and heart rate
readings from this last week. Current vital signs are temperature of 97.6°F
(36.4°C), heart rate of 56 beats per minute (bpm), respiratory rate of 18
breaths per minute, blood pressure of 128/74, and pulse oximetry reading
of 99%. At his last visit, his vital signs were temperature of 98.1°F (36.7°C),
heart rate of 80 bpm, respiratory rate of 19 breaths per minute, blood
pressure of 142/90, and pulse oximetry reading of 99%.
For each client parameter, click to indicate whether findings from this client
would indicate an anticipated/expected response to or effect of treatment
with metoprolol tartrate or if the finding is not anticipated/expected with
metoprolol tartrate therapy. - ANS✔✔---
Expected: - ANS✔✔---Blood Pressure
Heart Rate
Reports Sleep disturbances
Not expected: - ANS✔✔---Potassium Levels
Glucose Levels