Author Question: A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. ... (Read 94 times)

dbose · **on:** Jul 23, 2018

A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina.

The patient's BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient? a. An antihypertensive medication
b. Counseling about a weight loss diet
c. Discontinuing the ACE inhibitor
d. High-dose statin therapy

Question 2

A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted.

At this point, the nurse will expect the provider to: a. change the regimen to a two-drug contin-uation phase.
b. continue the four-drug regimen and re-check the sputum in 2 weeks.
c. obtain a chest radiograph and consider adding another drug to the regimen.
d. question the patient about adherence to the drug regimen.

aidanmbrowne · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

D
To help prevent recurrence of MI in patients post-STEMI, a high-dose statin should be given to patients with elevated cholesterol. This patient's blood pressure and BMI are normal, so antihy-pertensives and a weight loss diet are not recommended. The three drugs should be continued indefinitely.

Answer to Question 2

B
In patients with positive pretreatment sputum test results, sputum should be evaluated every 2 to 4 weeks until cultures are negative and then monthly thereafter. In the absence of drug resistance, treatment with the same regimen should continue. Sputum cultures should become negative in over 90 of patients in 3 or more months. The induction phase should last 2 months, so this pa-tient should remain on a four-drug regimen. It is not necessary to order a chest radiograph or to add another drug at this stage of treatment. The patient is stable and has not developed symptoms that cause concern, so the patient does not need to be questioned about adherence.