Pharmacology Reasoning
Bradycardia
Suggested Answer Guidelines
Marilyn Fitch, 78 years old
Medication Categories: Concepts/Content:
Antidysrhythmics Assessment
ACE Inhibitors Drug-drug interactions
Beta Blockers Evaluation of desired outcomes
Statins Monitoring for adverse effects
Oral Anticoagulants Emergency treatment of dysrhythmias
Diuretics Client education
Electrolytes Psychosocial support
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23% X
Safety and Infection Control 9-15% X
Health Promotion and Maintenance 6-12% X
Psychosocial Integrity 6-12% X
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18% X
Reduction of Risk Potential 9-15% X
Physiological Adaptation 11-17% X
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN
,I. Initial Presentation:
Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart
failure and has NKDA. She was brought in by her daughter after Marilyn complained of feeling dizzy several
times this morning and then almost passed out at home. Marilyn has a six-month history of paroxysmal atrial
fibrillation. Her heart rate has been regular and she has had no episodic dizziness since she had a synchronized
cardioversion one week prior to this visit. Her initial VS in triage were: T: 98.9 F/37.2 C (oral) P: 52 R: 16 BP:
94/52 and O2 sat: 98% room air.
Personal/Social History:
Marilyn is a widow and lives alone in her own home. She denies smoking and admits to drinking one glass of
wine with her dinner.
1. What data from the histories are RELEVANT and must be NOTICED as clinically significant by
the nurse?(NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Hx of hypercholesteremia, hypertension, and Pt already has pre- existing conditions that can implicate heart
heart failure complications. Would support showing an intermittent A-Fib.
Felt dizzy several times this am Pt is elderly and having dizziness, can be a fall risk and may need
help with setting up home for safety measures if this is continuous.
6 mo Hx of intermittent A-Fib.
Will need to keep eye on this as it seems to be continuing even after
Had sync. Cardioversion 1 wk ago, heartbeat treatment for this.
regular and no dizziness since until today.
Seemed to work short term, but a-fib seems to be appearing again
Pulse: 52 BP 94/52 so we may need a longer-term treatment/ and /or a better treatment
plan for care.
Pulse and BP are sig. low but pt is also on ace inhibitor and beta
blocker. Need to keep watch on these values.
RELEVANT Data from Social History: Clinical Significance:
Lives alone as a widow Safety concern with her continually getting dizzy spells and
possible fall risks. Would want to evaluate home for safety
Drinks wine with dinner. precautions and adjustments for falls.
May want to see if doctor asks to limit the alcohol as pt is already
dizzy and a fall concern. Maybe only drink one glass when
someone is over for dinner. Family or friends. In case she becomes
dizzy afterwards.
As the nurse responsible for this patient, you promptly review the medical
history and current home medications in the medical record:
2. What is the RELATIONSHIP of the past medical history and current medications? Why is your patient
receiving these medications? (Which medication treats which condition? Draw lines to connect)
Medical History (PMH): Home Medications:
, Hypercholesteremia Apixaban 2.5 mg po bid
Hypertension Captopril 100 mg po BID daily
Heart failure Amiodarone 100 mg po bid
Atrial fibrillation Hydrochlorothiazide 50 mg po daily
Atorvastatin 10 mg po daily
Carvedilol 6.25 mg po bid
Applying your knowledge of pharmacology, to provide safe
patient care, answer the following essential information:
Bradycardia
Suggested Answer Guidelines
Marilyn Fitch, 78 years old
Medication Categories: Concepts/Content:
Antidysrhythmics Assessment
ACE Inhibitors Drug-drug interactions
Beta Blockers Evaluation of desired outcomes
Statins Monitoring for adverse effects
Oral Anticoagulants Emergency treatment of dysrhythmias
Diuretics Client education
Electrolytes Psychosocial support
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23% X
Safety and Infection Control 9-15% X
Health Promotion and Maintenance 6-12% X
Psychosocial Integrity 6-12% X
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18% X
Reduction of Risk Potential 9-15% X
Physiological Adaptation 11-17% X
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN
,I. Initial Presentation:
Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart
failure and has NKDA. She was brought in by her daughter after Marilyn complained of feeling dizzy several
times this morning and then almost passed out at home. Marilyn has a six-month history of paroxysmal atrial
fibrillation. Her heart rate has been regular and she has had no episodic dizziness since she had a synchronized
cardioversion one week prior to this visit. Her initial VS in triage were: T: 98.9 F/37.2 C (oral) P: 52 R: 16 BP:
94/52 and O2 sat: 98% room air.
Personal/Social History:
Marilyn is a widow and lives alone in her own home. She denies smoking and admits to drinking one glass of
wine with her dinner.
1. What data from the histories are RELEVANT and must be NOTICED as clinically significant by
the nurse?(NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Hx of hypercholesteremia, hypertension, and Pt already has pre- existing conditions that can implicate heart
heart failure complications. Would support showing an intermittent A-Fib.
Felt dizzy several times this am Pt is elderly and having dizziness, can be a fall risk and may need
help with setting up home for safety measures if this is continuous.
6 mo Hx of intermittent A-Fib.
Will need to keep eye on this as it seems to be continuing even after
Had sync. Cardioversion 1 wk ago, heartbeat treatment for this.
regular and no dizziness since until today.
Seemed to work short term, but a-fib seems to be appearing again
Pulse: 52 BP 94/52 so we may need a longer-term treatment/ and /or a better treatment
plan for care.
Pulse and BP are sig. low but pt is also on ace inhibitor and beta
blocker. Need to keep watch on these values.
RELEVANT Data from Social History: Clinical Significance:
Lives alone as a widow Safety concern with her continually getting dizzy spells and
possible fall risks. Would want to evaluate home for safety
Drinks wine with dinner. precautions and adjustments for falls.
May want to see if doctor asks to limit the alcohol as pt is already
dizzy and a fall concern. Maybe only drink one glass when
someone is over for dinner. Family or friends. In case she becomes
dizzy afterwards.
As the nurse responsible for this patient, you promptly review the medical
history and current home medications in the medical record:
2. What is the RELATIONSHIP of the past medical history and current medications? Why is your patient
receiving these medications? (Which medication treats which condition? Draw lines to connect)
Medical History (PMH): Home Medications:
, Hypercholesteremia Apixaban 2.5 mg po bid
Hypertension Captopril 100 mg po BID daily
Heart failure Amiodarone 100 mg po bid
Atrial fibrillation Hydrochlorothiazide 50 mg po daily
Atorvastatin 10 mg po daily
Carvedilol 6.25 mg po bid
Applying your knowledge of pharmacology, to provide safe
patient care, answer the following essential information:
