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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 Covered in
Each 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: Hypercholesteremia, HTN, HF • Hx DX indicate patient is at increased risk for exacerbation
• Six-month DX of paroxysmal of HTN crisis, or HF symptoms.
AFIB • Synchronized cardioversion • Patient is living with sudden AFIB, increase risk for stroke
last week • Recurrent acute injury/treatment
• V/S: Pulse: 52 bpm, BP: 94/52 • V/S are below NL – adverse effect of AFIB
RELEVANT Data from Social History: Clinical Significance:
• Patient lives alone in her home. • Lack of support
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
, • Hypercholesteremia
▪ Atorvastatin 10mg po daily
• Hypertension
▪ Captopril 100mg po BID daily
▪ HCTZ 50 mg po daily
▪ Carvedilol 6.25 mg po BID
• Heart failure
© 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
▪ Carvedilol 6.25 mg po BID ▪
HCTZ 50 mg po daily
• Atrial fibrillation
▪ Apixaban 2.5 mg po BID
▪ Amiodarone 100 po BID
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 Covered in
Each 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: Hypercholesteremia, HTN, HF • Hx DX indicate patient is at increased risk for exacerbation
• Six-month DX of paroxysmal of HTN crisis, or HF symptoms.
AFIB • Synchronized cardioversion • Patient is living with sudden AFIB, increase risk for stroke
last week • Recurrent acute injury/treatment
• V/S: Pulse: 52 bpm, BP: 94/52 • V/S are below NL – adverse effect of AFIB
RELEVANT Data from Social History: Clinical Significance:
• Patient lives alone in her home. • Lack of support
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
, • Hypercholesteremia
▪ Atorvastatin 10mg po daily
• Hypertension
▪ Captopril 100mg po BID daily
▪ HCTZ 50 mg po daily
▪ Carvedilol 6.25 mg po BID
• Heart failure
© 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
▪ Carvedilol 6.25 mg po BID ▪
HCTZ 50 mg po daily
• Atrial fibrillation
▪ Apixaban 2.5 mg po BID
▪ Amiodarone 100 po BID
