Question

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, 'His pulmonary artery wedge pressures have been in the high normal range.' What additional assessment information would be important for the CSU nurse to obtain?

1) high urine output
2) dry mucous membranes
3) pulmonary crackles
4) hypertension

Answer 1

The CSU nurse should obtain additional assessment information related to the client's cardiac status, including checking for pulmonary crackles, blood pressure, and fluid balance.

Step-by-step explanation:

The CSU nurse should obtain additional assessment information related to the client's cardiac status. One important assessment would be to check for the presence of pulmonary crackles. Crackles in the lungs may indicate fluid accumulation, which could be related to the high pulmonary artery wedge pressures. Another important assessment would be to check the client's blood pressure, as hypertension is a common finding in individuals with a history of myocardial infarction. Lastly, it would also be important to assess the client's fluid balance, including evaluating for signs of fluid overload such as high urine output or dry mucous membranes.