Furosemide, a loop diuretic, does not alter pain. The Food and Drug Administration (FDA) has approved the use of furosemide in the treatment of conditions with volume overload and edema secondary to congestive heart failure exacerbation, liver failure, or renal failure including the nephrotic syndrome.

Option A: Furosemide acts on the kidneys to increase urinary output. Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle by inhibiting sodium-chloride cotransport system resulting in excessive excretion of water along with sodium, chloride, magnesium, and calcium.
Option B: Fluid may move from the periphery, decreasing edema. Careful monitoring of the clinical condition of the patient, daily weight, fluids intake, and urine output, electrolytes, i.e., potassium and magnesium, kidney function monitoring with serum creatinine and serum blood urea nitrogen level is vital to monitor the response to furosemide. Replete electrolytes if indicated as diuresis with furosemide lead to electrolyte depletion, and adjust the dose or even hold off on furosemide if laboratory work shows signs of kidney dysfunction.
Option D: Fluid load is reduced, lowering blood pressure. Furosemide can be a second-line agent in heart failure patients with symptoms, and in patients with advanced kidney disease with an estimated glomerular filtration rate, less than 30 ml per minute the loop diuretics (furosemide) are preferred over thiazide diuretics to treat hypertension.

Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss. Individuals are diagnosed as overweight when body mass index (BMI) is between 25 to 29.8 kg/m^2 and obese when BMI greater than or equal to 30 kg/m^2. Conditions of both overweight and obesity increase the ASCVD risk compared to normal weight. Recommendations include annual calculation of BMI, and lifestyle modification, including calorie restriction and weight loss, based on the BMI values.

Option B: Coronary artery disease is a multifactorial phenomenon. Etiologic factors can be broadly categorized into non-modifiable and modifiable factors. Non-modifiable factors include gender, age, family history, and genetics.
Option C: In developed countries like the U.S. and the UK, mortality rates due to ischemic heart diseases are decreasing. Nevertheless, according to AHA, 16.5 million people older than 20 in the U.S. had coronary artery disease in 2018, and 55% of them were males. The male gender is more predisposed than the female gender.
Option D: Advancing age increases risk but cannot be modified. The incidence of CAD is observed to rise with age, regardless of gender. In the ONACI registry in France, the incidence of CAD was about 1% in the 45 to 65 age group, which increased to about 4% as the age group reached 75 to 84 years.

A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. Bleeding associated with alteplase therapy can be divided into two broad categories. Internal bleeding includes intracranial bleeding (0.4% to 15.4%), retroperitoneal bleeding (less than 1%), gastrointestinal (GI) bleeding (5%), genitourinary bleeding (4%), and respiratory bleeding. Superficial or surface bleeding is observed mainly at invaded or disturbed sites such as venous cutdowns, arterial punctures, and recent surgical intervention sites.

Option A: TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Alteplase acts within the endogenous fibrinolytic cascade to convert plasminogen to plasmin by hydrolyzing the arginine-valine bond in plasminogen. The activated plasmin then degrades fibrin and fibrinogen, allowing for the dissolution of the clot and re-establishment of blood flow.
Option C: Prior MI is not a contraindication to tPA. FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters.
Option D: Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension. There are no therapeutic drug monitoring recommendations that pertain to the efficacy of tPA therapy. If prolonged off-label therapy is occurring in the event of catheter-directed treatment or repeated dosing in valve thrombosis, serial imaging of the thrombus is reasonable. The safety profile is best monitored by prothrombin time (PT), partial thromboplastin time (PTT), Hemoglobin, and hematocrit to assess ongoing bleeding.

Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. Encourage physical activity consistent with the patient’s energy levels. Helps promote a sense of autonomy while being realistic about capabilities. Walking down the hall 20 feet or walking through the house, then slowly progressing walking outside the house, saving energy for the return trip.

Option A: This exercise is not sufficiently vigorous to increase physical fitness. Encourage active ROM exercises. Encourage the patient to participate in planning activities that gradually build endurance. Exercise maintains muscle strength, joint ROM, and exercise tolerance. Physical inactive patients need to improve functional capacity through repetitive exercises over a long period of time. Strength training is valuable in enhancing endurance of many ADLs.
Option B: Inspect skin regularly, particularly over bony prominences. Gently massage any reddened areas and provide aids such as sheepskin pads as necessary. Pressure points over bony prominences are most at risk for decreased perfusion. Circulatory stimulation and padding help prevent skin breakdown and decubitus development. Change positions at least every 2 hr (supine, side-lying) and possibly more often if placed on the affected side.
Option D: It is not intended to prevent bedsores or constipation. Have the patient perform the activity more slowly, in a longer time with more rest or pauses, or with assistance if necessary. Gradually increase activity with active range-of-motion exercises in bed, increasing to sitting and then standing. Gradual progression of the activity prevents overexertion.

Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion. Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia.

Option A: If a sufficient area of myocardium undergoes ischemic injury, LV pump function becomes depressed and systemic hypotension develops. The pathophysiology of cardiogenic shock is complex and not fully understood. Ischemia to the myocardium causes derangement to both systolic and diastolic left ventricular function, resulting in a profound depression of myocardial contractility. This, in turn, leads to a potentially catastrophic and vicious spiral of reduced cardiac output and low blood pressure, perpetuating further coronary ischemia and impairment of contractility.
Option B: Myocardial ischemia is further exacerbated by impaired myocardial perfusion due to hypotension and tachycardia. The presenting symptoms of cardiogenic shock are variable. The most common clinical manifestations of shock, such as hypotension, altered mental status, oliguria, and cold, clammy skin, can be seen in patients with cardiogenic shock
Option C: Peripheral pulses are rapid and faint and may be irregular if arrhythmias are present. Clinical criteria include a systolic blood pressure of less than or equal to 90 mm Hg for greater than or equal to 30 minutes or support to maintain systolic blood pressure less than or equal to 90 mm Hg and urine output less than or equal to 30 mL/hr or cool extremities.