NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Example

NRNP 6566 Branching Exercise: Cardiac Case 1 AssignmentNRNP 6566 Branching Exercise: Cardiac Case 1 Assignment

NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Brief

Course: NRNP 6566 – Advanced Care of Adults in Acute Settings I

Assignment Title: NRNP 6566 Branching Exercise: Cardiac Case 1 Assignment

Assignment Instructions Overview

This assignment requires you to engage with an interactive media piece focusing on a cardiac patient case. You will be responsible for reviewing the patient presentation, including vital signs, past medical history (PMH), home medications, and diagnostic results. Based on this information, you will develop a comprehensive set of admission orders as the admitting provider, ensuring all aspects of patient care are addressed.

Understanding Assignment Objectives

The primary objective of this assignment is to apply your clinical knowledge and critical thinking skills to assess and treat a patient presenting with specific symptoms. You will develop a complete set of admission orders, ensuring no assumptions are made about prior treatments or protocols. The orders should include additional lab tests, diagnostics, medication adjustments, and rationales for each decision made.

The Student’s Role

As a student, you will take on the role of the admitting provider, responsible for the initial assessment and treatment plan for the patient. You must use the provided admission orders template, ensuring that each order is specific and leaves no room for interpretation by the nursing staff. Your role also involves justifying your decisions with evidence-based references, demonstrating an understanding of current guidelines and standards of care.

Competencies Measured

This assignment will measure your ability to:

  • Analyze patient data critically and develop appropriate treatment plans.
  • Apply current clinical guidelines and evidence-based practices in patient care.
  • Write clear and precise medical orders.
  • Justify clinical decisions with appropriate rationale and references.
  • Address all aspects of patient care, from immediate medical needs to long-term health promotion and discharge planning.

You Can Also Check Other Related Assessments for the NRNP 6566 – Advanced Care of Adults in Acute Settings I Course:

NRNP 6566 Impact of Pharmacokinetics on Medication Selection and Administration Assignment Example

NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Example

Admission Orders for Cardiac Case 1: 63-Year-Old Female

Primary Diagnosis

Atrial Fibrillation with Rapid Ventricular Response



Code Status

Full Code



Admit to Unit

Intensive Care Unit (ICU)

Activity Level

Ambulate as tolerated


  • Clear liquids, advance as tolerated to a cardiac diet and low carbohydrate diet

IV Fluids

  • 0.9% Normal Saline at 75 mL/hr for hydration. Discontinue once the patient starts oral intake adequately.

Critical Drips

  • None required at this time as the patient’s rate is controlled with Metoprolol tartrate IV bolus. Monitor closely and reassess need for additional bolus if the rate increases again.


  • Oxygen via nasal cannula at 2 L/min. Wean if oxygen saturation remains >95% and the patient does not experience shortness of breath.


  • Heparin 5000 units subcutaneously BID for anticoagulation to prevent thromboembolic events (source: Harris, 2023).
  • Metoprolol tartrate 50 mg PO BID for ongoing rate control (source: Barkley & Myers, 2020).
  • Lisinopril 10 mg PO daily (reduce from home dose of 20 mg due to addition of Metoprolol) for hypertension management (source: Fuller & McCauley, 2023).
  • Metformin 500 mg PO BID, continue as home medication for diabetes management.

Nursing Orders

  • Vital signs every 15 minutes for 1 hour, then every 30 minutes for 1 hour, then hourly if stable.
  • Continuous cardiac monitoring.
  • Strict intake and output monitoring.
  • Daily weight.
  • Skin care and reposition every 2 hours.
  • Encourage use of incentive spirometer every hour while awake.

Follow-Up Lab Tests

  • Repeat CBC: To monitor hemoglobin, hematocrit, and platelet levels.
  • Repeat CMP: To assess electrolyte balance, renal function, and liver enzymes.
  • TSH: To rule out thyroid-related causes of atrial fibrillation.
  • INR: To monitor anticoagulation status with Heparin.

Diagnostic Testing

  • Echocardiogram: To evaluate cardiac function and structure, particularly to assess for any valvular disease or cardiomyopathy.
  • Chest X-ray: To rule out any pulmonary causes for the shortness of breath and to assess cardiac silhouette.


  • Cardiology: For evaluation and management of new-onset atrial fibrillation, including consideration for potential cardioversion or ablation if rhythm does not stabilize with medical management.

Patient Education and Health Promotion

  • Educate the patient on the importance of medication adherence, particularly the new anticoagulant and rate control medications.
  • Discuss lifestyle modifications for heart health, including a low-sodium, heart-healthy diet, regular physical activity, and smoking cessation if applicable.
  • Explain the need for regular follow-up appointments to monitor the condition and adjust treatment as necessary.

Discharge Planning and Required Follow-Up Care

  • Plan for discharge once the patient is hemodynamically stable, with controlled heart rate and without symptoms.
  • Schedule follow-up with primary care provider and cardiology within one week of discharge.
  • Arrange for outpatient monitoring of INR if the patient continues on anticoagulation therapy.


Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.

Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.

Detailed Assessment Instructions for the NRNP 6566 Branching Exercise Cardiac Case 1 Assignment


Assignment: Branching Exercise: Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Photo Credit: [IMAGEMORE Co., Ltd.]/[none]/Getty Images

To prepare:

  • Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
  • Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed.

The Assignment:

  • Using the required admission orders template found under the Learning Resources: Required Reading.
  • Develop a set of orders as the admitting provider.
  • Be sure to address each aspect of the order template
  • Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
  • Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
  • Make sure the order is complete and applicable to the patient.
  • Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
  • Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
  • A minimum of three current (within the last 5 years), evidenced based references are required

By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “MD2Assgn1+last name+first initial.(extension)” as the name.
  • Click the Module 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
  • Click the Module 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn1+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.



Scenario #1 63 year old female (Branching Exercise: Cardiac Case 1: 63 Year Old Female)

    • 63-year-old female presents to the Emergency Department complaining of dizziness and shortness of breath.


    • PMH: HTN, Diabetes, TIA
    • Home Meds: Lisinopril, Metformin
    • Allergies: Penicillin
    • HR: 180, O2 Sat 94%, BP: 107/78, RR: 21
    • The patient is a full code 
    • Atrial Fibrillation with Rapid Ventricular Response
    • 12 lead EKG, TSH, CBC,CMP, INR
    • Metoprolol tartrate 2.5mg IV bolus over 2 minutes (Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. Anticoagulation is indicated unless there is a contraindication. Rate control and anticoagulation are the priority then Cardiology will advise on TEE/Cardioversion.)

Learning Resources – Branching Exercise: Cardiac Case 1: 63 Year Old Female

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

  • Chapter 21, “Arrhythmias” (pp. 263–290)

Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.

Tachycardia’s, pp. 106-109

Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.

Arrhythmias, pp. 54-58

Document: Admission Orders Template (Word document)Download Admission Orders Template (Word document)

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2019, June 9). ECG interpretation explained clearly and succinctly – arrhythmias, blocks, hypertrophy [Video file]. Retrieved from

MedCram. (2018, July 15). ST elevation – EKG/ECG interpretation case 12 (STEMI, MI, ACS) [Video file]. Retrieved from

MedCram. (2017, July 23). EKG/ECG practice strip interpretation explained clearly – case 10 [Video file]. Retrieved from

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1 [Interactive media file]. Minneapolis, MN: Author.

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1.[Interactive media file]. Minneapolis, MN: Author.

Antiarrhythmic Drugs for the AGACNP

Dr. Tony Anno, core faculty for the AGACNP program at Walden University reviews that cardiac cycle and arrythmia pathophysiology. A review and discussion on the use of antiarrhythmic drugs that the AGACNP may encounter in practice is also provided. (18m)

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

ECG Review for the AGACNP

Dr. Tony Anno reviews important concepts and skills needed in understanding and interpreting ECGs for the AGACNP in practice. This review will also build upon you previous knowledge and expertise in diagnosing and treating cardiac disorders. (14m)

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript


Required Media

The assignment this week is the branching exercise.  You can go through the exercise as much as you want, until it is submitted.  You can only submit the assignment one time for grading.   Your assignment at the end of the exercise is to write orders that reflect your treatment plan for this patient.  The template for your order set is located in the required reading. Please be sure that you are writing specific orders exactly as you would in a patient’s chart.    The assignment is due by Sunday. 

Admission Orders Template

Primary Diagnosis:

Status/Condition (Critical, Guarded, Stable, etc.):

Code Status:


Admit to Unit:

Activity Level:


IV Fluids:

 Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.):

Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:

Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route):

Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):

Follow-Up Lab Tests:

 Diagnostic testing (CXR, US, 2D Echo, etc.):


NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least a 24-hour period]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation,” or “Nutrition consult for TPN recommendations.”

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):

Discharge Planning and Required Follow-Up Care:

References (minimum of three timely references that prove this plan follows current standards of care):

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