Nokea
A client has an elevated AST 24 hours following chest pain and shortness of breath. This is suggestive of which of the following?
- A. Gallbladder disease
- B. Liver disease
- C. Myocardial infarction
- D. Skeletal muscle injury
Correct Answer: C
Rationale: AST is an enzyme released in response to tissue damage. The symptoms of chest pain and shortness of breath, along with elevated AST 24 hours later, are suggestive of myocardial infarction. AST rises after a myocardial infarction but may also rise with liver damage or skeletal muscle injury. Gallbladder disease typically presents with pain in the right scapula region and would not have an elevated AST.
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When the nurse at the physician's office reviews the client's medical record, which finding is the best indication that the client's heart has been affected by sustained high blood pressure?
- A. The client has a strong S2 heart sound.
- B. The client's heart rate is 100 beats/minute when active.
- C. The client's heart is a moderate disorder
- D. The client has an irregular heart rhythm.
Correct Answer: C
Rationale: A moderate heart disorder, such as left ventricular hypertrophy, is a common consequence of sustained hypertension due to increased workload on the heart. The other options are less specific to hypertensive heart damage.
If the chest pain is not relieved after taking one nitroglycerin tablet, the nurse should teach the client to take what action?
- A. Take another tablet in 5 minutes.
- B. The nurse is the energy department.
- C. Call the physician immediately.
- D. Swallow two additional tablets.
Correct Answer: A
Rationale: If angina persists after one nitroglycerin tablet, another can be taken every 5 minutes up to three doses, then seek medical help if unrelieved.
As part of the discharge instructions, the nurse correctly instructs the client that which symptom is a sign of artificial pacemaker malfunction?
- A. Tingling in the chest area
- B. Dizziness during activity
- C. Pain radiating to the arm
- D. Tenderness beneath the skin
Correct Answer: B
Rationale: Dizziness during activity may indicate pacemaker failure to maintain adequate heart rate.
The nurse provides discharge instructions for a client who has recovered after a cardiac catheterization. Which instructions should be included? Select all that apply.
- A. Take a shower rather than a tub bath until the puncture site heals.
- B. Perform leg exercises every 2 hours while awake.
- C. In the generous amount of fluids for the next 24 hours.
- D. Report worsening of pain in the leg that was catheterized.
- E. Flush the toilet twice after eliminating urine and stool in the next 24 hours.
- F. Change the dressing over the puncture site daily until it heals.
Correct Answer: A,C,D
Rationale: Showering prevents infection, generous fluids help flush contrast dye, and reporting worsening pain detects complications. Leg exercises, double flushing, and daily dressing changes are not standard.
When the client asks the nurse how cholesterol acts as a cardiac risk factor, what is the best explanation?
- A. Excess fat in the blood expands the circulating blood volume.
- B. Excess fat in the blood thickens the lining of the arteries.
- C. Excess fat in the blood causes slower blood clotting.
- D. Excess fat in the blood stimulates the heart to beat faster.
Correct Answer: B
Rationale: High cholesterol contributes to atherosclerosis, where excess fat (lipids) deposits thicken and harden the arterial walls, narrowing the lumen and increasing cardiac risk.