Nokea
The nurse is assessing the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. Which of the following laboratory results is most important for the nurse to review?
- A. LDL cholesterol
- B. Troponins T and I
- C. C-reactive protein
- D. Creatine kinase-MB (CK-MB)
Correct Answer: B
Rationale: Cardiac troponins start to elevate hours (average 4-6 hours) after myocardial injury and are specific to myocardium. Creatine kinase-MB (CK-MB) is specific to myocardial injury and infarction, but it does not increase until 6 hours after the infarction occurs. LDL cholesterol and C-reactive protein are useful in assessing cardiovascular risk but are not helpful in determining whether a patient is having an acute myocardial infarction.
You may also like to solve these questions
A transesophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which of the following actions included in the standard TEE orders should the nurse accomplish first?
- A. Administer O2 per mask.
- B. Start a large-gauge IV line.
- C. Place the patient on NPO status.
- D. Give lorazepam 1 mg IV.
Correct Answer: C
Rationale: The patient will need to be NPO for 6 hours preceding the TEE, so the nurse should place the patient on NPO status as soon as the order is received. The other actions also will need to be accomplished but not until just before or during the procedure.
The nurse is admitting a patient for a coronary arteriogram and angiogram. Which of the following information about the patient is most important for the nurse to communicate to the health care provider?
- A. The patient's pedal pulses are +1.
- B. The patient is allergic to iodine.
- C. The patient has not eaten anything today.
- D. The patient had an arteriogram a year ago.
Correct Answer: B
Rationale: The contrast dye used for the procedure is iodine based, so patients who have an iodine allergy should be communicated to the health care provider. The other information also is communicated to the health care provider but will not require a change in the usual prearteriogram orders or medications.
During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. Which of the following actions should the nurse implement next?
- A. Document that the PMI is in the normal anatomic location.
- B. Ask the patient about risk factors for coronary artery disease.
- C. Auscultate both the carotid arteries for the presence of a bruit.
- D. Assess the patient for symptoms of left ventricular hypertrophy.
Correct Answer: D
Rationale: The PMI should be felt at the intersection of the 5th intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with coronary or carotid artery disease.
The standard policy on the cardiac unit states: 'Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg.' Which of the following patients should the nurse report to the health care provider?
- A. Postoperative patient with a BP of 116/42
- B. Newly admitted patient with a BP of 122/60
- C. Patient with left ventricular failure who has a BP of 110/70
- D. Patient with a myocardial infarction who has a BP of 114/50
Correct Answer: A
Rationale: The mean arterial pressure (MAP) is calculated using the formula MAP = (diastolic BP + 1/3 pulse pressure). The MAP for the postoperative patient with a BP of 116/42 is 67. The MAP in the other three patients is higher than 70 mm Hg.
The nurse is auscultating over the patient's abdominal aorta and hears a humming sound. Which of the following terms should the nurse use to document this finding?
- A. Thrill
- B. Bruit
- C. Heave
- D. Murmur
Correct Answer: B
Rationale: A bruit is the sound created by turbulent blood flow in an artery. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. Heaves are sustained lifts over the precordium that can be observed or palpated. A murmur is the sound caused by turbulent blood flow through the heart.