A 45-year-old man presents to the emergency department with a complaint of chest pain that started an hour ago. He describes the pain as a pressure-like sensation that radiates to his left arm. His past medical history is significant for hypertension and hyperlipidemia. On examination, his vital signs are: blood pressure 140/90 mmHg, heart rate 78 beats per minute, respiratory rate 18 breaths per minute, and oxygen saturation 98% on room air. An electrocardiogram (ECG) shows normal sinus rhythm without any ST-segment changes. Which of the following is the most appropriate next step in the management of this patient? (Select All that Apply.)

Perform a stress test immediately

Discharge the patient with instructions to follow up with his primary care physician

Administer sublingual nitroglycerin and obtain cardiac enzymes

Start the patient on oral aspirin and a statin

Reassure the patient and provide analgesics for pain relief

Answer and Explanation

Correct Answer : C,D

A. Perform a stress test immediately is Incorrect. Stress testing is contraindicated in the acute phase of chest pain or suspected acute coronary syndrome (ACS) because it increases myocardial oxygen demand and may precipitate infarction. Stress tests should be performed only after stabilization.

B. Discharge the patient with instructions to follow up with his primary care physician is incorrect. The patient’s chest pain and risk factors suggest possible ACS. Discharging without cardiac enzyme evaluation and treatment is unsafe and could result in life-threatening complications.

C. Administer sublingual nitroglycerin and obtain cardiac enzymes is correct. The patient has symptoms suggestive of unstable angina or NSTEMI. Cardiac enzymes help detect myocardial injury, and nitroglycerin relieves ischemic pain by dilating coronary vessels. Early evaluation and treatment prevent progression to myocardial infarction.

D. Start the patient on oral aspirin and a statin is correct. Aspirin inhibits platelet aggregation, reducing thrombus risk in ACS. Statins stabilize atherosclerotic plaques, managing hyperlipidemia and providing both acute and long-term cardiovascular protection.

E. Reassure the patient and provide analgesics for pain relief is incorrect. Providing reassurance or analgesics alone ignores the possibility of ACS. Delaying evaluation and treatment increases the risk of adverse cardiac events.

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Correct Answer is D

Explanation

A. Premature junctional contractions are incorrect because while they can occur postoperatively, they are not the most common dysrhythmia following coronary artery bypass grafting (CABG). These are usually transient and less clinically significant.

B. Ventricular ectopy is incorrect as isolated premature ventricular contractions may appear after surgery, but they are not the most frequently encountered dysrhythmia in this patient population. Ventricular arrhythmias can be serious, but they are less common than atrial arrhythmias post-CABG.

C. Second degree heart block is incorrect because this type of conduction disturbance is less common after CABG. It may occur in patients with preexisting conduction system disease but is not the usual postoperative dysrhythmia.

D. Atrial fibrillation or flutter is correct because these are the most common dysrhythmias following CABG, occurring in up to 30–40% of patients. The atrial tissue is often irritated by surgical manipulation, inflammation, and electrolyte shifts, making the patient prone to atrial arrhythmias. Monitoring for these dysrhythmias is crucial as they can increase the risk of thromboembolism, hemodynamic instability, and prolonged hospitalization. Management may include rate control, rhythm control, anticoagulation, and addressing reversible causes such as electrolyte imbalances.

A. Physician orders to assess whether the patient is ready to have the chest tube removed B. To quickly empty or change disposable systems C. To accurately assess lung sounds once a shift D. To assess an air leak E. To quickly seal off the lungs if the system becomes disconnected

Correct Answer is ["A","E"]

Explanation

A. Hemostats can be used to temporarily clamp a chest tube under the direction of a physician to determine if the patient can tolerate tube removal. This allows the nurse and provider to assess lung expansion and drainage stability before permanently removing the tube.

B. Hemostats are not used for routine emptying or changing of drainage systems. Modern disposable chest tube systems are designed to be changed without clamping, minimizing risk of tension pneumothorax or lung collapse.

C. Clamping a chest tube is not necessary to auscultate lung sounds, and doing so without indication can be dangerous. Lung sounds can be assessed safely while the chest tube remains patent.

D. Air leaks are typically assessed by observing bubbling in the water-seal chamber, not by clamping the tube. Clamping to check for air leaks can cause tension pneumothorax if left in place too long.

E. In an emergency situation, such as if the chest tube becomes disconnected from the drainage system, hemostats can be temporarily applied to the tube to prevent air from entering the pleural space. This is a temporary, life-saving measure until the tube can be reconnected or the system replaced.

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Naxlex Comprehensive Predictor Exams

The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia?"

Correct Answer is D

Explanation

The nurse is caring for a patient who has a chest tube. Attached to the top of the patient's bed are two hemostats. In which situations would these be used? (Select all that apply.)

Correct Answer is ["A","E"]

Explanation

One of the complications we might see of heart failure is cardiogenic shock. What kinds of signs and symptoms might you see and how do we treat? (Select all that apply)

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