A client arrives in the emergency department with chest pain, but all test results come back negative. The healthcare provider diagnoses the client with angina pectoris and orders additional testing. Which test requires the client to exercise on a treadmill while being monitored for myocardial ischemia?
Cardiac catheterization
Electrocardiogram
Stress test
Echocardiogram
The Correct Answer is C
A. Cardiac catheterization: This is an invasive procedure where a catheter is threaded through the femoral or radial artery to inject dye and visualize the coronary anatomy. It is performed while the patient is stationary on a procedure table, not while exercising on a treadmill. It is the gold standard for diagnosing blockages but is not a "stress test."
B. Electrocardiogram: A standard 12-lead ECG records the electrical activity of the heart while the patient is at rest. While it can show signs of previous infarction or current ischemia, it does not involve physical exertion. It is a baseline diagnostic tool rather than a functional assessment of the heart under stress.
C. Stress test: An exercise stress test involves monitoring the patient's heart rate, blood pressure, and ECG while they walk on a treadmill at increasing levels of difficulty. This test is designed to uncover myocardial ischemia that may only be present when the heart's oxygen demand is elevated. It is a key functional evaluation for patients with suspected angina.
D. Echocardiogram: An echocardiogram uses ultrasound waves to visualize the structures and motion of the heart valves and chambers. While it can be performed after exercise in a "stress echo," the primary test focused on exercising on a treadmill for ischemia detection is the stress test. A standard echo is typically a resting imaging study.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. smoking cessation.: Thromboangiitis obliterans is an inflammatory vascular disease strongly linked to tobacco use. The primary pathophysiological trigger is an autoimmune response to nicotine that leads to segmental vasculitis and digital ischemia. Complete abstinence from all tobacco products is the only effective way to halt the progression of the disease and prevent gangrene or amputation.
B. reduction of alcohol intake.: While excessive ethanol consumption is detrimental to overall cardiovascular health, it is not the primary causative agent for Buerger's disease. Alcohol does not induce the specific segmental inflammation of small and medium-sized arteries seen in this pathology. Smoking cessation remains a far more critical lifestyle modification for these patients.
C. avoiding cold remedies.: Some over-the-counter cold medications contain sympathomimetics that can cause peripheral vasoconstriction. While patients with Raynaud's phenomenon should be cautious, these drugs do not drive the inflammatory process of Buerger's disease. The focus of nursing education must prioritize the elimination of tobacco rather than secondary pharmacological triggers.
D. weight reduction.: Obesity is a significant risk factor for atherosclerosis, but Buerger's disease is a non-atherosclerotic inflammatory condition. While maintaining a healthy body mass index is beneficial for systemic health, it does not stop the specific vasculitis associated with this condition. Tobacco use is the specific modifiable factor that determines the clinical trajectory.
Correct Answer is A
Explanation
A. "I will take another tablet every 5 minutes if the pain continues up to 3 doses and then I will call 911 if the chest pain does not go away.": This statement reflects the standard emergency protocol for managing acute anginal episodes at home. It ensures the patient receives maximum pharmacological benefit while establishing a clear timeline for seeking emergency medical intervention. Adhering to this 15-minute window is crucial for preventing extensive myocardial damage.
B. "I take this medication at bedtime everything.": Nitroglycerin tablets are intended for the PRN treatment of acute chest pain, not as a scheduled nightly medication. Taking the drug without active symptoms can lead to significant hypotension and unnecessary side effects like headaches. Bedtime dosing is not the indicated use for sublingual nitroglycerin therapy.
C. "I will swallow the tablet whole with grapefruit juice.": Sublingual nitroglycerin must be dissolved under the tongue to bypass first-pass hepatic metabolism and enter the bloodstream rapidly. Swallowing the tablet significantly reduces its effectiveness and delays the onset of action during an ischemic event. Furthermore, grapefruit juice can interact with various cardiovascular medications and should be avoided.
D. "I take three tablets all at one time if I have chest pain.": Taking multiple doses simultaneously can cause a profound and dangerous drop in blood pressure. The doses must be spaced 5 minutes apart to allow the nurse or patient to evaluate the effectiveness and monitor for adverse effects. Proper titration is essential for safe and effective vasodilation.
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