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 D
Explanation
A. Insert a 20-gauge peripheral IV catheter: Establishing venous access is necessary for administering intravenous diuretics but is not the most immediate action. Assessment of the clinical status must precede invasive interventions to determine the severity of the fluid overload. The nurse should prioritize gathering objective data on respiratory compromise before performing venipuncture.
B. Administer oxygen at 2 liters per minute via nasal cannula: The current oxygen saturation is 94% on room air, which is generally considered acceptable for many patients. While supplemental oxygen may be indicated later, it is not the most critical first step given these stable saturation levels. Respiratory assessment should guide the necessity and titration of oxygen therapy.
C. Place the client on a cardiac monitor: Continuous cardiac monitoring is important for detecting arrhythmias associated with heart failure or electrolyte shifts. However, it does not provide immediate information regarding the patient's primary risk of pulmonary congestion or respiratory distress. Monitoring is an adjunctive task rather than the primary diagnostic priority.
D. Auscultate the client's breath sounds: Assessing for crackles or diminished sounds is the priority to determine the extent of pulmonary edema. This assessment provides immediate data on the severity of the fluid-volume overload and the risk of respiratory failure. Objective respiratory findings are essential for prioritizing subsequent medical and nursing interventions.
Correct Answer is B
Explanation
A. Hypothyroidism: While the client has a history of hypothyroidism, the clinical presentation of visual disturbances and profound bradycardia is not typical of a thyroid deficit. Low thyroid hormone levels usually present with weight gain, cold intolerance, and dry skin rather than greenish halos. The dose of 25 mcg is a standard replacement and does not explain the acute confusion or visual changes.
B. Digoxin toxicity: The combination of bradycardia with a heart rate of 44, greenish-yellow visual halos, and new-onset confusion are classic signs of digitalis overdose. Furosemide use often leads to hypokalemia, which significantly sensitizes the myocardium to the toxic effects of digoxin. A dose of 0.5 mg is also relatively high, increasing the risk of systemic accumulation and toxic side effects.
C. Glaucoma: This ocular condition causes increased intraocular pressure and can lead to vision loss or seeing halos around lights. However, glaucoma does not cause systemic symptoms like profound bradycardia, confusion, or gastrointestinal disturbances such as constipation. The visual symptoms in this case are a secondary manifestation of a systemic pharmacological toxicity rather than a primary eye disease.
D. Unstable angina: Unstable angina presents with crescendo chest pain at rest and is often associated with EKG changes or hemodynamic instability. It does not typically manifest with bradycardia, constipation, or the characteristic visual disturbances described in the stem. The client's symptoms point toward a metabolic or drug-induced etiology rather than acute coronary artery narrowing.
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