A client arrives to the ER with chest pain, tightness and shortness of breath. An EKG is obtained along with a chest x-ray and a set of labs. The client's troponin level comes back elevated. The LPN explains to the family that troponin is:
A marker of cardiac muscle damage
A level of an electrolyte that when abnormal may cause chest pain
A marker of the amount of stretch the ventricle has done
A level of liver enzyme that can be elevated with right sided heart failure
The Correct Answer is A
A. A marker of cardiac muscle damage: Troponin is a protein found specifically in cardiac myocytes that is released into the bloodstream when the heart muscle is injured. Elevated levels are the most specific and sensitive laboratory indicator for diagnosing an acute myocardial infarction. It allows healthcare providers to differentiate between unstable angina and true myocardial necrosis.
B. A level of an electrolyte that when abnormal may cause chest pain: Electrolytes such as potassium or magnesium can cause arrhythmias when abnormal, but they are not troponins. Troponin is a structural protein, not a charged ion involved in cellular electrical potential. Monitoring electrolytes is important in cardiac care, but it is distinct from the necrotic marker testing.
C. A marker of the amount of stretch the ventricle has done: The marker for ventricular stretch and fluid volume overload is Brain Natriuretic Peptide (BNP), not troponin. BNP is used to diagnose and monitor the severity of heart failure. Troponin specifically indicates cell death and injury rather than the degree of volume expansion or pressure within the heart.
D. A level of liver enzyme that can be elevated with right sided heart failure: Liver enzymes like ALT and AST may rise during systemic venous congestion, but they are not cardiac-specific. Troponin has no diagnostic value for liver function or hepatic congestion. It is used exclusively to evaluate the integrity of the myocardial tissue during suspected ischemic events.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "I can go back to the gym and do light weight baring exercise and yoga.": Patients must avoid vigorous upper body activity and lifting heavy weights for several weeks to prevent lead dislodgement. Yoga often involves stretching the arms above the shoulder, which can pull on the newly implanted pacemaker leads. This statement reflects a misunderstanding of the immediate postoperative activity restrictions required for device stability.
B. "I will report any new dizziness or lightheadedness to my health care provider.": These symptoms may indicate pacemaker malfunction, such as failure to pace or loss of capture. Dizziness suggests that the heart rate is not being maintained at a level sufficient for adequate cerebral perfusion. Reporting these signs is a critical component of post-implantation safety and monitoring.
C. "I will take my pulse every day and left my health care provider if my heart rate is less than 60 beats per minute.": Monitoring the daily pulse ensures the pacemaker is maintaining the programmed minimum heart rate. A rate lower than the set threshold indicates a potential battery or electrode problem that requires urgent evaluation. This demonstrates the patient's understanding of how to monitor their own cardiac stability.
D. "I will avoid raising my arm over my head until cleared by my health care provider.": Restricting the range of motion on the affected side prevents the accidental pulling or displacement of the cardiac leads before they have scarred into place. This is a standard instruction during the first few weeks following a permanent pacemaker procedure. It is essential for ensuring long-term device functionality and successful healing.
Correct Answer is ["A","B","D"]
Explanation
A. Distended jugular veins: Right-sided failure increases pressure in the right atrium and vena cava, leading to visible engorgement of the internal jugular veins. This finding reflects the retrograde backup of blood into the systemic venous system. It is a primary clinical indicator of elevated central venous pressure.
B. Weight gain: Rapid increase in body mass in heart failure patients is almost exclusively due to the retention of sodium and water. As the kidneys perceive low perfusion, the renin-angiotensin-aldosterone system triggers fluid volume expansion. This leads to the systemic accumulation of fluid characteristic of right-sided dysfunction.
C. Orthopnea: This symptom involves difficulty breathing while lying flat and is a classic sign of left-sided heart failure and pulmonary congestion. It occurs when fluid from the lower extremities redistributes to the lungs in a recumbent position. Right-sided failure alone does not typically cause this pulmonary-specific symptom.
D. Peripheral edema: Increased systemic venous pressure causes fluid to leak from the capillaries into the interstitial spaces of the lower extremities. This presents as swelling in the feet, ankles, and pretibial areas, often worsening as the day progresses. It is a hallmark sign of right-heart pump failure.
E. Crackles the lungs: Adventitious lung sounds like crackles indicate fluid in the alveoli, which is a manifestation of pulmonary edema. Pulmonary edema is caused by the failure of the left ventricle to move blood into the systemic circulation. It is not a direct finding of isolated right-sided heart failure.
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