A client in the intensive care unit is experiencing an ST-elevation myocardial infarction (STEMI) confirmed by the 12-lead EKG. Which of the following interventions will the nurse anticipate for this client?

Choice A reason: An irregular heart rate without P waves is characteristic of atrial fibrillation, not an acute priority in this context. While it confirms the diagnosis, it is an expected finding and does not indicate an immediate life-threatening complication compared to new neurological symptoms in a client on heparin.

Choice B reason: Cloudy, odorous urine suggests a urinary tract infection, which is concerning but not the priority. Infections require treatment, but new neurological symptoms like slurred speech in a client on heparin suggest a possible stroke or bleed, which is more urgent and life-threatening.

Choice C reason: Slurred speech in a client on heparin is the priority, as it may indicate a hemorrhagic stroke or transient ischemic attack, both critical complications. Heparin increases bleeding risk, and new neurological symptoms suggest possible intracranial hemorrhage, requiring immediate assessment and intervention to prevent further brain damage.

Choice D reason: An aPTT of 80 seconds is within the therapeutic range for heparin (typically 60–80 seconds), indicating effective anticoagulation. While monitoring is necessary, it is not a priority over new neurological symptoms like slurred speech, which could signal a life-threatening complication requiring urgent attention.

Choice A reason: Getting 8 hours of sleep before an exercise stress test is appropriate, as rest ensures accurate results by minimizing fatigue-related heart rate variability. This comment reflects proper preparation, not requiring further teaching, as adequate rest supports reliable cardiovascular response during the test.

Choice B reason: Skipping coffee the morning of the test is correct, as caffeine can elevate heart rate and blood pressure, skewing stress test results. This comment indicates proper understanding of preparation, not requiring further teaching, as avoiding stimulants ensures accurate assessment of cardiac function during exercise.

Choice C reason: Taking heart medications the morning of the test requires clarification, as some (e.g., beta-blockers) may blunt heart rate response, affecting test accuracy. The client needs teaching to confirm with the provider which medications to hold, ensuring the stress test accurately evaluates cardiovascular response to exercise.

Choice D reason: Not smoking prior to the test is appropriate, as nicotine can increase heart rate and blood pressure, skewing results. This comment reflects correct preparation, not requiring further teaching, as avoiding smoking ensures the stress test accurately assesses cardiac function without external influences.