A client is admitted to the telemetry unit with an episode of substernal chest pain.
His diagnostic studies reveal an elevated ST segment on the electrocardiogram (ECG) and an elevated cardiac troponin level.
What would be an appropriate initial nursing goal?
Reduce anxiety and relieve pain.
Improve myocardial oxygenation and reduce cardiac workload.
Eliminate family stressors and provide a calm environment.
Start the client on a low-sodium diet and decrease fluid intake.
The Correct Answer is B
Choice A rationale
While reducing anxiety and relieving pain are important aspects of care, they are not the primary goal for a client with an elevated ST segment on the ECG and an elevated cardiac troponin level. These findings indicate myocardial injury, which requires interventions to improve myocardial oxygenation and reduce cardiac workload.
Choice B rationale
The primary goal for a client with an elevated ST segment on the ECG and an elevated cardiac troponin level is to improve myocardial oxygenation and reduce cardiac workload. This can be achieved through medications, oxygen therapy, and bed rest.
Choice C rationale
Eliminating family stressors and providing a calm environment can contribute to reducing anxiety and promoting relaxation, but it is not the primary goal in this situation.
Choice D rationale
Starting the client on a low-sodium diet and decreasing fluid intake are interventions for managing heart failure, not for an acute myocardial injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale
Advocating for a diet rich in saturated fats is not a recommended strategy to prevent cardiovascular disease. Saturated fats can raise the level of cholesterol in your blood and increase your risk of heart disease.
Choice B rationale
Recommending cessation of smoking is a crucial intervention to prevent cardiovascular disease. Chemicals in tobacco can damage the heart and blood vessels, leading to narrowing of the arteries (atherosclerosis), which can ultimately lead to a heart attack.
Choice C rationale
Regular blood pressure monitoring is important as high blood pressure is a significant risk factor for heart disease. Controlling blood pressure helps ensure that your heart is not working harder than it should be, which can prevent damage to your heart and arteries.
Choice D rationale
Regular cholesterol screenings are essential because high levels of cholesterol can lead to the buildup of plaques in your arteries, increasing your risk of heart disease.
Choice E rationale
Regular physical exercise helps control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol, and diabetes.
Choice F rationale
Suggesting no more than 5 alcoholic drinks a day is not a recommended strategy to prevent cardiovascular disease. In fact, it is advised to limit alcohol intake as excessive drinking can lead to high blood pressure, heart failure, or even stroke.
Correct Answer is B
Explanation
Choice A rationale
Calcium channel blockers are primarily used to treat hypertension, angina, and certain heart arrhythmias. They work by relaxing the muscles of your heart and blood vessels. While they can affect heart rate and blood pressure, they would not typically have immediate implications for a patient presenting with intermittent chest pain.
Choice B rationale
Phosphodiesterase 5 enzyme inhibitors, such as sildenafil (Viagra), are used to treat erectile dysfunction and pulmonary arterial hypertension. These medications can interact with nitroglycerin, a common medication used to treat chest pain, to cause a severe and life-threatening drop in blood pressure. Therefore, it’s crucial to know if a patient is taking this type of medication when they present with chest pain.
Choice C rationale
Anticoagulants are used to prevent blood clots. If a patient is taking an anticoagulant, it could affect their clotting times and could be important if the patient needs surgery or if the cause of their chest pain is a clot. However, this would not typically have immediate implications for the treatment of chest pain.
Choice D rationale
Loop diuretics are strong diuretics that are used to treat edema and hypertension. They work by preventing your body from absorbing too much salt, allowing the salt to instead be passed in your urine. While important to know for overall patient care, they would not typically have immediate implications for a patient presenting with chest pain.
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