A client reports having crushing chest pain that radiates to the jaw. The nurse obtains a 12-lead EKG. Which finding confirms the client had myocardial infarction?

A. A 57-year-old with a mechanical mitral valve in need of a tooth extraction: Clients with prosthetic heart valves are at high risk for infective endocarditis, particularly during procedures that can introduce bacteria into the bloodstream, such as dental work. Antibiotic prophylaxis is often indicated.

B. A 19-year-old college student presents with a sore throat and fever: While a sore throat may indicate a streptococcal infection, this client does not have predisposing cardiac conditions. However, untreated strep infections can rarely lead to endocarditis, but the risk is higher in individuals with cardiac abnormalities.

C. A 77-year-old with a history of angina and new onset of chest pain: Angina indicates coronary artery disease but does not directly increase the risk of endocarditis. This client has the least risk among the options because endocarditis is associated with structural heart abnormalities, prosthetic valves, or intravenous drug use rather than ischemic heart disease alone.

D. A 35-year-old who reports using intravenous drugs on a daily basis: Intravenous drug use is a major risk factor for infective endocarditis due to repeated introduction of bacteria into the bloodstream. The tricuspid valve is commonly affected in this population, making this client high-risk.

A. Call the health care provider for a change in cardiac drugs: Notifying the provider is important for ongoing management, but the rhythm shown in the image is ventricular fibrillation (VF), which is immediately life-threatening. Delaying action to call the provider risks the client’s survival.

B. Place the client in a sitting position and administer oxygen: Positioning and oxygen may support a stable client with mild symptoms, but VF causes ineffective cardiac output, so interventions that only support oxygenation are insufficient. Immediate resuscitative measures are required.

C. Call the rapid response team to come and assess the client: While the rapid response team can assist, VF requires immediate intervention—delaying defibrillation and CPR while waiting for others significantly reduces survival chances.

D. Call a code and initiate cardiopulmonary resuscitation: Ventricular fibrillation is a pulseless, life-threatening arrhythmia that requires immediate activation of a code and initiation of CPR, followed by defibrillation. Early chest compressions and defibrillation are critical to restoring cardiac output and preventing sudden cardiac death.