A client was brought to the emergency department for severe chest pain despite nitroglycerin and aspirin administration in the ambulance. Which of the following findings would suggest myocardial infarction (MI) with cardiac tissue injury?

Choice A reason: Gently restraining extremities during a tonic-clonic seizure is unsafe, as it can cause injury or increase muscle strain. The clonic phase involves rhythmic jerking, and restraint may lead to fractures or soft tissue damage. Protecting the client by cushioning the head and ensuring safety is the priority.

Choice B reason: Placing a client on a BiPAP machine during a seizure is impractical and unsafe. The clonic phase involves uncontrolled movements, making BiPAP application impossible. Post-seizure, oxygenation may be needed, but during the seizure, protecting the client from injury, like head trauma, takes precedence.

Choice C reason: Placing a pillow under the client’s head during a tonic-clonic seizure protects against head injury from repetitive clonic movements against the floor. This action ensures safety by cushioning the head, reducing the risk of trauma or skull fracture, which is a priority during active seizure activity.

Choice D reason: Inserting a padded tongue blade is contraindicated during a seizure, as it risks injury to the mouth or airway obstruction. The jaw is often clenched in the clonic phase, and forcing objects into the mouth can cause dental damage or aspiration, making this an unsafe intervention.

Choice A reason: Pain relief after the fourth nitroglycerin dose does not confirm myocardial infarction with cardiac tissue injury. While nitroglycerin relieves angina by dilating coronary arteries, persistent pain despite treatment suggests MI. ST-segment elevation on EKG is a more definitive indicator of acute myocardial injury.

Choice B reason: Positive urine cultures indicate a urinary tract infection, unrelated to myocardial infarction or cardiac tissue injury. MI is diagnosed via EKG changes (e.g., ST elevation) and biomarkers like troponin, reflecting myocardial ischemia, not systemic infections, which do not cause chest pain or cardiac damage.

Choice C reason: Normal troponin levels do not support a diagnosis of myocardial infarction with cardiac tissue injury. Troponin rises within hours of myocardial damage due to cell death. ST-segment elevation on EKG is a more immediate indicator of acute MI, preceding troponin elevation in early presentation.

Choice D reason: ST-segment elevation on a 12-lead EKG is a hallmark of myocardial infarction with cardiac tissue injury, indicating transmural ischemia due to coronary artery occlusion. This electrical change reflects acute myocardial damage, prompting urgent intervention like cardiac catheterization to restore blood flow and limit infarction size.