A nurse is caring for a patient who has a suspected myocardial infarction. Which of the following should the nurse administer first?

Nitroglycerin

Aspirin

Morphine

Oxygen

Answer and Explanation

The Correct Answer is D

A. Nitroglycerin: Nitroglycerin is used to relieve chest pain by dilating coronary arteries and increasing blood flow. However, in the immediate setting of a suspected MI, oxygen is prioritized to ensure adequate oxygenation.

B. Aspirin: Aspirin is essential in the early treatment of MI to prevent further clot formation by inhibiting platelet aggregation, but oxygen would still come first if the client’s oxygenation is compromised.

C. Morphine: Morphine is used for pain relief and to reduce anxiety and oxygen demand on the heart. However, it is administered after ensuring oxygen supply.

D. Oxygen: Oxygen should be administered first in a suspected myocardial infarction to ensure the heart and tissues receive adequate oxygen, especially if the patient is hypoxic.

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Correct Answer is C

Explanation

A. The QT interval is equal to the R to R interval. This is not a finding associated with myocardial infarction. QT interval changes are more related to electrolyte imbalances or medication effects.

B. The QRS intervals are 0.08 second. A QRS duration of 0.08 seconds is normal and does not indicate myocardial infarction. Prolongation of the QRS complex might suggest a bundle branch block or other conduction issues.

C. The ST segment is above the isoelectric line. ST-segment elevation is a hallmark sign of an acute myocardial infarction (STEMI). It reflects injury to the heart muscle.

D. The PR intervals are 0.15 second. A PR interval of 0.15 seconds is within the normal range (0.12–0.20 seconds) and does not indicate myocardial infarction.

A. Obtain platelet aggregation studies to confirm DVT B. Schedule deep tissue massage with physical therapy. C. Arrange for a venous duplex ultrasound. D. Monitor Homan's sign.

Correct Answer is C

Explanation

A. Obtain platelet aggregation studies to confirm DVT. Platelet aggregation studies are not used to diagnose deep vein thrombosis (DVT). They are more relevant for evaluating platelet function and clotting disorders.

B. Schedule deep tissue massage with physical therapy. Deep tissue massage is contraindicated in clients suspected of having DVT, as it could dislodge the clot and cause a pulmonary embolism or other complications.

C. Arrange for a venous duplex ultrasound. A venous duplex ultrasound is the standard diagnostic test used to confirm DVT. It visualizes the veins and assesses blood flow, helping to detect the presence of a clot.

D. Monitor Homan's sign. Homan’s sign (pain in the calf with dorsiflexion of the foot) was once considered a diagnostic indicator of DVT, but it is no longer considered reliable due to its low sensitivity and specificity. Therefore, it is not routinely used for DVT diagnosis.

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A nurse is caring for a patient who has a suspected myocardial infarction. Which of the following should the nurse administer first?

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