A nurse is providing care for a client who experienced a myocardial infarction prior to a cardiac arrest. Which of the following laboratory tests will identify early injury to the cardiac muscle?

Creatine kinase (CK) test

Creatine kinase-myocardial band (CK-MB) test

Brain natriuretic peptide (BNP) test

Troponin T test

Answer and Explanation

The Correct Answer is D

A. Creatine kinase (CK) test: While creatine kinase isoenzymes, including CK-MB, can be elevated following myocardial infarction (MI), they are not specific to cardiac muscle injury. CK is found in various tissues throughout the body, so elevated levels can also indicate damage to skeletal muscle or brain tissue, among other sources.

B. Creatine kinase-myocardial band (CK-MB) test: CK-MB is a cardiac-specific isoform of creatine kinase, and elevated levels can indicate myocardial injury, particularly in the context of an acute MI. However, troponin T is a more sensitive and specific marker for myocardial injury.

C. Brain natriuretic peptide (BNP) test: Brain natriuretic peptide is primarily used in the diagnosis and management of heart failure. While elevated BNP levels can indicate heart muscle strain or stress, they are not specific markers for acute myocardial infarction or early injury to the cardiac muscle.

D. Troponin T test: This is the correct answer. Troponin T is a highly specific marker for cardiac muscle injury. Elevated troponin levels can be detected within hours of myocardial infarction and persist for several days, making it an essential tool in the diagnosis of acute coronary syndromes, including myocardial infarction. Troponin T is considered one of the gold standard biomarkers for detecting early injury to the cardiac muscle.

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Correct Answer is C

Explanation

A. Lower blood pressure: Lowering blood pressure may be indicated in certain cases of brain herniation to reduce cerebral perfusion pressure (CPP) and decrease cerebral blood volume. However, this intervention should be carefully titrated based on the individual client's condition and should not be applied universally as a treatment for brain herniation. In some cases, lowering blood pressure may exacerbate cerebral ischemia and worsen neurological outcomes.

B. Decrease sedation: Reducing sedation may be necessary to allow for neurological assessment and evaluation of the client's neurological status. However, it is not a direct treatment for brain herniation. Sedation may need to be adjusted to facilitate neurological monitoring and assessment of the client's response to treatment interventions. Excessive sedation can obscure neurological signs and symptoms, making it difficult to assess the effectiveness of interventions aimed at reducing ICP.

C. Hyperventilate the client: Hyperventilation is a potential intervention for managing brain herniation as it helps temporarily lower intracranial pressure (ICP) by inducing cerebral vasoconstriction. By increasing the rate and depth of breathing, hyperventilation reduces the partial pressure of carbon dioxide (PaCO2) in the blood, leading to vasoconstriction of cerebral blood vessels and a decrease in cerebral blood flow. This can help alleviate symptoms associated with increased ICP and reduce the risk of further brain injury.

D. Reduce the temperature in the room: Therapeutic hypothermia may be considered as a treatment option in certain cases of brain injury to reduce metabolic demand, lower ICP, and attenuate secondary brain injury. However, simply reducing the temperature in the room without implementing therapeutic hypothermia protocols is unlikely to effectively manage brain herniation. Therapeutic hypothermia requires careful monitoring and control of the client's body temperature to prevent complications. Additionally, hypothermia alone may not provide immediate relief from increased ICP associated with brain herniation.

A. "The heart and the coronary arteries weaken, leading to poor perfusion and resulting in angina." B. "Coronary arteries become more elastic causing the arteries to stretch as individuals age causing the heart not to receive enough oxygen." C. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle." "Manifestations occur due to dilation of coronary arteries with increased blood flow causing increased pressure." D. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle."

Correct Answer is D

Explanation

A. "The heart and the coronary arteries weaken, leading to poor perfusion and resulting in angina": This statement is inaccurate. While angina can result from poor perfusion to the heart muscle, it is not typically due to weakening of the heart and coronary arteries. Angina often occurs due to coronary artery narrowing or blockage, leading to reduced blood flow and oxygen delivery to the myocardium.

B. "Coronary arteries become more elastic causing the arteries to stretch as individuals age causing the heart not to receive enough oxygen": This statement is incorrect. Coronary arteries do not become more elastic with age; in fact, they tend to become less elastic due to the development of atherosclerosis, which leads to arterial stiffening and decreased compliance. Atherosclerosis can cause narrowing or occlusion of the coronary arteries, resulting in reduced oxygen delivery to the heart muscle.

C. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle. Manifestations occur due to dilation of coronary arteries with increased blood flow causing increased pressure": This statement is partially incorrect. While it accurately describes the consequences of coronary artery narrowing (decrease in diameter) leading to insufficient blood, oxygen, and nutrient delivery to the heart muscle, the second part of the statement regarding dilation of coronary arteries with increased blood flow causing increased pressure is inaccurate. Coronary artery dilation is a compensatory response to increased demand for oxygen, aiming to improve blood flow to the myocardium. However, dilation alone does not increase pressure in the coronary arteries.

D. "Coronary arteries decrease in diameter leading to insufficient blood, oxygen, and nutrients reaching the heart muscle": This statement is accurate. Coronary artery disease (CAD) involves the progressive narrowing of the coronary arteries due to atherosclerosis, which reduces blood flow to the myocardium. As the arteries narrow, there is insufficient blood, oxygen, and nutrients reaching the heart muscle, leading to manifestations such as angina, myocardial ischemia, and potentially myocardial infarction.

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A nurse is providing care for a client who experienced a myocardial infarction prior to a cardiac arrest. Which of the following laboratory tests will identify early injury to the cardiac muscle?

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