A patient is admitted to the emergency department with clinical indications of an ST elevated myocardial infarction. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient?
Administer thrombolytic therapy unless contraindicated
Keep oxygen saturation levels to at least 88%
Maintain heart rate above 100 beats/min
Administer diuretics aggressively and monitor daily weight
The Correct Answer is A
A. Thrombolytic therapy is the priority in managing an ST-elevated myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not available. It helps dissolve the blood clot causing the blockage in the coronary artery.
B. Maintaining oxygen saturation is important, but the priority is to restore coronary blood flow.
C. The focus should be on stabilizing the heart rhythm, not specifically maintaining a high heart rate.
D. Diuretics are important in managing heart failure but are not the priority in acute STEMI management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. There is no time to wait for a DNR order in an emergency; immediate action is needed.
B. Without a written DNR order, the nurse is legally and ethically obligated to initiate CPR and call the emergency response team to attempt to save the client’s life.
C. Contacting the risk manager is not an immediate action that would benefit the patient in this emergency situation.
D. The family’s wishes cannot be respected in this scenario without a formal DNR order in place; thus, the nurse must perform CPR.
Correct Answer is B
Explanation
A. Spironolactone is a potassium-sparing diuretic, so it would not cause hypokalemia.
B. Furosemide is a loop diuretic that causes the kidneys to excrete potassium, leading to hypokalemia.
C. Metoprolol is a beta-blocker and does not directly affect potassium levels.
D. Nitroglycerin is a vasodilator and does not affect potassium levels.
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