A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first?

Troponin level

Electrocardiogram (ECG)

Insertion of a peripheral IV

Chest X-ray

Answer and Explanation

The Correct Answer is B

A. A troponin level will confirm myocardial injury but should be done after an ECG, as the ECG provides immediate information on the condition.

B. The first action in a chest pain situation is to obtain an ECG to assess for myocardial infarction or other cardiac abnormalities. The ECG provides immediate information about the heart's electrical activity and can help identify whether the chest pain is related to a cardiac event.

C. Insertion of a peripheral IV is important for administering medications and fluids, but it is not as urgent as obtaining an ECG to evaluate the patient's heart.

D. A chest X-ray is useful for other potential diagnoses (e.g., pulmonary embolism or pneumothorax) but is not the first step in diagnosing a myocardial event.

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Correct Answer is D

Explanation

A. Antihistamines can raise blood pressure, but this is less likely to be the primary cause compared to medication non-adherence.

B. Acetaminophen is generally safe for use in hypertensive patients and is unlikely to contribute to the high blood pressure in this scenario.

C. Stress can contribute to elevated blood pressure, but non-adherence to medications is a more likely cause of the severe BP elevation in this case.

D. Poor medication adherence is a common cause of elevated blood pressure despite treatment. If the client has not been consistently taking their antihypertensive medications, this could explain the elevated BP and symptoms (headache, blurred vision).

A. “Secondary hypertension only occurs in people over 65 years of age." B. "Primary hypertension does not cause the vascular and organ damage that occurs with secondary hypertension, C. “Secondary hypertension has a more gradual onset than primary hypertension." D. "Primary hypertension means there is not one single identifiable cause.”

Correct Answer is D

Explanation

A. Secondary hypertension is not age-specific. It can occur at any age and is caused by identifiable factors, such as kidney disease, hormone imbalances, or medication use.

B. Primary hypertension can cause vascular and organ damage if left untreated, but secondary hypertension is also associated with organ damage due to the underlying condition. The difference lies in the cause, not the severity of damage.

C. Secondary hypertension often has a more abrupt onset due to the underlying condition, whereas primary hypertension develops more gradually over time.

D. Primary (or essential) hypertension is high blood pressure with no identifiable secondary cause. It is thought to result from a complex interplay of genetic, environmental, and lifestyle factors. The exact cause is unknown, making it "primary."

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A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first?

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Correct Answer is D

Explanation

The patient diagnosed with primary hypertension asks why it is called primary and not secondary. What is the best explanation for the nurse to provide?

Correct Answer is D

Explanation

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