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
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.
Nursing Test Bank
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Related Questions
Correct Answer is C
Explanation
A. AST and ALT are liver enzymes, primarily used to assess liver function, not directly related to monitoring heparin therapy.
B. Prothrombin time (PT) is used to monitor warfarin therapy, not heparin. Heparin therapy is typically monitored with aPTT, whereas warfarin is monitored with PT/INR.
C. Heparin is an anticoagulant that works by inhibiting clotting factors, and the aPTT is used to monitor its effectiveness. The aPTT measures the time it takes for blood to clot and helps ensure the heparin dose is therapeutic without causing excessive bleeding. The typical therapeutic range for aPTT on heparin therapy is 1.5 to 2.5 times the normal value.
D. INR is used to monitor warfarin therapy, not heparin. Heparin does not affect INR levels.
Correct Answer is C
Explanation
A. Hydralazine is a vasodilator, but it does not have the same mechanism of action as ACE inhibitors or ARBs and would not be an appropriate substitute.
B. An antiplatelet medication is not appropriate for addressing a cough and is typically used for cardiovascular conditions like preventing blood clots.
C. ARBs, such as losartan, are a class of medications that work similarly to ACE inhibitors by blocking the effects of angiotensin II, but they do not cause the common side effect of a dry, hacking cough, which is seen with ACE inhibitors. This makes ARBs a good alternative for patients who experience this side effect.
D. Nitroglycerin is a vasodilator used in acute conditions like chest pain, not for managing hypertension or a cough related to ACE inhibitors.
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