The LPN is caring for a client that was recently started on furosemide for dependent edema caused by right sided heart failure. Which nursing actions are appropriate to add to the plan of care for the patient?

A. A marker of cardiac muscle damage: Troponin is a protein found specifically in cardiac myocytes that is released into the bloodstream when the heart muscle is injured. Elevated levels are the most specific and sensitive laboratory indicator for diagnosing an acute myocardial infarction. It allows healthcare providers to differentiate between unstable angina and true myocardial necrosis.

B. A level of an electrolyte that when abnormal may cause chest pain: Electrolytes such as potassium or magnesium can cause arrhythmias when abnormal, but they are not troponins. Troponin is a structural protein, not a charged ion involved in cellular electrical potential. Monitoring electrolytes is important in cardiac care, but it is distinct from the necrotic marker testing.

C. A marker of the amount of stretch the ventricle has done: The marker for ventricular stretch and fluid volume overload is Brain Natriuretic Peptide (BNP), not troponin. BNP is used to diagnose and monitor the severity of heart failure. Troponin specifically indicates cell death and injury rather than the degree of volume expansion or pressure within the heart.

D. A level of liver enzyme that can be elevated with right sided heart failure: Liver enzymes like ALT and AST may rise during systemic venous congestion, but they are not cardiac-specific. Troponin has no diagnostic value for liver function or hepatic congestion. It is used exclusively to evaluate the integrity of the myocardial tissue during suspected ischemic events.

A. Apply oxygen, administer morphine, and place the client on bed rest with cardiac monitoring: These interventions prioritize reducing myocardial oxygen demand and alleviating ischemic pain in the acute phase of NSTEMI. Morphine acts as a potent analgesic and vasodilator, while oxygen improves tissue saturation. Bed rest and continuous monitoring ensure hemodynamic stability and rapid detection of dysrhythmias.

B. Have the client chew two aspirin 325 mg each, administer oxygen and bring the crash cart to the bedside: While aspirin is indicated for its antiplatelet effects, a dose of 650 mg exceeds the standard loading dose of 162 to 325 mg. Administering excessive aspirin increases the risk of gastrointestinal hemorrhage without providing additional cardiac benefit. The crash cart is necessary but secondary to immediate pharmacological stabilization.

C. Administer oxygen, give a dose of nitroglycerin sublingual, and follow with a nonsteroidal anti-inflammatory: Nonsteroidal anti-inflammatory drugs, excluding aspirin, are contraindicated in acute myocardial infarction because they increase the risk of myocardial rupture and mortality. Nitroglycerin helps with vasodilation, but the addition of an NSAID is harmful. This combination fails to provide the necessary sedation and potent analgesia required.

D. Begin a heparin drip, administer oxygen, and call the lab for stat troponin levels: Heparin and troponin levels are essential components of NSTEMI management but do not address the client's immediate, unrelieved pain. Anticoagulation prevents further thrombus formation but does not actively reduce the current ischemic workload. Immediate nursing priorities must focus on symptomatic relief and cardiac workload reduction.