The nurse is caring for client who presented to the emergency department for chest pain. The nurse knows that which of the following laboratory tests is most specific for myocardial damage?

Troponins I & T

Creatine Kinase

C Reactive Protein

Myoglobin

Answer and Explanation

The Correct Answer is A

A. Troponins I & T:
Troponins I and T are the most specific biomarkers for myocardial damage. These proteins are released into the bloodstream when the heart muscle is injured, such as during a myocardial infarction (MI). Troponins remain elevated for a prolonged period (typically up to 1-2 weeks) after myocardial injury, making them highly sensitive for detecting both acute and recent myocardial damage. Because of their high specificity for heart muscle, they are considered the gold standard for diagnosing acute myocardial infarction.

B. Creatine Kinase:
Creatine kinase (CK) is an enzyme found in the heart, brain, and skeletal muscle. While CK-MB (the heart-specific isoenzyme) can be elevated in cases of myocardial damage, it is less specific than troponins because it can also be elevated due to skeletal muscle injury or other conditions. CK-MB levels rise more rapidly than troponins but return to baseline within 48-72 hours, making it less useful for detecting myocardial damage over a longer period.

C. C-Reactive Protein (CRP):
C-Reactive Protein (CRP) is an acute-phase reactant produced by the liver in response to inflammation or tissue injury. While CRP levels can be elevated in various inflammatory conditions, including atherosclerosis, it is not specific to myocardial damage. Elevated CRP is associated with increased risk for cardiovascular events but does not provide specific information about acute myocardial injury, making it less helpful for diagnosing myocardial infarction.

D. Myoglobin:
Myoglobin is an oxygen-binding protein found in both skeletal and cardiac muscle. While it is an early marker that rises rapidly after muscle injury, it lacks specificity for myocardial damage because it is also released from skeletal muscle. Myoglobin levels peak quickly (within 1-4 hours of injury) and return to baseline within 24 hours, so it is not as useful for diagnosing a myocardial infarction or monitoring long-term cardiac injury.

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Correct Answer is D

Explanation

A. Positive Trousseau's sign:
A positive Trousseau's sign (spasms of the hand and forearm when a blood pressure cuff is inflated) is a sign of hypocalcemia, not hypermagnesemia. It indicates low calcium levels in the blood, not elevated magnesium levels. Therefore, this is not indicative of hypermagnesemia.

B. Hypertension and headache:
Hypertension and headache are more commonly associated with hypomagnesemia (low magnesium levels), rather than hypermagnesemia. Elevated magnesium levels tend to cause vasodilation, which can lead to hypotension, not hypertension. Therefore, these symptoms are not consistent with hypermagnesemia.

C. Tachycardia and tachypnea:
Tachycardia and tachypnea are often signs of hypomagnesemia as well, where the body compensates for low magnesium by increasing heart rate and breathing rate. Hypermagnesemia, on the other hand, usually causes bradycardia (slowed heart rate) and respiratory depression. So, tachycardia and tachypnea are not indicative of hypermagnesemia.

D. Depressed deep tendon reflexes and lethargy:
This is the correct answer. Hypermagnesemia can lead to depressed deep tendon reflexes (DTRs) and lethargy, as magnesium is a central nervous system depressant. Elevated magnesium levels inhibit neuromuscular function, which can cause symptoms such as diminished reflexes, muscle weakness, and overall lethargy or drowsiness. This combination of findings is a key indicator of hypermagnesemia.

A. NG tube placement B. Low calorie and low protein diet C. Stool softeners and laxatives D. Barium contrast imaging studies

Correct Answer is A

Explanation

A. NG tube placement:
In patients with an exacerbation of inflammatory bowel disease (IBD), particularly in cases of severe flare-ups, the gastrointestinal tract may need rest, and the patient may have difficulty maintaining adequate nutrition. An NG (nasogastric) tube may be used for enteral feeding if the patient is unable to tolerate oral intake, or to provide bowel rest if indicated. Nutritional support via an NG tube can help provide essential nutrients and manage symptoms during an exacerbation, especially if the patient is experiencing severe nausea, vomiting, or malabsorption.

B. Low calorie and low protein diet:
During an IBD flare, the patient typically needs a higher-calorie, higher-protein diet to support healing and immune function. A low-calorie, low-protein diet would not be appropriate, as it would not provide the necessary nutrients for recovery and tissue repair. In fact, nutritional support is often one of the key components in managing IBD exacerbations. A diet rich in calories and protein is often recommended to prevent malnutrition.

C. Stool softeners and laxatives:
Stool softeners and laxatives are generally contraindicated during an IBD flare, as they can exacerbate diarrhea and increase bowel motility, which may worsen symptoms such as abdominal pain, cramping, and diarrhea. The focus during an exacerbation of IBD is typically on controlling inflammation, rest, and reducing bowel irritation, rather than promoting bowel movements.

D. Barium contrast imaging studies:
Barium contrast imaging studies are generally not performed during an acute exacerbation of IBD because they can cause further irritation to the inflamed bowel. Imaging studies are typically used for diagnosis and assessment of disease extent in a stable or chronic phase, rather than during an acute flare. The priority during a flare is managing symptoms and controlling inflammation, not conducting procedures that could aggravate the condition.

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The nurse is caring for client who presented to the emergency department for chest pain. The nurse knows that which of the following laboratory tests is most specific for myocardial damage?

Nursing Test Bank

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