The nurse is reviewing the chart of a client with an indication of myocardial infarction or unstable angina. Which laboratory test result(s) should the nurse recognize as an indication of myocardial injury? (Select all that apply)

Elevated troponins

Decreased homocysteine levels

Elevated CK-MB

Decreased alkaline phosphatase (ALP)

Increased platelet count

Answer and Explanation

Correct Answer : A,C

Choice A: Elevated troponins. This is a correct answer. Troponins are proteins that regulate the myocardial contractile process². They are released into the bloodstream when the myocardial cells are damaged by ischemia or infarction². Troponins are highly specific and sensitive indicators of myocardial injury². The normal range for troponin I is less than 0.03 ng/mL and for troponin T is less than 0.01 ng/mL².

Choice B: Decreased homocysteine levels. This is not a correct answer. Homocysteine is an amino acid that is involved in the metabolism of methionine². Elevated homocysteine levels are associated with an increased risk of cardiovascular disease, but they are not a direct marker of myocardial injury². The normal range for homocysteine is 5 to 15 micromol/L².

Choice C: Elevated CK-MB. This is a correct answer. CK-MB is one of the isoenzymes of creatine kinase, an enzyme that catalyzes the conversion of creatine to phosphocreatine, which is used for energy storage in the muscles². CK-MB is found mainly in the myocardium and is released into the blood when the myocardial cells are injured². CK-MB is a specific and sensitive marker of myocardial injury, but it is less specific than troponins². The normal range for CK-MB is 0 to 3 ng/mL².

Choice D: Decreased alkaline phosphatase (ALP).This is not a correct answer. ALP is an enzyme that is found in various tissues, such as the liver, bone, intestine, and placenta². ALP is not a marker of myocardial injury, and its levels are not affected by ischemia or infarction². The normal range for ALP is 30 to 120 U/L².

Choice E: Increased platelet count.This is not a correct answer. Platelets are blood cells that are involved in hemostasis and clot formation². Increased platelet count, or thrombocytosis, can be a sign of inflammation, infection, malignancy, or other conditions². Platelet count is not a marker of myocardial injury, and it does not reflect the extent of ischemia or infarction². The normal range for platelet count is 150,000 to 450,000 per microliter of blood².

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Correct Answer is B

Explanation

Choice A reason: A history of cardiac disease is not directly related to enlarged axillary lymph nodes. Cardiac disease may affect the heart, blood vessels, and circulation, but not the lymphatic system. ¹

Choice B reason: A recent infection is a possible cause of enlarged axillary lymph nodes. Lymph nodes are part of the immune system and they swell when they are fighting an infection. ² The nurse should ask the client about any signs or symptoms of infection, such as fever, sore throat, or skin rash.

Choice C reason: Shortness of breath is not directly related to enlarged axillary lymph nodes. Shortness of breath may indicate a respiratory problem, such as asthma, bronchitis, or pneumonia. ³ However, these conditions do not usually affect the lymph nodes in the armpit area.

Choice D reason: Surgery on the neck is not directly related to enlarged axillary lymph nodes. Surgery on the neck may affect the lymph nodes in the neck or the collarbone area, but not the lymph nodes in the armpit area. The nurse should ask the client about any history of surgery or trauma to the lymph nodes or the surrounding tissues.

A. will confirm a diagnosis of G6PD anemia. B. requires the patient to be NPO for 12 hours prior to the test. C. is a 24-hour urine specimen collection test. D. entails administration of methylcellulose prior to the test.

Correct Answer is C

Explanation

Choice A reason: The Schilling test is not used to diagnose G6PD anemia, which is a genetic disorder that causes red blood cells to break down when exposed to certain substances. The Schilling test is used to measure how well the body absorbs vitamin B12 from the intestine. ¹²

Choice B reason: The Schilling test does not require the patient to be NPO (nothing by mouth) for 12 hours prior to the test. The patient can drink water, but should avoid food for 8 hours before the test. ²

Choice C reason: The Schilling test is a 24-hour urine specimen collection test. The patient is given a dose of radioactive vitamin B12 by mouth and another dose of nonradioactive vitamin B12 by injection. The urine is collected for 24 hours to measure how much of the radioactive vitamin B12 is excreted. This indicates how well the body absorbs vitamin B12 from the intestine. ¹²

Choice D reason: The Schilling test does not entail administration of methylcellulose prior to the test. Methylcellulose is a type of laxative that can interfere with the absorption of vitamin B12. The patient should avoid taking any laxatives, antacids, or antibiotics before the test. ²³

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The nurse is reviewing the chart of a client with an indication of myocardial infarction or unstable angina. Which laboratory test result(s) should the nurse recognize as an indication of myocardial injury? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During an admission assessment of a client, the nurse palpates enlarged axillary lymph nodes. Which question should the nurse ask the client related to this finding?

Correct Answer is B

Explanation

In preparation for a patient having a Schilling test, the nurse should explain that the test:

Correct Answer is C

Explanation

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