The nurse knows which of the following types of angina is most closely related with an impending myocardial infarction (MI)?

A) Insert an oral airway and suction as needed:
This is generally not the first intervention for impaired glossopharyngeal (CN IX) and vagus nerve (CN X) function. The glossopharyngeal and vagus nerves play a critical role in swallowing, gag reflex, and the ability to protect the airway. While an airway might be necessary in cases of severe dysfunction, withholding food and fluids is a more immediate and specific concern when these cranial nerves are impaired, as it prevents aspiration risk.

B) Withhold oral fluids and food:
The glossopharyngeal nerve (CN IX) is involved in taste and swallowing, and the vagus nerve (CN X) is crucial for the motor control of the pharynx and larynx, which are involved in swallowing and protecting the airway. Dysfunction of these nerves can lead to difficulty swallowing (dysphagia), increased risk for aspiration, and the inability to protect the airway effectively. Withholding oral fluids and food helps prevent aspiration, a major risk when these nerves are impaired, until further assessment and management can be done.

C) Apply artificial tears to protect the cornea:
While it is important to protect the cornea in patients with cranial nerve dysfunction (specifically the facial nerve, CN VII), this does not directly relate to the glossopharyngeal (CN IX) and vagus (CN X) nerves. The glossopharyngeal and vagus nerves affect swallowing and airway protection, not eye lubrication. Applying artificial tears would not address the risk associated with impaired swallowing or airway protection.

D) Speak clearly while facing the patient:
Although speaking clearly and facing the patient might be helpful for communication, especially if the patient has difficulty with speech due to nerve impairment, it does not address the immediate and more critical concern of impaired swallowing and airway protection associated with dysfunction of the glossopharyngeal and vagus nerves. The primary concern is ensuring the patient is not at risk for aspiration while eating or drinking.

A) Equal but sluggishly reactive pupils:
Pupillary changes, including sluggish or unequal responses, are significant signs of increasing intracranial pressure (ICP) and should be monitored closely. However, altered level of consciousness (LOC) is typically one of the earliest signs of increased ICP. The response of the pupils to light can become abnormal later, once pressure increases within the brain, particularly when brainstem function is impacted.

B) Widening pulse pressure:
A widening pulse pressure is part of Cushing’s triad, which is a late sign of increased ICP. Cushing’s triad consists of hypertension, bradycardia, and irregular respirations (often seen as Cheyne-Stokes). These changes occur in the later stages of elevated ICP as a compensatory mechanism to preserve cerebral perfusion. While this is an important finding, altered LOC would precede the development of Cushing’s triad.

C) Altered level of consciousness:
Altered level of consciousness (LOC) is typically the first and most sensitive indicator of increased ICP. As pressure increases within the skull, it compresses brain tissue and affects the brainstem, which controls basic functions like consciousness. LOC can range from mild confusion and disorientation to full loss of consciousness or coma, depending on the severity of the ICP increase.

D) Tachycardia and hypotension:
Tachycardia and hypotension can be associated with shock or other conditions, but they are not characteristic of early increased ICP. In fact, as ICP rises, the body typically responds with bradycardia (slower heart rate) and hypertension (increased blood pressure), which are part of the compensatory mechanisms.