What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply.

The correct answer is A. Electrocardiogram.

Choice A rationale:

Electrocardiogram (ECG) is the priority diagnostic procedure for a suspected myocardial infarction (MI) due to several compelling reasons:

Rapidity: An ECG can be performed quickly and easily at the bedside, providing immediate results within minutes. This swiftness is crucial in the context of MI, where time is of the essence to initiate appropriate treatment and salvage viable heart tissue.

Sensitivity: The ECG is highly sensitive in detecting the electrical changes that occur during an MI. It can identify characteristic ST-segment elevation or depression, T wave inversions, and other abnormalities that strongly suggest myocardial ischemia or infarction.

Specificity: While not perfectly specific for MI, the ECG can often distinguish it from other conditions that may cause chest pain, such as pericarditis or pulmonary embolism. This diagnostic differentiation is crucial for guiding appropriate management.

Non-invasiveness: The ECG is a non-invasive procedure that does not involve any needles, catheters, or exposure to radiation. This makes it a safe and readily accessible test, even for patients who may be hemodynamically unstable or have other medical conditions.

Cost-effectiveness: The ECG is a relatively inexpensive diagnostic tool compared to other imaging modalities like echocardiography or cardiac angiography. This cost-effectiveness makes it a valuable first-line test in evaluating potential MI, allowing for efficient resource allocation.

Rationales for other choices:

Choice B (Papercut): This is not a relevant diagnostic procedure for MI and is therefore incorrect.

Choice C (Cardiac Angiogram): While cardiac angiography can definitively visualize coronary artery blockages, it is an invasive procedure that carries risks and requires specialized facilities and personnel. It is typically reserved for cases where the diagnosis remains uncertain after non-invasive testing or when intervention is planned.

Choice D (Echocardiogram): Echocardiography can assess heart function and detect structural abnormalities, but it is less sensitive than ECG for the early electrical changes of MI. It may be used as an adjunct test to provide additional information, but it is not the priority procedure in the initial evaluation.

Choice A rationale:

While educating the patient about the pathophysiology of acute coronary artery disease (ACAD) is important, it is not the priority intervention during an acute episode.

The patient is likely experiencing significant discomfort and anxiety, and their ability to process information may be impaired.

Providing immediate relief of symptoms and stabilizing the patient's condition take precedence over education at this time.

Choice B rationale:

Supplemental oxygen may be beneficial for patients with ACAD, but it is not the highest priority intervention.

Oxygen therapy can improve oxygen saturation levels in the blood, but it does not directly address the underlying issue of coronary artery occlusion.

It is important to administer nitroglycerin first to dilate the coronary arteries and improve blood flow to the heart muscle.

Choice C rationale:

Sublingual nitroglycerin is a vasodilator that relaxes and widens blood vessels, improving blood flow to the heart muscle.

It is a first-line medication for the treatment of acute angina (chest pain) and is often used in the setting of ACAD.

Nitroglycerin can rapidly relieve chest pain and other symptoms of ischemia, such as shortness of breath, and can help prevent further damage to the heart muscle.

Choice D rationale:

Staying with the patient to decrease anxiety is important, but it is not the priority intervention.

While providing emotional support can help to calm the patient and reduce stress, it does not directly address the underlying issue of myocardial ischemia.

It is crucial to administer nitroglycerin to dilate the coronary arteries and improve blood flow to the heart muscle.