Which electrocardiographic (ECG) change by a client with chest pain is most important for the nurse to report rapidly to the health care provider?

Jugular venous distention (JVD) is a clinical sign that indicates increased fluid volume or fluid overload in the cardiovascular system. When the head of the client's bed is elevated at 45 degrees, the jugular veins should normally be flat or slightly distended. However, if the jugular veins appear engorged and bulging, it suggests that there is an increased amount of blood returning to the right side of the heart and is unable to be efficiently pumped forward, leading to jugular venous distention.

JVD is commonly seen in conditions such as heart failure, where the heart's ability to pump blood efficiently is compromised, leading to fluid accumulation in the veins and eventually causing jugular venous distention.

Option A, jugular vein atherosclerosis, is not a common cause of JVD. Atherosclerosis refers to the build-up of plaque within arteries, not veins.

Option C, decreased fluid volume, would lead to dehydration and decreased venous filling, which would not cause jugular venous distention. It would lead to flat or sunken jugular veins.

Option D, incompetent jugular vein valves, would not cause jugular venous distention with the head of the bed elevated. Incompetent valves may lead to venous reflux or backward flow of blood, but it would not lead to the distention of the jugular veins in this position.

B-type natriuretic peptide (BNP) is a diagnostic blood test that can be most useful to the nurse in determining whether a client admitted with acute shortness of breath has heart failure.

BNP is a hormone produced by the heart in response to increased pressure and volume in the heart, especially in cases of heart failure. When the heart is under stress, such as in heart failure, it releases BNP into the bloodstream. Elevated levels of BNP are strongly indicative of heart failure, and the testis particularly helpful in differentiating heart failure from other conditions that may present withsimilar symptoms, such as pulmonary disorders.

When a patient presents with acute shortness of breath, the BNP test can provide valuable information to help guide the diagnosis and treatment. If the BNP level is elevated, it suggests that heart failure is likely the cause of the symptoms, and appropriate interventions can be initiated promptly.

While other diagnostic tests like serum troponin (A) are important for assessing heart damage in conditions like myocardial infarction (heart attack), they may not be as specific for heart failure.

Arterial blood gases (B) are helpful in evaluating gas exchange and acid-base balance, especially in patients with respiratory distress, but they are not specific for diagnosing heart failure.

A 12-lead electrocardiogram (ECG) (C) can provide valuable information about the heart's electrical activity and any signs of acute myocardial infarction or other cardiac abnormalities, but it is not the primary test for diagnosing heart failure. An ECG can support the diagnosis if specific changes suggestive of heart failure are present, but the BNP test provides more direct evidence for heart failure diagnosis.