Which of the following clinical manifestations would make the nurse suspect the client is experiencing a myocardial infarction (MI)?
A. Nausea and vomiting.
Radiating pain to the left arm.
Shortness of breath.
Headache.
The Correct Answer is B
Choice B rationale
Radiating pain to the left arm is a classic symptom of a myocardial infarction (MI). This pain occurs due to the heart muscle not receiving enough oxygen, often because of a blockage in one or more coronary arteries. The pain can radiate to the left arm, jaw, neck, or back, and is a key indicator for diagnosing an MI.
Choice A rationale
Nausea and vomiting can occur during an MI but are not the most distinctive symptoms for diagnosis. They can also be associated with other conditions, making them less specific indicators of MI.
Choice C rationale
Shortness of breath is a common symptom during an MI, resulting from reduced oxygen supply to the heart. However, while it is an important clinical manifestation, it can also be associated with other cardiac or respiratory conditions.
Choice D rationale
Headache is not a typical symptom of an MI. It is less commonly associated with heart attacks and can be caused by a wide range of other factors, making it an unreliable symptom for diagnosing MI.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A rationale
Lying down after meals can increase the risk of acid reflux in individuals with a hiatal hernia. Patients are often advised to remain upright after eating to minimize symptoms.
Choice B rationale
Elevating the head of the bed helps prevent gastric contents from refluxing into the esophagus, reducing symptoms of hiatal hernia and promoting better sleep.
Choice C rationale
Reducing caffeine and spicy foods can help manage symptoms, as these substances can irritate the stomach lining and exacerbate reflux in hiatal hernia patients.
Choice D rationale
Maintaining a healthy weight is important because excess weight can increase abdominal pressure and contribute to the worsening of hiatal hernia symptoms.
Choice E rationale
Drinking less fluid is not typically a recommendation for hiatal hernia. Adequate hydration is important for overall health, and reducing fluid intake may not have a significant impact on symptoms.
Correct Answer is A
Explanation
Choice A rationale
The oral mucosa is the most reliable indicator of central cyanosis because it reflects the oxygenation of central tissues. When there is a lack of oxygen in the bloodstream, the lips and mucous membranes, such as the oral mucosa, appear blue or cyanotic. This is a clear sign that the central tissues are not receiving adequate oxygenation.
Choice B rationale
The sclera of the eye is not a reliable indicator of central cyanosis. The sclera is white and does not change color due to oxygen levels. Instead, it may become yellow in jaundice or red in inflammation but does not reflect central cyanosis.
Choice C rationale
The ear lobes are peripheral areas and do not reliably indicate central cyanosis. Peripheral cyanosis can occur due to local blood flow issues, and ear lobes can appear blue in cold conditions even when central oxygenation is normal.
Choice D rationale
The soles of the feet, similar to the ear lobes, are peripheral areas and not reliable indicators of central cyanosis. Cyanosis in the feet can result from poor peripheral circulation rather than central hypoxia.
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