While evaluating a patient diagnosed with angina, the patient asks, “What causes this pain in my heart?” What is the nurse’s BEST response?
Increased afterload.
Inadequate myocardial oxygenation.
Coronary artery disease.
Increased preload.
The Correct Answer is C
Choice A rationale:
Increased afterload refers to the resistance against which the heart must pump to eject blood into the aorta. While increased afterload can contribute to chest pain in certain conditions like aortic stenosis, it's not the primary cause of angina.
Angina is typically triggered by exertion or emotional stress, which increase myocardial oxygen demand. Increased afterload doesn't directly cause this imbalance in oxygen supply and demand, making it less likely to be the primary driver of angina pain.
Choice B rationale:
Inadequate myocardial oxygenation is a key concept in understanding angina, but it's not the most precise answer to the patient's question about the cause of their pain.
It's important to explain the underlying reason for the inadequate oxygenation, which is coronary artery disease.
Choice C rationale:
Coronary artery disease (CAD) is the most common cause of angina. It's characterized by narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle.
When the heart's demand for oxygen exceeds the supply available through the narrowed arteries, it experiences ischemia (lack of oxygen), leading to the characteristic chest pain of angina.
This explanation directly addresses the patient's question about the cause of their pain, linking the symptom to the underlying disease process. Choice D rationale:
Increased preload refers to the amount of blood filling the ventricles before they contract. While increased preload can contribute to heart failure and pulmonary edema, it's not typically a direct cause of angina.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Normal sinus rhythm (NSR) is the typical heart rhythm in healthy individuals. It's characterized by the following features on an ECG:
Heart rate: 60-100 beats per minute
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question does not meet the criteria for NSR because the heart rate exceeds 100 beats per minute.
Choice B rationale:
Sinus tachycardia is a rhythm that originates in the sinus node (the heart's natural pacemaker) but has a faster rate than normal. Its ECG features include:
Heart rate: greater than 100 beats per minute (typically 100-150)
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question aligns with the characteristics of sinus tachycardia, making it the most likely correct answer.
Choice C rationale:
Sinus bradycardia is a rhythm that also originates in the sinus node but has a slower rate than normal. Its ECG features include:
Heart rate: less than 60 beats per minute
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question does not meet the criteria for sinus bradycardia due to its heart rate being above 60 beats per minute.
Choice D rationale:
Atrial fibrillation (AFib) is a common arrhythmia characterized by rapid, irregular, and disorganized electrical activity in the atria. Its ECG features include: Irregular rhythm
Absence of distinct P waves (replaced by fibrillatory waves)
QRS complexes typically narrow (unless there's concomitant bundle branch block)
The rhythm in question does not exhibit the characteristic features of AFib, notably the irregular rhythm and absence of P waves.
Correct Answer is A
Explanation
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.
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