You are getting a history from your 45 year old female patient.
She tells you that she has been having intermittent chest pain.
When you ask her more details about it, she tells you that the pain does not get worse with activity.
She notices it more when she is just sitting around.
It usually resolves spontaneously.
Her only past medical history is migraines.
Based on this information, which of the following might she have?
Gastroesophageal Reflux Disease (GERD).
Prinzmetal's angina.
First degree heart block.
Chronic stable angina.
The Correct Answer is B
Choice A rationale
Gastroesophageal Reflux Disease (GERD) pain is often described as burning and is typically exacerbated by meals, bending over, or lying down, which increases intra-abdominal pressure and allows gastric acid reflux. The patient's pain, which occurs when sitting and is not worse with activity, is less typical of GERD-related chest pain.
Choice B rationale
Prinzmetal's angina, or variant angina, is caused by transient, spontaneous spasm of a coronary artery, often occurring at rest or during the night/early morning, rather than with exertion. Its resolution is typically spontaneous or with nitrates, aligning well with the described pattern of intermittent pain when "just sitting around.”.
Choice C rationale
A first-degree heart block is an electrical conduction delay through the AV node, characterized by a prolonged PR interval (normal range: 0.12–0.20 seconds) on an ECG. It is usually asymptomatic and does not directly cause chest pain, making it an unlikely cause of the described intermittent symptoms.
Choice D rationale
Chronic stable angina is classically and predictably brought on by exertion or emotional stress due to fixed atherosclerotic plaque limiting blood flow (supply-demand mismatch). The pain is relieved by rest or nitroglycerin; the patient's pain not worsening with activity makes this diagnosis less likely. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Ventricular Fibrillation (VF) is a chaotic ventricular electrical activity resulting in no cardiac output, leading to immediate circulatory collapse and sudden cardiac death. Defibrillation is the critical intervention that delivers a massive electrical shock to reset the heart's electrical system, making it the absolute priority over airway insertion or medication administration.
Choice B rationale
Immediate defibrillation is the definitive and life-saving intervention for Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (pVT). This electrical therapy stops the chaotic activity, allowing the natural pacemaker (SA node) to resume a normal rhythm. Time is muscle and brain; every minute of delay significantly reduces survival probability.
Choice C rationale
While a 12-lead ECG is essential for diagnostic confirmation and determining the location of myocardial injury, obtaining it delays the immediate life-saving therapy needed for VF. CPR and defibrillation protocols must be initiated immediately; rhythm confirmation is done using the quick-look paddles or monitor patches.
Choice D rationale
Amiodarone is an antiarrhythmic drug used to stabilize the heart rhythm and increase the success rate of defibrillation, often administered after initial unsuccessful shocks. However, defibrillation remains the primary, most urgent intervention to terminate VF; drug administration should not delay the immediate electrical countershock. —. ##.
Correct Answer is D
Explanation
Choice A rationale
Ordering a breathing treatment, such as a bronchodilator, is appropriate for a patient with documented bronchospasm or underlying reactive airway disease. Since CABG patients are generally high-risk for atelectasis due to incisional pain, a more generalized and preventative measure like an incentive spirometer is the priority intervention.
Choice B rationale
Giving adequate pain medication is crucial because post-surgical pain leads to shallow breathing and splinting, which directly increases the risk of atelectasis and pneumonia. However, while pain control facilitates respiratory efforts, the direct and most effective intervention to prevent collapse of the alveoli is mechanical lung inflation.
Choice C rationale
Applying oxygen via nasal cannula is used to treat or prevent hypoxemia by increasing the fraction of inspired oxygen (FiO_2). Unless the patient's oxygen saturation is low (normal SpO_2 is 95-100%), this is not a primary intervention to prevent respiratory mechanical compromise like atelectasis; it merely treats the resulting hypoxemia.
Choice D rationale
Incentive spirometry is the most crucial mechanical intervention for preventing postoperative respiratory complications in CABG patients. It encourages maximal inspiratory effort, which helps re-expand collapsed alveoli, preventing atelectasis and subsequent pneumonia caused by shallow, painful post-sternotomy breathing. —.
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