Difficulty: Medium
Average Score: 71%
Simulated
Passage / Scenario
Physical Examination0900:
Client admitted with report of chest pain radiating to the left arm,
sweating, shortness of breath, and epigastric discomfort.
Client awake, alert, and oriented x3.
Lung sounds clear bilaterally, 5152 heart sounds noted.
All pulses palpable.
Skin cool and diaphoretic to touch.
Rates pain as 6 on a 0 to 10 pain scale.
Pain described as sharp in the chest area with feelings of tightness and indigestion.
Bowel sounds active in all 4 quadrants.
Diagnostic Results
0905:
ECG Sinus Tachycardia with ST elevation
Blood glucose 84 mg/dL (74 to 106 mg/dl)
WBC 9,000/mm3 (5,000 to 10,000 mm2)
Platelets 275,000/mm2 (150,000 to 400,000/mm3)
Troponin I 0.7 ng/mL (less than 0.1 ng/mL)
Troponin 10.09 ng/mL (less than 0.03 ng/mL)
Medical History
Hypertension
1 pack per day nicotine use- smoker
Coronary artery disease
Obesity
Erectile dysfunction
Nurses Notes
0915:
18 gauge IV inserted right forearm infusing 0.9% Normal Saline 100 mL/hr. Continuous 12-lead ECG monitoring indicating sinus tachycardia with ST elevation. Provider notified.
Medication Administration Record
Sildenafil 50 mg PO once daily
Simvastatin 40 mg PO once daily
Metoprolol 100 mg PO once daily
Multivitamin once daily
A nurse in the emergency department is caring for client who is experiencing chest pain. Exhibits :The nurse is reviewing the clientÔÇÖs assessment data to prepare the plan of care. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Rationale
Action to Take: Administer Oxygen via nasal canula 2 L/min., Administer transdermal nitroglycerin; Potential Condition: Myocardial Infarction; Parameter to Monitor: Vital signs, Electrocardiogram (ECG) rhythm. Myocardial infarction is the most likely condition due to chest pain. Administering oxygen and nitroglycerin help improve oxygenation and reduce chest pain. Monitoring vital signs and ECG rhythm helps assess the client's cardiovascular status. The other choices are incorrect: Verapamil, aspirin, and morphine are not first-line treatments for myocardial infarction. Ischemic stroke, cardiogenic shock, and chronic stable angina are not the most likely conditions for chest pain. Monitoring serum glucose, WBC count, and platelet count are not specific to assessing myocardial infarction.