Difficulty: Medium
Average Score: 66%
Simulated
Passage / Scenario
Vital Signs1000
Temperature 37.1┬░ C (98.8┬░ F)
Heart rate 110/min and irregular Respiratory rate 24/min Blood pressure 164/80 mm Hg
Oxygen saturation 93% on room air
A nurse is admitting a client who reports tightness in their chest that radiates to left arm. The nurse is reviewing the client's medical record. Select the four findings that require immediate follow-up.
Correct answer
C,D,E,G
Rationale
Elevated BP, pain, ECG changes, and troponin levels indicate a potential myocardial infarction.