Medical Surgical Cardiac Angina #1

Question

A client is brought to the emergency department for unrelieved chest pain for 45 minutes. ECG performed by EMS suspects a non-ST elevation myocardial infarction (NSTEMI). Which of the following interventions is most important?

Answers

  1. Administer oxygen, give a dose of NTG sublingual, and follow with a nonsteroidal anti-inflammatory.
    • Rationale:

      This answer is not correct because while application of oxygen, administration of nitroglycerin sublingual tablets are used in the ED for treatment of suspected MI, administration of NSAIDs are not appropriate. NSAIDS are contraindicated in heart clients due to the negative effect they cause on clotting factors.

  2. Begin a heparin drip, administer oxygen, and call the lab for stat troponin levels.
    • Rationale:

      This answer is not correct because the client may have an anticoagulant provided IV, but the emergent priority is to decrease cardiac demand in that moment. A client with a suspected myocardial infarction should be placed on bed rest, have oxygen placed, and have morphine administered. Troponin levels will be assessed and IV heparin may be administered to disrupt the formation of blood clots.

  3. Apply oxygen, administer morphine sulphate, and place the client on bed rest with cardiac monitoring.
    • Rationale:

      This answer is correct because a client with suspected myocardial infarction with non-ST elevation should be placed on bed rest, have oxygen placed, and have morphine administered. Morphine reduces preload and decreases workload of the heart, while bed rest will reduce workload and oxygen needs. Other interventions indicated will be administering two aspirin for the client to chew due to its antiplatelet properties. Nitroglycerin is a vasodilator and this will assist in improved blood flow for adequate perfusion.

  4. Have the client chew two aspirin 325 mg each, administer oxygen, and bring the crash cart to the bedside.
    • Rationale:

      This answer is not correct because although aspirin is part of the advanced cardiac life support protocol, the best answer choice is to apply oxygen, administer morphine sulphate, and place the client on bed rest with cardiac monitoring. Aspirin 162 mg to 325 mg should be given to the client presenting with acute coronary symptoms, unless there is a known allergy to aspirin.

Overview

A client with a suspected myocardial infarction with non-ST elevation should be placed on bed rest, have oxygen placed, and have morphine administered. Morphine reduces preload and decreases workload of the heart, while bed rest will reduce workload and oxygen needs.

Explanation

Learning Outcomes

A client with suspected myocardial injury should have oxygen available, morphine, and should be on bed rest. Morphine reduces preload and decreases workload of the heart, while bed rest will reduce workload and oxygen needs. These actions will decrease cardiac demand. Other interventions indicated will be administering two aspirin for the client to chew due to its antiplatelet properties. Nitroglycerin is a vasodilator and this will assist in improved blood flow for adequate perfusion. NSAIDS are contraindicated in heart clients due to the negative effect they cause on clotting factors.

Test Taking Tip

When there is a list of things in an answer, remember that all answers must be correct for the selection to be correct.

Video Rationale