Medical Surgical Labs Cardiac #1

Question

The nurse is caring for a 35-year-old client brought into the ER for a MVA. No comorbidities and the client is otherwise in good health. Cardiac labs indicate a troponin level of 0.52 but the client reports no chest pain and is not short of breath. Vitals are normal at the present time. The provider has ordered additional lab studies. Which next action by the nurse may be priority?

Answers

  1. Obtain chest x-ray.
    • Rationale:

      This answer is not correct because it would not be the priority option. Elevated troponin signals trauma to heart muscle and cell death and an ECG is the best option to indicate ischemia.

  2. Schedule for coronary angiogram.
    • Rationale:

      This answer is not correct because a coronary angiogram assesses for obstructed coronary artery lesions. Elevated troponins indicate ischemia of the heart muscle for this reason, an ECG would be first, as it is less invasive.

  3. Initiation of nitroglycerin.
    • Rationale:

      This answer is not correct because nitroglycerin is given in the event of chest pain. Also, the client’s vitals are normal. Nitroglycerin is a vasodilator and will drop the blood pressure significantly.

  4. Obtain an ECG.
    • Rationale:

      This answer is correct because a troponin level over 0.5 requires further investigation since it may indicate a myocardial infarction. An ECG can determine if there are any ischemic changes. Additional lab studies along with ECG will indicate if the elevation is due to other problems, such as renal insufficiency.

Overview

An elevated troponin level over 0.5 indicates trauma to heart muscle and cell death. This should be followed up with additional lab studies and an ECG to determine if there is any ischemia.

Explanation

Learning Outcomes

An elevated troponin level over 0.5 indicates trauma to heart muscle and cell death. This should be followed up with additional lab studies and an ECG to determine if there is any ischemia. Additional investigations would include serial troponin levels/additional lab studies and a chest x-ray. If these prove to be abnormal, then cardiology will be brought on board and initiate treatment.

Test Taking Tip

Read the question very carefully. Make note of what is normal and what is abnormal. Then, decide on the next course of action.

Video Rationale