A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care?

Correct Answer: A

Rationale: The correct focus of nursing care is A: Improving myocardial oxygenation and reducing cardiac workload. Substernal chest pain with electrocardiographic changes and elevated troponin indicates a myocardial infarction. By improving oxygenation, we can help reduce myocardial damage. Reducing workload can prevent further strain on the heart. Choice B is incorrect as diagnosis is already established. Choice C is not the priority compared to addressing the physiological issue. Choice D is not directly addressing the cardiovascular problem.

Correct Answer: C

Rationale: The correct answer is C. The client receiving antibiotics for bacterial endocarditis reporting anxiety and chest pain should be seen first. This client is at risk for complications like infective endocarditis, which can lead to serious cardiac issues. Addressing the anxiety and chest pain promptly is essential to prevent further deterioration. A client with hypertrophic cardiomyopathy reporting dyspnea may need attention next, but it's not as urgent as addressing a potential complication like infective endocarditis. The client post-cardiac catheterization ambulating for the first time and the client recovering from CABG with a fever of 101 F can be seen after the client with bacterial endocarditis due to the acuity of their presenting symptoms.

Correct Answer: A

Rationale: Step-by-step rationale for choice A being correct: 1. Return to her usual activities of daily living indicates improved health and well-being. 2. Managing hypertension should not significantly impact daily activities if controlled. 3. Indicates successful management and adherence to treatment plan. Summary of the incorrect choices: B. Identifying actions to counteract risk factors is important but not the key outcome in the question. C. Lowering blood pressure by a specific percentage is not as relevant as overall improvement in daily living. D. Discontinuing lifestyle modifications would be detrimental to managing hypertension effectively.

Correct Answer: D

Rationale: The correct answer is D: Troponin. Troponin is a cardiac-specific biomarker released into the bloodstream following myocardial injury, making it the most sensitive and specific marker for detecting acute myocardial infarction. It rises rapidly within hours of the infarction and remains elevated for several days, providing a reliable indication of recent heart damage. LDH (choice A), CK-MM (choice B), and SGOT (choice C) are also cardiac enzymes, but they lack the cardiac specificity and sensitivity of Troponin for detecting acute myocardial infarction. LDH and CK-MM are less specific and slower to rise, while SGOT is found in other tissues besides the heart, leading to lower diagnostic accuracy compared to Troponin.

Correct Answer: B

Rationale: The absence of "P" waves suggests the impulse is not originating from the sinus node (A). In a junctional rhythm (B), the impulse originates from the AV node, resulting in the absence of "P" waves. Atrial fibrillation (C) would show irregularly spaced "P" waves due to chaotic atrial activity. A ventricular rhythm (D) would have widened QRS complexes without preceding "P" waves. Thus, based on the absence of "P" waves and normal other components, a junctional rhythm is the most likely explanation.