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 answer is A because in a client presenting with substernal chest pain, electrocardiographic changes, and elevated cardiac troponin level, the priority is to improve myocardial oxygenation and reduce cardiac workload. This is crucial to prevent further damage to the heart muscle and potential complications like myocardial infarction. By focusing on improving oxygen supply and reducing workload, the nurse can help stabilize the client's condition and prevent further cardiac events. Choice B is incorrect because while confirming the diagnosis and preventing complications are essential, the immediate focus should be on addressing the physiological needs of the heart. Choice C is incorrect as reducing anxiety and relieving pain are important but secondary to addressing the underlying cardiac issue. Choice D is incorrect as eliminating stressors and providing a nondemanding environment may be beneficial but not the immediate priority in this situation.

Correct Answer: C

Rationale: The correct answer is C because a client receiving antibiotics for bacterial endocarditis who is reporting anxiety and chest pain is showing signs of a potential cardiac emergency that requires immediate attention to prevent further complications. Chest pain and anxiety are red flags for cardiac issues such as myocardial infarction that could lead to life-threatening situations. Therefore, the nurse should prioritize this client to assess and intervene promptly. Choice A is incorrect because dyspnea in a client with hypertrophic cardiomyopathy, while concerning, does not indicate an acute cardiac emergency that requires immediate attention. Choice B is incorrect because a client who had a cardiac catheterization and will be ambulating for the first time does not exhibit urgent signs that necessitate immediate intervention compared to a client with chest pain and anxiety. Choice D is incorrect because a temperature of 101 F in a client recovering from CABG surgery is not as concerning as chest pain and anxiety, which could indicate a cardiac complication.

Correct Answer: A

Rationale: The correct answer is A: Return to her usual activities of daily living. This outcome indicates successful management of hypertension, as it implies that the client's blood pressure is controlled and stable enough for her to resume normal activities without significant limitations. This reflects a holistic approach to care, focusing on improving the client's quality of life. Explanation for other choices: B: Identifying actions to counteract risk factors is important but doesn't necessarily indicate that the client's hypertension is well managed. C: Lowering blood pressure by a specific percentage is not as meaningful as the client being able to function normally in daily life. D: Discontinuing lifestyle modifications would be detrimental as lifestyle changes are crucial for managing hypertension effectively.

Correct Answer: D

Rationale: The correct answer is D: Troponin. Troponin is a cardiac-specific protein released into the bloodstream following myocardial injury, making it the most sensitive and specific marker for detecting acute myocardial infarction. It rapidly rises within 3-6 hours of injury, peaks at 12-48 hours, and remains elevated for up to 14 days. LDH (choice A) and SGOT (choice C) are less specific for cardiac injury, while CK-MM (choice B) is a skeletal muscle enzyme, not specific to the heart. Troponin's kinetics, cardiac specificity, and prolonged elevation make it the best choice for quickly identifying recent myocardial infarction.

Correct Answer: B

Rationale: The correct answer is B: A junctional rhythm. In a junctional rhythm, the atrioventricular (AV) node takes over as the pacemaker, resulting in the absence of P waves. The other components (QRS complex and T waves) are normal, indicating a regular ventricular depolarization and repolarization. A normal sinus rhythm (choice A) would have visible P waves preceding each QRS complex. Atrial fibrillation (choice C) would show irregularly irregular rhythm with no discernible P waves. A ventricular rhythm (choice D) would display wide QRS complexes and lack preceding P waves.