A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first?

Correct Answer: C

Rationale: The correct answer is C: Electrocardiogram (ECG) should be completed first. This is because an ECG provides immediate information on the patient's cardiac status and can help in diagnosing conditions like a heart attack. This test is crucial in quickly determining the presence of significant cardiac abnormalities. Chest x-ray (A) may provide information on lung conditions but does not directly assess the heart. Troponin level (B) is important for diagnosing a heart attack but takes time to process. Insertion of a peripheral IV (D) is necessary for treatment but is not as urgent as obtaining the ECG results.

Correct Answer: C

Rationale: The correct answer is C: A rise in pulmonary artery diastolic pressure. This finding most strongly suggests left-sided heart failure because increased pressure in the pulmonary artery indicates increased resistance to blood flow from the left side of the heart. Left-sided heart failure leads to blood backing up into the pulmonary circulation, causing elevated pressures in the pulmonary artery. A: A drop in central venous pressure is more indicative of right-sided heart failure. B: An increase in the cardiac index may indicate compensation for decreased cardiac output, but it is not specific to left-sided heart failure. D: A decline in mean pulmonary artery pressure is not a typical finding in left-sided heart failure, as it usually causes increased pressure in the pulmonary artery due to congestion.

Correct Answer: D

Rationale: Step-by-step rationale for choosing D (Indomethacin): 1. Indomethacin is a prostaglandin inhibitor that helps close the patent ductus arteriosus by constricting the blood vessel. 2. The ductus arteriosus is a connection between the aorta and pulmonary artery in fetuses that should close after birth. 3. By inhibiting prostaglandin production, Indomethacin promotes closure of the ductus arteriosus in infants with patent ductus arteriosus. 4. Digoxin (Choice A) is a cardiac glycoside used for heart failure; Prednisone (Choice B) is a corticosteroid; Furosemide (Choice C) is a diuretic - none of these medications close the ductus arteriosus like Indomethacin.

Correct Answer: A

Rationale: The correct answer is A because strenuous activities can worsen aortic stenosis symptoms like angina and syncope. Stairs and lifting can increase the workload on the heart, which is already compromised in aortic stenosis. By avoiding these activities, the client reduces the risk of complications before surgery. Choice B is incorrect because although some activity is encouraged, taking short walks may not be appropriate if the client is experiencing angina and syncope. Choice C is incorrect because waiting for angina to reoccur before taking action can be dangerous, as it may indicate worsening of the condition. Choice D is incorrect because gradually increasing activity may not be safe for someone with aortic stenosis, as it can exacerbate symptoms and increase the risk of complications.

Correct Answer: C

Rationale: The correct answer is C because smoking and oral contraceptive use are both risk factors for developing deep-vein thrombosis (DVT). Smoking increases the risk of blood clot formation, while oral contraceptives can also contribute to blood clot formation. The combination of these two factors significantly increases the likelihood of developing DVT. Choice A is less likely to develop DVT as being young and postpartum does not carry as high a risk compared to the other options. Choice B, although on anticoagulant therapy, is at a lower risk compared to Choice C due to the specific risk factors mentioned. Choice D, having undergone laparoscopic cholecystectomy, has a lower risk compared to Choice C as surgery alone is not as significant a risk factor for DVT as smoking and oral contraceptive use.