At 9:00 pm, you admit a 63-year-old with a diagnosis of acute myocardial infarction (AMI) to the ED. The physician is considering the use of fibrinolytic therapy with tissue plasminogen activator (tPA, alteplase). Which information is most important to communicate to the physician?

Correct Answer: D

Rationale: In this scenario, the most important information to communicate to the physician regarding the use of fibrinolytic therapy with tPA for a patient with acute myocardial infarction is option D) The patient has had continuous chest pain since 1:00 PM. The correct answer is D because the duration of chest pain is a critical factor in determining the eligibility for fibrinolytic therapy. The time frame of symptom onset is crucial as fibrinolytic therapy is most effective when administered within a specific window period from the onset of symptoms. Option A is incorrect because a history of alteplase use 8 months ago does not impact the current decision-making process for acute management of AMI. Option B is not directly relevant to the decision to administer fibrinolytic therapy. Option C, T wave inversions on the ECG, while important for diagnosing AMI, are not as time-sensitive as the duration of chest pain in determining the need for immediate fibrinolytic therapy. Educationally, understanding the time-sensitive nature of interventions in acute conditions like AMI is crucial for healthcare providers. Timely communication of critical information to the healthcare team can significantly impact patient outcomes, making it essential for healthcare professionals to prioritize and convey relevant details accurately and promptly.

Correct Answer: A

Rationale: The correct answer is A) Transesophageal echocardiography (TEE). In TEE, the nurse instructs the client to avoid eating or drinking until sensation and the gag reflex return because the procedure involves passing a probe through the mouth and into the esophagus to obtain detailed images of the heart. This requires the client to have a numb throat to prevent gagging during the procedure, hence the need to wait until sensation returns. Option B) Magnetic resonance imaging (MRI) does not require the client to avoid eating or drinking for an extended period of time. Option C) Echocardiography is a non-invasive test that does not involve any restrictions on eating or drinking. Option D) Cardiac catheterization involves inserting a catheter into a blood vessel but does not require the client to avoid eating or drinking for an extended period. In an educational context, understanding the specific instructions and preparations for different cardiovascular tests is crucial for nurses to ensure the safety and well-being of their patients. Educating nurses on the rationale behind these instructions helps them provide optimal care and support to clients undergoing cardiovascular procedures.

Correct Answer: A

Rationale: In this question, the correct answer is A) Aortic regurgitation. A water hammer pulse, also known as a Corrigan pulse, is a characteristic sign of aortic regurgitation. This condition is caused by the backflow of blood from the aorta into the left ventricle during diastole, leading to a rapid rise and fall in arterial pressure, resulting in a bounding and forceful pulse. Option B) Mitral valve stenosis is incorrect because it is associated with a low-pitched rumbling diastolic murmur and not a water hammer pulse. Option C) Mitral regurgitation is incorrect as it is characterized by a holosystolic murmur radiating to the axilla, not a water hammer pulse. Option D) Aortic stenosis presents with a crescendo-decrescendo systolic ejection murmur, not a water hammer pulse. Understanding these clinical correlations is essential for healthcare professionals, especially those in cardiology. Recognizing the specific characteristics of different heart conditions not only aids in diagnosis but also informs appropriate treatment strategies. This knowledge is crucial for providing quality patient care and ensuring positive health outcomes.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Monitor fluid intake and output. When administering isoproterenol to a client with dysrhythmia, monitoring fluid intake and output is crucial because isoproterenol, a non-selective beta-adrenergic agonist, can increase heart rate and cardiac output, leading to increased fluid loss through diuresis. Monitoring fluid intake and output allows the nurse to assess the client's hydration status, renal function, and the effect of the medication on fluid balance. Option A) Monitor vital signs is a general assessment approach and may not provide specific information on the drug's response related to fluid balance. Option B) Closely monitor the pulse rate is important when administering isoproterenol, but it focuses solely on one aspect of the drug response (heart rate) and does not address the potential fluid imbalances. Option C) Monitor blood pressure is essential when administering isoproterenol due to its potential effects on blood pressure, but it does not directly assess the drug's impact on fluid balance. Educational context: Understanding the rationale behind monitoring fluid intake and output when administering medications that can affect fluid balance is crucial for nurses caring for patients with cardiovascular conditions. By monitoring fluid status, nurses can detect early signs of fluid overload or dehydration, assess renal function, and evaluate the effectiveness and side effects of medications impacting fluid balance. This holistic approach to patient assessment enhances patient safety and contributes to optimal outcomes in cardiovascular care.

Correct Answer: C

Rationale: In the context of the cardiovascular system, understanding the early signs of heart failure is crucial for timely intervention and patient care. The correct answer to the question, "Which of the following should the nurse identify as the earliest symptom of heart failure in many older clients?" is option C) Dyspnea on exertion. Dyspnea on exertion is a hallmark early symptom of heart failure in older clients. It occurs due to the heart's inability to pump blood effectively, leading to inadequate oxygen delivery to tissues during increased physical activity. This symptom often precedes other manifestations of heart failure and can be a significant indicator of underlying cardiac dysfunction. Option A) Increased urine output is not typically an early symptom of heart failure. In fact, heart failure often leads to decreased urine output due to poor perfusion of the kidneys. Option B) Swollen joints are not indicative of heart failure but can be seen in conditions such as arthritis or joint injuries. Option D) Nausea and vomiting are nonspecific symptoms and are less likely to be the earliest indicators of heart failure in older clients. Educationally, understanding the progression of heart failure symptoms is essential for healthcare providers to recognize early warning signs, initiate appropriate interventions, and prevent complications. By identifying dyspnea on exertion as a key early symptom, nurses can collaborate with healthcare teams to provide timely and effective care to older clients at risk for heart failure.