In the patient with chest pain, which results can differentiate unstable angina from an MI?

Correct Answer: A

Rationale: The correct answer is A) ECG changes present at the onset of the pain. This is the differentiating factor between unstable angina and myocardial infarction (MI). In unstable angina, ECG changes are usually transient or absent, whereas in MI, ECG changes indicating myocardial damage such as ST-segment elevation or Q waves are typically present. Option B) A chest x-ray indicating left ventricular hypertrophy is not a specific marker for either unstable angina or MI. Left ventricular hypertrophy can be seen in various cardiac conditions and is not a distinguishing feature between the two. Option C) Appearance of troponin in the blood 48 hours after the infarct is a marker for MI but not specific to differentiate unstable angina from MI. Troponin levels rise within a few hours after MI, not 48 hours later. Option D) Creatine kinase (CK)-MB enzyme elevations that peak 18 hours after the infarct are indicative of MI but again not helpful in differentiating unstable angina from MI as CK-MB levels can also rise in other conditions causing myocardial damage. Understanding the distinctions between unstable angina and MI is crucial in clinical practice as the management and urgency of treatment differ significantly between the two conditions. Recognizing the specific diagnostic markers helps healthcare providers make accurate and timely decisions to provide the best care for patients presenting with chest pain related to cardiovascular issues.

Correct Answer: C

Rationale: In this practice exam question about pneumothorax symptoms, the correct answer is C) Both A and B (Chest pain and Shortness of breath). Pneumothorax is a condition characterized by the presence of air in the pleural space, leading to lung collapse. Chest pain is a common symptom of pneumothorax due to irritation of the pleura. The presence of air in the pleural space also leads to lung compression, causing shortness of breath as the lung is unable to expand fully. Option A (Chest pain) is incorrect because pneumothorax does not typically cause localized chest pain, but rather a more generalized discomfort or sharp pain due to lung collapse. Option B (Shortness of breath) is incorrect as pneumothorax directly impacts lung function, leading to decreased lung capacity and difficulty breathing. Educationally, understanding the symptoms of pneumothorax is crucial for healthcare professionals, especially those working in emergency or critical care settings. Recognizing these symptoms promptly can lead to early diagnosis and intervention, potentially preventing further complications or progression of the condition. This knowledge is vital for providing timely and appropriate care to patients with pneumothorax.

Correct Answer: A

Rationale: In this scenario, the correct nursing action is to choose option A) call Mr. K.'s physician to report the PT result. A significantly elevated prothrombin time indicates a prolonged clotting time, which may lead to an increased risk of bleeding. Therefore, it is crucial to inform the physician promptly to ensure appropriate management. Option B) stopping the heparin infusion is incorrect because heparin is an anticoagulant used to prevent blood clots, and abruptly discontinuing it can lead to an increased risk of clot formation. Option C) increasing the heparin infusion is also incorrect as it would further exacerbate the anticoagulation effect, potentially leading to serious bleeding complications. Option D) doing nothing is not the appropriate course of action when faced with a critical lab result that can impact patient safety. Educationally, understanding the significance of prothrombin time values is vital for nurses caring for patients on anticoagulant therapy. This knowledge helps in recognizing abnormal results, taking appropriate actions, and collaborating effectively with the healthcare team to ensure patient safety and optimal outcomes.

Correct Answer: C

Rationale: In the context of teaching about methyldopa to patients, it is crucial for them to understand that option C) may produce drowsiness initially is the correct answer. Methyldopa is an antihypertensive medication that acts centrally to reduce blood pressure. One of the common side effects of methyldopa is drowsiness, especially when initiating treatment. Educating patients about this potential side effect is important for them to be aware and to prevent any unnecessary concerns or alarm. Option A) decreases cardiac output is incorrect because methyldopa primarily acts on the central nervous system to reduce blood pressure and does not directly impact cardiac output. Option B) may produce mental confusion is incorrect as mental confusion is not a common side effect associated with methyldopa use. Option D) blocks the release of norepinephrine is incorrect as methyldopa works by being converted into alpha-methyl norepinephrine, which then acts in the brain to decrease sympathetic outflow, thereby lowering blood pressure. In an educational context, teaching patients about the potential side effects of medications like methyldopa empowers them to recognize and manage these effects effectively. It also fosters a sense of autonomy and responsibility in their own healthcare management. This knowledge enables patients to make informed decisions and seek timely medical advice if needed.

Correct Answer: C

Rationale: The correct answer is C) left ventricular failure. Pulmonary capillary wedge pressure (PCWP) is a measure of the pressure in the left side of the heart and reflects left ventricular function. When PCWP rises above normal values, it indicates increased pressure in the left side of the heart, which commonly occurs in left ventricular failure. This can lead to symptoms of pulmonary congestion and edema due to the backflow of blood into the lungs. Option A) right ventricular failure is incorrect because PCWP specifically reflects left ventricular function, not right ventricular function. Right ventricular failure would manifest with other signs and symptoms. Option B) hypovolemia is incorrect because in hypovolemia, the PCWP would be low rather than high. Hypovolemia indicates a decreased blood volume, leading to reduced filling pressures in the heart. Option D) ventricular irritability is incorrect as this term refers to abnormal electrical activity in the heart, such as arrhythmias, and is not directly related to PCWP levels. In an educational context, understanding the significance of monitoring PCWP is crucial in assessing cardiac function and guiding treatment in patients with heart failure. This question highlights the importance of recognizing the implications of changes in PCWP values and their correlation with specific cardiac conditions, aiding in clinical decision-making and patient management.