The nurse has finished reviewing the shift report on a cardiac unit. The nurse should plan to see which of the following assigned clients first?

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Beck's triad. Beck's triad consists of hypotension, distended neck veins, and muffled heart sounds, which are classic signs of cardiac tamponade. Hypotension results from decreased cardiac output due to compression of the heart by the fluid in the pericardial sac. Distended neck veins occur due to increased venous pressure from impaired right heart filling. Muffled heart sounds are heard because the fluid around the heart dampens sound transmission. Shortness of breath (Choice A) is a non-specific symptom and can be present in various cardiac conditions. Holosystolic murmur (Choice C) and bounding peripheral pulse (Choice D) are not characteristic of cardiac tamponade.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Exercise stress test. An exercise stress test is a noninvasive diagnostic tool used to assess how well the heart responds to physical stress. It helps differentiate between angina and other types of chest pain by monitoring the patient's heart rate, blood pressure, and ECG changes during exercise. In the case of angina, there may be characteristic ECG changes or symptoms induced by exercise that are not present in other types of chest pain. Option A) ECG, while commonly used in evaluating chest pain, may not always show definitive changes in the early stages of angina. It is a valuable tool but may not provide the differentiation needed in this specific case. Option C) Coronary angiogram is an invasive procedure that involves injecting contrast dye into the coronary arteries to visualize any blockages. It is usually reserved for cases where noninvasive tests like the exercise stress test are inconclusive or when there is a high suspicion of coronary artery disease. Option D) Transesophageal echocardiogram is a procedure that uses sound waves to create detailed images of the heart. While it can provide valuable information about the heart's structure and function, it is not typically used as a first-line diagnostic test for differentiating angina from other types of chest pain. In an educational context, understanding the appropriate use of diagnostic tests in evaluating chest pain is crucial for healthcare professionals. It enables them to make informed decisions about patient management and treatment. The rationale behind selecting the exercise stress test in this case highlights the importance of considering noninvasive options before proceeding to more invasive procedures, taking into account both the clinical presentation of the patient and the diagnostic capabilities of each test.