A client is admitted to the Emergency Department (ED) with a suspected ST elevation myocardial infarction (STEMI) involving the inferior wall. The nurse anticipates that this client will be immediately scheduled for the cardiac catheterization laboratory. The goal of treatment is to:

Administer antiplatelet and anticoagulant medications to prevent further clot formation.

Relieve the blockage in the coronary artery and restore blood flow to the heart muscle.

Provide pain relief and initiate cardiac rehabilitation.

Stabilize the dient's blood pressure and administer thrombolytic therapy.

Answer and Explanation

The Correct Answer is B

A) Administer antiplatelet and anticoagulant medications to prevent further clot formation:
While antiplatelet and anticoagulant medications are essential in the management of STEMI to reduce the risk of further clot formation, they are not the primary goal of treatment in the immediate phase. These medications are typically administered before or during the procedure (such as during cardiac catheterization) to prevent new clots, but the primary objective is to restore blood flow to the heart muscle through reperfusion therapy, either by angioplasty or thrombolytics.

B) Relieve the blockage in the coronary artery and restore blood flow to the heart muscle:
This is the primary goal of treatment in STEMI. The most urgent intervention for a client with an ST elevation myocardial infarction (STEMI) is to relieve the blockage in the coronary artery and restore blood flow to the ischemic heart muscle. This is typically achieved through percutaneous coronary intervention (PCI) via cardiac catheterization, which involves either angioplasty (ballooning the artery) or stent placement. Restoring blood flow as quickly as possible reduces the extent of myocardial damage, improves the prognosis, and prevents complications like heart failure.

C) Provide pain relief and initiate cardiac rehabilitation:
Pain relief is important in the initial management of STEMI, typically with nitroglycerin and opioids for chest pain. However, the immediate goal in the ED is to address the underlying cause of the chest pain, which is the blockage of blood flow. Cardiac rehabilitation, while essential for long-term recovery, is not the immediate goal of treatment during the acute phase of a STEMI. The primary focus should be on restoring circulation to the affected myocardium.

D) Stabilize the client's blood pressure and administer thrombolytic therapy:
Stabilizing the client’s blood pressure is important, especially if the client is hypotensive, but it is not the main treatment goal. Thrombolytic therapy (clot-busting medications) is an option if PCI is not available or if it needs to be done within a certain time frame; however, the current best practice in STEMI is to perform PCI as soon as possible. Thrombolytics are typically used when PCI is not immediately available, but the ideal treatment is to restore blood flow through catheterization in a timely manner, as it is more effective than thrombolytic therapy at re-opening the blocked artery.

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Correct Answer is A

Explanation

A. "Reports taking an extra dose each day of their anticholinesterase medication."
This client is at highest risk for developing a cholinergic crisis. A cholinergic crisis occurs when there is overdose or excessive stimulation of acetylcholine receptors due to too much anticholinesterase medication. Symptoms include muscle weakness, respiratory distress, salivation, sweating, and bradycardia. Taking an extra dose of the medication can result in an overdose of acetylcholine, triggering these symptoms. Therefore, this client is at the greatest risk for a cholinergic crisis.

B. "Is experiencing a respiratory infection and is short of breath."
While respiratory infections can worsen symptoms of myasthenia gravis due to increased muscle weakness, this client is not directly at risk for a cholinergic crisis. Respiratory infections can increase the risk of myasthenic crisis, which is a different complication where muscle weakness worsens to the point of respiratory failure. A myasthenic crisis is caused by insufficient anticholinesterase medication or a disease exacerbation, not an overdose.

C. "Has a family history of autoimmune disorders."
A family history of autoimmune disorders may suggest a genetic predisposition to autoimmune diseases, but it does not increase the risk of a cholinergic crisis specifically. The risk of a cholinergic crisis is more directly related to medication management, not family history.

D. "Has a past medical history of type 2 diabetes mellitus."
Type 2 diabetes mellitus does not directly increase the risk of a cholinergic crisis. While diabetes may influence overall health and immune function, it does not have a direct impact on anticholinesterase therapy or the risk of cholinergic crisis in myasthenia gravis.

A. Partially compensated metabolic alkalosis B. Partially compensated respiratory acidosis C. Fully compensated metabolic alkalosis D. Fully compensated respiratory acidosis

Correct Answer is B

Explanation

A. Partially compensated metabolic alkalosis:
Metabolic alkalosis is characterized by elevated bicarbonate levels (HCO3), but in this case, the HCO3 is elevated (29 mEq/L), which suggests alkalosis. However, the PaCO2 is elevated at 47 mmHg, which is more consistent with a respiratory problem. A fully or partially compensated metabolic alkalosis would show a normal or low PaCO2 (due to respiratory compensation). Therefore, this option does not fit the ABG results.

B. Partially compensated respiratory acidosis: In this case, the pH is 7.17, which is low and indicates acidosis. The PaCO2 is 47 mmHg, which is elevated (normal range: 35-45 mmHg), indicating that the respiratory system is contributing to the acidosis. The HCO3 is 29 mEq/L, which is elevated (normal range: 22-26 mEq/L), suggesting a compensatory response from the kidneys to retain bicarbonate in an attempt to buffer the acidosis. Since the pH is still below normal and has not yet returned to the normal range (7.35-7.45), this suggests that the compensation is partial and the primary issue is respiratory acidosis.

C. Fully compensated metabolic alkalosis:
This answer is incorrect because metabolic alkalosis is not the primary disturbance here. Also, for a condition to be fully compensated, the pH would need to be within the normal range (7.35-7.45). Since the pH is 7.17, the condition is not fully compensated.

D. Fully compensated respiratory acidosis:
For fully compensated respiratory acidosis, the pH should be within the normal range, as the kidneys would have fully compensated for the elevated PaCO2. Since the pH is 7.17, this is a sign of partial compensation, not full compensation. Therefore, this option is incorrect.

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A client is admitted to the Emergency Department (ED) with a suspected ST elevation myocardial infarction (STEMI) involving the inferior wall. The nurse anticipates that this client will be immediately scheduled for the cardiac catheterization laboratory. The goal of treatment is to:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Correct Answer is B

Explanation

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