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A nurse is caring for a 62-year-old female client who was admitted for pain between their shoulder blades.

Exhibits

Complete the following sentence by using the list of options.
The nurse has completed the client's admission history. The client is most likely suffering from
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as evidenced by the client's
dropdown
.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}

Rationale for correct answers:

Gastroesophageal reflux disease (GERD): GERD is a condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus and lead to symptoms such as heartburn and pain between the shoulder blades. The client’s report of pain between the shoulder blades and history of hypertension aligns with GERD symptoms.
Severe pain between shoulder blades and history of hypertension: These symptoms indicate the possibility of GERD. The client's pain is exacerbated by activity, which is a common characteristic of reflux pain. Also, a history of hypertension increases the likelihood of GERD due to its association with increased abdominal pressure.

Rationale for incorrect answers (Response 1 Options):

Myocardial infarction: A myocardial infarction (heart attack) would typically present with elevated troponin levels and possibly ST-segment elevation on ECG. The client’s troponin levels are within normal limits (normal troponin I levels are typically less than 0.04 ng/mL) and ECG shows no ST-segment elevation, making this diagnosis less likely.
Aortic dissection: This condition would usually present with severe, sudden chest pain that radiates to the back, and it is a medical emergency. The client's presentation does not fit the acute, severe pain typically associated with aortic dissection, and there is no mention of sudden onset or ripping/tearing sensation.
Musculoskeletal strain: This condition would likely be characterized by localized tenderness and pain with movement. The client denies radiation of pain, and the pain is exacerbated by activity, which can overlap with GERD rather than musculoskeletal strain.

Rationale for incorrect answers (Response 2 Options):

Elevated troponin levels and ST-segment elevation on ECG: These findings are indicative of myocardial infarction. The client’s troponin levels are within normal limits, and the ECG shows sinus rhythm with no ST-segment elevation, making myocardial infarction unlikely.
Heartburn and regurgitation after meals: While these are classic symptoms of GERD, the client's primary complaint is severe pain between the shoulder blades. The absence of these specific symptoms in the client’s report does not support this option as the primary evidence.
Localized tenderness and pain with movement: These symptoms are more characteristic of a musculoskeletal strain. The client's pain does not exhibit localized tenderness, and although it is activity-related, it lacks the hallmark features of a musculoskeletal strain.

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Correct Answer is A

Explanation

Choice A rationale

Nitroglycerin causes vasodilation, leading to headaches as a common adverse effect. These headaches are due to the increased blood flow and dilation of cerebral blood vessels.

Choice B rationale

Headaches do not indicate tolerance to nitroglycerin. Tolerance typically presents with a diminished therapeutic effect, not adverse effects like headaches.

Choice C rationale

Anxiety-induced headaches are unlikely since nitroglycerin-induced headaches are a physiological response to vasodilation, not psychological factors.

Choice D rationale

An allergic reaction to nitroglycerin would present with symptoms like rash or itching, not headaches. Headaches are a known and expected adverse effect.

A. 0.9% normal saline IV at 50 mL/hr continuous. B. Laboratory testing of serum potassium upon admission. C. Bumetanide 1 mg IV bolus every 12 hr. D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain.

Correct Answer is A

Explanation

Choice A rationale

Administering 0.9% normal saline IV at 50 mL/hr continuously in acute heart failure can exacerbate fluid overload, worsening symptoms like pulmonary edema.

Choice B rationale

Serum potassium testing is essential in heart failure management due to potential electrolyte imbalances from medications like diuretics.

Choice C rationale

Bumetanide, a loop diuretic, is used to manage fluid overload in acute heart failure by promoting diuresis and reducing volume overload.

Choice D rationale

Morphine sulfate can help alleviate pain and anxiety in heart failure patients, reducing oxygen demand and improving symptoms.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain.The client reports relief from the chest pain but now he is experiencing a headache.Which of the following statements should the nurse make?

Correct Answer is A

Explanation

A nurse is admitting a client who has acute heart failure following a myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?

Correct Answer is A

Explanation

A nurse on a medical-surgical unit is caring for a client who reports pain in the jaw, back, and shoulder, shortness of breath, and nausea.Which of the following actions should the nurse take?

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A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client.Which of the following statements should the nurse make regarding cardiac enzyme studies?

A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker.Which of the following prescriptions should the nurse clarify?

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