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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

as evidenced by the client's .
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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Related Questions

Correct Answer is A

Explanation

Choice A rationale

The first upward deflection in an ECG represents the P wave, indicating atrial depolarization. It precedes the QRS complex and corresponds to the electrical activity associated with atrial contraction, initiating the cardiac cycle.

Choice B rationale

The peak of the first wave corresponds to the R wave, not the P wave. The R wave is a part of the QRS complex, representing ventricular depolarization, and is not associated with atrial depolarization.

Choice C rationale

The downward deflection following the peak is the S wave, part of the QRS complex, indicating ventricular depolarization. It is not related to the P wave, which specifically represents atrial depolarization.

Choice D rationale

The second upward deflection is the T wave, which represents ventricular repolarization. It follows the QRS complex and is not associated with atrial depolarization or the P wave.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

Rationales:

  • Administer O2 to maintain oxygen saturation greater than 90%: This prescription is indicated. Hypoxia can exacerbate cardiac and respiratory issues, so it is essential to maintain adequate oxygen levels in the blood. Supplemental oxygen can help improve tissue oxygenation and reduce strain on the heart.
  • Apply continuous ECG monitoring: This prescription is indicated. Continuous ECG monitoring is crucial in detecting arrhythmias and ischemic changes in a patient with cardiac symptoms and irregular pulse. Early detection allows for timely intervention and management of potentially life-threatening cardiac events.
  • Obtain the client’s family history: This prescription is nonessential. While obtaining a family history is useful for identifying potential genetic predispositions to cardiac and metabolic conditions, it is not immediately necessary for the acute management of the client’s current symptoms.
  • Prepare the client for intubation: This prescription is contraindicated. The client is currently maintaining an adequate respiratory rate and oxygen saturation on room air. There is no indication of respiratory failure or inability to maintain airway patency. Intubation would be an unnecessarily invasive procedure at this time.

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