A nurse is caring for a client who is having an acute myocardial infarction (MI). The nurse is aware that which of the following are part of the assessment of cardiac pain. (SELECT ALL THAT APPLY)
Distribution
Onset
Intensity
Location
Radiation
Alleviated
Correct Answer : A,B,C,D,E,F
Rationale:
A. Distribution refers to the area of the body where the pain is felt.
B. Onset refers to when the pain started.
C. Intensity refers to the severity of the pain.
D. Location refers to where the pain is felt.
E. Radiation refers to whether the pain spreads to other areas.
F. Alleviated refers to what makes the pain better or worse.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. Amiodarone administration is used for the treatment of ventricular fibrillation (VF) and ventricular tachycardia (VT) that is unresponsive to cardioversion.
B. Synchronized Cardioversion is used for the treatment of atrial fibrillation (AF), atrial flutter (AFL), and unstable ventricular tachycardia (VT).
C. Epinephrine administration is part of the ACLS algorithm for the treatment of VF and pulseless VT. It is given after defibrillation.
D. Defibrillation is the immediate treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
Correct Answer is D
Explanation
Rationale:
A. A weight gain of 0.5 kg (1 lb) in a week is not typically concerning for heart failure exacerbation.
B. Skipping a dose of a diuretic can lead to fluid retention and exacerbate heart failure symptoms.
C. Weighing daily is important for monitoring fluid retention, but the specific time of day is not as crucial as consistent timing.
D. A weight gain of 2 lbs. in 24 hours can indicate fluid retention and worsening heart failure.
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