A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following actions should the nurse take to determine if the client is experiencing a myocardial infarction?

Perform a 12-lead ECG

Determine if pain radiates to the left arm

Check the client's blood pressure

Auscultate heart tones

Answer and Explanation

The Correct Answer is A

Choice A reason: A 12-lead ECG can reveal changes in the ST segment, T wave, and QRS complex, which are indicative of myocardial ischemia, injury, or infarction. It is the first line diagnostic test that needs to be recorded within 10 minutes after the first medical contact in cases of suspected acute coronary syndromes.

Choice B reason: While pain radiating to the left arm can be a symptom of MI, it is not a definitive diagnostic action. It is a common symptom but can also be associated with other conditions.

Choice C reason: Checking the client's blood pressure is important in the overall assessment of the client's cardiovascular status but does not specifically diagnose MI. Blood pressure can be normal, elevated, or decreased in the case of MI.

Choice D reason: Auscultating heart tones can provide information about the presence of murmurs, gallops, or rubs, but it is not a specific diagnostic action for MI. Heart sounds may be normal during an MI.

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Free Nursing Study Resources

Correct Answer is ["A","B","C","D","E"]

Explanation

Choice A reason: Pain occurring 30 to 60 minutes after a meal is a common symptom of gastric ulcers due to the increased gastric acid secretion during digestion that can aggravate the ulcer.

Choice B reason: Pain at night is also typical for gastric ulcers as the circadian rhythm can influence acid secretion, potentially leading to increased discomfort during the night.

Choice C reason: A sensation of bloating can be associated with gastric ulcers due to delayed gastric emptying or increased sensitivity of the stomach lining.

Choice D reason:Pain relieved by eating is indicative of gastric ulcers because food can act as a buffer to stomach acid, temporarily relieving pain².

Choice E reason:Pain upon palpation of the epigastric region is expected in clients with gastric ulcers due to the localized inflammation and sensitivity of the stomach lining².

Correct Answer is ["1.2"]

Explanation

- Step 1: Identify the child's weight in pounds. The child weighs 33 lbs.

- Step 2: Convert the child's weight from pounds to kilograms. We know that 1 kg = 2.2 lbs. So, 33 lbs = 33 ÷ 2.2 kg. Calculating the division gives us approximately 15 kg.

- Step 3: Identify the prescribed dose in mcg/kg/day. The child is scheduled to receive 8 mcg/kg/day of digoxin, divided equally every 12 hours.

- Step 4: Calculate the total daily dose in mcg. We can do this by multiplying the child's weight in kg by the prescribed dose in mcg/kg:

- Total daily dose = 8 mcg/kg/day × 15 kg.

- Calculating the multiplication gives us: Total daily dose = 120 mcg/day.

- Step 5: Since the dose is divided equally every 12 hours, we divide the total daily dose by 2 to get the dose per administration:

- Dose per administration = Total daily dose ÷ 2.

- Dose per administration = 120 mcg ÷ 2.

- Calculating the division gives us: Dose per administration = 60 mcg.

- Step 6: Identify the concentration of the available solution. The available solution contains 0.05 mg/mL of digoxin. Convert this to mcg/mL for consistency with the dose per administration. We know that 1 mg = 1000 mcg. So, 0.05 mg = 0.05 × 1000 mcg = 50 mcg/mL.

- Step 7: Calculate the volume of solution needed to deliver the required dose. We can set up a proportion to solve for this:

- 50 mcg is to 1 mL as 60 mcg is to X mL.

- In other words, 50 mcg : 1 mL = 60 mcg : X mL.

- Step 8: Solve for X using cross-multiplication and division:

- Cross-multiplication gives us: 50 mcg × X mL = 60 mcg × 1 mL.

- Simplifying this gives us: 50X = 60.

- Dividing both sides by 50 gives us: X = 60 ÷ 50.

- Calculating the division gives us: X = 1.2.

Administer 1.2 mL of the digoxin elixir per dose.

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A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following actions should the nurse take to determine if the client is experiencing a myocardial infarction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply).

Correct Answer is ["A","B","C","D","E"]

Explanation

Correct Answer is ["1.2"]

Explanation

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