A nurse is caring for a client who reports chest pain. Which of the following laboratory findings indicates myocardial damage?

Troponin 11.8 ng/mL

Erythrocyte sedimentation rate (ESR) 17 mm/hr

Human B-type natriuretic peptide 88 pg/ml.

aPTT 80 seconds

Answer and Explanation

The Correct Answer is A

A. Troponin is a protein released into the bloodstream when there is damage to the heart muscle (myocardium), such as during a heart attack. Elevated troponin levels indicate myocardial injury or damage, making this the correct choice for indicating myocardial damage.

B. Erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells settle in a tube of blood. It is a non-specific marker of inflammation and is not specific to myocardial damage.

C. Human B-type natriuretic peptide (BNP) is released by the heart in response to increased pressure and volume. Elevated levels are indicative of heart failure, not necessarily myocardial damage.

D. Activated partial thromboplastin time (aPTT) measures the time it takes for blood to clot. It is used to monitor the effectiveness of anticoagulant therapy and is not specific to myocardial

damage.

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Correct Answer is D

Explanation

A. Allowing the infant to suck on a pacifier during tube feedings can lead to aspiration or choking and is not recommended.

B. Placing enough formula for 12 hours in the feeding container may lead to formula spoilage and contamination, as formula should be prepared fresh for each feeding.

C. Changing the tube feeding setup every 36 hours is not typically necessary unless there are signs of contamination or malfunction. The frequency of changing the setup should be based on institutional policies and manufacturer recommendations.

D. Flushing the tube with water before and after feedings helps ensure proper hydration and prevents tube blockage. A volume of 30 mL is commonly recommended for infants.

A. Encourage the client to ambulate in the hallway 1 hr before bedtime. B. Tell the client to avoid drinking fluids 1 hr before bedtime. C. Schedule routine care tasks during hours when the client is awake. D. Advise the client to leave the television in the room on when trying to fall asleep.

Correct Answer is C

Explanation

A. Encourage the client to ambulate in the hallway 1 hr before bedtime - While light exercise during the day can promote better sleep, exercising close to bedtime can actually disrupt sleep.

B. Tell the client to avoid drinking fluids 1 hr before bedtime - While limiting fluids close to bedtime can reduce nighttime awakenings to urinate, it may not directly address difficulty falling asleep.

C. Schedule routine care tasks during hours when the client is awake - This action ensures that the client can maximize restful sleep during the night by minimizing disruptions from care

activities.

D. Advise the client to leave the television in the room on when trying to fall asleep - Screen

time before bed can interfere with falling asleep due to the stimulating effect of light and content.

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A nurse is caring for a client who reports chest pain. Which of the following laboratory findings indicates myocardial damage?

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