A nurse is reviewing the cardiac monitor strip for a client who is recovering from an acute myocardial infarction. Which of the following findings should the nurse report to the provider immediately?

Sinus tachycardia rate 104/min

Two premature ventricular contractions per minute

First degree heart block

A new onset of atrial fibrillation

Answer and Explanation

The Correct Answer is D

A. Sinus tachycardia rate 104/min: Mild sinus tachycardia may occur in response to pain, anxiety, or hypovolemia and is usually not immediately life-threatening. While it should be monitored, it does not require urgent reporting unless it worsens or is accompanied by other concerning signs.

B. Two premature ventricular contractions per minute: Occasional PVCs can be benign, especially in a post-MI patient, and may not require immediate intervention. Frequent or paired PVCs, or those occurring in runs, are more concerning for ventricular arrhythmias.

C. First degree heart block: This is characterized by a prolonged PR interval but generally does not compromise cardiac output. It is often stable and can be monitored rather than reported as an urgent finding.

D. A new onset of atrial fibrillation: New-onset atrial fibrillation following a myocardial infarction increases the risk of decreased cardiac output, thromboembolism, and hemodynamic instability. This arrhythmia requires immediate notification of the provider for assessment and initiation of appropriate interventions such as rate or rhythm control and anticoagulation.

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Correct Answer is B

Explanation

A. "I will sleep on a soft mattress.": A soft mattress does not provide adequate joint support and may allow excessive joint flexion, increasing stiffness and discomfort in osteoarthritis. Firm or supportive surfaces help maintain proper spinal alignment and reduce mechanical stress on weight-bearing joints.

B. "I will apply a heating pad to make my hands feel better.": Heat therapy promotes vasodilation, increases blood flow, and relaxes periarticular muscles, which can reduce stiffness and improve joint mobility in osteoarthritis. Application of warm compresses or heating pads is particularly beneficial before activity to decrease morning stiffness and enhance range of motion.

C. "I will take aspirin on an empty stomach.": Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate the gastric mucosa by inhibiting prostaglandin synthesis, increasing the risk of gastritis and gastrointestinal bleeding. Taking these medications with food or milk reduces gastric irritation.

D. "I will exercise my joints as much as I can when they are inflamed.": During periods of acute inflammation, excessive joint use can worsen pain and tissue irritation. Low-impact, regular exercise is encouraged, but it should be balanced with rest during flare-ups to prevent additional joint stress and exacerbation of symptoms.

A. Prepare the client for a barium enema. B. Prepare the client for a colonoscopy. C. Request an aPTT level. D. Request an INR level.

Correct Answer is D

Explanation

A. Prepare the client for a barium enema: A barium enema is a diagnostic imaging procedure used to evaluate structural abnormalities in the colon, but it is not the immediate priority when a client on warfarin reports blood in stools. The focus should first be on assessing coagulation status and risk of bleeding.

B. Prepare the client for a colonoscopy: Colonoscopy allows direct visualization of the colon to identify sources of bleeding, but performing an invasive procedure in a client on anticoagulation without assessing clotting parameters first increases the risk of severe hemorrhage. Immediate evaluation of anticoagulation levels is safer.

C. Request an aPTT level: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. Checking aPTT would not provide accurate information about the client’s anticoagulation status or bleeding risk with warfarin therapy.

D. Request an INR level: The international normalized ratio (INR) is the standard laboratory test for monitoring warfarin therapy. An elevated INR indicates increased anticoagulation and a higher risk of bleeding. Assessing the INR provides critical information to guide interventions such as dose adjustment or vitamin K administration.

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A nurse is reviewing the cardiac monitor strip for a client who is recovering from an acute myocardial infarction. Which of the following findings should the nurse report to the provider immediately?

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