A nurse working in an emergency department is assessing a client who is experiencing chest pain that began 6 hr ago. Which of the following findings indicates that the client is having a myocardial Infarction?

Decreased creatine kinase-MB

Decrease in respiratory rate

ST segment depression

Increased troponin I

Answer and Explanation

The Correct Answer is D

Rationale:

A. Decreased creatine kinase-MB: CK-MB is a cardiac enzyme that rises within 4–6 hours of myocardial infarction and peaks around 24 hours. A decrease in CK-MB would not indicate acute myocardial injury and is not a diagnostic marker in this case.

B. Decrease in respiratory rate: A lower respiratory rate is not a typical or reliable indicator of myocardial infarction. Clients experiencing an MI are more likely to show signs of dyspnea, anxiety, or increased respiratory effort due to pain or decreased oxygenation.

C. ST segment depression: ST segment depression may indicate myocardial ischemia or a non-ST elevation myocardial infarction (NSTEMI), but it is less specific than biomarkers like troponin. It may also appear in other conditions such as angina or electrolyte imbalances.

D. Increased troponin I: Troponin I is a highly specific and sensitive cardiac biomarker that rises within 3–6 hours of myocardial injury. An elevated troponin I level 6 hours after the onset of chest pain strongly supports the diagnosis of myocardial infarction.

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Correct Answer is D

Explanation

Rationale:

A. "I will set a timer for 10 minutes for each timeout session.": Timeout duration should be age-appropriate, generally one minute per year of the child's age. A 10-minute timeout for a toddler would be too long and ineffective for promoting behavioral correction.

B. "My child will learn rules through physical punishment.": Physical punishment is not recommended for children as it may lead to increased aggression, fear, and long-term emotional harm. Positive discipline strategies like timeouts and redirection are more appropriate.

C. "I will remind my child of their misbehavior to reinforce discipline.": Repeated reminders can reinforce negative behavior by drawing excessive attention to it. Discipline should focus on clear, consistent consequences rather than prolonged discussion of misbehavior.

D. "A timeout session should begin once my child is quiet.": Timeout should start after the child calms down to encourage self-regulation. Starting it during a tantrum may reinforce the behavior, while waiting promotes emotional control and helps the child learn to calm themselves.

A. "I will avoid strenuous exercise." B. "I will increase my intake of high-fiber foods." C. "I will take a bulk-forming laxative every day." D. "I will limit my fluid intake to 1 liter per day."

Correct Answer is B

Explanation

Rationale:

A. "I will avoid strenuous exercise.": Physical activity, including regular moderate exercise like walking, actually helps stimulate bowel function. Avoiding exercise may worsen constipation rather than prevent it.

B. "I will increase my intake of high-fiber foods.": A high-fiber diet supports regular bowel movements by increasing stool bulk and promoting peristalsis. This is a key strategy for preventing opioid-induced constipation.

C. "I will take a bulk-forming laxative every day.": Bulk-forming laxatives can be helpful, but daily use should be discussed with a provider, as they can worsen constipation if fluid intake is insufficient. Dietary changes are usually the first recommended step.

D. "I will limit my fluid intake to 1 liter per day.": Limiting fluid intake can lead to dehydration and hard stools, worsening constipation. Adequate hydration is essential to help fiber work effectively and support regular bowel function.

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A nurse working in an emergency department is assessing a client who is experiencing chest pain that began 6 hr ago. Which of the following findings indicates that the client is having a myocardial Infarction?

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