A patient has been admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI). The patient is restless, anxious, has a blood pressure of 86/40 mm Hg, and a heart rate of 132 beats/min.
What is the priority problem for this patient?
Anxiety
Acute pain
Decreased cardiac output
Stress management
The Correct Answer is C
Choice A rationale
Anxiety is a common response to the stress of hospitalization and illness, especially in the context of a serious condition like ST-segment-elevation myocardial infarction (STEMI).
However, while anxiety can exacerbate physical symptoms and should be addressed, it is not the primary problem in this scenario.
Choice B rationale
Acute pain is a common symptom of STEMI, as the heart muscle is deprived of oxygen. However, the patient’s blood pressure and heart rate readings suggest a more immediate concern related to the cardiovascular system.
Choice C rationale
Decreased cardiac output is likely the priority problem for this patient. The patient’s low blood pressure (86/40 mm Hg) and high heart rate (132 beats/min) suggest that the heart is not pumping enough blood to meet the body’s needs, which is a direct consequence of the STEMI1. This can lead to organ failure and other serious complications if not addressed promptly.
Choice D rationale
Stress management is an important aspect of long-term care for patients with heart disease, as chronic stress can contribute to further heart damage. However, in the acute phase of a STEMI, the focus is on stabilizing the patient’s condition and preventing complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While reducing anxiety and alleviating pain are important, they are not the most appropriate initial nursing intervention for a client with substernal chest pain, elevated ST segment on the ECG, and increased cardiac troponin level.
Choice B rationale
Enhancing myocardial oxygenation and decreasing cardiac workload are crucial initial nursing interventions for a client presenting with these symptoms. These actions can help prevent further damage to the heart muscle.
Choice C rationale
Removing family stressors and providing a tranquil environment, while beneficial, are not the most appropriate initial nursing interventions for a client with these symptoms.
Choice D rationale
Initiating a low-sodium diet and limiting fluid intake are important for managing heart failure, but they are not the most appropriate initial nursing interventions for a client with these symptoms.
Correct Answer is C
Explanation
Choice A rationale
Daily alcohol use is not a direct contraindication for Propranolol (Inderal), but it’s important to note that alcohol can increase the blood pressure-lowering effect of propranolol, which can make you feel dizzy or lightheaded.
Choice B rationale
Propranolol is often used in the treatment of conditions related to heart disease, such as hypertension and angina, and it can also be used in the secondary prevention of myocardial infarction.
Choice C rationale
Asthma is a contraindication for the use of Propranolol (Inderal). Propranolol can cause bronchial constriction by blocking beta-adrenergic receptors in the lungs, which can exacerbate asthma symptoms.
Choice D rationale
Peptic ulcer disease is not a direct contraindication for Propranolol (Inderal). However, like any medication, Propranolol should be used with caution in patients with a history of peptic ulcer disease.
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