The nurse is caring for a client admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this client. The nurse should recognize what implication of this assessment finding?

This result indicates muscle injury but does not specify the source.

Because the client has a history of unstable angina, this is a poor indicator of myocardial injury.

This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.

This is an accurate indicator of myocardial injury.

Answer and Explanation

The Correct Answer is D

A. This result indicates muscle injury but does not specify the source.

This statement is partly correct. An elevated troponin I level does indicate muscle injury, specifically damage to the heart muscle. However, troponin I is highly specific to cardiac muscle, so an elevated level would indeed specify the source as cardiac or myocardial injury.

B. Because the client has a history of unstable angina, this is a poor indicator of myocardial injury.

This statement is incorrect. A history of unstable angina does not diminish the significance of an elevated troponin I level. In fact, unstable angina is itself a serious condition that can lead to myocardial injury or heart attack, and an elevated troponin I level in this context indicates ongoing or recent myocardial damage.

C. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.

This statement is not entirely accurate. While it is true that troponin I levels may continue to rise and peak within 12-24 hours after the onset of myocardial injury, an elevated troponin I level at any point is still a significant indicator of myocardial damage. It's essential to recognize elevated troponin I levels promptly to initiate appropriate interventions and monitor the client's cardiac status closely.

D. This is an accurate indicator of myocardial injury.

This statement is correct. An elevated troponin I level is a highly sensitive and specific marker of myocardial injury. It indicates damage to the heart muscle, which can occur due to conditions like unstable angina, heart attack (myocardial infarction), myocarditis, or other cardiac issues. Therefore, recognizing an elevated troponin I level in a client with unstable angina is crucial for proper management and further evaluation.

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Correct Answer is C

Explanation

A. Weigh yourself once a week:

This is an important part of heart failure management as weight gain can indicate fluid retention, a common symptom of heart failure. The nurse should instruct the client to weigh themselves at the same time of day, using the same scale, and wearing similar clothing each time. Any sudden weight gain should be reported to the healthcare provider promptly.

B. Drink 3 liters of fluid per day:

This option is not appropriate for most heart failure patients, especially those with fluid retention issues. Fluid intake should be monitored and restricted based on the individual's condition and healthcare provider's recommendations. Consuming too much fluid can exacerbate fluid retention and worsen heart failure symptoms.

C. Engage in exercise daily:

Exercise is generally recommended for heart failure patients, but the type, intensity, and frequency of exercise should be tailored to the individual's condition. The nurse should encourage the client to engage in regular physical activity as tolerated, following a structured exercise plan approved by their healthcare provider. Activities like walking, cycling, or water aerobics can be beneficial for heart health.

D. Restrict dietary potassium:

This option is not typically included in lifestyle modifications for heart failure unless the client has specific potassium-related issues or is taking medications that require potassium restriction. Potassium is an important electrolyte for heart function, and most heart failure patients are advised to consume a balanced diet with moderate potassium intake, unless otherwise directed by their healthcare provider.

A. "The decreased HOL level will increase the amount of cholesterol moved away from the artery walls." B. "Increased LDL and decreased HDL increase my risk of coronary artery disease." C. "Increased LDL has the potential to decrease my risk of heart disease." D. "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."

Correct Answer is B

Explanation

A. "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls":

This statement is incorrect. High-density lipoprotein (HDL) is often referred to as "good" cholesterol because it helps remove excess cholesterol from the bloodstream and transport it to the liver for processing. A decreased HDL level is associated with an increased risk of cardiovascular disease, not with moving cholesterol away from artery walls.

B. "Increased LDL and decreased HDL increase my risk of coronary artery disease":

This statement is correct. Low-density lipoprotein (LDL) is often referred to as "bad" cholesterol because elevated LDL levels contribute to the buildup of plaque in the arteries, increasing the risk of coronary artery disease (CAD). Conversely, decreased HDL levels are associated with reduced cholesterol removal from the bloodstream, further increasing the risk of CAD.

C. "Increased LDL has the potential to decrease my risk of heart disease":

This statement is incorrect. Elevated LDL levels are a major risk factor for heart disease and are associated with an increased risk of atherosclerosis and cardiovascular events.

D. "The increased LDL will decrease the amount of cholesterol deposited on the artery walls":

This statement is incorrect. Increased LDL levels contribute to the deposition of cholesterol on artery walls, leading to the formation of plaque and narrowing of the arteries, which is detrimental to heart health.

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The nurse is caring for a client admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this client. The nurse should recognize what implication of this assessment finding?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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