The nurse is caring for a client who is undergoing an exercise stress test. Prior to reaching the target heart rate, the client develops chest pain. What is the nurse’s most appropriate interpretation of the chest pain?
The patient pain reflects the target heart rate has been set too high and needs to be lowered to finish the test.
The patient’s pain reflects pericarditis and the test should be stopped.
The patient’s pain reflects ischemia to the myocardium and the test should be stopped.
The patient’s pain reflects that supplemental oxygen is needed to finish the test.
The Correct Answer is C
A. The patient pain reflects the target heart rate has been set too high and needs to be lowered to finish the test.
This option suggests that the chest pain is related to the target heart rate being set too high. However, chest pain during an exercise stress test is more commonly associated with myocardial ischemia rather than an inappropriate target heart rate. Lowering the target heart rate may not address the underlying issue of ischemia.
B. The patient’s pain reflects pericarditis and the test should be stopped.
Chest pain during an exercise stress test is more commonly associated with myocardial ischemia rather than pericarditis. Pericarditis is inflammation of the pericardium, and its symptoms may include chest pain that is often sharp and pleuritic. However, during an exercise stress test, the focus is on detecting cardiovascular abnormalities, and chest pain is more concerning for ischemia.
C. The patient’s pain reflects ischemia to the myocardium and the test should be stopped.
This is the most appropriate interpretation. Chest pain during an exercise stress test may indicate insufficient oxygen supply to the myocardium (ischemia). Stopping the test allows for further evaluation and appropriate intervention.
D. The patient’s pain reflects that supplemental oxygen is needed to finish the test.
Chest pain during an exercise stress test is not typically addressed by providing supplemental oxygen. Stopping the test and evaluating the cause of the chest pain is a more appropriate action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "Did you have rheumatic fever as a child?"
Rheumatic fever is an inflammatory condition that can affect the heart, especially the heart valves. Rheumatic fever is a known risk factor for the development of valvular heart disease. Asking about a history of rheumatic fever helps identify a potential cause for valve malfunction.
B. "Do you have a family history of valve problems?"
Family history can be relevant in understanding genetic predispositions to certain cardiac conditions. While it may contribute to the overall assessment of cardiac risk, it may not be as directly linked to valve malfunction as a history of rheumatic fever.
C. "Do you have a history of MRSA?"
MRSA (Methicillin-resistant Staphylococcus aureus) is a type of bacterial infection and is not directly associated with valve malfunction. This question may be relevant for other aspects of the client's health but is not specific to ruling out cardiac issues related to valve malfunction.
D. "What over-the-counter medications do you take?"
While knowing the medications a client takes is important for a comprehensive assessment, asking about over-the-counter medications may not be as directly related to ruling out cardiac issues related to valve malfunction. It is more relevant for assessing potential interactions or effects on cardiovascular health.
Correct Answer is B
Explanation
A. Intermittent claudication:
Intermittent claudication is more commonly associated with peripheral arterial insufficiency rather than venous insufficiency. It is caused by inadequate blood flow to the muscles during activity, resulting in cramping or pain that typically resolves with rest.
B. Brownish discoloration to the legs:
Brownish discoloration to the legs, often referred to as hemosiderin staining, is a common finding in peripheral venous insufficiency. It occurs due to the breakdown of red blood cells and the deposition of hemosiderin in the tissues, especially around the ankles.
C. Weak or absent pedal pulses:
Weak or absent pedal pulses are more indicative of peripheral arterial insufficiency rather than venous insufficiency. Peripheral arterial disease can result in decreased blood flow to the extremities, leading to diminished pulses.
D. Unequal peripheral pulses between extremities:
Unequal peripheral pulses between extremities are also more suggestive of arterial insufficiency. Conditions such as atherosclerosis or arterial embolism can cause variations in pulses between different limbs.
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