The nurse is reviewing the chart of a client with an indication of myocardial infarction or unstable angina. Which laboratory test result(s) should the nurse recognize as an indication of myocardial injury? (Select all that apply)

Elevated troponins

Decreased homocysteine levels

Elevated CK-MB

Decreased alkaline phosphatase (ALP)

Increased platelet count

Answer and Explanation

Correct Answer : A,C

Choice A: Elevated troponins. This is a correct answer. Troponins are proteins that regulate the myocardial contractile process². They are released into the bloodstream when the myocardial cells are damaged by ischemia or infarction². Troponins are highly specific and sensitive indicators of myocardial injury². The normal range for troponin I is less than 0.03 ng/mL and for troponin T is less than 0.01 ng/mL².

Choice B: Decreased homocysteine levels. This is not a correct answer. Homocysteine is an amino acid that is involved in the metabolism of methionine². Elevated homocysteine levels are associated with an increased risk of cardiovascular disease, but they are not a direct marker of myocardial injury². The normal range for homocysteine is 5 to 15 micromol/L².

Choice C: Elevated CK-MB. This is a correct answer. CK-MB is one of the isoenzymes of creatine kinase, an enzyme that catalyzes the conversion of creatine to phosphocreatine, which is used for energy storage in the muscles². CK-MB is found mainly in the myocardium and is released into the blood when the myocardial cells are injured². CK-MB is a specific and sensitive marker of myocardial injury, but it is less specific than troponins². The normal range for CK-MB is 0 to 3 ng/mL².

Choice D: Decreased alkaline phosphatase (ALP).This is not a correct answer. ALP is an enzyme that is found in various tissues, such as the liver, bone, intestine, and placenta². ALP is not a marker of myocardial injury, and its levels are not affected by ischemia or infarction². The normal range for ALP is 30 to 120 U/L².

Choice E: Increased platelet count.This is not a correct answer. Platelets are blood cells that are involved in hemostasis and clot formation². Increased platelet count, or thrombocytosis, can be a sign of inflammation, infection, malignancy, or other conditions². Platelet count is not a marker of myocardial injury, and it does not reflect the extent of ischemia or infarction². The normal range for platelet count is 150,000 to 450,000 per microliter of blood².

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Correct Answer is A

Explanation

Choice A reason: Exertional dyspnea is a common symptom of unstable angina, which is caused by reduced blood flow to the heart muscle. Carvedilol is a beta-blocker that reduces the workload of the heart and improves its oxygen supply. Therefore, resolving exertional dyspnea indicates that the medication has been effective.

Choice B reason: A heart rate of 50 beats/minute is not a desired outcome of carvedilol therapy. It may indicate that the dose is too high or that the client has a conduction problem. A normal resting heart rate for adults is between 60 and 100 beats/minute.

Choice C reason: A regular heart rhythm is not a specific indicator of carvedilol effectiveness. Carvedilol can prevent or treat some arrhythmias, but it is not the primary goal of therapy for unstable angina. A regular heart rhythm may also be influenced by other factors such as electrolytes, hydration, and stress.

Choice D reason: A blood pressure of 120/90 is not a sign of carvedilol effectiveness. Carvedilol can lower blood pressure, but it is not the main purpose of treatment for unstable angina. A blood pressure of 120/90 is considered prehypertension, which may increase the risk of cardiovascular complications.

A. An early morning headache. B. Occasional nausea. C. A chronic cough. D. A dry mouth after eating.

Correct Answer is C

Explanation

Choice A reason: An early morning headache is not the most common side effect of lisinopril. Lisinopril is a drug that lowers blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Headache is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ²

Choice B reason: Occasional nausea is not the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Nausea is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ²

Choice C reason: A chronic cough is the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ However, ACE inhibitors can also cause a dry, persistent cough that does not go away with time or treatment. ² This cough is due to the accumulation of a substance called bradykinin in the lungs, which irritates the airways and triggers the cough reflex. ³ The cough can be annoying and interfere with the quality of life of the client, but it is not harmful or dangerous. ²

Choice D reason: A dry mouth after eating is not the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Dry mouth is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ² Dry mouth can be caused by many factors, such as dehydration, medication, or disease. It can be relieved by drinking water, chewing gum, or using saliva substitutes.

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The nurse is reviewing the chart of a client with an indication of myocardial infarction or unstable angina. Which laboratory test result(s) should the nurse recognize as an indication of myocardial injury? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is evaluating the effects of the prescribed carvedilol 6.25 mg PO daily for a client with a history of unstable angina. Which of the following reflects that the medication has been effective?

Correct Answer is A

Explanation

The nurse is providing medication teaching to a client prescribed lisinopril 10 mg PO daily. Which side effect of the medication will the nurse explain to the client is most common?

Correct Answer is C

Explanation

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