The nurse is to begin a nitroglycerin infusion for a client diagnosed with an anterior wall myocardial infarction. Which assessment finding should the nurse report to the provider immediately?

Serum potassium of 5.2 mEq/L (normal 3.5 mEq/L-5.3 mEq/L.)

T wave depression on electrocardiogram

Heart rate of 90 beats per minute

Blood pressure of 90/50

Answer and Explanation

The Correct Answer is D

A. Serum potassium of 5.2 mEq/L: A potassium level of 5.2 mEq/L is slightly elevated but is still within a potentially acceptable range (normal is 3.5-5.3 mEq/L). While elevated potassium can be a concern, particularly in the context of an MI or with certain medications (like potassium-sparing diuretics), this level is not critically high. The nurse should monitor the potassium levels, but this is not an urgent finding requiring immediate reporting unless it increases further or is accompanied by significant symptoms (such as arrhythmias).

B. T wave depression on electrocardiogram (ECG): T wave depression can be a sign of ischemia or injury, which is common in the setting of an acute myocardial infarction. However, T wave changes are expected in this context and do not indicate an immediate emergency. The nurse should continue to monitor the ECG for any progression or worsening of ischemic changes but should prioritize concerns such as hypotension or worsening clinical status over this finding.

C. Heart rate of 90 beats per minute: A heart rate of 90 beats per minute is within normal limits (60-100 beats per minute), especially in the early stages of an MI. Nitroglycerin may cause a reflex tachycardia as a compensatory response to the decreased blood pressure, but a heart rate of 90 bpm is not an alarming finding. The nurse should continue to monitor the heart rate, but it is not the most pressing concern compared to hypotension. 4o mini

D. Blood pressure of 90/50: A blood pressure of 90/50 mmHg is significantly low and could indicate that the client is experiencing hypotension, which is a known side effect of nitroglycerin infusion. Nitroglycerin causes vasodilation, which can reduce blood pressure, especially in clients who are already at risk due to an acute myocardial infarction (MI). Low blood pressure can compromise perfusion to vital organs, including the heart, brain, and kidneys, and may lead to shock if not corrected promptly. This finding should be reported immediately to the healthcare provider, as it may require adjustment of the nitroglycerin dosage or discontinuation of the infusion.

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Correct Answer is A

Explanation

A. Sublingual nitroglycerin each day to prevent chest pain:
The statement about taking sublingual nitroglycerin daily is incorrect. Sublingual nitroglycerin is prescribed as needed for acute chest pain (angina) or for relieving chest discomfort associated with myocardial infarction (MI). It is not intended for daily use as a preventive measure. The client should be educated to use sublingual nitroglycerin only when experiencing chest pain, and if the pain persists or worsens, they should seek immediate medical help. Daily or routine use of nitroglycerin should be avoided unless specifically instructed by a healthcare provider. The client should also be educated about other preventive measures like long-acting nitrates if needed for chest pain prevention.

Explanation of other options:

B. Clopidogrel to prevent clots from forming:
This statement is correct. Clopidogrel (Plavix) is an antiplatelet medication commonly prescribed after a myocardial infarction to help prevent the formation of blood clots, which can reduce the risk of future cardiovascular events such as stroke or further heart attacks. It works by inhibiting platelets from clumping together, which is crucial in the post-MI period.

C. Atorvastatin at bedtime to reduce my cholesterol levels:
This statement is correct. Atorvastatin is a statin medication that is used to lower cholesterol levels, particularly LDL cholesterol (the "bad" cholesterol), which contributes to atherosclerosis and increases the risk of further heart problems. Statins are often prescribed after a myocardial infarction to help reduce the risk of future events. Taking atorvastatin at bedtime is also a common recommendation because cholesterol synthesis is higher during the night.

D. Metoprolol to decrease my heart's need for oxygen:
This statement is correct. Metoprolol is a beta-blocker that reduces the heart rate and blood pressure, which in turn lowers the heart's oxygen demand. After a myocardial infarction, beta-blockers like metoprolol are commonly prescribed to prevent further heart damage, reduce ischemia, and decrease the likelihood of arrhythmias. They help in the management of heart failure as well by improving the heart's efficiency.

A. Expect fluctuations of symptoms with temperature change B. New surgical techniques offer the best hope for a cure C. Information about genetic testing D. The disease process is intense but short in duration

Correct Answer is C

Explanation

A. Expect fluctuations of symptoms with temperature change: While symptom fluctuations may occur due to various factors, temperature changes are not a hallmark feature of Huntington's Disease (HD). HD is characterized by progressive motor, cognitive, and psychiatric symptoms, including involuntary movements (chorea), cognitive decline, and mood disturbances. Although other neurological conditions may show symptom fluctuations with temperature changes, this is not specific to HD.

B. New surgical techniques offer the best hope for a cure: There are currently no cures for Huntington's Disease, and while medical management can help manage symptoms (such as using medications for chorea or psychiatric symptoms), surgical techniques do not offer a cure for HD. The disease is progressive, and interventions typically focus on symptom management rather than cure. Families should be informed that while research is ongoing, a cure is not currently available.

C. Information about genetic testing: Huntington's Disease (HD) is a genetic disorder caused by a mutation in the HTT gene. It is inherited in an autosomal dominant pattern, meaning that a person with a parent who has HD has a 50% chance of inheriting the disease. Genetic testing is a critical part of the diagnosis process, and it can confirm the presence of the mutated gene before symptoms appear, which is important for family planning and early intervention. However, while genetic testing can provide information about whether an individual will develop the disease, it does not alter the course of the disease or provide a cure. It is essential to provide this information to clients and families, so they understand the role of genetic counseling and testing in managing the disease.

D. The disease process is intense but short in duration: Huntington's Disease is progressive and long-lasting. The disease usually begins in mid-adulthood (typically between ages 30-50), and the symptoms worsen over time. Individuals with HD may live for 15-20 years after symptom onset. The disease duration is long-term, not short, and it becomes increasingly debilitating as it progresses. The intensity of symptoms increases over time, and the disease is not characterized by a short duration.

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