The standard policy on the cardiac unit states, “Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg.”. Which patient should the nurse call the health care provider about?
Newly admitted patient with a BP of 150/87 mm Hg.
Patient with left ventricular failure who has a BP of 110/70 mm Hg.
Postoperative patient with a BP of 116/42 mm Hg.
Patient with a myocardial infarction who has a BP of 140/86 mm Hg.
The Correct Answer is C
The patient with a blood pressure of 116/42 mm Hg has a mean arterial pressure (MAP) of approximately 67 mm Hg, which is less than the standard policy of 70 mm Hg. This could indicate inadequate blood flow to the vital organs, necessitating notification of the healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
High-output heart failure is not typically associated with chronic pulmonary disease and elevated pulmonary vascular resistance. High-output heart failure occurs when the heart is unable to meet the body’s increased demand for blood flow, which is not the case in this scenario.
Choice B rationale
Low-output heart failure is also not typically associated with chronic pulmonary disease and elevated pulmonary vascular resistance. Low-output heart failure occurs when the heart is unable to pump enough blood to meet the body’s needs, which is not the case in this scenario.
Choice C rationale
Left heart failure is not typically associated with chronic pulmonary disease and elevated pulmonary vascular resistance. Left heart failure occurs when the left side of the heart is unable to pump enough blood to the body, which is not the case in this scenario.
Choice D rationale
Right heart failure is the correct answer. In the context of a 65-year-old male patient diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance, the nurse should assess for right heart failure. This is because the right side of the heart pumps blood to the lungs, and if the pulmonary vascular resistance is elevated, it can put strain on the right side of the heart, leading to right heart failure.
Correct Answer is D
Explanation
Choice A rationale
Homocysteine is an amino acid that your body uses to make protein and to build and maintain tissue. But too much homocysteine in your blood might increase your risk of heart disease.
However, it is not the most specific marker for AMI.
Choice B rationale
C-reactive protein (CRP) is produced by the liver and its level rises when there is inflammation in your body. While its level can increase in those with a heart attack, it is not the most specific marker for AMI6.
Choice C rationale
Myoglobin is a small protein that stores oxygen. It is measured occasionally. Myoglobin is sometimes measured in addition to troponin to help diagnose a heart attack. However, it is not as specific as cardiac-specific troponin.
Choice D rationale
Cardiac-specific troponin is a cardio-specific, highly sensitive marker for myocardial damage. The absolute cardiospecificity of cTnI allows the diagnosis of myocardial infarction distinct from muscle lesions and non-cardiac surgery.
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