When assessing a male patient in the telemetry unit who is experiencing persistent, crushing chest pain, which symptoms would lead the nurse to suspect a myocardial infarction?
Intermittent claudication and pallor.
Jugular vein distention and dependent edema.
Mid-epigastric pain and heartburn.
Sweating and cool, clammy skin.
The Correct Answer is D
Choice A rationale
Intermittent claudication and pallor are not typically symptoms of a myocardial infarction. Intermittent claudication, or pain in the legs with exercise, is more commonly associated with peripheral artery disease. Pallor, or paleness, can occur with various conditions but is not a specific sign of myocardial infarction3.
Choice B rationale
Jugular vein distention and dependent edema are not typically symptoms of a myocardial infarction. These signs are more commonly associated with heart failure3.
Choice C rationale
Mid-epigastric pain and heartburn can sometimes be symptoms of a myocardial infarction, particularly in women. However, these symptoms can also occur with many other conditions, including gastrointestinal disorders3.
Choice D rationale
Sweating and cool, clammy skin are common symptoms of a myocardial infarction. These symptoms occur due to the body’s stress response to the decreased blood flow to the heart muscle3.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Assessing the need for smoking cessation is a standard part of nursing care, especially for patients with circulatory issues. Smoking can exacerbate circulatory problems and delay wound healing.
Choice B rationale
Applying TED hose to bilateral legs might not be appropriate for this patient. TED hose are compression stockings designed to prevent deep vein thrombosis and promote circulation.
However, in a patient with weak pedal pulses and a full-thickness wound on the leg, the compression from the stockings could potentially worsen circulation to the area and impede wound healing.
Choice C rationale
Consulting physical therapy could be beneficial for this patient. Physical therapists can provide exercises and interventions to improve circulation and mobility, which could help with the patient’s circulatory issues and wound healing.
Choice D rationale
Obtaining an Ankle-Brachial Index (ABI) with a hand-held Doppler could be useful in this situation. The ABI is a simple, non-invasive test that can help diagnose peripheral artery disease (PAD), a condition that could be causing the patient’s weak pedal pulses and wound healing issues.
Correct Answer is B
Explanation
Choice A rationale
Cracked lips are a symptom of Kawasaki disease, but they are more commonly associated with the subacute phase of the disease, not the acute phase.
Choice B rationale
Conjunctival hyperemia, or redness of the whites of the eyes, is a common symptom in the acute phase of Kawasaki disease. It typically presents as bilateral, non-exudative conjunctival injection, primarily in the bulbar conjunctivae.
Choice C rationale
A normal appearance is not typically seen in the acute phase of Kawasaki disease, which is characterized by a high fever and at least four of the five main symptoms, including conjunctival hyperemia.
Choice D rationale
Desquamation of the skin, or peeling, is a symptom of Kawasaki disease, but it typically occurs in the subacute phase, not the acute phase.
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