A nurse is assisting with the care of a client in the emergency department and reports severe radiating chest pain and shortness of breath. The client appears restless, frightened, and slightly cyanotic. The provider prescribes oxygen by nasal cannula at 4 L/min stat, cardiac enzyme levels, IV fluids, and a 12-lead ECG. Which of the following actions should the nurse take first?
Obtain a blood sample.
Initiate oxygen therapy.
Attach the leads for a 12-lead ECG.
Insert the IV catheter.
The Correct Answer is B
A. Obtain a blood sample. Although obtaining a blood sample is essential for cardiac enzyme levels, it is not the highest priority. Addressing oxygenation takes precedence to relieve hypoxia.
B. Initiate oxygen therapy. Oxygen is the first priority to improve oxygenation in a client showing signs of hypoxia (cyanosis, dyspnea), which can prevent further ischemic damage to the heart.
C. Attach the leads for a 12-lead ECG. While obtaining an ECG is essential for diagnosing myocardial ischemia, ensuring oxygenation is more critical in this moment.
D. Insert the IV catheter. An IV line is necessary to administer fluids and medications, but oxygenation should be prioritized first to stabilize the client.
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Correct Answer is B
Explanation
A. Creatine kinase-myocardial band (CK-MB) test: While CK-MB is also a marker of myocardial injury, it is less specific than troponin and can be elevated in other conditions, such as muscle injury.
B. Troponin T test. The Troponin T test is highly specific and sensitive for myocardial injury and is considered the gold standard for diagnosing a myocardial infarction. Troponin levels rise within hours of cardiac muscle injury and remain elevated for days, providing an early and reliable indicator of cardiac muscle damage.
C. Brain natriuretic peptide (BNP) test. BNP levels are used to assess heart failure and do not indicate acute cardiac muscle injury.
D. Creatine kinase (CK) test. CK measures overall muscle injury, not specific to cardiac muscle.
Correct Answer is B
Explanation
A. "Your heart condition is caused from stiffening of the walls of the ventricles." Stiffening of the ventricular walls describes restrictive cardiomyopathy, not DCM.
B. "Your heart condition is caused by excessive stretching of the ventricles." DCM involves excessive stretching and thinning of the ventricular walls, leading to impaired contraction.
C. "Your heart condition is caused when the ventricular tissue becomes fibrous and fatty." This describes arrhythmogenic right ventricular dysplasia, not DCM.
D. "Your heart condition is caused by thickening of the ventricular walls and septum." This describes hypertrophic cardiomyopathy, not DCM.