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A nurse is caring for a client brought to the emergency room with acute chest pain. The client is being worked up for possible acute myocardial infarction (MI). The client asks why blood is being drawn for cardiac enzymes. What should the nurse explain to the client regarding why the cardiac enzyme troponin is being collected?

"These tests will enable the provider to determine the heart structure and mobility of the heart valves."

"Cardiac enzymes assist in diagnosing the presence of congestive heart failure."

"Cardiac enzymes like troponin shows there has been damage to the heart tissues and muscle."

"Cardiac enzymes will identify the exact location of the MI."

Answer and Explanation

The Correct Answer is C

A) "These tests will enable the provider to determine the heart structure and mobility of the heart valves." This statement is incorrect because cardiac enzyme tests, including troponin levels, do not assess heart structure or valve mobility. Imaging studies like echocardiograms are typically used for evaluating heart structure and function.

B) "Cardiac enzymes assist in diagnosing the presence of congestive heart failure." While cardiac enzymes can provide some information about heart function, they are not specifically used to diagnose congestive heart failure. The primary role of cardiac enzymes, particularly troponin, is in diagnosing myocardial injury, such as an acute myocardial infarction.

C) "Cardiac enzymes like troponin shows there has been damage to the heart tissues and muscle." This statement accurately reflects the purpose of measuring troponin levels. Troponin is a protein released into the bloodstream when heart muscle cells are damaged, making it a crucial biomarker for diagnosing an acute myocardial infarction.

D) "Cardiac enzymes will identify the exact location of the MI." This statement is misleading. While troponin levels can indicate that damage has occurred, they do not provide information about the specific location of the myocardial infarction. Other imaging techniques, such as an angiogram, are needed to determine the exact location of blockages or damage.

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A. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on 2 or more separate occasions." B. "For confirmed diagnosis of hypertension, BP readings should be lower than normal on only one occasion." C. "For confirmed diagnosis of hypertension, BP readings should be higher than normal on more than three separate occasions." D. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on only one occasion."

Correct Answer is A

Explanation

A. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on 2 or more separate occasions.": This statement accurately reflects the criteria for diagnosing hypertension. According to guidelines, a diagnosis is typically confirmed when blood pressure readings consistently exceed normal levels (usually defined as 130/80 mm Hg) on two or more separate visits.

B. "For confirmed diagnosis of hypertension, BP readings should be lower than normal on only one occasion.": This statement is incorrect. A single low reading does not confirm a diagnosis of hypertension. In fact, it contradicts the concept of hypertension, which involves consistently high readings.

C. "For confirmed diagnosis of hypertension, BP readings should be higher than normal on more than three separate occasions.": This statement is misleading. While multiple readings are often taken, the threshold for diagnosis is two or more elevated readings, not three.

D. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on only one occasion.": This statement is inaccurate, as a single elevated reading is not sufficient for diagnosis. Consistent elevations over multiple occasions are necessary for a confirmed diagnosis.

A. Within the expected reference range B. Elevated C. Stage 2 hypertension D. Stage 1 hypertension

Correct Answer is B

Explanation

A. Within the expected reference range: While a blood pressure of 130/82 mm Hg is close to normal, it is not considered fully within the expected reference range. The normal range is typically defined as less than 120/80 mm Hg.

B. Elevated: The reading of 130/82 mm Hg falls into the "elevated" category, which is defined as systolic blood pressure between 120-129 mm Hg and diastolic pressure less than 80 mm Hg. This indicates that while the client is not hypertensive, they are at increased risk for developing hypertension in the future.

C. Stage 2 hypertension: This category is defined by a systolic reading of 140 mm Hg or higher, or a diastolic reading of 90 mm Hg or higher. The client’s reading does not meet these criteria, so this option is not applicable.

D. Stage 1 hypertension: Stage 1 hypertension is characterized by systolic readings between 130-139 mm Hg and diastolic readings between 80-89 mm Hg. Although the systolic reading is in the Stage 1 range, the diastolic reading of 82 mm Hg places the overall reading in the "elevated" category, rather than Stage 1 hypertension.

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Correct Answer is A

Explanation

Correct Answer is B

Explanation

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Correct Answer is A

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A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 130/82 mm Hg places him in which of the following categories?

Correct Answer is B

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