A nurse is collecting data for a client who experienced a myocardial infarction prior to a cardiac arrest. Which of the following laboratory tests will identify early injury to the cardiac muscle?
Creatine kinase-myocardial band (CK-MB) test
Troponin T test
Brain natriuretic peptide (BNP) test
Creatine kinase (CK) test
The Correct Answer is B
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.
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Correct Answer is B
Explanation
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.
Correct Answer is C
Explanation
A. Advise the client to come into the office. The client needs immediate emergency intervention, not a routine office visit.
B. Advise the client to take an antacid. Chest pain unrelieved by nitroglycerin may indicate myocardial infarction; an antacid would not help.
C. Instruct the client to call 911. Persistent chest pain unrelieved by nitroglycerin warrants emergency attention due to potential heart attack.
D. Tell the client to take another nitroglycerin tablet in 15 min. The protocol allows taking an additional dose in 5 minutes, but emergency services should be called for unrelieved chest pain.