Emergency Medicine Chapter 7 Flashcards

Questions and Answers

Which laboratory test will be most useful in determining whether you should anticipate implementing the acute coronary syndrome (ACS) standard protocol?

Myoglobin level

Creatine kinase MB level

Troponin I level (correct)

C-reactive protein level

Which client finding will require the most immediate action during a treadmill stress test?

Oxygen saturation of 91%

Heart rate of 134 beats/min

Chest pain level of 3 (on a scale of 10) (correct)

Blood pressure of 152/88 mm Hg

Which actions are appropriate to delegate to an experienced LPN/LVN working in the ED? (Select all that apply.)

Asking the client about pertinent medical history

Attaching cardiac monitor leads (correct)

Having the client chew and swallow aspirin 162 mg (correct)

Giving heparin 5000 units IV push

Obtaining a 12-lead electrocardiogram (ECG) (correct)

Administering morphine sulfate 4 mg IV

Which topic will you plan on including in the initial teaching plan for a patient with a new diagnosis of stage 1 hypertension?

Low-sodium food choices when eating out Signup and view all the answers

Which finding indicates that you need to contact the health care provider about a change in drug therapy for a hypertensive client taking enalapril?

Client coughs often during the visit. Signup and view all the answers

Which interventions will be important to include in the discharge planning for a client with cardiovascular risk factors? (Select all that apply)

Referral to community programs that assist in smoking cessation Signup and view all the answers

Which client is best to assign to a float RN who has come for the day from the general medical-surgical unit?

Client receiving IV furosemide (Lasix) to treat acute left ventricular failure Signup and view all the answers

What finding is most important to communicate to the health care provider considering fibrinolytic therapy for a client with acute MI?

The client has had continuous chest pain since 8:00 AM. Signup and view all the answers

Which nursing activity included in the care plan is best delegated to the LPN/LVN for a client who had an acute MI?

Administering nitroglycerin if chest discomfort occurs during client activities Signup and view all the answers

Which action will you take first for a patient admitted with left anterior chest pain, possible ACS?

Administer sublingual nitroglycerin Signup and view all the answers

Which action is most appropriate when an 80-year-old client refuses docusate?

Explain that his decreased activity level may cause constipation. Signup and view all the answers

Which finding indicates a need for immediate further action after administering morphine to a client with an acute MI?

Respiratory rate drop from 18 to 12 breaths/min Signup and view all the answers

Which response is most appropriate for a client needing education about a heart-healthy diet after an MI?

'Can you tell me why you don't feel that you need to make any changes?' Signup and view all the answers

Which laboratory value is most important to monitor for a client on captopril and spironolactone?

Potassium level Signup and view all the answers

Which medication should be clarified with the health care provider for a client with unstable angina taking clopidogrel?

Omeprazole 20 mg daily Signup and view all the answers

What is the first action you will take for a client scheduled for transesophageal echocardiography?

Put the client on 'nothing by mouth' (NPO) status. Signup and view all the answers

Which information is of most concern after a client returns from coronary arteriography?

Apical pulse is 122 beats/min and regular. Signup and view all the answers

Which task associated with vascular testing is most appropriate to delegate to an experienced UAP?

Measuring ankle and brachial pressures for the ankle-brachial index. Signup and view all the answers

Which client is best for a newly graduated RN preceptor on the cardiac step-down unit?

33-year-old with endocarditis receiving ceftriaxone 2 g IV. Signup and view all the answers

Which client needs immediate intervention in the coronary care unit?

Client with acute MI and sinus rhythm at 76 beats/min with PVCs. Signup and view all the answers

What is the first action taken when ventricular fibrillation is identified in an unresponsive client?

Defibrillate at 200 J. Signup and view all the answers

Which finding is of most concern during evaluation after the new prescription of carvedilol?

Sinus bradycardia at a rate of 48 beats/min. Signup and view all the answers

Which client will you assess first after the shift change on the coronary step-down unit?

45-year-old with constrictive cardiomyopathy who developed dyspnea. Signup and view all the answers

Which activity is most appropriate to delegate to an LPN/LVN in a long-term care facility with residents with heart failure?

Listening to lung sounds and checking for edema weekly. Signup and view all the answers

Which finding during a home visit for a client taking digoxin is most important to communicate to the health care provider?

Vision that is becoming 'fuzzy'. Signup and view all the answers

In which order will you take the following actions for a client who has developed supraventricular tachycardia?

Call the client's physician. Signup and view all the answers

Which action should you take next for a client with endocarditis reporting severe left foot pain?

Notify the client's physician about the change in status. Signup and view all the answers

Which nursing activity included in the resident's care is best for you to delegate to the UAP?

Assisting the client in cleaning around the Unna boot. Signup and view all the answers

Which finding has the most immediate implications for a client after abdominal aortic aneurysm repair?

There is no response to verbal stimulation. Signup and view all the answers

Which nursing activity included in the care plan for clients undergoing cardiac surgery must be performed by RN staff members?

Developing an individual plan for discharge teaching. Signup and view all the answers

Which medication should you double-check with another licensed nurse for a patient with deep vein thrombosis?

Warfarin 2.5 mg PO Signup and view all the answers

Which laboratory result will be the most useful to monitor for a client being evaluated for heart failure?

B-type natriuretic peptide Signup and view all the answers

Study Notes

Laboratory Tests in Acute Coronary Syndrome

Troponin I levels are crucial for diagnosing acute coronary syndrome (ACS).
Creatine kinase MB and myoglobin levels are less specific for ACS.

Treadmill Stress Test Monitoring

Chest pain rated 3/10 demands immediate intervention.
Elevated heart rate and blood pressure provide secondary concerns.

Delegation to LPN/LVN in Emergency Department

Appropriate tasks include attaching cardiac monitor leads, obtaining 12-lead ECG, and administering aspirin.
IV push of heparin and administering morphine should not be delegated.

Teaching Plan for Stage 1 Hypertension

Focus on low-sodium food choices for frequent restaurant goers.
Discuss adverse effects of medications and alcohol on blood pressure.

Assessing Hypertensive Clients on Enalapril

A persistent cough indicates a need for medication reassessment.
Normal blood pressure and frequent urination are less critical.

Discharge Planning for Cardiovascular Risk

Smoking cessation programs are vital for clients with a family history of myocardial infarctions (MIs).
Discuss family history's impact on cardiovascular risks.

Appropriate Assignments for Charge Nurses

Assign clients under stable conditions or requiring routine medication administration to less experienced staff.

Fibrinolytic Therapy Communication

Continuous chest pain since admission is critical when considering fibrinolytic therapy.

Best Delegated Nursing Activities

Administering nitroglycerin for chest discomfort is suitable for an LPN/LVN.
Monitoring vital signs should be done by RN staff.

Emergency Care

Sublingual nitroglycerin is prioritized in cases of suspected acute coronary syndrome.
Persisting chest pain after morphine treatment requires immediate attention.

Heart Failure Client Education

Educate clients on lifestyle changes post-myocardial infarction to prevent denial regarding necessary changes.

Monitoring Potassium Levels

Potassium levels are critical for clients on captopril and spironolactone to avoid complications.

Clarifying Medication Orders

Confirm the need for omeprazole if the client is already on clopidogrel due to potential drug interactions.

Pre-Test Preparations

Clients undergoing transesophageal echocardiography must be placed on NPO status prior to the procedure.

Post-Operative Assessment

Apical pulse increases to 122 bpm after coronary arteriography raises concern for possible complications.

Delegation of Vascular Testing Tasks

Measuring ankle and brachial pressures can be delegated to an experienced UAP for ankle-brachial index calculations.

New Graduate Assignments

More stable clients with less need for complex medical care are suitable for new graduate nurses.

Immediate Interventions in Cardiac Monitoring

Clients presenting with acute myocardial infarction and significant arrhythmias require urgent assessment.

Cardiac Emergencies

Immediate action is required for clients in ventricular fibrillation, starting with defibrillation.

Assessing Changes in Heart Failure Clients

Sinus bradycardia indicates the need for intervention in clients taking beta-blockers.

Prioritizing Client Assessments

Assess clients who exhibit sudden changes in condition, such as worsening dyspnea and agitation.

Long-Term Care Activity Delegation

Routine assessments like checking for edema in heart failure residents are suitable for LPNs/LVNs.

Communication of Medication Side Effects

Report any visual disturbances in clients taking digoxin, as it may indicate toxicity.

Postoperative Action Steps

Blood pressure readings significantly elevated post-surgery require immediate intervention.

Standardized Care Plan Development

RNs must develop personalized discharge education plans due to the complexity of care required.

Double-Checking Medications

High-risk medications like warfarin must be verified with another licensed nurse before administration.

Monitoring Heart Failure Indicators

B-type natriuretic peptide levels are critical in diagnosing heart failure during evaluations.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge of critical concepts in emergency medicine with these flashcards focusing on Chapter 7. These cards cover important laboratory tests and their relevance in diagnosing acute coronary syndrome (ACS). Prepare effectively for clinical scenarios in the emergency department.