A patient presents to the ED in distress and complaining of "crushing" chest pain. What is the nurse's priority for assessment?
A) Prompt initiation of an ECG
B) Auscultation of the patient's point of maximal impulse (PMI)
C) Rapid assessment of the patient's peripheral pulses
D) Palpation of the patient's cardiac apex
Ans: A
Feedback:
The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. Each of the other listed assessments is valid, but ECG monitoring is the most time dependent priority.
You might also like to view...
What is the initial intervention in a patient with sinus tachycardia with the following vital signs: HR, 136 beats/min; BP, 102/60 mm Hg; RR, 24 breaths/min; T, 99.2° F; SpO2, 94% on oxygen 2 L/min by nasal cannula?
a. Stat adenosine to decrease heart rate b. Identification and correction of the cause of the increased heart rate c. Sublingual nitroglycerine 0.4 mg d. Lidocaine 75 mg IV push
Infectious mononucleosis is suspected in a client being seen in the clinic. In addition to swollen lymph glands and an increased lymphocyte count, the nurse can expect the client to:
A) complain of headaches and malaise. B) have an enlarged liver. C) have petechiae over the anterior chest. D) report having insomnia.
A client asks the nurse how he developed chronic obstructive pulmonary disease (COPD). Which of the following would be the best response for the nurse to make to this client?
1. Cigarette smoking is the number one cause of COPD. 2. COPD is caused from asthma. 3. COPD is caused from working in an industrial environment. 4. Once diagnosed with COPD, quitting smoking won't help the disease.
A nurse using a clinical information system is required to document the same data in more than one area because the data do not “flow over” to the other areas and the data fields are not universally designed. Which of the following is lacking?
A) Interoperability
B) Intangibles
C) Return on investment
D) Biometrics