A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending
The nurse caring for this patient will expect to:
a. administer aspirin when cardiac enzymes are completed.
b. give alteplase (Activase) within 2 hours.
c. give tenecteplase (TNKase) immediately.
d. obtain an order for an INR.
ANS: B
When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset. ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results. Tenecteplase may be given more than 2 hours after onset of symptoms. Obtaining an order for an INR is not indicated.
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