Question

62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Answer 1

Correct Answers

Hyperlipidemia [ Risk factor ]
Diet – high carbohydrate/protein, poor fruits and vegetables [ Risk factor ]
Nicotine use – smokes ½ pack/day [ Risk factor ]
Male gender [ Risk factor ]
Diabetes mellitus [ Risk factor ]
Asthma [ Not a risk factor ]
BMI 34 kg/m² [ Risk factor ]
GERD [ Not a risk factor ]
Familial genetics – family history of CAD [ Risk factor ]
Hypertension [ Risk factor ]

Rationale :

➡️ Hyperlipidemia promotes cholesterol deposition and atherosclerotic plaque formation in coronary arteries.

➡️ An unhealthy diet can contribute to obesity, dyslipidemia, diabetes, and cardiovascular disease.

➡️ Nicotine/tobacco use damages vascular endothelium, promotes vasoconstriction and thrombosis, and substantially increases cardiovascular risk.

➡️ Male sex is a recognized nonmodifiable cardiovascular risk factor, particularly in middle age.

➡️ Diabetes mellitus accelerates atherosclerosis and significantly increases the risk of coronary artery disease and myocardial infarction.

➡️ A BMI of 34 kg/m² is in the obesity range and is associated with increased cardiovascular risk.

➡️ Family history of coronary artery disease represents a nonmodifiable genetic/familial cardiovascular risk factor.

➡️ Hypertension contributes to endothelial and arterial damage, accelerating coronary atherosclerosis and increasing MI risk.

❌ Not Risk Factors

➡️ Asthma is a chronic inflammatory airway disorder and is not one of the classic direct risk factors for myocardial infarction assessed in this scenario.

➡️ GERD can produce chest discomfort that resembles cardiac pain, but GERD itself is not a classic coronary artery disease risk factor.

➡️ Neither condition explains the client's combination of major cardiovascular risk factors as directly as smoking, diabetes, obesity, hyperlipidemia, hypertension, and family history.

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Answer 2

Correct Answers:

ST elevations in V3, V4
Troponin T
CK-MB
Oxygen saturation
Blood pressure

Rationale :

✅ ST elevations in V3 and V4

➡️ ST-segment elevation in V3 and V4 indicates acute myocardial injury involving the anterior wall of the heart.

➡️ Combined with crushing substernal pain radiating to the left arm, this finding is highly concerning for an acute STEMI.

➡️ The client's symptoms have persisted for 2 hours, making rapid recognition and reperfusion especially important.

➡️ Acute coronary occlusion causes progressive myocardial ischemia and necrosis when blood flow is not restored.

➡️ V3 and V4 primarily reflect electrical activity involving the anterior left ventricle.

➡️ The ECG findings correlate with the markedly elevated cardiac biomarkers in this case.

➡️ Rapid intervention is required to restore coronary perfusion and limit irreversible myocardial damage.

➡️ Therefore, the ST elevations require immediate follow-up.

✅ Troponin T: 0.7 ng/mL

➡️ The client's troponin T of 0.7 ng/mL is markedly above the stated reference range of 0–0.04 ng/mL.

➡️ Troponin is a highly important biomarker of myocardial injury.

➡️ Elevated troponin in this symptomatic client strongly supports acute myocardial infarction.

➡️ The finding correlates with the client's crushing chest pain and ST-segment elevation.

➡️ Myocardial cell injury causes intracellular cardiac proteins such as troponin to enter the bloodstream.

➡️ Serial troponin measurements may be used to evaluate the pattern of myocardial injury, but treatment of an apparent STEMI should not be delayed awaiting additional measurements.

➡️ The elevated level therefore represents active cardiac injury requiring urgent management.

➡️ This finding requires immediate follow-up.

✅ CK-MB: 187 IU/L

➡️ The CK-MB of 187 IU/L is dramatically elevated above the stated reference range of 5–25 IU/L.

➡️ CK-MB elevation is consistent with myocardial muscle injury in the appropriate clinical setting.

➡️ The finding supports the evidence already provided by the client's symptoms, ECG, and elevated troponin.

➡️ The client's crushing chest pain and diaphoresis further strengthen concern for acute myocardial infarction.

➡️ CK-MB begins increasing after myocardial injury and can help demonstrate an evolving cardiac event.

➡️ Troponin is generally more cardiac-specific, but this markedly abnormal CK-MB remains clinically significant.

➡️ The simultaneous abnormalities indicate substantial acute myocardial injury requiring urgent treatment.

➡️ Therefore, the CK-MB result requires immediate follow-up.

✅ Oxygen saturation: 90% on room air

➡️ An oxygen saturation of 90% on room air indicates clinically significant reduced oxygenation.

➡️ Adequate oxygenation is especially important during an acute MI because ischemic myocardium already has an inadequate oxygen supply.

➡️ Hypoxemia can worsen the imbalance between myocardial oxygen supply and oxygen demand.

➡️ The client is also reporting shortness of breath, making the low oxygen saturation particularly concerning.

➡️ Oxygen therapy is appropriate in an acute coronary syndrome patient who is hypoxemic.

➡️ Respiratory and oxygenation status should be reassessed closely for further deterioration.

➡️ Correcting hypoxemia supports oxygen delivery to the myocardium and other vital organs.

➡️ Therefore, the oxygen saturation requires immediate follow-up.

✅ Blood pressure: 162/89 mm Hg

➡️ A blood pressure of 162/89 mm Hg represents significant systolic hypertension during an acute cardiac event.

➡️ Elevated blood pressure increases left ventricular workload and myocardial oxygen demand.

➡️ Increased myocardial oxygen demand is undesirable when coronary blood flow is already compromised by acute ischemia.

➡️ Pain, anxiety, and sympathetic nervous system activation during an MI can contribute to elevated blood pressure.

➡️ The client also has a history of hypertension, which increases overall cardiovascular risk.

➡️ Blood pressure must be monitored closely because acute MI can subsequently produce hemodynamic instability.

➡️ Blood pressure also influences the safe administration of several medications used during acute coronary syndrome management.

➡️ Therefore, this elevated blood pressure warrants prompt assessment and follow-up in the context of an acute STEMI.

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Answer 3

Correct Answers

Blank 1 Correct Option: ST elevated myocardial infarction
Blank 2 Correct Option: blockage

Rationale :

🏵️ The client has classic symptoms of acute myocardial infarction, including crushing substernal chest pain, radiation to the left arm, dyspnea, and diaphoresis.

🏵️ The pain has persisted for 2 hours despite stopping physical activity, which is more consistent with myocardial infarction than stable angina.

🏵️ The ECG demonstrates ST-segment elevation in V3 and V4, which indicates acute myocardial injury and supports a diagnosis of STEMI.

🏵️ Leads V3 and V4 correspond primarily to the anterior wall of the left ventricle, making an anterior STEMI likely.

🏵️ The troponin T of 0.7 ng/mL is markedly above the reference range and provides biochemical evidence of myocardial injury.

🏵️ The CK-MB of 187 IU/L is also markedly elevated, further supporting acute myocardial necrosis.

🏵️ STEMI typically results from acute coronary artery occlusion/blockage, commonly after disruption of an atherosclerotic plaque with thrombus formation.

🏵️ The combination of persistent ischemic symptoms, ST elevation, and elevated cardiac biomarkers strongly supports STEMI caused by coronary artery blockage.

❌ Non-ST elevated myocardial infarction (NSTEMI)

🏵️ NSTEMI produces myocardial necrosis with elevated cardiac biomarkers, but persistent diagnostic ST-segment elevation is not its defining ECG pattern.

🏵️ This client's ECG specifically demonstrates ST elevation in V3 and V4, supporting STEMI instead.

🏵️ The clinical presentation and ECG therefore make NSTEMI the less appropriate selection.

❌ Prinzmetal's angina

🏵️ Prinzmetal's angina is caused primarily by transient coronary artery vasospasm and can produce temporary ST-segment elevation during an episode.

🏵️ It classically occurs at rest, whereas this client's symptoms began during exertion and are accompanied by markedly elevated cardiac biomarkers consistent with myocardial necrosis.

🏵️ The overall presentation is therefore much more consistent with an acute STEMI.

❌ Coronary artery spasm

🏵️ Coronary vasospasm is the characteristic mechanism underlying Prinzmetal's or variant angina.

🏵️ The client's persistent symptoms, elevated troponin and CK-MB, and STEMI pattern indicate acute myocardial injury associated with coronary occlusion rather than transient vasospasm.

🏵️ Therefore, blockage is the appropriate mechanism among the available choices.

❌ Coronary artery rupture

🏵️ Atherosclerotic plaque rupture can initiate thrombus formation, but the coronary artery itself does not typically “rupture” as the mechanism of an acute STEMI.

🏵️ Plaque disruption can lead to formation of an occlusive coronary thrombus.

🏵️ Among the provided choices, blockage most accurately describes the resulting coronary artery problem.

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Answer 4

Correct Answers

Thrombolytic therapy per protocol [ Indicated ]
Aspirin 325 mg PO [ Indicated ]
Insert IV [ Indicated ]
Digoxin 0.25 mcg PO [ Not indicated ]
Q1HR complete neurological checks [ Indicated ]
Metoprolol 50 mg PO [ Indicated ]
Nitroglycerin—titrate infusion per protocol [ Indicated ]
Oxygen therapy—maintain O₂ >92%, up to 6 L [ Indicated ]
Morphine 0.5 mg IV [ Indicated ]
Cephalexin 500 mg PO [ Not indicated ]

Rationale :

Thrombolytic Therapy per Protocol — Indicated

✨ The client has an acute ST-elevation myocardial infarction (STEMI) with ST elevation in V3 and V4.

✨ His symptoms began approximately 2 hours ago, placing him within the potential treatment window for fibrinolytic therapy when timely PCI is unavailable.

✨ Thrombolytic medications dissolve the coronary thrombus responsible for acute coronary artery occlusion.

✨ Restoring coronary blood flow limits the amount of irreversible myocardial necrosis.

✨ The markedly elevated troponin T and CK-MB further support acute myocardial injury.

✨ The client must first be screened carefully for contraindications to fibrinolytic therapy, particularly active bleeding and prior intracranial hemorrhage.

✨ Reperfusion should occur as rapidly as possible because prolonged coronary occlusion results in increasing myocardial damage.

✨ Therefore, thrombolytic therapy per protocol is indicated if PCI cannot be provided within the recommended timeframe and no contraindications exist.

Aspirin 325 mg PO — Indicated

✨ Aspirin inhibits platelet aggregation and helps prevent further enlargement of the coronary thrombus.

✨ Aspirin is an important early medication in the management of suspected acute myocardial infarction when no contraindication exists.

✨ The client's STEMI is most likely associated with acute coronary thrombosis following atherosclerotic plaque disruption.

✨ Reducing platelet aggregation helps limit additional coronary artery occlusion.

✨ Aspirin should generally be administered promptly because early antiplatelet therapy improves outcomes in acute coronary syndromes.

✨ A dose in the range represented by 325 mg is appropriate for initial acute treatment according to common ACS protocols.

✨ The nurse should verify that the client does not have an aspirin allergy or another major contraindication.

✨ Therefore, aspirin is clearly indicated for this client's acute STEMI.

Insert IV — Indicated

✨ Reliable intravenous access is essential for a client experiencing an acute STEMI.

✨ IV access permits rapid administration of medications such as nitroglycerin and morphine when clinically appropriate.

✨ It also provides immediate access if the client develops a life-threatening dysrhythmia or hemodynamic instability.

✨ Acute MI can deteriorate rapidly into cardiogenic shock, cardiac arrest, or other serious complications.

✨ IV access is also necessary for many medications used during emergency reperfusion management.

✨ The client's current condition requires continuous monitoring and readiness for emergency treatment.

✨ Establishing vascular access should therefore occur early during emergency stabilization.

✨ The order to insert an IV is indicated.

Digoxin 0.25 mcg PO — Not Indicated

✨ Digoxin is primarily used for selected clients with heart failure or certain supraventricular dysrhythmias such as atrial fibrillation.

✨ The client has sinus rhythm and no documented indication requiring digoxin therapy.

✨ Digoxin does not restore blood flow through an acutely occluded coronary artery.

Q1HR Complete Neurological Checks — Indicated

✨ Frequent neurological assessments are particularly important when a client receives thrombolytic therapy because intracranial hemorrhage is a serious potential complication.

✨ The nurse should establish and monitor the client's level of consciousness and neurological status.

✨ New confusion, decreased consciousness, severe headache, weakness, or speech changes can indicate intracranial bleeding.

✨ Early identification of neurological deterioration allows rapid intervention and evaluation.

✨ Thrombolytic therapy increases bleeding risk because it promotes breakdown of fibrin-containing clots.

✨ Neurological monitoring therefore becomes an important component of the client's safety surveillance following fibrinolytic administration.

✨ The client's baseline neurological status is currently alert and oriented ×3, providing a useful comparison for subsequent assessments.

✨ Therefore, scheduled complete neurological checks are indicated in this treatment plan.

Metoprolol 50 mg PO — Indicated

✨ Metoprolol is a beta₁-adrenergic blocker that reduces heart rate, blood pressure, and myocardial contractility.

✨ These effects decrease myocardial oxygen demand, which can be beneficial during acute myocardial ischemia.

✨ The client has a blood pressure of 162/89 mm Hg, so hypotension is not currently present.

✨ His heart rate of 99/min also does not indicate bradycardia.

✨ Beta-blockers may reduce recurrent ischemia and certain cardiac complications when appropriately used after acute MI.

✨ The nurse should monitor for bradycardia, hypotension, heart block, and signs of heart failure.

✨ The client's history of asthma warrants additional caution because beta-blockers can potentially contribute to bronchospasm, although metoprolol is relatively beta₁-selective.

✨ Therefore, metoprolol is indicated with appropriate assessment and monitoring.

Nitroglycerin Infusion — Indicated

✨ Nitroglycerin causes vasodilation and can reduce myocardial oxygen demand and ischemic chest discomfort.

✨ This client continues to experience severe 8/10 crushing chest pain, making anti-ischemic treatment appropriate.

✨ His blood pressure of 162/89 mm Hg provides adequate pressure for cautious nitrate administration.

✨ The infusion can be titrated according to the client's pain response and blood pressure.

✨ Nitroglycerin reduces preload through venodilation and can decrease cardiac workload.

✨ The nurse must monitor carefully for hypotension and headache during treatment.

✨ Recent use of a phosphodiesterase-5 inhibitor would be an important contraindication that must be assessed before nitrate administration.

✨ Therefore, titrated IV nitroglycerin is indicated for this client's ongoing ischemic symptoms.

Oxygen Therapy — Indicated

✨ The client's oxygen saturation is 90% on room air, demonstrating hypoxemia.

✨ Supplemental oxygen is appropriate during acute MI when oxygen saturation is reduced.

✨ The order specifically directs oxygen administration to maintain saturation above 92%.

✨ Adequate oxygenation supports oxygen delivery to the ischemic myocardium and other vital organs.

✨ The client also reports shortness of breath, further supporting the need for oxygen therapy.

✨ Oxygen saturation should be continuously reassessed and therapy adjusted according to the client's response.

✨ Routine oxygen is unnecessary in adequately oxygenated MI patients, but this client's saturation is clearly below the prescribed target.

✨ Therefore, supplemental oxygen is indicated.

Morphine 0.5 mg IV — Indicated

✨ Morphine may be used cautiously for severe ischemic chest pain that persists despite appropriate anti-ischemic therapy.

✨ This client reports severe 8/10 chest pain, indicating substantial ongoing discomfort.

✨ Morphine provides analgesia and can decrease sympathetic activation associated with severe pain and anxiety.

✨ Reduced sympathetic activity can decrease cardiac workload and myocardial oxygen demand.

✨ IV administration allows rapid onset and careful titration of the medication's effects.

✨ The nurse must monitor blood pressure, respiratory rate, level of consciousness, and oxygen saturation after administration.

✨ Current ACS practice generally reserves morphine for persistent severe pain rather than administering it routinely to every MI patient.

✨ Given the prescribed dose and severe persistent pain, morphine is indicated with careful monitoring.

Cephalexin 500 mg PO — Not Indicated

✨ Cephalexin is an antibiotic used to treat susceptible bacterial infections.

✨ The client has no findings suggesting an active bacterial infection, and his WBC count is normal at 9,000/mm³.

✨ Antibiotic therapy does not treat the coronary occlusion responsible for this client's acute STEMI.

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Answer 5

Correct Answers:

Oxygen

Rationale :

🌸 The client's oxygen saturation is 90% on room air, indicating hypoxemia that requires immediate correction.

🌸 Using the ABC priority framework, breathing and oxygenation take priority over medication administration.

🌸 The prescription specifically directs oxygen therapy to maintain an oxygen saturation above 92%.

🌸 The client also reports shortness of breath, further supporting the immediate need for supplemental oxygen.

🌸 Acute STEMI causes an imbalance between myocardial oxygen supply and demand, and hypoxemia can worsen myocardial ischemia.

🌸 Supplemental oxygen is appropriate in acute myocardial infarction when the client has low oxygen saturation, rather than being given routinely to every MI client.

🌸 Aspirin, nitroglycerin, and appropriate analgesia should follow promptly as part of the client's acute STEMI management.

🌸 Therefore, correcting the client's impaired oxygenation is the nurse's priority among the available interventions.

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Answer 6

Correct Answers

Avoid IM injections [ Indicated ]
Monitor site for bleeding [ Indicated ]
Monitor for arrhythmias [ Indicated ]
Monitor for back pain [ Indicated ]
Assess urine [ Indicated ]
Place patient in High Fowler's position [ Not indicated ]
Place a Foley catheter [ Not indicated ]
Assess stool [ Indicated ]
Take off dressing and assess insertion site [ Not indicated ]
Monitor LOC [ Indicated ]
Educate patient that MRI cannot be performed in future [ Not indicated ]

Rationale :

Indicated Interventions

🌻 Avoid IM injections because fibrinolytic therapy substantially increases the client's risk for bleeding and hematoma formation.

🌻 Monitor the vascular insertion site for bleeding because both PTCI and fibrinolytic therapy increase the possibility of access-site hemorrhage.

🌻 Monitor for arrhythmias because reperfusion of ischemic myocardium can produce reperfusion dysrhythmias following restoration of coronary blood flow.

🌻 Monitor for back pain because new back or flank pain can indicate retroperitoneal bleeding, particularly after femoral vascular access.

🌻 Assess the urine for hematuria because blood in the urine can indicate internal bleeding following fibrinolytic therapy.

🌻 Assess the stool for visible or occult blood because gastrointestinal bleeding is another potential complication of fibrinolysis.

🌻 Monitor level of consciousness (LOC) closely because sudden neurological changes can indicate intracranial hemorrhage, a life-threatening complication.

🌻 These interventions emphasize early detection of hemorrhage and reperfusion complications, which are major concerns following fibrinolytic therapy and PTCI.

High Fowler's Position — Not Indicated

🌻 High Fowler's position is not routinely required specifically because the client received fibrinolytic therapy.

🌻 Positioning should be determined by the client's respiratory and hemodynamic condition and the vascular access site used during PTCI.

🌻 If femoral access was used, the affected extremity may need to remain straight according to post-procedure protocol.

Place a Foley Catheter — Contraindicated

🌻 Invasive procedures should be minimized after fibrinolytic therapy because they can create sites of persistent bleeding.

🌻 Inserting a urinary catheter can traumatize the urethral mucosa and cause hematuria or hemorrhage.

🌻 A Foley catheter should therefore be avoided unless there is a compelling clinical indication.

Take Off the Dressing and Assess the Insertion Site — Contraindicated

🌻 The vascular access site should be assessed frequently, but the protective dressing should not be routinely removed simply to inspect it.

🌻 Unnecessary manipulation can disrupt clot formation and contribute to access-site bleeding.

🌻 The nurse should inspect and palpate according to the post-PTCI protocol while maintaining the prescribed dressing.

MRI Teaching — Not Indicated

🌻 Receiving fibrinolytic therapy or routine PTCI does not mean that the client can never undergo an MRI.

🌻 Coronary stents are generally not an automatic lifelong contraindication to MRI, although device-specific information and timing requirements should always be verified.

🌻 Therefore, telling the client that MRI will never be possible is inaccurate teaching.

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Answer 7

Correct Answers:

Hypertension

Rationale :

🌼 Hypertension is a major modifiable risk factor for stroke because it can be treated and controlled through lifestyle changes and medications.

🌼 Persistent high blood pressure damages the vascular endothelium and accelerates atherosclerotic changes in cerebral arteries.

🌼 Hypertension increases the risk for both ischemic and hemorrhagic stroke.

🌼 Chronic vascular damage can promote arterial narrowing, thrombosis, and eventual interruption of cerebral blood flow.

🌼 High blood pressure can also weaken cerebral blood vessels, increasing the possibility of vessel rupture and intracranial hemorrhage.

🌼 Blood pressure control through prescribed medications, physical activity, weight management, and dietary modification can significantly reduce stroke risk.

🌼 The term modifiable means that the risk factor can potentially be changed or controlled through intervention.

🌼 Therefore, hypertension is the modifiable risk factor among the findings provided.

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Answer 8

Correct Answers:

The client should maintain systolic BP between 120 and 129 mm Hg.

Rationale :

🏵️ Hypertension is one of the most important modifiable risk factors for recurrent TIA and stroke.

🏵️ Maintaining systolic blood pressure in the 120–129 mm Hg range provides the best option listed for reducing ongoing cerebrovascular risk.

🏵️ Persistent hypertension damages the vascular endothelium and promotes atherosclerosis within cerebral arteries.

🏵️ Effective blood pressure management decreases stress on cerebral blood vessels and reduces the likelihood of another ischemic event.

🏵️ Blood pressure control is especially important after a TIA because a TIA serves as a warning of an increased risk for a subsequent stroke.

🏵️ Management commonly includes prescribed antihypertensive medications together with lifestyle modifications such as reducing sodium intake and maintaining appropriate physical activity.

🏵️ The client should monitor blood pressure regularly and follow the individualized target established by the healthcare provider.

🏵️ Among the ranges provided, 120–129 mm Hg represents the most appropriate systolic blood pressure goal.

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Answer 9

Correct Answers:

"Coronary arteries decrease in diameter, leading to insufficient blood, oxygen, and nutrients reaching the heart muscle."

Rationale :

🌹 With aging and coronary artery disease (CAD), atherosclerotic changes can cause the coronary arteries to become narrower.

🌹 Atherosclerosis involves accumulation of lipid-containing plaque within the arterial walls, reducing the vessel lumen.

🌹 A decreased coronary artery diameter limits the amount of blood flowing to the myocardium.

🌹 Reduced coronary blood flow decreases delivery of oxygen and nutrients required by cardiac muscle cells.

🌹 When myocardial oxygen supply becomes inadequate for myocardial demand, myocardial ischemia develops.

🌹 Myocardial ischemia commonly produces angina, especially when physical activity increases the heart's oxygen requirements.

🌹 Aging is also associated with increased arterial stiffness, which can contribute to cardiovascular disease and increased cardiac workload.

🌹 Therefore, narrowing of the coronary arteries and resulting reduction in myocardial perfusion best explains the manifestations associated with CAD.

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Answer 10

Correct Answers:

The client has a history of severe bronchial asthma.

Rationale :

✍️ Propranolol is a nonselective beta-adrenergic blocker that blocks both beta₁ and beta₂ receptors.

✍️ Blocking beta₁ receptors decreases heart rate, myocardial contractility, and myocardial oxygen demand, which helps manage angina pectoris.

✍️ Blocking beta₂ receptors can cause bronchoconstriction by preventing beta₂-mediated relaxation of bronchial smooth muscle.

✍️ A client with severe bronchial asthma is particularly vulnerable to potentially serious bronchospasm from nonselective beta blockers.

✍️ Propranolol can also interfere with the therapeutic effects of beta₂-agonist bronchodilators, such as albuterol.

✍️ The client's history of severe asthma should therefore be identified before propranolol is administered.

✍️ The nurse should report the asthma history to the provider so the medication regimen can be reevaluated.

✍️ Therefore, severe bronchial asthma is the finding that requires provider notification.

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Lab	Results	Reference Range
WBC	9 x 10^3 cells/mm3	4500-11,000/mm3
RBC	5.3 x 10^6/µL	4.7-6.1 x 10^6/µL
Hgb	15.8 g/dL	Male: 14-17.4 g/dL
Hct	44%	Male: 42-52%
Plts	254,000/mm3	140,000-400,000/mm3
Na	144 mEq/L	135-147 mEq/L
Cl	104 mEq/L	95-106 mEq/L
K	4.8 mEq/L	3.5-5.3 mEq/L
CO2	29 mEq/L	22-30 mEq/L
BUN	12 mg/dL	6-20 mg/dL
Cr	1.1 mg/dL	0.6-1.3 mg/dL
Troponin T	0.7 ng/mL	0-0.04 ng/mL
Creatine Kinase MB (CK-MB)	187 IU/L	5-25 IU/L
Cholesterol	265 mg/dL	<200 mg/dL normal; 200-239 borderline; >240 high

Lab	Results	Reference Range
WBC	9 x 10^3 cells/mm3	4500-11,000/mm3
RBC	5.3 x 10^6/µL	4.7-6.1 x 10^6/µL
Hgb	15.8 g/dL	Male: 14-17.4 g/dL
Hct	44%	Male: 42-52%
Plts	254,000/mm3	140,000-400,000/mm3
Na	144 mEq/L	135-147 mEq/L
Cl	104 mEq/L	95-106 mEq/L
K	4.8 mEq/L	3.5-5.3 mEq/L
CO2	29 mEq/L	22-30 mEq/L
BUN	12 mg/dL	6-20 mg/dL
Cr	1.1 mg/dL	0.6-1.3 mg/dL
Troponin T	0.7 ng/mL	0-0.04 ng/mL
Creatine Kinase MB (CK-MB)	187 IU/L	5-25 IU/L
Cholesterol	265 mg/dL	<200 mg/dL normal; 200-239 borderline; >240 high

Lab	Results	Reference Range
WBC	9 x 10^3 cells/mm3	4500-11,000/mm3
RBC	5.3 x 10^6/µL	4.7-6.1 x 10^6/µL
Hgb	15.8 g/dL	Male: 14-17.4 g/dL
Hct	44%	Male: 42-52%
Plts	254,000/mm3	140,000-400,000/mm3
Na	144 mEq/L	135-147 mEq/L
Cl	104 mEq/L	95-106 mEq/L
K	4.8 mEq/L	3.5-5.3 mEq/L
CO2	29 mEq/L	22-30 mEq/L
BUN	12 mg/dL	6-20 mg/dL
Cr	1.1 mg/dL	0.6-1.3 mg/dL
Troponin T	0.7 ng/mL	0-0.04 ng/mL
Creatine Kinase MB (CK-MB)	187 IU/L	5-25 IU/L
Cholesterol	265 mg/dL	<200 mg/dL normal; 200-239 borderline; >240 high

Physician Order	Indicated	Not indicated
Thrombolytic therapy per protocol
Aspirin 325 mg PO
Insert IV
Digoxin 0.25 mcg PO
Q1HR complete neurological checks
Metoprolol 50 mg PO
Nitroglycerin—titrate infusion per protocol
Oxygen therapy—maintain O₂ >92%, up to 6 L
Morphine 0.5 mg IV
Cephalexin 500 mg PO

Lab	Results	Reference Range
WBC	9 x 10^3 cells/mm3	4500-11,000/mm3
RBC	5.3 x 10^6/µL	4.7-6.1 x 10^6/µL
Hgb	15.8 g/dL	Male: 14-17.4 g/dL
Hct	44%	Male: 42-52%
Plts	254,000/mm3	140,000-400,000/mm3
Na	144 mEq/L	135-147 mEq/L
Cl	104 mEq/L	95-106 mEq/L
K	4.8 mEq/L	3.5-5.3 mEq/L
CO2	29 mEq/L	22-30 mEq/L
BUN	12 mg/dL	6-20 mg/dL
Cr	1.1 mg/dL	0.6-1.3 mg/dL
Troponin T	0.7 ng/mL	0-0.04 ng/mL
Creatine Kinase MB (CK-MB)	187 IU/L	5-25 IU/L
Cholesterol	265 mg/dL	<200 mg/dL normal; 200-239 borderline; >240 high

RN Test 4 Cardiac Angina/MI/HTN, Shock (Fall 2026)

No.

1 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

2 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Answer Options

3 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

4 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

5 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Answer Options

6 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

7 :
A nurse is reviewing the electronic medical record of a middle-aged client who was admitted following a stroke. Which of the following findings should the nurse identify as a modifiable risk factor for stroke?

8 :
A nurse is providing discharge instruction to a client who has hypertension that has resulted in a transient ischemic attack (TIA). Which of the following information should the nurse discuss with the client regarding blood pressure (BP) management?

9 :
A nurse is providing teaching to a client who has coronary artery disease. Which of the following statements should the nurse include to explain the correlation between changes in the coronary arteries and manifestations that occur as we age?

10 :
A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?

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Potential Finding	Risk factor	Not a risk factor
Hyperlipidemia
Diet – high carbohydrate/protein, poor fruits and vegetables
Nicotine use – smokes ½ pack/day
Male gender
Diabetes mellitus
Asthma
BMI 34 kg/m²
GERD
Familial genetics – family history of CAD
Hypertension

Intervention	Indicated	Not indicated
Avoid IM injections
Monitor site for bleeding
Monitor for arrhythmias
Monitor for back pain
Assess urine
Place patient in High Fowler's position
Place a Foley catheter
Assess stool
Take off dressing and assess insertion site
Monitor LOC
Educate patient that MRI cannot be performed in future

RN Test 4 Cardiac Angina/MI/HTN, Shock (Fall 2026)

No.

1 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

2 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Answer Options

3 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

4 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

5 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Answer Options

6 : 62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

Correct Answers

7 : A nurse is reviewing the electronic medical record of a middle-aged client who was admitted following a stroke. Which of the following findings should the nurse identify as a modifiable risk factor for stroke?

8 : A nurse is providing discharge instruction to a client who has hypertension that has resulted in a transient ischemic attack (TIA). Which of the following information should the nurse discuss with the client regarding blood pressure (BP) management?

9 : A nurse is providing teaching to a client who has coronary artery disease. Which of the following statements should the nurse include to explain the correlation between changes in the coronary arteries and manifestations that occur as we age?

10 : A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?

1 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

2 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

3 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

4 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

5 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

6 :
62 y/o male presents to the ER with crushing sternal pain with radiation down left arm and shortness of breath. Client was in the yard working at the time, pain persisted after stopping the activity. Onset is 2 hours.

7 :
A nurse is reviewing the electronic medical record of a middle-aged client who was admitted following a stroke. Which of the following findings should the nurse identify as a modifiable risk factor for stroke?

8 :
A nurse is providing discharge instruction to a client who has hypertension that has resulted in a transient ischemic attack (TIA). Which of the following information should the nurse discuss with the client regarding blood pressure (BP) management?

9 :
A nurse is providing teaching to a client who has coronary artery disease. Which of the following statements should the nurse include to explain the correlation between changes in the coronary arteries and manifestations that occur as we age?

10 :
A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?