Author Question: Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that ... (Read 108 times)

kamilo84 · **on:** Jun 25, 2018

Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first?

a. Auscultate the heart sounds.
b. Check the patient's temperature.
c. Notify the patient's health care provider.
d. Give the PRN acetaminophen (Tylenol).

Question 2

The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider?

a. The patient complains of chest pressure when ambulating.
b. A loud systolic murmur is heard along the right sternal border.
c. A thrill is palpated at the second intercostal space, right sternal border.
d. The point of maximum impulse (PMI) is at the left midclavicular line.

parker125 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A
The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature and notifying the health care provider are also appropriate actions but would not be done before listening for a rub. It is not stated for what symptom (e.g., headache) or finding (e.g., increased temperature) the PRN acetaminophen (Tylenol) is ordered.

Answer to Question 2

ANS: A
Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.