A patient had a nonST-segment-elevation myocardial infarction ...

[Mr3Hunna]

A patient had a nonST-segment-elevation myocardial infarction (NSTEMI) 3 days ago.
 
  Which nursing intervention included in the plan of care is most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
  a. Evaluation of the patient's response to walking in the hallway
  b. Completion of the referral form for a home health nurse follow-up
  c. Education of the patient about the pathophysiology of heart disease
  d. Reinforcement of teaching about the purpose of prescribed medications

Question 2

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?
 
  a. The troponin level is elevated.
  b. The patient denies ever having a heart attack.
  c. Bilateral crackles are auscultated in the mid-lower lobes.
  d. The patient has occasional premature atrial contractions (PACs).

[vickybb89]

Answer to Question 1

ANS: D
LPN/LVN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning/ documentation are higher level skills that require RN education and scope of practice.

Answer to Question 2

ANS: C
The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI.

[Mr3Hunna]

TYSM

[isabelt_18]

Excellent