1. A patient with a history of myocardial infarction is admitted to the

telemetry unit with chest pain and shortness of breath. The nurse obtains

the following vital signs: BP 180/100 mmHg, HR 110 bpm, RR 24

breaths/min, SpO2 92% on room air. The nurse should:

a) Administer nitroglycerin sublingually and monitor the patient's blood

pressure.

b) Apply oxygen via nasal cannula and notify the physician.

c) Perform a 12-lead ECG and prepare the patient for cardiac

catheterization.

d) Administer morphine intravenously and monitor the patient's pain level.

Answer: C

Rationale: The patient is showing signs of acute coronary syndrome

(ACS), which is a medical emergency that requires prompt diagnosis and

treatment. A 12-lead ECG can help identify the location and extent of

myocardial ischemia or infarction, and cardiac catheterization can provide

definitive diagnosis and intervention. Nitroglycerin, oxygen, and

morphine are also part of the initial management of ACS, but they are not

as urgent as ECG and catheterization.

2. A patient with a history of congestive heart failure is admitted to the

telemetry unit with worsening dyspnea, orthopnea, and peripheral edema.

The nurse auscultates crackles in both lung bases and notes a third heart

sound (S3). The nurse should:

a) Increase the rate of the intravenous diuretic and monitor the patient's

urine output.

b) Administer digoxin intravenously and monitor the patient's heart rate

and rhythm.

c) Elevate the head of the bed and administer oxygen via face mask.

d) All of the above.

Answer: D

Rationale: The patient is showing signs of acute decompensated heart

failure (ADHF), which is a worsening of chronic heart failure symptoms

that requires immediate treatment. The goals of therapy are to improve

oxygenation, reduce preload and afterload, enhance cardiac contractility,

and promote diuresis. Increasing the rate of the intravenous diuretic can

help reduce fluid overload and edema. Administering digoxin can help

increase cardiac output and decrease sympathetic activity. Elevating the

head of the bed and administering oxygen can help improve respiratory