Ch. 27 Cardiac

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for: a. a history of diabetes mellitus b. elevated high-density lipoprotein (HDL) levels c. a history of ischemic heart disease d. alcoholism

a. a history of diabetes mellitus

A client is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina can result from: a. activities that increase myocardial oxygen demand. b. an unpredictable amount of activity. c. coronary artery spasm. d. the same type of activity that caused previous angina episodes.

c. coronary artery spasm.

the nurse is caring for a patient who is having chest pain associated with an MI. what medication should the nurse administer IV to reduce pain and anxiety? a. meterpidine hydrochloride b. hydromorphone hydrochloride c. morphine sulfate d. codeine sulphate

c. morphine sulfate

Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a. Risk for imbalanced body temperature b. Decreased cardiac output c. Anxiety d. Acute pain

d. Acute pain

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. c. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a. Inform client of diagnostic tests. b. Remove hair from skin insertion sites. c. Assess distal pulses. d. Withhold anticoagulant therapy.

d. Withhold anticoagulant therapy.

During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: a. the client's pupils to become dilated. b. the client to experience bronchodilation. c. a decrease in the client's gastric secretions. d. a drop in the client's heart rate.

d. a drop in the client's heart rate.

A patient, who is resting quietly in a step-down cardiac care unit, reports chest pain. The cardiac monitor indicates the presence of reversible ST-segment elevation. The nurse understands that the patient may be experiencing coronary artery vasospasm. This is a type of angina known as: a. silent b. stable c. intractable d. variant

d. variant

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? a. Minimal oozing of blood from the IV site b. Altered level of consciousness c. Presence of reperfusion dysrhythmias d. Chest pain 2 of 10 (on a 1-to-10 pain scale)

b. Altered level of consciousness

Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? a. Cardiac tamponade b. Fluid overload c. Hypertension d. Hypothermia

a. Cardiac tamponade

A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? a. Decreases resting heart rate b. Decreases cholesterol level c. Increases cardiac output d. Decreases platelet aggregation

a. Decreases resting heart rate

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? a. IV morphine b. IV nitroglycerin c. Atenolol d. Amlodipine

a. IV morphine

Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? a. .25 to .75 b. .75 to 1.5 c. 2.0 to 2.5 d. 2.5 to 3.0

c. 2.0 to 2.5

A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience: a. nausea, vomiting, depression, fatigue, and impotence. b. sedation, nausea, vomiting, constipation, and respiratory depression. c. headache, hypotension, dizziness, and flushing. d. flushing, dizziness, headache, and pedal edema.

c. headache, hypotension, dizziness, and flushing.

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? a. recent consumption of a meal b. shellfish allergy c. prior intracranial hemorrhage d. use of heparin

c. prior intracranial hemorrhage

the nurse is educating the patient about administering nitro prior to discharge. what info should the nurse include in the instructions? a. take a nitro and if the pain is not relieved, drive to the nearest ED b. take 2 nitros and if the pain is not relieved, go to the nearest ED c. take a nitro and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. if the pain is not relieved, activate the emergency medical system d. take 2 nitros every 10 minutes until a total of 6 pills are taken. if pain is not relieved, activate the emergency medical system

c. take a nitro and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. if the pain is not relieved, activate the emergency medical system

a patient with CAD is having a cardiac catheterization. what indicator is present for the patient to have a percutaneous transluminal coronary angioplasty (PTCA)? a. the patient has compromised left ventricular function b. the patient has had angina longer than 3 years c. the patient has at least a 70% occlusion of a major artery d. the patient has an ejection fraction of 65%

c. the patient has at least a 70% occlusion of a major artery

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? a. Blood pressure of 129/72 mm Hg b. Heart rate of 87 bpm c. Hemoglobin of 16 g/dL d. Hematocrit of 30%

d. Hematocrit of 30%

In arteriosclerosis, commonly referred to as hardening of the arteries, the rigid arterial vessels fail to stretch. This has the potential for what? a. Decreasing the flow of unoxygenated blood through the body b. Slowing the flow of blood throughout the body c. Increasing the flow of blood throughout the body d. Sending a reduced volume of oxygenated blood to the major organs of the body

d. Sending a reduced volume of oxygenated blood to the major organs of the body

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? a. Inadequate tissue perfusion b. Mental alertness c. Blood glucose concentration d. Activity intolerance

a. Inadequate tissue perfusion

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a. Cholesterol, 280 mg/dL b. Low density lipoprotein (LDL), 160 mg/dL c. High-density lipoprotein (HDL), 80 mg/dL d. A ratio of LDL to HDL, 4.5 to 1.0

c. High-density lipoprotein (HDL), 80 mg/dL

a patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. what type of electrolyte imbalance does the nurse suspect this patient is having? a. Ca b. Mg c. K d. Na

c. K

Which technique is used to surgically revascularize the myocardium? a. Balloon bypass b. Peripheral bypass c. Minimally invasive direct coronary bypass d. Gastric bypass

c. Minimally invasive direct coronary bypass

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? a. Isosorbide mononitrate (Isordil) b. Meperidine hydrochloride (Demerol) c. Morphine sulfate (Morphine) d. Nitroglycerin transdermal patch

c. Morphine sulfate (Morphine)

The nurse knows to review laboratory tests for cardiac biomarkers for a patient suspected of suffering an MI. The nurse knows that all can be detected within hours of an injury. Which of the following is the earliest marker? a. Creatinine kinase-myocardial band (CK-MB) b. Total creatinine kinase (CK) c. Myoglobin d. Troponin I and T

c. Myoglobin

A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? a. Cyanosis b. Gangrene c. Pallor d. Clubbing of the fingers

c. Pallor

The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is: a. Described as crushing and substernal b. Associated with nausea and vomiting c. Relieved by rest and nitroglycerin d. Accompanied by diaphoresis and dyspnea

c. Relieved by rest and nitroglycerin

Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a. 50 seconds or less. b. 75 seconds or less. c. 100 seconds or less. d. 125 seconds or less.

a. 50 seconds or less.

The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) a. Abrupt closure of the artery b. Arterial dissection c. Coronary artery vasospasm d. Aortic dissection e. Nerve root pressure

a. Abrupt closure of the artery b. Arterial dissection c. Coronary artery vasospasm

Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? a. Application of a vascular closure device such as Angio-Seal or VasoSeal b. Direct manual pressure c. Application of a pneumatic compression device (e.g., FemoStop) d. Application of a sandbag to the area

a. Application of a vascular closure device such as Angio-Seal or VasoSeal

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? a. "See if rest relieves the chest pain before using the nitroglycerin." b. "Call 911 if you develop a headache following nitroglycerin use." c. "Place the nitroglycerin tablet between cheek and gum." d. "Only take one nitroglycerin tablet for each episode of angina."

a. "See if rest relieves the chest pain before using the nitroglycerin."

A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? a. 12-lead ECG b. 2 L oxygen via nasal cannula c. Troponin level d. Aspirin 325 mg orally

a. 12-lead ECG

the nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). what results display the effectiveness of the medication? a. 160-190mg/dL b. 210-240mg/dL c. 250-275mg/dL d. 280-300mg/dL

a. 160-190mg/dL

a patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. what is the best answer by the nurse? a. 3 mins b. 15 mins c. 30 mins d. 60 mins

a. 3 mins

A patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? a. 3 minutes b. 15 minutes c. 30 minutes d. 60 mintues

a. 3 minutes

Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a. 50 seconds or less b. 75 seconds or less c. 100 seconds or less d. 125 seconds or less

a. 50 seconds or less

Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a. Inability to speak. b. Adequate cough and gag reflex. c. Adequate vital capacity. d. Acceptable arterial blood gas (ABG) values.

a. Inability to speak.

A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan? a. Instruct the patient on side effects of flushing, throbbing headache, and tachycardia. b. Instruct the patient to renew the nitroglycerin supply every 3 months. c. Instruct the patient not to crush the tablet. d. Instruct the patient to place nitroglycerin tablets in a plastic pill box.

a. Instruct the patient on side effects of flushing, throbbing headache, and tachycardia.

Which is the analgesic of choice for acute myocardial infarction (MI)? a. Morphine b. Aspirin c. Meperidine d. Ibuprofen

a. Morphine

A nurse is teaching nitroglycerin to a client with hospitalized client with coronary artery disease who is being discharged. The nurse tells the client that nitroglycerin has which of the following actions? Choose all that apply. a. Reduces myocardial oxygen consumption b. Decreases the urge to use tobacco c. Dilates blood vessels d. Decreases ischemia e. Relieves pain

a. Reduces myocardial oxygen consumption c. Dilates blood vessels d. Decreases ischemia e. Relieves pain

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? a. ST elevation b. Isolated premature ventricular contractions (PVCs) c. Sinus tachycardia d. Frequent premature atrial contractions (PACs)

a. ST elevation

The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? a. Severe back pain b. Hematemesis c. Rectal bleeding d. Hypertensive crisis

a. Severe back pain

Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? a. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. b. The nurse should report the incident to her supervisor immediately. c. The nurse should instruct the nursing assistants to avoid answering his call light. d. The nurse should explain that the client most likely wants extra attention.

a. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask.

A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? a. ankle-brachial index b. exercise electrocardiography c. electron beam computed tomography d. photoplethysmography

a. ankle-brachial index

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is most probably: a. anterior. b. posterior. c. lateral. d. inferior.

a. anterior.

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? a. calcium-channel blocker b. beta-adrenergic blocker c. nitrate d. diuretic

a. calcium-channel blocker

a patient has had cardiac surgery and is being monitored in the ICU. what complication should the nurse monitor for that is associated with an alteration in preload? a. cardiac tamponade b. elevated central venous pressure c. hypertension d. hypothermia

a. cardiac tamponade

A client who has been diagnosed with Prinzmetal's angina will present with which symptom? a. chest pain that occurs at rest and usually in the middle of the night b. radiating chest pain that lasts 15 minutes or less c. prolonged chest pain that accompanies exercise d. chest pain of increased frequency, severity, and duration

a. chest pain that occurs at rest and usually in the middle of the night

What is a modifiable risk factor for the development of atherosclerosis? a. consumption of a high-fat diet b. prior infection with Chlamydia pneumoniae c. gender d. history of rheumatic fever

a. consumption of a high-fat diet

the nurse is administering a CCB to a patient who has symptomatic sinus tachycardia at a rate of 132bpm. what is the anticipated action of the drug for this patient? a. decreases the SA node automaticity b. increases the AV node conduction c. increases the heart rate d. creates a positive inotropic effect

a. decreases the SA node automaticity

a patient who had a CABG is exhibiting signs of cardiac failure. what medications does this nurse anticipate administering for this patient? (SAA) a. diuretics b. digoxin c. inotropic agents d. dialysis e. nitroprusside

a. diuretics b. digoxin c. inotropic agents

The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with a. percutaneous coronary intervention (PCI) b. IV heparin c. IV nitroglycerin d. thrombolytics

a. percutaneous coronary intervention (PCI)

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? a. smoking cessation b. a protein-rich diet c. exercise avoidance d. antioxidant supplements

a. smoking cessation

A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? a. "I should avoid taking a tub bath until my catheter site heals." b. "I should expect a low-grade fever and swelling at the site for the next week." c. "I should avoid prolonged sitting." d. "I should expect bruising at the catheter site for up to 3 weeks."

b. "I should expect a low-grade fever and swelling at the site for the next week."

When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor? a. flushing b. AV block c. renal failure d. hypertension

b. AV block

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? a. Atherosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. b. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. c. Arteriosclerosis is a formation of clots in the inner lining of the arteries. d. Atherosclerosis is a formation of clots in the inner lining of the arteries.

b. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.

A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? a. Assessing the patient's capillary refill time and peripheral pulses b. Assessing the patient for signs and symptoms of hemorrhage c. Assessing the patient for signs and symptoms of acute renal failure d. Assessing the patient for signs and symptoms of infection

b. Assessing the patient for signs and symptoms of hemorrhage

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) a. It is relieved by rest and inactivity. b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms. e. It subsides after taking nitroglycerin.

b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms.

A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? a. Thrombolytics, oxygen administration, and bed rest b. Morphine sulfate, oxygen administration, and bed rest c. Oxygen administration, anticoagulants, and bed rest d. Bed rest, albuterol nebulizer treatments, and oxygen administration

b. Morphine sulfate, oxygen administration, and bed rest

After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? a. Troponin I b. Myoglobin c. WBC (white blood cell) count d. C-reactive protein

b. Myoglobin

what ECG findings does the nurse observe in a patient who has had an MI? (SAA) a. an absent P wave b. an abnormal Q wave c. T wave insertion d. ST segment elevation e. prolonged PR interval

b. an abnormal Q wave c. T wave insertion d. ST segment elevation

the nurse administers propranolol hydrochloride to a patient with a heart rate of 64bpm. an hour later, the nurse observes the heart rate to be 36bpm. what medication should the nurse prepare to administer that is an antidote for the propranolol? a. digoxin b. atropine c. protamine sulfate d. sodium nitroprisside

b. atropine

the nurse is reviewing the lab results for a patient having a suspected MI. what cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? a. alkaline phosphatase b. creatine kinase (CK-MB) c. myoglobin d. troponin

b. creatine kinase (CK-MB)

The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is a. low b. high c. normal d. extremely high

b. high

the nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and an MI. how should the nurse describe the pain experienced during a MI? a. it is relieved by rest and inactivity b. it is substernal in location c. it is sudden in onset and prolonged in duration d. it is viselike and radiates to the shoulders and arms e. it subsides after taking nitro

b. it is substernal in location c. it is sudden in onset and prolonged in duration d. it is viselike and radiates to the shoulders and arms

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of: a. amantadine (Symmetrel). b. nitroglycerin (Nitrostat). c. digoxin (Lanoxin). d. diphenhydramine (Benadryl).

b. nitroglycerin (Nitrostat).

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." b. "Client will verbalize the intention to avoid exercise." c. "Client will verbalize the intention to stop smoking." d. "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."

c. "Client will verbalize the intention to stop smoking."

Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm? a. High blood pressure b. Severe back pain c. Abdomen bruit d. Nausea and vomiting

c. Abdomen bruit

You are caring for a client with CAD. What is an appropriate nursing action when evaluating a client with coronary artery disease (CAD)? a. Assess the client's mental and emotional status. b. Assess the skin of the client. c. Assess the characteristics of chest pain. d. Assess for any kind of drug abuse.

c. Assess the characteristics of chest pain.

The nurse is presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would the nurse name as the most common cause of peripheral arterial problems in the older adult? a. Coronary thrombosis b. Arteriosclerosis c. Atherosclerosis d. Raynaud's disease

c. Atherosclerosis

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? a. Amlodipine b. Diltiazem c. Clopidogrel d. Felodipine

c. Clopidogrel

the nurse is discussing risk factors for developing CAD with a patient in the clinic. which results would indicate that the patient is not at significant risk for the development of CAD? a. cholesterol, 280mg/dL b. LDL, 160mg/dL c. HDL, 80mg/dL d. a ratio of LDL to HDL, 4.5 to 1.0

c. HDL, 80mg/dL

A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms: a. Predictable and consistent pain that occurs on exertion and is relieved by rest b. Pain that may occur at rest, but the threshold for pain is lower than expected c. Severe, incapacitating chest pain d. Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina

c. Severe, incapacitating chest pain

A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician? a. Streptokinase, aspirin, and morphine administration b. Morphine administration, stress testing, and admission to the cardiac care unit c. Serial liver enzyme testing, telemetry, and a lidocaine infusion d. Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

d. Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry