The nurse is planning care for a client who was admitted after having a myocardial infarction. Based upon this history, the nurse’s greatest concern is that this client might develop which health problem?
1. Chronic renal failure
2. A gastric ulcer
3. Hypoxemia
4. A cerebral vascular accident
ANSWER
Correct Answer: 3
Rationale 1: Injury to the heart muscle might affect renal function, but this is not the nurse’s greatest concern.
Rationale 2: Although an injury to the heart muscle can cause stress to the client and lead to a gastric ulcer, this is not the nurse’s greatest concern.
Rationale 3: Although injury to the heart muscle might affect any or all of the body systems, at this point the nurse is most concerned that the client will develop hypoxemia. The status of the respiratory system is closely linked to and dependent upon the cardiovascular system.
Rationale 4: Injury to the heart muscle may or may not cause a cerebral vascular accident. This is not the area of greatest concern to the nurse at this time.
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