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1. A patient with a history of hypertension and diabetes
presents to the emergency department with chest pain and
shortness of breath. The nurse obtains an electrocardiogram
(ECG) and observes ST segment elevation in leads V1 to
V4. What is the most likely diagnosis for this patient?
a) Anterior wall myocardial infarction*
b) Inferior wall myocardial infarction
c) Pericarditis
d) Pulmonary embolism
Rationale: ST segment elevation in leads V1 to V4
indicates an acute anterior wall myocardial infarction,
which is caused by occlusion of the left anterior descending
coronary artery. This is a medical emergency that requires
immediate revascularization.
2. A patient with a history of atrial fibrillation is on
warfarin therapy and has a target international normalized
ratio (INR) of 2.5 to 3.5. The nurse reviews the patient's
laboratory results and notes that the INR is 4.8. The
nurse also observes irregular R-R intervals and absent P
waves on the ECG. What is the most appropriate action for
the nurse to take?
a) Administer vitamin K as ordered by the physician
b) Hold the next dose of warfarin and notify the physician*
c) Increase the dose of warfarin to achieve therapeutic INR
d) No action is needed as the ECG findings are normal for
this patient
Rationale: An INR of 4.8 indicates that the patient is at risk
of bleeding due to over-anticoagulation. The nurse should
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