How ACS is tested on the NCLEX-RN
Items center on prioritization, first actions for chest pain, medication safety, and post-procedure monitoring.
For STEMI the goal is rapid reperfusion. The nurse speeds care by getting the ECG, starting monitoring, and notifying the team without delay.
First actions for chest pain
Act fast and in order; several steps happen at once in a team.
| Drug | Nursing check | Key point |
|---|---|---|
| Aspirin (chewed) | Allergy, active bleeding | Chewing speeds absorption |
| Nitroglycerin sublingual | BP before each dose; recent PDE-5 inhibitor use | Up to 3 doses 5 minutes apart per protocol; headache and hypotension are common |
| Morphine | Respiratory rate, BP | For pain not relieved by nitrates, per order |
| Beta blocker | HR, BP, signs of heart failure | Reduces myocardial oxygen demand |
| Heparin or other anticoagulant | aPTT or anti-Xa per protocol, platelets | Bleeding precautions |
Exact protocols vary by facility and guideline.
Biomarkers and timing
Troponin is the preferred marker of myocardial injury.
After reperfusion: PCI and complications
Post-procedure care focuses on bleeding, perfusion of the limb, and dysrhythmias.
| Assessment | What to look for | Action |
|---|---|---|
| Access site | Bleeding, hematoma | Apply firm pressure above the site and notify |
| Distal pulses, color, temperature | Diminished pulse, cool or pale limb | Notify immediately; possible occlusion |
| Back or flank pain, falling BP | Retroperitoneal bleeding (femoral access) | Notify immediately; prepare for fluids and labs |
| Cardiac rhythm | Reperfusion dysrhythmias, VT/VF | Follow protocol; defibrillator ready |
| Positioning (femoral) | Leg straight, head of bed limited as ordered | Prevents site bleeding |
Radial access allows earlier mobility; a compression band is used and the hand is checked for perfusion.
NGN-style case and teaching
Prioritization and nitroglycerin safety appear repeatedly.
A client with chest pain has an order for sublingual nitroglycerin. Vital signs: BP 84/52, HR 104. The client took sildenafil last night. What should the nurse do?
- Recognize cues: hypotension and recent use of a PDE-5 inhibitor.
- Analyze: nitrates plus a PDE-5 inhibitor can cause profound hypotension.
- Withhold nitroglycerin.
- Notify the provider, keep the client supine or as tolerated, and continue the chest-pain workup.
Answer. Hold the nitroglycerin and notify the provider right away. Hypotension and recent sildenafil use are both contraindications.
- Carry sublingual nitroglycerin; take one tablet at chest-pain onset and call emergency services if pain is not improved or is worse 5 minutes after the first dose.
- Store nitroglycerin in its original dark glass container.
- Attend cardiac rehabilitation; take antiplatelet drugs exactly as prescribed, especially after a stent.
- Report chest pain, shortness of breath, or bleeding.