# An adult has crushing chest pressure and ST elevation in leads II, III, and aVF. Blood pressure is 84/56 mm Hg, jugular veins are distended, and lungs are clear. Complete the emergency plan. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question An adult has crushing chest pressure and ST elevation in leads II, III, and aVF. Blood pressure is 84/56 mm Hg, jugular veins are distended, and lungs are clear. Complete the emergency plan. The findings suggest ::선택::right ventricular infarctionstable anginaisolated left-sided heart failureuncomplicated pericarditis. The nurse should prepare for ::선택::routine outpatient stress testingright-sided ECG leads such as V3R and V4Rdischarge after one normal troponinexercise testing before repeat vital signs and ::선택::IV nitroglycerin despite the current hypotensiona beta-blocker before reassessing perfusionavoidance of nitroglycerin during hypotension while immediate STEMI reperfusion is activatedunassisted ambulation while awaiting repeat ECG. ## Explanation Inferior STEMI with hypotension, jugular venous distention, and clear lungs suggests right ventricular infarction. Right-sided leads such as V3R and V4R help confirm right ventricular involvement. Nitroglycerin can further reduce preload and worsen hypotension, so it is avoided while the client is hypotensive. The STEMI reperfusion pathway is activated immediately rather than delaying for an outpatient test or symptom resolution. ## In-depth explanation Correct Answer Identify possible right ventricular infarction, obtain right-sided ECG leads, and avoid nitroglycerin during hypotension while activating immediate reperfusion. Why It Fits The right ventricle is preload dependent. Venodilation can worsen shock when right ventricular filling is already impaired. Clinical Picture Clear lungs with elevated neck veins and hypotension in an inferior STEMI is the important cluster, not one finding in isolation. Memory Link Inferior STEMI plus clear lungs and high neck veins: think right side and protect preload. NCLEX Rule Confirm suspected right ventricular involvement without delaying the STEMI reperfusion pathway, and avoid preload-reducing nitrate therapy during hypotension. Why the Alternatives Fail Stable angina, routine stress testing, or discharge does not fit an unstable STEMI. Giving nitrate despite hypotension can worsen perfusion. Sources 12025 ACC/AHA Acute Coronary Syndromes Guideline 22026 NCLEX-RN Test Plan ## Clinical scenario The inferior STEMI pattern plus hypotension, elevated jugular venous pressure, and clear lungs raises concern for right ventricular involvement and preload-sensitive shock. ## Key concepts - **STEMI** — ST-elevation myocardial infarction requiring time-sensitive reperfusion evaluation. - **Inferior Leads** — ECG leads II, III, and aVF that view the inferior heart wall. - **Reperfusion** — Restoring blood flow to ischemic heart muscle. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395552&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._