Chest Pain and NCLEX

[Turd Ferguson]

Still studying for NCLEX... I have a question about chest pain in the hospital.

If a patient complains of crushing chest pain while they're hospitalized, why would you give IV Morphine before you give SL Nitro? My resource says IV Morphine is the priority... why?

[Tree525]

Morphine immediately decreases the workload of the heart. Hope this helps!

[caliotter3]

Sounds like the best answer.

[mern11]

Nitro increases the risks of hypotension too.

[dontra07]

try to remember MONA -

Morphine

Oxygen

Nitro

Αspirin

[Turd Ferguson]

I was taught MONA, but was taught that the order was wrong... in class MONA was easy to remember but the sequence was taught OANM... maybe we were taught wrong...

Thanks for the responses!

[jelly221,RN, MSN]

Turd, that's what I was taught as well- in class and ACLS. We were told that morphine was used for CP unrelieved by nitro. Morphine can cause hypotension as well...

[jelly221,RN, MSN]

OK, got my lazy *** off the couch and upstairs to fetch my ATI book. Angina is relieved by nitrates, AMI pain is only relieved by IV morphine. Like gcat626 said, opioids decrease preload- ATI says the mechanism is by venous vasodilation, and decreasing pain and hence sympathetic stress that would increase preload. ATI doesn't give an order of administration, though.

What reference material are you using?

[MN-Nurse, ASN, RN]

OK, got my lazy *** off the couch and upstairs to fetch my ATI book. Angina is relieved by nitrates, AMI pain is only relieved by IV morphine. Like gcat626 said, opioids decrease preload- ATI says the mechanism is by venous vasodilation, and decreasing pain and hence sympathetic stress that would increase preload. ATI doesn't give an order of administration, though.

What reference material are you using?

This exact question came up in a Kaplan class taken by some friends of mine.

It stumped the teacher for a while because she kept wondering why they were treating the pain "first." She had fallen for the trap of this question: getting you to think that the morphine is for pain and not for decreasing preload.

One of my classmates remembered our med surg instructor lecturing us on this and corrected the Kaplan instructor.

[Turd Ferguson]

I'm using Kaplan... actually on a similar question they prioritized morphine ahead of oxygen... maybe MONA is right after all?

[~Mi Vida Loca~RN, ASN, RN]

I was taught MONA, but was taught that the order was wrong... in class MONA was easy to remember but the sequence was taught OANM... maybe we were taught wrong...

Thanks for the responses!

We were taught Mona first year but second year they said it changed to OANM, I don't know if NCLEX was updated with that change. I didn't have any questions like that on my NCLEX.

[Heartnurse17]

Stop...don't get yourself confused! ALWAYS START WITH THE ABCs!! If you guys start second-guessing the ABCs, it will really get you off track. While MONA is a longing standing rule, it really is oxygen is always first...at least until the AHA changes it.