Chest Pain and NCLEX

Students NCLEX

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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

1 Article; 69 Posts

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

caliotter3

38,333 Posts

Sounds like the best answer.

mern11

15 Posts

Nitro increases the risks of hypotension too.

dontra07

150 Posts

try to remember MONA -

Morphine

Oxygen

Nitro

Αspirin

Turd Ferguson

455 Posts

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

306 Posts

Specializes in Neurosciences, cardiac, critical care.

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

306 Posts

Specializes in Neurosciences, cardiac, critical care.

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

1,398 Posts

Specializes in Med Surg - Renal.
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

455 Posts

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

Specializes in Emergency Dept. Trauma. Pediatrics.
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

3 Posts

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.

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