HESI Registered Nurse EXIT Practice Exam

What is the appropriate intervention for a client with myocardial infarction if the temperature is 101.1 degrees Fahrenheit (38.5 degrees Celsius)?

1. Call the health care provider immediately

2. Administer acetaminophen as ordered as this is normal at this time

3. Send blood, urine, and sputum for culture

4. Increase the client's fluid intake

The correct answer is: Administer acetaminophen as ordered as this is normal at this time

The appropriate intervention when a client with myocardial infarction has a temperature of 101.1 degrees Fahrenheit (38.5 degrees Celsius) is to administer acetaminophen as ordered, since a low-grade fever can be a common physiological response in the context of myocardial infarction. This response can occur due to the inflammatory processes and tissue damage associated with the heart attack. Maintaining the client's comfort and addressing the fever is important, particularly if the fever is not excessively high and does not indicate an underlying infection. In these cases, antipyretics like acetaminophen can help reduce the fever and improve the patient's comfort without masking serious underlying conditions. While close monitoring of the patient’s condition is essential, especially for any signs of complications, the presence of a low-grade fever like this often does not necessitate immediate action such as contacting a healthcare provider or sending cultures unless other concerning symptoms arise. Increasing fluid intake can also be beneficial, but it is not the primary focus when a fever is present, and specific orders for fluid intake should guide this intervention.