A nurse is caring for a client in an emergency department (ED). Which of the following medications should the nurse expect the physician to prescribe for this client? Select All That Apply

An ST-elevation myocardial infarction (STEMI) occurs when a coronary artery is completely occluded, leading to transmural myocardial ischemia and necrosis. This medical emergency is identified by specific ECG changes and elevated cardiac biomarkers like Troponin I (> 0.03 ng/mL). Immediate pharmacologic intervention focuses on reperfusion, preventing further thrombus propagation, and reducing myocardial oxygen demand to preserve functional cardiac tissue. Rationale: A. Heparin is an anticoagulant indicated in the acute phase of a STEMI to prevent the formation and extension of fibrin clots. By accelerating the action of antithrombin 3, it neutralizes thrombin and factor Xa. This prevents further occlusion of the coronary artery while the patient awaits definitive reperfusion therapy like percutaneous coronary intervention. B. Digoxin is a positive inotrope and negative chronotrope primarily used for chronic heart failure or atrial fibrillation with rapid ventricular response. In the setting of an acute STEMI, it is generally avoided because it increases myocardial oxygen consumption by increasing contractility. Excessive oxygen demand during an active infarction can exacerbate myocardial injury and extend the area of necrosis. C. Aspirin is a cornerstone of acute coronary syndrome management due to its immediate antiplatelet effects. It irreversibly inhibits cyclooxygenase-1, preventing the synthesis of thromboxane A2, which is a potent stimulator of platelet aggregation. Administering aspirin early significantly reduces mortality by limiting the size of the developing thrombus within the obstructed coronary vessel. D. Morphine is the preferred analgesic for managing the crushing chest pain associated with myocardial infarction when nitrates are insufficient. Beyond pain relief, it provides beneficial hemodynamic effects by reducing preload through venous dilation and decreasing systemic vascular resistance. These actions lower the myocardial workload and oxygen demand, while also alleviating the patient's anxiety and sympathetic surge. E. Dopamine is a sympathomimetic amine used for hemodynamic support in cases of cardiogenic shock or clinically significant hypotension. The client's blood pressure is currently stable at 126/80 mm Hg, making a vasopressor or potent inotrope unnecessary and potentially harmful. Administering dopamine in a stable STEMI patient would unnecessarily increase heart rate and myocardial metabolic demand, worsening the ischemia.