MONA Chest Pain Treatment Mnemonic
MONA is a classic mnemonic for the initial treatment of acute chest pain suggestive of myocardial infarction. While current AHA guidelines have updated the protocol order, MONA remains a widely taught and NCLEX-tested framework for remembering the key interventions for acute coronary syndrome. Understanding when and how to apply each intervention is essential for cardiac nursing questions.
The Mnemonic
"MONA"
Breakdown
Morphine
Morphine sulfate is given IV for chest pain not relieved by nitroglycerin. It reduces pain, anxiety, and cardiac workload through vasodilation and decreased preload. Monitor respiratory rate (hold if below 12) and blood pressure. Naloxone is the reversal agent.
Oxygen
Administer supplemental oxygen if SpO2 is below 94% or if the patient is in respiratory distress. Current guidelines recommend oxygen only when indicated by hypoxemia rather than routinely for all chest pain patients. Apply via nasal cannula at 2-4 L/min or non-rebreather mask as needed.
Nitroglycerin
Nitroglycerin is given sublingually (0.4 mg) to dilate coronary arteries and relieve chest pain. May repeat every 5 minutes for up to 3 doses. Hold if systolic BP is below 90 mmHg. Contraindicated if the patient has taken phosphodiesterase inhibitors (sildenafil/Viagra) within 24-48 hours.
Aspirin
Administer 162-325 mg of chewable aspirin immediately to inhibit platelet aggregation and reduce thrombus formation. Aspirin is the most time-sensitive intervention and should be given first in practice. Have the patient chew the aspirin for faster absorption. Contraindicated in true aspirin allergy.
Clinical Relevance
While the traditional MONA order is useful for memorization, current AHA guidelines prioritize aspirin first because it directly addresses the underlying pathology of clot formation in MI. On the NCLEX, know that aspirin is the first medication given for suspected MI. Nitroglycerin is given next for pain relief, oxygen only if SpO2 is below 94%, and morphine is reserved for pain not controlled by nitroglycerin.
Study Tips
- ✓For NCLEX, remember the actual priority order is Aspirin first (A-MONA) because it is the most evidence-based intervention for MI.
- ✓Nitroglycerin: check BP first (hold if SBP below 90), ask about erectile dysfunction medications (contraindicated within 24-48 hours).
- ✓Morphine is a last-resort analgesic for chest pain. It can cause hypotension and respiratory depression.
- ✓Oxygen is no longer given routinely for chest pain. Only administer if SpO2 is below 94% per current guidelines.
FAQs
Common questions about this mnemonic
MONA is still used as a teaching mnemonic, but the application has evolved. Current AHA guidelines recommend aspirin as the first intervention, followed by nitroglycerin for pain. Oxygen is given only for documented hypoxemia (SpO2 below 94%), and morphine is used cautiously due to its association with increased mortality in some studies. The NCLEX reflects these updated guidelines.
Aspirin directly inhibits platelet aggregation, which addresses the underlying cause of myocardial infarction (coronary artery thrombosis). The sooner aspirin is administered, the more it limits clot formation and reduces myocardial damage. Nitroglycerin provides symptomatic relief through vasodilation but does not address the thrombotic process. That is why aspirin is the first priority intervention.