Critical Care Nursing - Cardiovascular - Chapter 12

Which statements related to the management of unstable angina are true? (Select all that apply.) A. Aspirin is given at the onset of each chest pain episode. B. Calcium channel blockers help to reduce symptoms. C. Early revascularization (e.g., angioplasty) may be helpful. D. It is best treated with rest and nitroglycerin.

A - Aspirin is given at the onset of each chest pain episode. B - Calcium channel blockers help to reduce symptoms. C - Early revascularization (e.g., angioplasty) may be helpful. Unstable angina can be treated by conservative management or early intervention with percutaneous intervention or surgical revascularization. Conservative intervention for the patient experiencing angina includes the administration of nitrates, beta-adrenergic blocking agents, and/or calcium channel blocking agents. Angioplasty, stenting, and bypass surgery are approaches to revascularization. Rest and nitroglycerin are treatments for stable angina.

The patient presents to the emergency department after having crushing chest pain for the past 5 hours. The ECG and laboratory work confirm suspicions of an acute myocardial infarction (AMI). Which findings would be the most conclusive that the patient is having an AMI? (Select all that apply.) A. ECG changes with ST-elevation B. Elevated CK-MB isoenzymes C. Elevated serum troponin levels D. Elevated urinary myoglobin level

A - ECG changes with ST-elevation B - Elevated CK-MB isoenzymes C - Elevated serum troponin levels ST-segment elevation and elevated cardiac enzymes are seen in Q-wave MI. Serum myoglobin may assist in diagnosis of AMI.

An adult patient suffered an anterior wall myocardial infarction (MI) 4 days ago. Today the patient is experiencing dyspnea and sitting straight up in bed. The nurse's assessment includes bibasilar crackles, an S3 heart sound with a heart rate of 125 beats/min. What condition are these signs and symptoms consistent with? A. Heart failure B. Papillary muscle rupture C. Pericarditis D. Pulmonary embolism

A - Heart failure These are classic signs of fluid overload and heart failure. Presence of a heart murmur, not the S3, might alert the nurse to a papillary muscle rupture. The patient with pericarditis

The patient presents to the emergency department with severe substernal chest discomfort. Cardiac enzymes are elevated and his ECG shows ST-segment depression in V2 and V3. This patient is most likely experiencing: A. non-Q-wave myocardial infarction (MI). B. pulmonary embolism. C. Q-wave myocardial infarction (MI). D. right ventricular infarction.

A - Non-Q-wave myocardial infarction (MI). These are symptoms of angina. Administration of nitrates is indicated as a first-line treatment.

The initial drug recommended at the onset of acute myocardial infarction (AMI) to reduce platelet aggregation is: A. aspirin. B. lidocaine. C. nitroglycerin. D. oxygen.

A - aspirin. Aspirin blocks synthesis of thromboxane A2, thus inhibiting aggregation of platelets.

Angiotensin-converting enzymes inhibitors (ACE inhibitors) should be started within 24 hours of acute myocardial infarction (AMI) to reduce the incidence of: A. hibernating myocardium. B. myocardial remodeling. C. myocardial stunning. D. tachycardia.

B - myocardial remodeling. Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors should be ordered.

A 67-year-old female is admitted to the emergency department complaining of mid-back pain and shortness of breath for the preceding 2 hours. She also complains of nausea and states that she vomited twice before coming to the hospital. She denies any chest discomfort or arm pain. The presenting symptoms suggest that this patient may be: A. exhibiting flu symptoms. B. having an anxiety attack. C. having a myocardial infarction (MI). D. suffering from osteoporosis.

C - Having a myocardial infarction (MI). Women are more likely to have atypical signs and symptoms of acute myocardial infarction (AMI), such as shortness of breath, nausea and vomiting, and back or jaw pain.

The patient, who is being treated for hypercholesterolemia, complains of hot flashes and a metallic taste in the mouth. These are common side effects of: A. bile acid resins. B. clopidogrel. C. nicotinic acid. D. statins.

C - nicotinic acid Common side effects of nicotinic acid include metallic taste in mouth, flushing, and increased feelings of warmth.

A patient is complaining of midsternal chest discomfort radiating down the right arm. The discomfort has been present for about 5 minutes. The patient is also asthmatic and allergic to calcium channel blockers. The medication of choice for this patient at this time is: A. isoptin. B. metoprolol. C. nifedipine. D. nitroglycerin sublingual.

D - nitroglycerin sublingual. These are symptoms of angina. Administration of nitrates is indicated as a first-line treatment.

The most sensitive cardiac enzyme to assess myocardial necrosis is: A. CK. B. CK-MB. C. potassium. D. troponin I.

D - troponin I. Troponin I has a greater specificity than other tests in the diagnosis of acute myocardial infarction (AMI) at 7 to 14 hours after the onset of chest pain.