Myocardial Infarction and Heart Failure Part 1

What is the first intervention for a client experiencing MI? A. Administer morphine B. Administer oxygen C. Administer sublingual nitroglycerin D. Obtain an ECG

Administer oxygen Administering supp oxygen to the client is the 1st priority of care. The myocardium is deprived of O2 during an infarction, so additional O2 is administered to assist in oxygenation and prevent further damage. Morphine and nitro are also used to treat MI, but they're more commonly administered after the O2. An ECG is the most common diagnostic tool used to evaluate MI.

Which of the following is the most common symptom of myocardial infarction (MI)? A. Chest pain B. Dyspnea C. Edema D. Palpitations

Chest pain The most common symptom due to deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to increase in the metabolic need of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced CO, producing arrhythmias.

Which of the following conditions is most commonly responsible for myocardial infarction? A. Aneurysm B. Heart failure C. Coronary artery thrombosis D. Renal failure

Coronary artery thrombosis Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an out pouching of a vessel and doesn't cause an MI. Renal failure can be assoc. w MI but isn't a direct cause. HF is usually a result from an MI.

Which of the following symptoms is most commonly associated with left-sided heart failure? A. Crackles B. Arrhythmias C. Hepatic engorgement D. Hypotension

Crackles Crackles in the lungs are a classic sign of left-sided HF. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be assoc. w both R and L sided HF. L sided HF causes hypertension secondary to an increased workload on the system.

What is the most common complication of an MI? A. Cardiogenic shock B. Heart failure C. Arrhythmias D. Pericarditis

Arrhythmias Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of and MI. Cardiogenic shock, another complication of MI, is defined as the end stage of L ventricular dysfx. This condition occurs in approx 15% of clients w MI. Bc the pumping fx of the heart is compromised by an MI, HF is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection by may occur after the MI.

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A. Beta-adrenergic blockers B. Calcium channel blockers C. Narcotics D. Nitrates

Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial O2 demand. Ca-channel blockers reduce the workload of the heart by decreasing the HR. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption buy decreasing L ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

Toxicity from which of the following meds may cause a pt to see a green-yellow halo around lights? A. Digoxin B. Furosemide (Lasix) C. Metoprolol (Lopressor) D. Enalapril (Vasotec)

Digoxin One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other medications aren't assoc. w such an effect.

Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? A. Decreased anxiety B. Enhanced myocardial oxygenation C. Administer sublingual nitroglycerin D. Educate the client about this symptoms

Enhanced myocardial oxygenation Enhancing myocardial oxygenation is always the 1st priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.

With which of the following disorders is jugular vein distention most prominent? A. Abdominal aortic aneurysm B. Heart failure C. Mi D. Pneumothorax

Heart failure Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. JVD isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to HF, however, in and of itself, an MI doesn't cause JVD.

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? A. Left-sided heart failure B. Pulmonic valve malfunction C. Right-sided heart failure D. Tricupsid valve malfunction

Left-sided heart failure The L ventricle is responsible for most of the CO. An anterior wall MI may result in a decrease in L ventricular fx. When the L ventricle doesn't fx properly, resulting in L-sided HF, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfx causes R sided HF.

Medical treatment of coronary artery disease includes which of the following procedures? A. Cardiac catheterization B. Coronary artery bypass surgery C. Oral medication therapy D. Percutaneous transluminal coronary angioplasty

Oral medication therapy Oral medication administration is noninvasive, medical treatment for CAD. Cardiac cauterization isn't a treatment, by a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity w inspiration? A. Cardiac B. Gastrointestinal C. Musculoskeletal D. Pulmonary

Pulmonary Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases w mvmt. Cardiac and GI pains don't change with respiration.

What is the primary reason for administering morphine to a client w an MI? A. To sedate the client B. To decrease the client's pain C. To decrease the client's anxiety D. To decrease oxygen demand on the client's heart

To decrease oxygen demand on the client's heart Morphine is administered bc it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons.

Which of the following blood tests is most indicative of cardiac damage? A. Lactate dehydrogenase B. Complete blood count (CBC) C. Troponin I D. Creatine kinase (CK)

Troponin I Troponin I levels rise rapidly and are detectable within I hr of myocardial injury. Troponin I levels aren't detectable in ppl wo cardiac injury. LDH is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Bc CK levels may rise w skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

Which of the following complications is indicated by a third heart sound (S3)? A. Ventricular dilation B. Systemic hypertension C. Aortic valve malfunction D. Increased partial contractions

Ventricular dilation Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a 4th heart sound. Aortic valve malfunction is heard as a murmur.