NUR 202 Module 5 Quiz A

Which laboratory value will be most important for the nurse to monitor to determine whether a client with chest pain has acute coronary syndrome (ACS)? 1. Troponin T (cTnT) 2. C-reactive protein (CRP) 3. Low-density lipoprotein (LDL) 4. B-type natriuretic protein (BNP)

1 Cardiac troponins are released into circulation within hours after myocardial injury or infarction, and elevation in troponin levels helps determine that the client is experiencing ACS. The other three values will also be monitored but are not markers for ACS or acute myocardial infarction. C-reactive protein is a marker for inflammation and elevated levels can predict cardiac disease. Elevated LDL is a risk factor for atherosclerosis and coronary artery disease. Elevated BNP is diagnostic for heart failure.

After the nurse teaches a group of women about coronary artery disease (CAD) and myocardial infarction (MI), which statement by the women indicates that the teaching has been effective? 1. Unusual fatigue is a common symptom of CAD in women. 2. Women usually have a more rapid recovery than men after MI. 3. Cardiac surgery is generally more successful in women than men. 4. High-density lipoprotein (HDL) levels increase after menopause.

1 Studies indicate that women who have myocardial infarctions often experience unusual prodromal fatigue; also, during the prodromal period, women more commonly experience upper abdominal fullness instigated by exertion or emotional stress. Women report more disability than men after a cardiac event. Women have higher mortality and more complications than men after coronary artery bypass graft surgery. Low-density lipoprotein levels increase after menopause, increasing CAD risk.

Which information is most important to include when the nurse is teaching a client who has had an ST segment elevation myocardial infarction (STEMI) about the purpose of salt restriction? 1. Low salt intake helps prevent ankle swelling. 2. Salt intake increases the work of the heart. 3. Decreasing salt intake will lower blood pressure. 4. Salt intake prevents diuretics from being effective.

2 After STEMI, changes in cardiac contractility may lead to chronic heart failure; some of these changes can be prevented by decreasing cardiac work through lowering fluid retention. Although a high salt intake may lead to ankle edema, this is not the most important point to emphasize with this client. A decrease in salt intake will help lower blood pressure, but decreasing blood pressure is not the most important reason for salt restriction in this client. Many diuretics do work by increasing sodium excretion, but improving the effectiveness of diuretics is not the most relevant reason for low salt diet in this client.

When a client who has had a myocardial infarction suddenly develops a heart rate of 120 beats/minute, which action would the nurse take first? 1. Offer reassurance. 2. Check blood pressure. 3. Call for an electrocardiogram (ECG). 4. Activate the hospital rapid response team

2 With a sudden change in heart rate, the nurse's first action would be to determine whether the client was perfusing adequately by checking blood pressure. Reassurance may be needed if the client's high rate is due to anxiety, but more information about the client is needed before meaningful reassurance is offered. An ECG is needed for a sudden change in heart rate, because the client may be re-infarcting, but the nurse would initially check vital signs. The hospital rapid response team may need to be activated, but more information about the client is needed first.

A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess for which medication side effect? 1. Nausea 2. Delirium 3. Bradycardia 4. Hypotension

4 The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure and resulting in decreased cardiac workload. Nausea is not a common side effect of intravenous nitroglycerin. Nitroglycerin does not cause delirium. Reflex tachycardia may occur with the decrease in blood pressure.