Advanced SOLE CH 13
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)?
ST-segment elevation on ECG and elevated CPK-MB or troponin levels
A 72-year-old woman is brought to the ED by her family. The family states that shes just not herself. Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST segments in leads II, III, and AVF. The nurse knows that these symptoms are most likely associated with which diagnosis?
Silent myocardial infarction
The cardiologist has told the patient and family that the diagnosis is hypertrophic cardiomyopathy. Later they ask the nurse what the patient did wrong to cause this condition. The nurse explains:
This is an inherited condition. You should give serious consideration to having family members screened for it.
Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink?
Transesophageal echocardiogram
A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.)
Cardiac dysrhythmias Heart failure Pericarditis Ventricular rupture
While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process?
Death of cardiac muscle from lack of oxygen (tissue necrosis).
Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery?
Left main coronary artery
Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED. (Select all that apply).
Administration of morphine Administration of nitroglycerin (NTG) Oxygen therapy
A patient has been prescribed nitroglycerin in the ED for chest pain. In taking the health history, the nurse will be sure to verify whether the patient has taken medications prior to admission for:
Erectile dysfunction
A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated?
Nitroglycerin, oxygen, and beta-blockers
The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurses responsibilities is to monitor the patient for which common postoperative dysrhythmia?
Atrial fibrillation or flutter
A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzymes (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process?
Myocardial remodeling
Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.)
NonQ wave Q wave
An essential aspect of teaching that may prevent recurrence of heart failure is:
compliance with diuretic therapy.
The patient presents to the ED with sudden severe sharp chest discomfort radiating to his back and down both arms, as well as numbness in his left arm. While taking the patients vital signs, the nurse notices a 30-point discrepancy in systolic blood pressure between the right and left arm. Based on these findings, the nurse should:
contact the physician immediately and begin prepping the patient for surgery.
A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient?
Statins
The physician orders a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be
Adenosine
A patient is admitted to the emergency department with clinical indications of an acute myocardial infarction. Symptoms began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient?
Administer thrombolytic therapy unless contraindicated
Which nursing interventions would be appropriate after angioplasty? (Select all that apply.)
Assess pedal pulses on the involved limb every 15 minutes for 2 hours Monitor the vascular hemostatic device for signs of bleeding Instruct the patient bend his/her knee every 15 minutes while the sheath is in place
A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. He is nauseous and diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question?
Emergent pacemaker insertion
Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.)
Jugular venous distention Peripheral edema
A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patients quality of life?
Left ventricular assist device (LVAD)
The patient is admitted with an acute myocardial infarction (AMI). Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture?
Murmur
The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse?
My back is killing me!
The patients husband tells the nurse, We didnt think she was having a heart attack because the pain was in her neck and back. The nurse explains: (Select all that apply.)
Pain can occur anywhere in the chest, neck, arms, or back. Dont hesitate to call the emergency medical services if you think its a heart attack. For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone. The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack.
A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following?
Partial occlusion of a coronary artery with a thrombus
The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient?
Radiofrequency catheter ablation
The patient presents to the ED with severe chest discomfort. He is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed?
Coronary artery bypass graft surgery
The patient has been in chronic heart failure for the past 10 years. He has been treated with beta-blockers and angiotensin-converting enzyme inhibitors as well as diuretics. His symptoms have recently worsened, and he presents to the ED with severe shortness of breath and crackles throughout his lung fields. His respirations are labored and arterial blood gases show that he is at risk for respiratory failure. Which of the following therapies may be used for acute, short-term management of the patient? (Select all that apply).
Dobutamine Intraaortic balloon pump Nesiritide (Natrecor)
The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find?
Dyspnea and crackles
Which statements are true regarding the symptoms of an AMI? (Select all that apply.)
Dysrhythmias are common occurrences. Midsternal chest pain is a common presenting symptom. Some patients are asymptomatic.
A patient with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers?
Echocardiogram
The patients wife asks the nurse if the angioplasty will remove all the buildup in the vessel walls so that the patient will be healthy again. The nurse explains:
The best outcome will be if 20% to 50% of the diameter of the vessel can be restored. Your husband will need to diet and exercise carefully to avoid further cardiac risk.
The patients wife is feeling overwhelmed and tells the nurse that she doesnt know if she can manage to cook different dinners for her husband and the rest of the family to satisfy his cholesterol-reducing diet. The nurse tells her:
The low-cholesterol diet is one from which everyone can benefit.
Which comment by the patient indicates a good understanding of her diagnosis of coronary heart disease?
The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on.
A patient presents to the ED complaining of severe substernal chest pressure radiating to his left shoulder and back that started about 12 hours ago. The patient delayed coming to the ED since he was hoping the pain would go away. The patients 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. The hospital does not have the capability for percutaneous coronary intervention. Thrombolysis is one possible treatment. Based on these data, the nurse understands that?
The patient is not a candidate for thrombolysis
The patients wife is confused about the scheduling of a stent insertion. She says that she thought the angioplasty was surgery to fix her husbands heart problem. The nurse explains to her:
The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again.
