Chapter 13 Bank
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 patient's 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? a. The patient is not a candidate for thrombolysis. b. The patient's history makes him a good candidate for thrombolysis. c. Thrombolysis is appropriate for a candidate having a non-Q wave MI. d. Thrombolysis should be started immediately.
A
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? a. "My back is killing me!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"
A
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? a. Coronary artery bypass graft surgery b. Intracoronary stent placement c. Percutaneous transluminal coronary angioplasty (PTCA) d. Transmyocardial revascularization
A
The patient's husband tells the nurse, "We didn't think she was having a heart attack because the pain was in her neck and back." The nurse explains: (Select all that apply.) a. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." b. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." c. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack." d. "You need to make sure it's a heart attack before you call the emergency response personnel."
A B, C
Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.) a. Jugular venous distention b. Peripheral edema c. Crackles audible in the lungs d. Weak peripheral pulses
A, B
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? a. Myocardial stunning b. Hibernating myocardium c. Myocardial remodeling d. Tachycardia
C
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). a. Dobutamine b. Intraaortic balloon pump c. Nesiritide (Natrecor) d. Ventricular assist device
A, B, C
Which statements are true regarding the symptoms of an AMI? (Select all that apply.) a. Dysrhythmias are common occurrences. b. Men have more atypical symptoms than women. c. Midsternal chest pain is a common presenting symptom. d. Some patients are asymptomatic.
A, C, D
When assessing the risk for stress ulcers after a coronary artery bypass graft (CABG) surgery, which factors would contribute to this risk? (Select all that apply.) A) Alcohol abuse or excess B) Age less than 70 years C) Incidence of postoperative hemorrhaging D) Need for vasodilators for postoperative hypertension E) Prolonged use of CRB
A, C, E
A patient says to his nurse, Ive never heard of an acute coronary syndrome. Please explain what happened to me. The nurse should respond, Acute coronary syndrome is: A) Another name for a myocardial infarction (MI) or heart attack B) A group of disorders that result in insufficient oxygen supply to the heart. C) The second leading cause of death in the United States; D) A type of abnormal heart rhythm.
B
A patient tells a nurse, My chest pain starts when I am resting and when I had a cardiac catheterization, the doctor said I was having vasospasms; Which of the following types of medications would the nurse anticipate would be utilized to treat the patients angina? A) A vasodilator such as nitroglycerin (NTG) B) A calcium channel blocking agent C) An antidysrhythmic such as lidocaine D) A beta adrenergic blocking agent
B
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 patient's quality of life? a. Intraaortic balloon pump (IABP) b. Left ventricular assist device (LVAD) c. Nothing, because the patient is in terminal heart failure d. Nothing additional; medical management is the only option
B
The patient's wife is confused about the scheduling of a stent insertion. She says that she thought the angioplasty was surgery to fix her husband's heart problem. The nurse explains to her: a. "The angioplasty was a failure, and so this procedure has to be done to fix the heart vessel." b. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." c. "This procedure is being done instead of using clot-dissolving medication to help keep the heart vessel open." d. "The stent will remove any clots that are in the vessel and protect the heart muscle from damage."
B
Which nursing interventions would be appropriate after angioplasty? (Select all that apply.) a. Elevate the head of the bed by 45 degrees for 6 hours b. Assess pedal pulses on the involved limb every 15 minutes for 2 hours c. Monitor the vascular hemostatic device for signs of bleeding d. Instruct the patient bend his/her knee every 15 minutes while the sheath is in place
B, C, D
To increase patient compliance and reduce postoperative complications, the nurse should include which of the following topics in the preoperative teaching for a patient who is to have a coronary artery bypass graft (CABG)? (Select all that apply.) A) Reasons for cooling blankets in post-op period B) Equipment used: IVs, Foley, pacer wires, chest tubes, NG tubes, ECG leads C) Drug management: need for sedation when intubated, pain med through PCA D) Alternate methods for communicating when intubated E) Reasons and techniques of turning, coughing, and deep-breathing once extubated
B, C, D, E
Which of the following findings should cause the nurse to suspect that a post coronary artery bypass patient might be developing cardiac tamponade? (Select all that apply.) A) Widening pulse pressure B) Increased jugular vein distension C) Decreasing central venous pressure (CVP) D) Lack of pleural (chest) tube drainage E) Muffled heart sounds
B, D, E
A 72-year-old woman is brought to the ED by her family. The family states that she's "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? a. Hypokalemia b. Non-Q wave MI c. Silent myocardial infarction d. Unstable angina
C
A patient is admitted with chest discomfort and a possible UA/NSTEMI. Which of the following would be a contraindication to administration of GP-IIb- IIIA inhibitors to the patient? The patient had: A) A platelet count greater than 150,000 mm 3 . B) Major surgery in the last 6 months. C) A stroke within the past month. D) A creatinine level of 1.4 mg/dL.
C
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? a. Complete occlusion of a coronary artery b. Fatty streak within the intima of a coronary artery c. Partial occlusion of a coronary artery with a thrombus d. Vasospasm of a coronary artery
C
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? a. 12-lead electrocardiogram b. Cardiac catheterization c. Echocardiogram d. Electrophysiology study
C
The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find? a. Dependent edema b. Distended neck veins c. Dyspnea and crackles d. Nausea and vomiting
C
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 patient's 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: a. contact the physician and report the cardiac enzyme results. b. contact the physician and prepare the patient for thrombolytic therapy. c. contact the physician immediately and begin prepping the patient for surgery. d. give the patient aspirin and heparin.
C
The physician orders a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be a. Dopamine b. Dobutamine c. Adenosine d. Atropine
C
Which of the following lab findings would the nurse review to validate a diagnosis of a myocardial infarction (MI) that was suspected of occurring approximately 3 hours earlier? A) CK B) Troponin T assay C) Myoglobin D) PTT
C
Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.) a. Angina b. Nonischemic c. Non-Q wave d. Q wave
C, D
A nurse is evaluating a patients understanding after he was diagnosed with a myocardial infarction. Which of the following would indicate that the patient did not understand important information and needs additional teaching? A) A heart attack is the same as a myocardial infarction (MI). B) A heart attack causes tissue death and that part of the heart may not pump as well. C) A heart attack in the anterior wall of the heart can be very serious because a large portion of the heart may not pump as well. D) Angina always leads first to decreased blood flow to the heart muscle and then to tissue death.
D
A nurse is preparing to administer the first 5-mg dose of metoprolol to a patient who is 12 hours post MI. For which of the following findings should the nurse withhold administration of the medication? A) Blood pressure of 110/65 B) PR interval 0.12 second C) Serum potassium 3.9 mEq/L D) Sinus bradycardia 52 beats per minute
D
A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient? a. Bile acid resins b. Nicotinic acid c. Nitroglycerin d. Statins
D
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? a. Gallop rhythm b. Murmur c. S1 heart sound d. S3 heart sound
B
When a patient says, The chest pain occurs each time I play basketball; it does not occur when I am sleeping; and it improves when I take those pills under my tongue; the pain will most likely be classified as: A) Variant or Prinzmetals angina. B) Undifferentiated angina. C) Unstable angina. D) Stable angina.
D
A nurse is caring for a patient who has just started to bleed from her insertion site following a cardiac catheterization. What should be the nurses first response? The nurse should: A) Apply manual pressure to the site. B) Locate and apply a compression clamp. C) Apply a collagen patch or sheath. D) Administer vitamin K (AquaMEPHYTON).
A
A nurse is discussing management of hypertension with a patient. Which of the following statements by the patient would indicate that the patient needs additional teaching about the relationship between hypertension and acute coronary syndrome (ACS)? A) My high blood pressure has no relationship to the severity of heart disease or its outcomes. B) Because I'm over 80, even a 20 mm Hg drop in my blood pressure can reduce my risk. C) High blood pressure will increase my bodys need for oxygen and increase my hearts workload. D) Controlling my blood pressure will decrease my risk of having a heart attack to some degree.
A
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: a. Erectile dysfunction b. Prostate enlargement c. Asthma d. Peripheral vascular disease
A
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? a. Administer thrombolytic therapy unless contraindicated b. Diurese aggressively and monitor daily weight c. Keep oxygen saturation levels at least 88% d. Maintain heart rate above 100 beats/min
A
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? a. Emergent pacemaker insertion b. Emergent percutaneous coronary intervention c. Emergent thrombolytic therapy d. Immediate coronary artery bypass graft surgery
A
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)? a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels b. Depressed ST-segment on ECG and elevated total CPK c. Depressed ST-segment on ECG and normal cardiac enzymes d. Q wave on ECG with normal enzymes and troponin levels
A
A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.) a. Cardiac dysrhythmias b. Heart failure c. Pericarditis d. Ventricular rupture
A, B, C, D
Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED. (Select all that apply). a. Administration of morphine b. Administration of nitroglycerin (NTG) c. Dopamine infusion d. Oxygen therapy
A, B, D
The multidisciplinary team would identify which of the following goals for initial collaborative management of a patient with an acute coronary event (ACS)? (Select all that apply.) A) Maximize coronary artery blood flow. B) Limit the size of infarction by decreasing oxygen demands. C) Strengthen the heart by increasing activity as soon as possible. D) Balance oxygen demand with supply. E) Prevent dysrhythmias with prophylactic antidysrhythmic medications.
A, B, D
A nurse is teaching a patient with coronary artery disease about his prescribed nitroglycerin therapy. Which of the following statements, if made by the patient, would indicate that he needs further teaching? A) I should not take nitroglycerin if I have taken Viagra. B) I'll put a couple of tablets in a plastic bag in my pocket so I have them with me all the time. C) If the pain doesnt go away I can take a second tablet after 5 minutes. D) I should try to sit or lie down when I take the nitroglycerin.
B
A patient is being discharged after an MI taking lisinopril 10 mg daily. Which of the following instructions is most appropriate for the nurse to give to the patient? A) Avoid crossing your legs B) Change your position slowly when going from lying to sitting C) Cut down on your sodium intake to 1,500 mg/day D) Weigh yourself at least three times a week
B
An essential aspect of teaching that may prevent recurrence of heart failure is: a. notifying the physician if a 2-lb weight gain occurs in 24 hours. b. compliance with diuretic therapy. c. taking nitroglycerin if chest pain occurs. d. assessment of an apical pulse.
B
The ECG of a patient receiving tPA for a myocardial infarction shows that the ST segment has returned to baseline. How should the nurse interpret this finding? A) The myocardial injury is evolving. B) The blocked artery has been reperfused. C) The patient has become more relaxed. D) The spasm in the coronary artery has resolved.
B
The nurse is discussing the Dietary Approaches to Stop Hypertension (DASH) program with a patient and his spouse. They are overwhelmed and ask if there is one measure recommended by the program that would have the biggest impact so they can start with that measure first. The nurse should suggest: A) Controlling diabetes to an A1C less than 7%. B) Decreasing their sodium intake to less than 1,500 mg/day. C) Increasing their intake of dairy products. D) Losing weight.
B
The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia? a. Second degree heart block b. Atrial fibrillation or flutter c. Ventricular ectopy d. Premature junctional contractions
B
The patient's wife is feeling overwhelmed and tells the nurse that she doesn't 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: a. "It will be worth it to have him healthy, won't it?" b. "The low-cholesterol diet is one from which everyone can benefit." c. "As long as you change at least a few things in the diet, it will be okay." d. "You can go on the diet with him, and then just let the children eat whatever they want."
B
Which comment by the patient indicates a good understanding of her diagnosis of coronary heart disease? a. "I had a heart attack because I work too hard and it puts too much strain on my heart." b. "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." c. "If I change my diet and exercise more, I should get over this and be healthy." d. "What kind of pills can you give me to get me over this and back to my lifestyle?"
B
Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink? a. Barium swallow b. Transesophageal echocardiogram c. MUGA scan d. Stress test
B
Which of the following is appropriate in collaborative management of a patients pulmonary status following coronary artery bypass graft surgery? A) Keeping the patient intubated for at least 48 hours to maximize gas exchange B) Mobilizing the patient as soon as possible to prevent atelectasis and venous stasis C) Evaluating readiness for extubation based on guidelines: PO 2 less than 80 mm Hg with an FiO 2 greater than 40% and a PCO 2 greater than 45 D) Extubating when the patient is arousible to noxious stimuli and shows increased effort for spontaneous breathing
B
Which of the following would be most helpful to the nurse in determining whether the chest pain of a patient who has just entered the emergency department is cardiac in origin? A) Gathering a complete medical history B) Performing a 12-lead ECG C) Administering NTG to see if the pain goes away D) Asking the patient if performing a Valsalva maneuver reduces the pain
B
A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated? a. ACE inhibitors and diuretics b. Morphine sulfate and oxygen c. Nitroglycerin, oxygen, and beta-blockers d. Statins, bile acid, and nicotinic acid
C
An 80-year- old woman has arrived in the ED. The ED physician is questioning whether she has had an MI although she is not displaying the classic chest pain. Which of the following symptoms might cause him to suspect that she was experiencing an MI? A) Jaw and/or tooth pain B) Confusion accompanied by hypotension C) Generalized fatigue accompanied by dyspnea and diaphoresis D) Dyspnea accompanied by crackles in all lobes
C
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: a. "This is a result of a high-cholesterol diet and poor exercise habits." b. "The heart has not been getting enough aerobic exercise and has developed this condition. In cardiac rehabilitation they will work with the patient to strengthen his heart through special exercises." c. "This is an inherited condition. You should give serious consideration to having family members screened for it." d. "This is a result of clot formation in the blood vessels in the heart. We will need to use medications to reduce the risk of further clotting."
C
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? a. Implantable cardioverter-defibrillator placement b. Permanent pacemaker insertion c. Radiofrequency catheter ablation d. Temporary transvenous pacemaker placement
C
The patient's 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: a. "The operation will remove all of the plaque, and if your husband exercises and diets he will be free of cardiac problems." b. "The surgery will remove all the buildup, but it will reaccumulate and he will probably need this surgery again this time next year." c. "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." d. "The surgeon will only be able to get 5% to 10% of the plaque, but this will bring about marked relief of your husband's symptoms."
C
Which of the following is an accurate description of the progression of events in an acute coronary syndrome (ACS)? A) A thin fibrin layer stabilizes the ruptured plaque and prevents the occlusion of coronary vessels when stable angina is present in ACS. B) When complete platelet occlusion occurs in a vessel, the ECG changes include nonspecific ST elevation without necrosis occurring in ACS. C) The growth of platelet-rich thrombi in the smaller vessels creates a blockage and is the cause for unstable angina symptoms in ACS. D) Sudden plaque buildup in a narrow vessel immediately leads to an acute myocardial infarction when stable angina is present in ACS.
C
While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process? a. Coronary artery spasm. b. Decreased blood flow (ischemia). c. Death of cardiac muscle from lack of oxygen (tissue necrosis). d. Sporadic decrease in oxygen to the heart (transient oxygen imbalance).
C
A patient starting cardiac rehabilitation will work with the rehabilitation team to meet all of the following goals except: A) Taking control of his life through healthy choices. B) Managing his symptoms by monitoring his exercise. C) Reducing risks by controlling the modifiable risk factors. D) Stabilizing any severe depression that developed post MI.
D
Following angioplasty, a patient develops the following: hematuria,hypotension, tachycardia, a drop in hemoglobin and Hematocrit, and a decrease in oxygen saturation. Which of the following is most likely to be responsible for the symptoms? A) Reaction to vasovagal stimulation B) Myocardial ischemia C) Peripheral emboli distal to the insertion site D) Overanticoagulation
D
Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery? a. Right coronary artery b. Left coronary artery c. Circumflex d. Left main coronary artery
D
Which of the following explanations of the relationship of being overweight to (ACS) should the nurse include when presenting a healthy heart program to a community group? A) Excessive weight will result in a decrease in low-density lipoproteins (LDL) that is linked to ACS. B) Extra weight can lead to diabetes insipidus that will increase the risk for ACS. C) Losing as little as 5% of ones body weight will significantly lower the risk for ACS. D) Obesity, a BMI of greater than 30, increases the risk for ACS at a greater rate than just being overweight.
D
