Exam 1: Angina & MI (NCLEX)

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the a. patient is restless and agitated. b. blood pressure is 90/54 mm Hg. c. patient complains about feeling anxious. d. cardiac monitor shows a heart rate of 61 beats/minute.

B

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours? 1.Creatine kinase (CK or CPK) 2.Lactic dehydrogenase (LDH) 3.LDH-1 4.LDH-2

1

Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn't understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is: 1."Cardiac rehabilitation is not a cure but can help restore you to many of your former activities." 2."Here we teach you to gradually change your lifestyle to accommodate your heart disease." 3."You are probably right but we can gradually increase your activities so that you can live a more active life." 4."Do you feel that you will have to make some changes in your life now?"

1

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? 1.A change in the pattern of her pain 2.Pain during sex 3.Pain during an argument with her husband 4.Pain during or after an activity such as lawnmowing

1

Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch? 1."Apply the patch to a nonhairy, nonfatty area of the upper torso or arms." 2."Apply the patch to the same site each day to maintain consistent drug absorption." 3."If you get a headache, remove the patch for 4 hours and then reapply." 4."If you get chest pain, apply a second patch right next to the first patch."

1 A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? 1.Review the intake and output records for the last 2 days 2.Change the time of diuretic administration from morning to evening 3.Request a sodium restriction of 1 g/day from the physician. 4.Order daily weights starting the following morning.

1 Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: 1.Check the client status and lead placement 2.Press the recorder button on the electrocardiogram console. 3.Call the physician 4.Call a code blue

1 Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

The client diagnosed with a myocardial infarction asks the nurse, "why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response? 1. "Your heart is damaged and needs about 4 to 6 weeks to heal" 2. "There is necrotic myocardial tissue that puts you at risk for dysrhythmias" 3. "Your doctor has ordered bedrest. Therefore, you must stay in bed." 4. "Just because your chest doesn't hurt anymore doesn't mean you are out of danger"

1 The heart tissue is dead, stress or activity may cause heart failure, and it does take about 6-8 weeks for scar tissue to form

A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: 1.Call for the doctor 2.Start an intravenous line 3.Obtain a portable chest radiograph 4.Draw blood for laboratory studies

2 Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction? 1. Midepigastric pain and pyrosis 2. Diaphoresis and cool clammy skin 3. Intermittent claudication and paloor 4. Jugular vein distention and dependent edema

2 Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this in turn, leads to cold, clammy skin

A 57-year-old client with a history of asthma is prescribed propanolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first? 1.Monitor the apical pulse rate 2.Instruct the client to take medication with food 3.Question the physician about the order 4.Caution the client to rise slowly when standing.

3 Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician

The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement first? Select All that Apply 1. Administer morphine sulfate Intramuscularly 2. Administer an aspirin orally 3. Apply oxygen via nasal cannula 4. Place the client in a supine position 5. Administer nitroglycerin subcutaneously

23

The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select All that Apply 1. Obtain a midstream urine specimen 2. Attach telemetry monitor to the client 3. Start a saline lock in the right arm 4. Draw a baseline metabolic panel (BMP) 5. Request an order for a STAT 12-lead ECG

235 Anytime a nurse suspects cardiac problems, the electrical conductivity of the heart should be assessed. Emergency medications for heart problems are primarily administered intravenously, so starting a saline lock in the right arm is appropriate. A 12-lead ECG evaluates the electrical conductivity of the heart from all planes.

A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? 1.Monitoring vital signs 2.Completing a physical assessment 3.Maintaining cardiac monitoring 4.Maintaining at least one IV access site

3

In order to prevent the development of tolerance, the nurse instructs the patient to: 1.Apply the nitroglycerin patch every other day 2.Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg 3.Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night 4.Use the nitroglycerin patch for acute episodes of angina only

3

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? 1.Take one tablet every 2 to 5 minutes until the pain stops. 2.Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. 3.Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets. 4.Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

3

The client who has had a myocardial infarction is admitted to the telementry unit from intensive care. Which referral would be most appropriate for the client? 1. Social worker 2. Physical therapy 3. Cardiac rehabilitation 4. Occupation therapy

3 Cardiac rehabilitation is the most appropriate referral. The client can start rehabilitation in the hospital and then attend an outpatient cardiac rehabilitation clinic, which includes progressive exercises, diet teaching, and classes on modifying risk factors.

During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem? 1.Visit her friend earlier in the day. 2.Rest for at least an hour before climbing the stairs. 3.Take a nitroglycerin tablet before climbing the stairs. 4.Lie down once she reaches the friend's apartment.

3 Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? 1.Vitamin K 2.Aminocaporic acid 3.Potassium chloride 4.Protamine sulfate

4

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication? 1. The client's apical pulse is 64 2. The client's calcium level is elevated 3. The client's telemetry shows occasional PVCs 4. The client's blood pressure is 90/62

4

A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? 1.Seating the client with arm bared, supported, and at heart level. 2.Measuring the blood pressure after the client has been seated quietly for 5 minutes. 3.Using a cuff with a rubber bladder that encircles at least 80% of the limb. 4.Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

4 BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy

The client is 3 hours post myocardial infarction. Which data would warrant immediate intervention by the nurse? 1. Bilateral peripheral pulses 2+ 2. The pulse oximeter reading is 96% 3. The urine output is 240 mL in the last 4 hours 4. Cool, clammy, diaphoretic skin

4 Cold, clammy skin is an indicator of cardiogenic shock, which is a complication of MI and warrants immediate intervention.

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Captopril (Capoten) d. Warfarin (Coumadin)

A

The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that: A) Angina is relieved with nitroglycerin and rest. B) Angina can be fatal. C) MI pain always radiates to the left arm or jaw. D) MI pain cannot be treated.

A

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

A

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

A

Which of the following parameters should be checked before administering digoxin? a.) Apical pulse b.) Blood pressure c.) Radial pulse d.) Respiratory rate

A

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a.Oxygen saturation of 88% b.Weight gain of 1 kg (2.2 lb) c.Heart rate of 106 beats/minute d.Urine output of 50 mL over 2 hours

A A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.

A client admitted to the hospital for chest pain is diagnosed with angina. The nurse should teach the client that the most common characteristic of anginal pain is that it is: A. Relieved by rest B. Precipitated by light activity C. Described by sharp or knifelike D. Unaffected by the administration of vasodilators

A Anginal pain is commonly relieved by immediate rest because rest decreases the cardiac workload. Angina is usually precipitated by exertion, emotion, or a heavy meal. anginal pain is usually described as tightness, or heaviness. Nitroglycerin dilates coronary arteries which increases oxygen to the myocardium, decreasing the pain.

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following? A) Obtaining an infusion pump for the medication B) Monitoring BP q4h C) Monitoring urine output hourly D) Obtaining serum potassium levels daily

A IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will a. reduce heart palpitations. b. decrease spasm of the coronary arteries. c. increase the force of the heart contractions. d. help prevent plaque from forming in the coronary arteries.

B

A client admitted with angina compains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? A) Activate the resuscitation team B) Open the client's airway C) Check for breathing D) Check for signs of circulation

A Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and feeling for no more than 10-seconds). If the client isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.

Which of the following results is the primary treatment goal for angina? A) Reversal of ischemia B) Reversal of infarction C) Reduction of stress and anxiety D) Reduction of associated risk factors

A Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed.

Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? A) Sit the client down B) Get the client back to bed C) Obtain an ECG D) Administer sublingual nitroglycerin

A The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECGm sublingual nitro would be administered. When the client's condition is stabilized, he can be returned to bed.

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.) Tricuspid valve malfunction

A The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

The standard policy on the cardiac unit states, "Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg." The nurse will need to call the health care provider about the a.postoperative patient with a BP of 116/42. b.newly admitted patient with a BP of 150/87. c.patient with left ventricular failure who has a BP of 110/70. d.patient with a myocardial infarction who has a BP of 140/86.

A The mean arterial pressure (MAP) is calculated using the formula MAP = (systolic BP + 2 diastolic BP)/3. The MAP for the postoperative patient in answer 3 is 67. The MAP in the other three patients is higher than 70 mm Hg.

The healthcare provider prescribes Nitroglycerin ointment to be applied topically every 8 hours for a client who was admitted for chest pain and a MI. Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? "I may experience: A. A headache B. Increased BP readings C. A slow Pulse rate D. Confusion

A The most common SE of Nitro is a headache. Additional cardio SE are tachycardia, hypotension and dizziness not confusion.

A client who had several episodes of chest pain is scheduled for an exercise ECG. Which explanation should the nurse include when teaching the client about this procedure? A. "This is a noninvasive test to check your heart's response to physical activity". B. "This test is the definitive method to identify the actual cause of your chest pain". C. "The findings of this test will be of minimal assistance in the treatment of angina". D. "The findings from this minimally invasive test will show how your body reacts to exercise".

A This test evaluates the hearts ability to meet the need for additional oxygen in response to the stress of exercising. Changes in the ECG identify dysrhythmias and ST changes indicative of myocardial ischemia. This test assists in the differential diagnosis of chest pain; the diagnosis of heart disease is made via the results of a variety of diagnostic procedures and laboratory tests. This is a valuable test that will influence the diagnosis and treatment of heart disease. This is a noninvasive test.

The nurse knows that which of the following people groups are more likely to experience nontraditional signs and symptoms of a heart attack/angina? A) Elderly B) Patients with hx of heart failure C) Patients with hx of diabetes D) Women E) Patients taking a beta blocker

ACD The elderly, there are often no symptoms that present (silent CAD) and sometimes may have weakness or changes in mental status as signs of an MI. Patients with a history of diabetes also can have silent heart attacks. Women often experience atypical signs and symptoms of a heart attack such as fatigue, shoulder blade discomfort, and SOB.

A client admitted for uncontrolled hypertension and chest pain was started on a daily diuretic two days ago upon admission, with prescriptions for a daily basic metabolic panel. The clients potassium level this morning is 2.7 mEq/L. Which action should the nurse take next? A. Notify the healthcare provider that the potassium level is above normal B. Notify the healthcare provider that the potassium level is below normal C. No action is required because the potassium level is within normal limits D. Hold the clients morning diuretic dose

B

A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The healthcare provider prescribes an ECG and lab tests. A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction? A. QRS complex B. ST segment C. P wave D. R wave

B

A client who had a MI receives 15 mg of morphine sulfate for chest pain. 15 minutes after receiving the drug, The client complains of feeling dizzy. What action should the nurse take? A. Determine if this is an allergic reaction B. Place the client in the supine position and take the vital signs C. Elevate the clients head and keep the extremities warm D. Tell the client that this is not a typical sensation after receiving morphine sulfate

B

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best? a. "Most patients are able to enjoy intercourse without any complications." b. "Sexual activity uses about as much energy as climbing two flights of stairs." c. "The doctor will provide sexual guidelines when your heart is strong enough." d. "Holding and cuddling are good ways to maintain intimacy after a heart attack."

B

A patient with cardiogenic shock receives a nursing diagnosis of decreased cardiac output. With the appropriate interventions, the anticipated outcome is for the patient to achieve: a.) Baseline activity level. b.) Baseline cardiac function. c.) Reduced anxiety. d.) Decreased afterload.

B

After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. "Carvedilol will help my heart muscle work harder." b. "It is important not to suddenly stop taking the carvedilol." c. "I can expect to feel short of breath when taking carvedilol." d. "Carvedilol will increase the blood flow to my heart muscle."

B

Aspirin is administered to the client experiencing an MI because of its: A) Antipyrectic action B) Antithrombotic action C) Antiplatelet action D) Analgesic action

B

The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include? A) Limit exercise to 30 minutes twice per week. B) Avoid alcohol consumption. C) Monitor intake and output. D) Report skin flushing to the physician.

B

To improve the physical activity level for a mildly obese 71-year-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

B

What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina? A) Discontinue drug if heart rate <60. B) Do not discontinue drug abruptly. C) Exercise heart rate should be 110-120. D) Monitor for hyperglycemia.

B

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

B

When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Monitor heart rate. b. Ask about chest pain. c. Check blood pressure. d. Observe for dysrhythmias.

B

Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.

B

Which of the following landmarks is the correct one for obtaining an apical pulse? a.) Left intercostal space, midaxillary line b.) Left fifth intercostal space, midclavicular line c.) Left second intercostal space, midclavicular line d.) Left seventh intercostal space, midclavicular line

B

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

B Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen 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 oxygen. An ECG is the most common diagnostic tool used to evaluate MI

The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by: A) Increasing preload. B) Decreasing afterload. C) Positive chronotropic effect. D) Positive inotropic effect.

B Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand, and reduces frequency of anginal pain.

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

B Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or 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.

A pregnant woman develops chest pain and is found to be in atrial fibrillation. Which medication would be appropriate to prescribe for this client? A. Warfarin B. Heparin C. Aspirin D. Atenolol

B Heparin is the only one of the medications that would be used for this problem and does not cross the placental barrier. Warfarin, atenolol and aspirin cross the placenta and are distributed in breast milk, leading to potential fetal death, neonatal hemorrhage, or intrauterine death.

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a.Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b.Patient with stable angina whose chest pain has recently increased in frequency c.Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d.Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

B The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are stable.

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a.Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b.Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c.Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache d.Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

B The patient's low potassium level increases the risk for digoxin toxicity and potentially fatal dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their medications, but their symptoms do not indicate potentially life-threatening complications.

The nurse and unlicensed assistive personnel (UAP) on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP? a.Teaching a patient scheduled for exercise electrocardiography about the procedure b.Placing electrodes in the correct position for a patient who is to receive ECG monitoring c.Checking the catheter insertion site for a patient who is recovering from a coronary angiogram d.Monitoring a patient who has just returned to the unit after a transesophageal echocardiogram

B UAP can be educated in standardized lead placement for ECG monitoring. Assessment of patients who have had procedures where airway maintenance (transesophageal echocardiography) or bleeding (coronary angiogram) is a concern must be done by the registered nurse (RN). Patient teaching requires RN level education and scope of practice.

The nurse is caring for the patient with unstable angina. She is administering Cardizem as ordered to this client. The nurse knows that this medication is mainly used for the following reason. Select all that Apply: A) This medication will help increase myocardial contraction B) This medication will relax the heart and decrease the strength of the heart contractions C) This medication will increase the heart rate and therefore increase perfusion to the heart D) This medication will vasodilate blood vessels reducing preload and opening up coronary arteries E) This medication will protects the heart cells by preventing remodeling

BD This medication will "soften" the heart and the blood vessels. It will decrease strength of contractions, which will decrease the workload of the heart. This will also decrease the oxygen needs of the heart. It also has a vasodilating property which will allow more blood to flow through the coronary arteries and decrease blood pressure.

A 55-year-old patient who is diagnosed with an evolving myocardial infarction (MI) insists on going home. The cardiac/vascular nurse encourages the patient to be admitted, because the greatest risk within the first 24 hours of sustaining an MI is: a.) Heart failure. b.) Pulmonary embolism. c.) Sudden death. d.) Ventricular aneurysm.

C

A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. "Do you have any allergies?" b. "Do you take aspirin on a daily basis?" c. "What time did your chest pain begin?" d. "Can you rate your chest pain using a 0 to 10 scale?"

C

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. "I can expect some nausea as a side effect of nitroglycerin." b. "I should only take the nitroglycerin if I start to have chest pain." c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart." d. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

C

During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. increase in blood pressure. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

C

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? a. Heparin enhances platelet aggregation. b. Heparin decreases coronary artery plaque size. c. Heparin prevents the development of new clots in the coronary arteries. d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.

C

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. "I will check my pulse rate before I take any nitroglycerin tablets." b. "I will put the nitroglycerin patch on as soon as I get any chest pain." c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." d. "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin."

C

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies ever having a heart attack. c. Bilateral crackles are auscultated in the mid-lower lobes. d. The patient has occasional premature atrial contractions (PACs).

C

Which nursing intervention will be most effective when assisting the patient with coronary artery disease (CAD) to make appropriate dietary changes? a. Give the patient a list of low-sodium, low-cholesterol foods that should be included in the diet. b. Emphasize the increased risk for heart problems unless the patient makes the dietary changes. c. Help the patient modify favorite high-fat recipes by using monosaturated oils when possible. d. Inform the patient that a diet containing no saturated fat and minimal salt will be necessary.

C

Which of the following arteries primarily feeds the anterior wall of the heart? a.) Circumflex artery b.) Internal mammary artery c.) Left anterior descending artery d.) Right coronary artery

C

A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client? A. Prevent dyspnea B. Prevent cyanosis C. Increase oxygen concentration to heart cells D. Increase oxygen tension in the circulating blood

C Administration of oxygen increases the transalveolar oxygenngradient, which improves the efficiency of the cardiopulmonary system; this increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, is usually associated with MI. Although administrating oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a MI.

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

C Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.

The nurse caring for a client admitted for chest pain and a MI is preparing to apply nitroglycerin ointment. Before applying, the nurse should: A. Assess the client's pulse rate B. Prepare the site with an alcohol swab C. Remove ointment previously applied D. Expect the client to be relieved of pain within 20 minutes

C Before applying the nitro ointment, the nurse should remove the previous ointment. If the previously applied ointment is not removed, the client could receive too much medication. The nurse should assess blood pressure reading, not pulse rate. There is no need to clean the site with alcohol before administration. nitro ointment is not used to treat acute pain.

The nurse determines that treatment of a client with a beta-adrenergic blocker for myocardial infarction has been effective when: A) Tachycardia occurs. B) Blood pressure is 90/50. C) Decreased dysrhythmias occur. D) Decreased urinary output occurs.

C Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. Tachycardia would not be desired with an MI. A low BP alone would not indicate effective treatment of the MI.

A client presenting to the ER with chest pain and dizziness was found to be having a MI and subsequently suffered cardiac arrest. The ER health care team was able to successfully resuscitate the client. Lab work shows that the client is now acidotic. The nurse understands that the acidic serum pH most likely is caused from: A. fat forming ketoacids that are broken down. B. The client receiving too much sodium bicarbonate during resuscitation efforts. C. The decreased tissue perfusion that subsequently caused lactic acid production. D. An irregular heartbeat the client experienced during cardiac arrest.

C Cardiac arrest causes decreased tissue perfusion, which results in ischemic and cardiac insufficiency. Cardiac insufficiency causes anaerobic metabolism, which leads to lactic acid production. Fat-forming ketoacids occur in diabetes. Too much sodium bicarbonate causes alkalosis, not acidosis. An irregular heartbeat does not cause acidosis necessarily.

An ECG is prescribed for a client who reports chest pain. What early finding does the nurse expect on the lead over the infarcted area? A. Flattened T waves B. Absence of P waves C. Elevated ST segments D. Disappearance of Q waves

C Elevated ST segments are an early typical finding after a MI, because of altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation Q waves may become distorted with conduction or rhythm problems but they do not disappear unless cardiac standstill occurs.

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

C Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or 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.3. Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a.ventricular ectopy. b.a dry, hacking cough. c.a systolic BP <90 mm Hg. d.a heart rate <50 beats/minute.

C Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.

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)

C Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase (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. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

Which of the following EKG changes on the patient with chest pain indicates the highest level of damage? A) T wave inversion B) T wave enlargement C) ST segment elevation D) Q wave widening

D Abnormal Q waves represent myocardial necrosis and can develop with 1-3 days of an MI. T wave inversion is often the first symptom of ischemia of the heart and may be seen with angina. T wave enlargement and ST segment elevation are often seen with injury to the heart.

A client admitted for uncontrolled hypertension and chest pain was prescribed a low sodium diet and started on furosemide (Lasix). The nurse should instruct the client to include which foods in the diet? A. cabbage B. Liver C. Apples D. Bananas

D

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Evaluation of the patient's response to walking in the hallway b. Completion of the referral form for a home health nurse follow-up c. Education of the patient about the pathophysiology of heart disease d. Reinforcement of teaching about the purpose of prescribed medications

D

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. 39-year-old with pericarditis who is complaining of sharp, stabbing chest pain b. 56-year-old with variant angina who is to receive a dose of nifedipine (Procardia) c. 65-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge d. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

D

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and heart rate. b. fewer complaints of having cold hands and feet. c. improvement in the strength of the distal pulses. d. the ability to do daily activities without chest pain.

D

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A) Dilating just the coronary arteries B) Decreasing the blood pressure C) Increasing contractility of the heart D) Dilating arteries and veins

D

What is the primary reason for administering morphine to a client with 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

D

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patient's gender. c. increased risk of cardiovascular disease as people age. d. elevation of the patient's low-density lipoprotein (LDL) level.

D

When reviewing the 12-lead electrocardiograph (ECG) for a healthy 79-year-old patient who is having an annual physical examination, what will be of most concern to the nurse? a.The PR interval is 0.21 seconds. b.The QRS duration is 0.13 seconds. c.There is a right bundle-branch block. d.The heart rate (HR) is 42 beats/minute.

D

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? a. The patient states that the pain "wakes me up at night." b. The patient rates the pain at a level 3 to 5 (0 to 10 scale). c. The patient states that the pain has increased in frequency over the last week. d. The patient states that the pain "goes away" with one sublingual nitroglycerin tablet.

D

Which is the primary consideration when preparing to administer thrombolytic therapy to a patient who is experiencing an acute myocardial infarction (MI)? a.) History of heart disease. b.) Sensitivity to aspirin. c.) Size and location of the MI. d.) Time since onset of symptoms.

D

Which of the following conditions is the predominant cause of angina? A) Increased preload B) Decreased afterload C) Coronary artery spasm D) Inadequate oxygen supply to the myocardium

D

Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? A) Has severe chest pain B) Can identify risks factors for MI C) Agrees to participate in a cardiac rehabilitation walking program D) Can perform personal self-care activities without pain

D By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors for MI or begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present.

Which of the following clients is at the highest risk for experiencing an MI? a) The 71 year old African American female who smoked 10 years ago b) The 57 year old Caucasian male whose HDL is 30 and triglyceride level is 160 c) The 60 year old Native American male who has had an MI in the past d) The 65 year old Hispanic male with type II diabetes and peripheral arterial disease

D Diabetes and PAD are considered CAD risk equivalents, meaning that they place the client at the same risk of experiencing a cardiac event as someone who has already had an MI. Considering this patients age, race, and two CAD risk equivalents, the nurse knows that this patient is at the highest risk for experiencing an MI.

A client is admitted to the ER with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? A. Gabapentin B. Midazolam C. Alprazolam D. Aspirin

D Early administration of aspirin in the setting of acute MI has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, can be lifesaving.

Which of the following tests is used most often to diagnose angina? A) Chest x-ray B) Echocardiogram C) Cardiac catherization D) 12-lead electrocardiogram (ECG)

D The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.

The nurse is instructing the patient with stable angina about the use of nitroglycerin. Which of the following statements, made by the patient, indicates the need for further teaching? A) "When the pain is really bad, I can crush the tablet with my teeth to make it work faster" B) "I will be sure to never remove the pills from the container they are in" C) "It's probably a good idea to take the medication before I have sex with my wife" D) "I should call my doctor if I experience flushing of the face or a HA"

D These are common side effects of this medication and there is not a need to call the physician for this issue. The patient can crush the tablet between his teeth, then place sublingually for hastening of effect. The nitroglycerin pills must be stored in a dry, cool place and should be kept in the dark bottles they come in. Nitroglycerin should be taken in advance of any activity that may produce pain, such as sexual activity.

Which of the following types of angina is most closely related with an impending MI? A) Angina decubitus B) Chronic stable angina C) Noctural angina D) Unstable angina

D Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.